Learn About the Revised DSM-V

 

DSM-V

     In May of 2013, the American Psychiatric Association released the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM’s primary focus is to provide standard criteria for the diagnosis of psychological disorders.  The DSM-5 presents 2 substantial changes to the diagnostic criteria for autism.

 

     First is the collapsing of several related diagnoses into one disorder.  In the DSM-IV, there were 5 diagnoses under the Pervasive Developmental Disorder category (Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, Rett’s Disorder and Pervasive Developmental Disorder-NOS).  The DSM-5 integrated 4 of these diagnoses (all but Rett’s Disorder) into one diagnosis – Autism Spectrum Disorder (ASD).  The collapsing of the 4 disorders into one was based on the lack of a consistent body of research to support the diagnostic distinction between these disorders. Distinctions in the presentation of autism symptoms across individuals will now be expressed by rating the level of support the individual needs in each of the affected areas. For example a child with ASD may be described according to the DSM-5 as requiring very substantial support with social and communication difficulties but requiring only substantial support with restricted or repetitive behaviors.  Rett’s Disorder was removed from ASD because individuals with this genetic disorder do not always present with the symptoms of Autism. However, those children with Rett’s who do develop all of the symptoms of ASD would receive the diagnosis.

 

     A second important area of change in the DSM-5 is the criteria itself.  In the DSM-IV, individuals had to meet criteria associated with 1. Impaired social interactions, 2. Impaired communication, and 3. Restricted, repetitive and stereotyped behavior.  The DSM-5 combined the first two criteria into one (deficits in social communication and social interaction).  Additionally, the DSM-5 requires more symptoms to be displayed in order to meet the criteria for restricted, repetitive behavior. Moreover, lesser forms of social and behavioral impairment are no longer sufficient to receive a diagnosis, as was the case with the DMS-IV’s Pervasive Developmental Disorder (NOS).  These last two points suggest that some individuals with less severe forms of autism may no longer meet the criteria for ASD and research has indicated that this is the case.  As can be seen in the table below, six studies completed to date indicate that only 60% to 91% of children with Pervasive Developmental Disorder met the new criteria for ASD. 

 

 

Authors

% with PDD-NOS who received ASD

 

Reference

McPartland, Reichow, & Volkmar

60%

Sensitivity and specificity of proposed DSM-5 diagnostic criteria for AUTISM spectrum disorder. J Am Acad Child Adolesc Psychiatry. Apr 2012; 51(4):368-383.

Worley & Matson

76%

Comparing symptoms of Autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria. Research in AUTISM Spectrum Disorders. 2012; 6(2): 965-970.

Matson, Kozlowski, Hattier, Horovitz, Sipes

68%

 

DSM-IV vs. DSM-5 diagnostic criteria for toddlers with AUTISM. Dev Neurorehabil. 2012; 15(3):185-90.

Gibbs, Aldridge, Chandler, Witzlsperger, & Smith

52%

Brief Report: An Exploratory study comparing diagnostic outcomes for autism spectrum disorders under DSM-IV-TR with the proposed DSM-5 revision.J AUTISM Dev Disord. Aug 2012; 42(8): 1750-1756.

Huerta et al.

91%

Application of DSM-5 criteria for autism spectrum disorders to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. Am J Psychiatry. Oct 2012; 169 (10):1056-1064.

Young-Shin Kim et al,

63%

  A comparison of DSM-IV and DSM-5 ASD prevalence in Epidemiologic Sample. J of the Acad  Child and Adolesc  Psychiatry. (In Press).

 

     The question that remains is what will happen to this large number of children who would have been diagnosed with one of the Pervasive Developmental Disorders under the DSM-IV, but will not be diagnosed with ASD under the DSM-5.  The answer may lie in a newly added diagnosis called Social Communication Disorder (SCD). SCD is diagnosed when there is a deficit in social communication without the presence of restrictive, repetitive, or stereotyped behavior. A brand new study is consistent with this idea (Young-Shin Kim et al, In Press).  In this study, of the children who received a PDD-NOS diagnosis, 63% met the ASD diagnosis and interestingly 32% met the SCD diagnosis.  A great deal of research is needed to identify what supports at what intensity children with SCD require to make improvements.

 

It should be noted that in order for a diagnosis of SCD to be given, a child must show a deficit in relatively sophisticated language (e.g., impairment in the ability to change communication to match context).  Thus, SCD is rarely diagnosed before age 4.  Therefore the addition of this new disorder does not help identify those children under 4 with severe social communication deficits but who do not have restricted behavior. Given the assumption that the most intensive Preschool Special Education is often reserved for children with specific diagnoses such as Autism, the question remains – what will happen to children under 4 years of age who display severe social communication deficits but who do not have restricted behavior?  Many or all of these children may still qualify for services under early intervention or Preschool Special Education if they demonstrate a deficit in one or more of the 5 domains assessed during the early intervention or preschool evaluation (i.e., social-emotional, language, cognitive, motor, or adaptive domain). If you think that your child displays symptoms of AUTISM, regardless if they would meet the new DSM-5 criteria of AUTISM spectrum disorder, it is recommended that your child receive an evaluation.  Evaluations are funded by Nassau and Suffolk Counties and New York State, at no cost to you. If your child is under three years of age contact:

 

1.      Nassau County Department of Health – (516) 227-8661

         http://www.nassaucountyny.gov/agencies/Health/childhealth.html

 

2.     Suffolk County Department of Health – (631) 853-3100

               http://www.suffolkcountyny.gov/Departments/HealthServices/ServicesforChildrenwithSpecialNeeds.aspx

 

If your child is between the ages of 3 and 5, Contact:

 

The Committee on Preschool Special Education (CPSE) in the school district in which you reside.

