DSM Reclassification of Autism Spectrum Disorder
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DSM Reclassification of Autism Spectrum Disorder (Obj. 4.1 and 4.2)
Lila Matthews
College of Humanities and Social Sciences, Grand Canyon University
PCN 673 Development Disabilities
Instructor: Dr. Christy Land
October 12, 2023
Introduction
The publishing gap between the DSM-IV and the DSM 5 is nearly close to 21 years.
Because of the many changes that transpired between the DSM- IV and the DSM-5 there were
many professionals that seen it as a topic for debate and controversy within the Mental,
behavioral, Disabled, and psychological health world. Some have their reserved opinions about
the changes made from the DSM-IV to the DSM-5, while there are some who feel that it is about
time that these changes began to reflect and take place. Due to so much changing in the mental
health, behavioral health, and disability diagnosis world is important that we accept change as it
comes. There are many changes that have transpired within the DSM, but one we really should
acknowledge and accept these as a step in a good direction when it comes to diagnosing our
clients. We will touch on many situations and advantages and why they took placed. We will
look at the full circle effect of how the DSM – IV and the DSM 5 view and have viewed the
autism diagnosis. Finally, we will then look at the pros and cons of changes due to this
significant but historic change.
Current DSM-5 Umbrella Diagnosis
The foundation that was built for the Diagnostic and Statistical Manual of Mental
disorder also known as the DSM can be tracked as far back as to the late 19
th
century, but the
classification of mental health disorders first began as early as when the Second World War took
place (Wilson, 1993). This is considered a major part of history due to the fact that when
veterans came back from war the US Department of Veteran Affairs needed a way to treat and
diagnose soldiers that had accumulated and developed multiple mental illnesses due to their
trauma from war or military background. From the start of the DSM-1 to the current DSM -5, we
have seen the mental health industry continue to discover new disorders, diagnosis, and
treatments , the views on mental health have significantly change through the course of the years
especially when you are comparing information that was provided into the DSM-IV to the DSM-
5. The DSM-IV was published around 1994, when released to the public they appeared to have
added diagnostics and either removed or reclassified different diagnoses. Around 2013 the
publishers of the Diagnostic and Statistical Manual of Mental Disorders released the DSM-5 in
order to aid the health care field, regulators, researchers, and clinical practitioners a guide to be
able to properly guide through treating mental health issues. Knowing this bit of information, the
DSM-5 being the latest version has provided the Doctors who diagnose clients with a huge
impact of being able to appropriately diagnose and build a clinical pathway appropriate to the
client. The most significant change that transpired in the DSM-5 is that it provided a
modification of artificial categorization.
The DSM-IV provided a “Axial” system that grouped
the many disorders into 5 different categories. Yet with the changes made in the DSM-5 we are
able to see that now the classifications have been clarified about the disorders and their
relationship amongst the various diseases. A huge and impactful change that many providers and
doctors have found controversial within the DSM-5 compared to the DSM IV is the knowledge
that Autism is that of not only a developmental disorder but also a mental illness.
With many more changes when it comes to Autism and how it is classified, another huge
controversy that was noticed among professionals when it came to the diagnostic criteria for
Autism, it completed elimination Asperger’s disease within the DSM-5.
The 19 years that the
DSM- IV held its ground, the Autism Spectrum Disorders criteria was revised. "Previously, in
DSM-IV, autism was described as a group of disorders including autistic disorder, Asperger's,
Rett, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise
specified" (Germain et.al., 2015).
The DSM-5 provided a changes to the four sperate
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classifications problems by amalgamating them under one heading known as the Autism
Spectrum Disorder. In previous history, Autism, Asperger’s, Children’s Disintegrative disorder,
and pervasive developmental disorder descriptions are no longer in use. When looking at the
DSM-IV you begin to notice the change that the symptoms were divided into three different
cocategories such as social reciprocity, communication intention, restrictive, and repetitive
behavior.
When the updated DSM was released man individuals were against the idea and some
agreed to the significant change. It is believed that some professionals that Asperger’s should
have never been eliminated because there is still some important studying that needs to take
place on its own. Personally, I believe that it is good the Asperger’s and Autism are separated but
again we still have many more things we need to address in the disorder.
Many neurodevelopmental disorder work groups have stated that the integration of
Asperger’s Syndrome and Pervasive Developmental disorder into Autism Spectrum Disorder.
