Like many parents with a child diagnosed on the autistic spectrum, I’ve been following the controversy over the proposed revisions for the new Diagnostic and Statistical Manual of Mental Disorders (DSM) 5. Under the proposed new revisions, the categories of autism, PDD-NOS, and Asperger’s syndrome would all be collapsed into the label “Autism Spectrum Disorder.” Criteria for this new diagnosis, which are much more stringent than those used in the previous DSM IV, are causing the autism world to buzz with concern that many higher functioning individuals could “lose” their diagnoses. Dr. Fred Volkmar of the Yale Child Study Center, who had been a member of the panel involved in the rewriting of the DSM before his resignation, recently reported his results of a study in which he claimed that up to 45% of individuals on the higher ends of the spectrum would no longer be diagnosed with a spectrum disorder. Somewhat speciously, Dr. Volkmar in a New York Times article heralded the “end of the autism epidemic.”
Specifically, Dr. Volkmar and colleagues examined the case records of 1000 children diagnosed with autism in 1993, identified 372 of the highest functioning children, and then applied the proposed DSM 5 criteria to them. Of these children, about a quarter of those who had been diagnosed with autism, about three quarters who had been diagnosed with Asperger’s, and 85% of those diagnosed with PDD-NOS would not be diagnosed with an autism spectrum disorder under the proposed new criteria. But members of the American Psychiatric Association (APA) who are involved in the DSM diagnostic changes are crying, “Not so fast” to Dr. Volkmar’s report, which is scheduled to be published this spring. Dr. Volkmar’s critics, including Dr. Catherine Lord who serves on the DSM panel, are saying that the data are inadequate to re-diagnose the 1993 cohort using the new criteria. The study is simply not valid.