Updated autism criteria would leave fewer kids diagnosed with disorder: Study

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The latest edition of the "psychiatry bible" -- the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) -- caused controversy ahead of its June 2013 release because of an updated definition of autism spectrum disorders (ASDs). The new description placed specific, “milder" autism diagnoses like Asperger's under the broader "autism spectrum disorder" term, but with stricter diagnostic criteria.

A new study published in JAMA Psychiatry on Jan. 22 looked at the hypothetical impact the change would have had on the number of people being diagnosed with the developmental disorder. The researchers believe that based on the new criteria, about one out of 100 U.S. children would be diagnosed with the autism, much less than the current government estimate of one out of 50 American schoolchildren.

 “Autism spectrum disorder prevalence estimates will likely be lower under DSM-5 than under DSM-IV-TR (the previous version) diagnostic criteria, although this effect could be tempered by future adaptation of diagnostic practices and documentation of behaviors to fit the new criteria,” the authors wrote.

ASDs are a group of developmental disorders that are characterized by communication, social and behavioral issues.

The Centers for Disease Control and Prevention notes that many symptoms manifest before the age of 3 and persist throughout the person’s life. They include children not responding to their name by the age of 1, not pointing at objects they are interested in by 14 months, not playing “pretend” games by 18 months, avoiding eye contact, wanting to be alone, not understanding or sharing feelings and delayed speech or language skills. They may also repeat certain phrases (echolalia), give random answers to questions, be upset by subtle changes, be obsessed with certain subjects, have unusual reactions to tangible, audible, visual or palatable objects and flap their hands, rock their body or spin in circles.

Doctors can detect ASD behaviors at the age of 18 months or even younger in some cases, and an accurate diagnosis can usually be made around the age of 2. There is no cure for ASD, but early intervention, and treatments like behavioral therapy and medication may help improve outcomes.

The old definition of autism encompassed anyone who had six out of 12 behaviors on an autism spectrum disorder (ASD) criteria list. They were given specific diagnoses like Asperger’s, autism, or pervasive developmental disorder not otherwise specified (PDD-NOS) based on those results.

However the newer, DSM-5 definition states that anyone who has all three described social communication deficits and two out of four different kinds of restricted or repetitive patterns of behavior are diagnosed under the single term of autism spectrum disorders.

  The researchers looked at 644,883 children who were being tracked by the Autism and Developmental Disabilities Monitoring Network. Of the group, 6,577 had been diagnosed with an autism spectrum disorder before the DSM-5 changes.

Under the new diagnosis, just 81 percent of those children would have kept their diagnosis. Many of the children lost the diagnosis because they didn’t have issues with nonverbal communication, including reading, using body language or their facial expressions.

"Most of the children who didn't make the cut, they didn't miss by a lot," study author Matthew Maenner, an epidemiologist with the CDC, told HealthDay. "They only needed one additional criterion to meet the DSM-5 definition. They had four of the five."

Prior to the DSM-5's release, advocates expressed concerns that changes in diagnostic criteria would leave fewer children funded for state and educational services.

The researchers said that this was just a hypothetical scenario, and the new diagnoses may not have the same impact in the real world. For example, doctors may change how they observe their patients in order to fit the new diagnoses terms. Also, the children who don’t qualify under autism now might be diagnosed with social communication disorder instead. 


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