 

Starting Early Program, DDI is an approved evaluation site, by the NYSDOH and NYSED for children aged birth to 5,

Expert diagnostic teams perform multi-disciplinary evaluations in your home, in your child’s preschool/ day care or at Starting Early locations in Huntington and Ronkonkoma. Click here for information on scheduling an evaluation.

DDI held its annual Rockin’ for Autism concert.  Over 500 Long Islanders packed Mulcahy’s Pub and Music Hall in Wantagh to raise over $30,000 for DDI.

 

“It is truly remarkable and heartwarming to see so many people come together to help those challenged with a disability,” statedJim Cronin, Chairman of the event and a member of the DDI Foundation Board.  “This wonderful event is crucial in supporting the vital programs that DDI has to benefit Long Islanders with autism and other developmental disabilities.”

 

For a $30.00 donation guests enjoyed the sounds of live music with an all-star lineup of legendary Long Island bands including 1 Step Ahead, The Cold Spring Harbor Band, 3, and Generations.  Legendary Saturday Night Live Band Leader GE Smith made a surprise appearance and performance. Gift baskets, raffles, food and live music were enjoyed by all into the late evening.

 

“Every year this event lends itself to being a great day,” commented Event Music Director, Steve Alliano.  “I want to give a special thanks to the talented musicians who donated their services and talents to make the day a true success.”

 

New Study Reveals 1 in 68 Children are Diagnosed with Autism

 

A report released on Thursday from the Centers for Disease Control (CDC) found that the number of U.S. children with autism has surgedto one in 68, a 30% increase from 1 in 88 two years ago.  The report comes as Autism Awareness Month begins April 1st.  According to the new report, the CDC estimates 1 in 42 boys has autism, 4.5 times as many as girls (1 in 189).

 

One thing that hasn't changed over the years is that children are still being diagnosed late. According to the report, the average age of diagnosis is still over age 4, even though autism can be diagnosed by age 2. 

 

Read more from the startling report.

Lake Avenue Music RoomDevelopmental Disabilities Institute dedicated the Matthew Stansky Memorial Music Room Friday, March 21st.Family, friends and staff joined together for a dedication ceremony in Matthew's honor.

 

“Matthew had an immense love for music,” commented mother Millie Stansky.  It didn’t matter if he was listening to his transistor radio or a fellow peer playing the piano. Mathew would lose himself listening to music for hours on end. It only seems fitting to dedicate a newly refurbished music room in his honor so that music can live on with his fellow peers in his name.”Millie, Danielle and Joe Stansky

 

 

Matthew Stansky is a former student of DDI who sadly passed away last year after fighting a long illness at the age of 23.  The Music Room is located at DDI’s Lake Avenue Adult Day Program.  The program, located in Nesconset, provides numerous services for over 70 adults with autism and other developmental disabilities.  The vibrant room received all new musical instruments, along with a state of the art sound system and display. Some of the items included are a new smart tv, wireless microphones, piano, acoustic guitars, a new drum set, music stools, benches and numerous other instruments.  A plaque hangs on the wall that reads, “A song may end but its melody lingers on forever.”  The renovations to the music room were made possible by the Mathew Stansky Memorial Fund.

 

 “During his short life with us, Matthew became a source of inspiration to all who knew him and provided care to him,” commented John Lessard, DDI’s Executive Director. “With the generosity of his family and friends, we will be able to preserve his memory here at DDI. I cannot thank them enough.”

 

 

St. Johns University Students & Alum Walk to Benefit Services provided by DDI for Children & Adults with Autism and other Developmental Disabilities

 

 

Nathan Holmes, John Kenny, Liam Kenny, Morgan Zajkowski, Rita Rausch, Ellen McBurney, and Peter Barker, will be back at it again, walking from the Brooklyn Bridge to Montauk Point Lighthouse from May 25th - 31st. 

 

 

The Walk will raise funds to support the renovation and expansion of DDI’s Little Plains School, which provides educational programs for over 300 children with developmental disabilities and their typically developing peers."These students and alumni are embarking on a noble journey to better the lives of others.  It's really wonderful to see the dedication and generosity that Nathan, John and the students have shown.  We are truly honored that they have chosen to support DDI, and to also bring about greater awareness of disability," stated John Lessard, Executive Director of DDI.