The main idea is to look at the bigger picture when it comes to Asperger’s syndrome and
pervasive developmental disorder, by knowing that they are a part of Autism Spectrum disorder ,
the allows for an understanding of the challenging and inconsistent
diagnosis programs, and to
be able to disregard
an specific and unpredictable discrepancies that clinicians make in a altered
diagnosis centers.
It is also stressed by various researchers that the diagnosis criteria for
Asperger’s syndrome in the DSM-IV are seen as defective and unreliable. It is seen that there
about 2 problems with the diagnosis of Asperger’s such as, it can be hard to truly observe
whether a single word was said by a child before the age of 2 or even if a phrase has been said
before the age of 3. For people that have received the diagnosis of Asperger’s usually are seen in
by a clinic mid childhood or a lot farther along in life. "Another problem comes from the
precedence rule: diagnose Asperger disorder only if the individual does not meet the criteria for
autistic disorder" (Leekamet.al., 2000). Also, the DSM-5 is hard to understand when it comes to
boundaries between its subgroups, it allows for the diagnosis to be describe according to its
specific patterns, rather than it being categorized and it not really following or matching
appropriately (Regier et.al.,2013). With that being said, “the diagnosis of autism spectrum
disorder will be a supplement and comprehensive description of individual symptoms,
advantages, or dysfunction" (Francesc, 2013).
Pros
& Cons of Diagnosis Changes
When it comes to making changes in any medical practice or diagnosis there are always
going to have some benefits and consequences no matter how severe or minor the change may
be. When it comes to the DSM- IV and the DSM 5 there are various changes that were made that
could benefit the course of history in a very profound way. A great change that was made within
the DSM-5 was the fact of providing a reduction in the patient stigma. In reality the general
public’s view on mental health diseases and disorders have always been poorly understood or
had no clear understanding, which also is why there is so much stigma behind patients.
Because
of the important changes that the DSM made in making sure that they modified the diagnosis
labels it makes sure that many will begin to understand.
We also being to notice within the
DSM-5 that with these changes provided and providing a clear picture of what a clinician should
look for to diagnose a client many diagnosis are a lot more accurate due to there are a list of
standards that can be observed and reflected upon from the view point of the most advanced
discoveries in science and medicine.
When it comes to the Cons of the DSM-5, there are a few that do stand out. "DSM-5 had
no one experienced in writing diagnostic criteria and there was little text editing to ensure
accuracy and consistency. As a result, DSM-5 is filled with writing mistakes and ambiguous
wordings that will make many of its diagnoses inherently unreliable and inaccurate" (Frances,
2013). Nonetheless, the DSM-5 provides a strong foundation when it comes to defining mental
disorders and including the diagnosis of carelessness. The DSM-5 has provided various new
diseases with high predominance for example mild neurocognition, destructive emotional
disorder, overeating, and may more just to name a few. The DSM -5 even reduced some of the
ideas of what an ideal patient would look like when they are diagnosed with ADHD while also
taking a look at the transformation of normal sadness into serious depression disorder.
Conclusion
In conclusion, when it comes to any medical changes, reasoning, or research there is
always going to be controversy. There are always going to be individuals who do not accept the
change, see the change, or want to be able to understand the change that has taken place. The
DSM-5 has good and bad changes like anything in medical history that has been researched,
hypothesized, and reviewed. With the changes in the DSM-5 we have observed that there are a
few beneficial increases and decreases that were not provided to us in the DSM IV. With the
increase of information provided in the DSM-5 it provides everyone with the knowledge and
understanding for new information and subjects that we may not have understood before.
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Reference:
Frances A. (2013).
DSM-5 writing mistakes will cause great confusion
. Huffpost Science 2013.
http://m.huffpost.com/us/entry/3419747
Germain, B., Eppinger, M. A., Mostofsky, S. H., DiCicco-Bloom, E., & Maria, B. L. (2015).
Recent Advances in Understanding and Managing Autism Spectrum Disorders
. Journal
of child neurology, 30(14), 1887-1920.
Leekam, S., Libby, S., Wing, L., Gould, J., & Gillberg, C. (2000).
Comparison of ICD-10 and
Gillberg's Criteria for Asperger Syndrome
. Autism, 4(1), 11-28.
https://doi.org/10.1177/1362361300004001002
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013).
The DSM-5: Classification and criteria
changes
. World psychiatry: official journal of the World Psychiatric Association
(WPA), 12(2), 92-98. https://doi.org/10.1002/wps.20050
Wilson M. (1993).
DSM-III and the transformation of American psychiatry: A history
. Am J
Psychiatry. 1993;150(3):399-410. doi:10.1176/ajp.150.3.399