![]() ![]() With regard to the diagnosis of pervasive developmental disorders (PDDs) (the categorical title used for the “autism spectrum disorders” in DSM-IV), DSM-5 has introduced several major changes, which include (1) converging the diagnostic groups previously subsumed under the category of PDDs into a single diagnosis of ASD (2) merging the social and communication impairment symptom domains required for the diagnosis of autism into a single domain, thus reducing the symptom domains involved in diagnosis from 3 to 2 (3) expanding the “restricted, repetitive behaviors” symptom domain to include abnormalities in sensory processing and (4) relaxing the age at onset criterion.įor autism and related conditions, the most significant and controversial revision in DSM-5 is the merging of 4 disorders that were distinct under DSM-IV criteria into a single diagnostic category. Furthermore, the applicability of items and concepts taken out of context and without formal training in the assessment processes from which the items are derived may create some significant issues. This approach, while both cost efficient and research focused, comes at the potential price of some loss of “ecological validity.” In other words, in real-world settings, clinicians do not have the time to take weeks of training on a panoply of research instruments. The use of such instruments for research is well known, and often, as in autism, these have been explicitly “keyed” to categorical diagnostic criteria. ![]() A second shift in the DSM-5 has been the focus on the use of relevant dimensional and other assessment instruments. Historically, DSM has been used for both research and clinical purposes this differs from the current ICD-10 approach, which has separate manuals for research and clinical work. This decision, understandable particularly from the point of view of more specific and research-based criteria sets, also poses some practical challenges for DSM-5. One is the elimination of “subthreshold” categories, such as pervasive developmental disorder not otherwise specified (PDD-NOS), throughout the manual. This article discusses the clinical implications of these findings and demonstrates it from a case report.Before discussing the specific changes, it is important to note 2 overarching conceptual shifts in DSM-5. These changes especially affect the clinical diagnosis of young children as their symptomatic manifestation is not yet clear and distinct enough due to their age and maturation processes. Alongside the increase in consistency and stability, there is a decrease in sensitivity, and about a quarter of the children who were previously diagnosed with PDD are not diagnosed as such, due to a failure to meet all the necessary symptoms. Studies evaluating the transition from PDD to ASD, found an increase in the specificity of the diagnosis and its potential ability to distinguish between clinical and non-clinical populations. The differences between individuals are expressed in the levels of severity rated. By this definition, the symptomatic manifestation was reduced and the criteria for diagnosis are fixed for the entire spectrum. The DSM-5 eliminated the separate,diagnoses and created one continuum (Autism Spectrum Disorder = ASD). Under this category, there were five separate diagnoses. Until recently, ASDs were defined by the American Manual of Psychiatric Diagnoses: The DSM-IV-TR, under one conceptual umbrella of "Pervasive Developmental Disorders" (PDD). In recent decades the worldwide prevalence of ASDs is rising almost exponentially, without a clear known etiological explanation. Autistic spectrum disorders (ASDs) are characterized by significant disability in interpersonal communication, social interactions and patterns of unusual behavior. ![]()
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