In this article, will discuss the New Model of Autism as defined by the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (edition 2013), and its implications on Autism diagnosis.

DSM 5 Autism Spectrum Disorder

In on of the previous articles, we looked at the detailed autism symptoms checklist that can help in an accurate diagnosis of Autism. To provide a common framework that can be applied to test the presence of Autism, the Diagnostic and Statistical Manual of Mental Disorders DSM-5 has been adopted by psychologists across most major nations.  The DSM 5 also eludes to diet recommendations and medication for autism and similar neuro-behavioral disorders.

Over the years there have been changes to the DSM 5 manual. Recent concerns being that there have been changes to the categories for Autism.  This has given rise to the concern that some of the psychological and screening tools that have traditionally been used to determine a diagnosis of Autism are now either too simplistic or archaic.

The changes in the fifth edition of the manual now mean that Asperger’s, Pervasive Development Disorders, and Autism are now diagnosed as Autistic Spectrum Disorder Level I, II or III.

This now means that Rett’s Syndrome and Childhood Disintegrative Disorders are included in the Spectrum but are diagnosed by their severity of need within Social Communication and Ritualistic behaviors.

Table 1: A Snapshot of Autism Spectrum Disorder Support Levels

Autism Spectrum Disorder DSM 5 Level I – Requiring Support

Social Communication

• Without support in place, there is a deficit in communication ability which can cause noticeable difficulties.
• Has difficulty initiating any social interactions.
• Demonstrates clear examples of atypical or unsuccessful responses to the approaches of others.
• May appear to have little or no interest in social interactions.

Restricted Interests and Repetitive Behaviours

• Rituals and repetitive behaviours cause significant interference and difficulty in their daily lives and general functioning.
• This disruption affects more that one area of their lives.
• A resistance of any attempt by others to be distracted from their fixated interest.

Children and People assigned to this level would defiantly be at the high end of the spectrum, namely what was earlier referred to as Asperger’s Syndrome.

DSM 5 Autism Spectrum Disorder Level II – Requiring Substantial Support

Social Communication

• Marked deficits in verbal and non-verbal communication skills.
• Social impairment even with support in place.
• Limited initiation in social interaction.
• Reduced or abnormal response to the social approaches of others.

Restricted Interests and Repetitive Behaviours

• Restricted Interests and Repetitive Behaviours that are very frequent and are obvious to the casual observer.
• The child or adult becomes very distressed and frustrated if there is an attempt to distract them from their interests and repetitive behaviours
• It is extremely difficult to divert their interest if at all.

Autism Spectrum Disorder DSM 5 Level III – Requiring VERY Substantial Support

Social Communication

• Severe deficits in verbal and non-verbal communication skills. Language may be absent.
• Their deficits cause severe impairment for any functioning.
• Very limited initiation of social interaction if at all.
• Minimal response to social approaches of others.

Restricted Interests and Repetitive Behaviours

• Total preoccupation with fixated rituals and repetitive behaviours that occur all of the time.
• Very distressed if the rituals are interrupted.
• They immediately return to their interest and/or rituals if interrupted.

Does Asperger’s Syndrome Still Exist in DSM 5?

With the new model of Autism, it means that Asperger’s Syndrome which was added to the DSM  back in 1994 and has existed for a period of time, was removed in May 2013. Which begs the question does Asperger’s still exist? In official terms ‘no’, because the diagnosis would be Autistic Spectrum Disorder Level I.

The reason for diagnosing what was Asperger’s as Autistic Spectrum Disorder Level I is that in general terms the need is ‘of a low level of support’. On the face of it, that is correct, but the type of low-level support that is needed has to be of a different genre than for someone who is ASD Level III.

However, to just give a label of ASD Level I, is not sufficient. Autism, at different level, affects each child or adult differently. On a personal experience, I have encountered clients with similar autistic traits but how the traits impact on their lives will depend on their personality; levels of sensitivity; resilience and the effectiveness of their support. To counteract the impact of ASD labelling, there should be specific descriptors to highlight individual signs and symptoms.

Asperger’s may not exist as a definitive within the DSM 5 Autism Spectrum Disorder, but clinicians will still carry on using the international coding system especially when they are dealing with medical insurance companies (especially in the USA), as Asperger’s is still included in that system. Groups and organisations that support their members that have Asperger’s will continue to use the descriptor.

Research to Drive the Future of Autism

Nevertheless, no matter how controversial these changes are, they were based on sound research, analysis and expert opinion. The aim of the changes to the DSM 5 for Autism Spectrum Disorder, were made in the hope that diagnosing Autistic disorders would be more reliable, more specific and hold more validity by standing the test of time.

There is apprehension as to how the changes will impact people who will no longer meet the stricter criteria for diagnosis, especially people at the higher end of the spectrum. Will they still be eligible for the support that they have had within education? This is concerning especially as it is likely that they also have additional learning difficulties.

Obviously, these changes will have an impact not just on the people who are diagnosed with Autism, but also their families.

Since the publication of the Autism Spectrum Disorder DSM 5, scientists have found that there is distinct brain connectivity difference between children with Autism in comparison with children who have other forms of Autism. A specific example is where that children with Asperger’s do not have a speech delay but children with other forms of Autism do.