What is autism?
Autism Spectrum Disorder

One of the most important changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is to autism spectrum disorder
(ASD). The revised diagnosis represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related
disorders.

Using DSM-IV, patients could be diagnosed with four separate disorders:
- autistic disorder,
- Asperger’s disorder,
- childhood disintegrative disorder,
- or pervasive developmental disorder not otherwise specified (PDD-NOS).

Researchers found that these separate diagnoses were not consistently applied across
different clinics and treatment centers. Anyone diagnosed with one of the four pervasive
developmental disorders (PDD) from DSM-IV should still meet the criteria for ASD in DSM-5
or another, more accurate DSM-5 diagnosis.

While DSM does not outline recommended treatment and services for mental disorders,
determining an accurate diagnosis is a first step for a clinician in defining a treatment plan for
a patient.

The Neurodevelopmental Work Group, led by Susan Swedo, MD, senior investigator at the
National Institute of Mental Health, recommended the DSM-5 criteria for ASD to be a better
reflection of the state of knowledge about autism. The Work Group believes a single umbrella disorder will improve the diagnosis of ASD without limiting
the sensitivity of the criteria, or substantially changing the number of children being diagnosed.

People with ASD tend to have communication deficits, such as responding inappropriately in conversations, misreading nonverbal interactions, or having
difficulty building friendships appropriate to their age. In addition, people with ASD may be overly dependent on routines, highly sensitive to changes in
their environment, or intensely focused on inappropriate items. Again, the symptoms of people with ASD will fall on a continuum, with some individuals
showing mild symptoms and others having much more severe symptoms. This spectrum will allow clinicians to account for the variations in symptoms and
behaviors from person to person.

Under the DSM-5 criteria, individuals with ASD must show symptoms from early childhood, even if those symptoms are not recognized until later. This
criteria change encourages earlier diagnosis of ASD but also allows people whose symptoms may not be fully recognized until social demands exceed
their capacity to receive the diagnosis. It is an important change from DSM-IV criteria, which was geared toward identifying school-aged children with
autism-related disorders, but not as useful in diagnosing younger children.

The DSM-5 criteria were tested in real-life clinical settings as part of DSM-5 field trials, and analysis from that testing indicated that there will be no
significant changes in the prevalence of the disorder. More recently, the largest and most up-to-date study, published by Huerta, et al, in the October
2012 issue of American Journal of Psychiatry, provided the most comprehensive assessment of the DSM-5 criteria for ASD based on symptom extraction
from previously collected data. The study found that DSM-5 criteria identified 91 percent of children with clinical DSM-IV PDD diagnoses, suggesting that
most children with DSM-IV PDD diagnoses will retain their diagnosis of ASD using the new criteria. Several other studies, using various methodologies,
have been inconsistent in their findings.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish
DSM-5 in 2013, culminating a 14-year revision process.

APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention and research
of mental illnesses, including substance use disorders.

Visit the APA at
www.psychiatry.org. For more information, please contact Eve Herold at 703-907-8640 or press@psych.org.

© 2013 American Psychiatric Association
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