Did the definition of autism change with the DSM-5?
In May 2013 the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), changing the definition of autism spectrum differences. Instead of using the terms “Autistic Disorder,” Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), “ and “Asperger’s Disorder” all forms of autism are now called Autism Spectrum Disorder.
Three Levels of Support now distinguish the spectrum of autism differences, with the following distinctions: Level 1 Requiring Support, Level 2 Requiring Substantial Support, and Level 3 Requiring Very Substantial Support.
Differences in development are divided into two categories for Autism Spectrum Disorder: Social Communication and Restricted, Repetitive Behaviors.
How do these changes fit with the three terms we have been using up until now?
Think of each of the three Levels of Support as roughly corresponding to Autistic Disorder, PDD-NOS and Asperger’s Syndrome, with Level 3 corresponding approximately to Autistic Disorder, Level 2 to PDD-NOS, and Level 1 to Asperger’s Syndrome.
How do these changes fit with the Descriptive Triangle?
The DSM-5 uses two areas instead of the three areas highlighted in the Descriptive Triangle.
The first DSM-5 area, Social Communication, combines two areas of the Descriptive Triangle: Language and Communication and Social Relationships and Emotions.
The second DSM-5 area, Restricted, Repetitive Behaviors, corresponds to the Descriptive Triangle area of Sensory Use and Interests.
Although the DSM-5 combines Language and Communication and Social Relationships and Emotions into one area—Social Communication—it is helpful for evaluators, parents, and clinicians to look closely at the distinctive behavioral differences within an individual’s use of Social Communication. Language differences, understanding and use of social cues, and emotional regulation issues all fall under the umbrella of Social Communication. The Descriptive Triangle helps clinicians identify specific and nuanced behavioral differences within the broad area of Social Communication.
Although the DSM-5 requires the use of the language Restrictive, Repetitive Behaviors when making a diagnosis, it is useful for clinicians working directly with children to identify the child’s differences in the area of Sensory Use and Interests, as this wording leads clinicians to describe the positive attributes associated with the child’s interests and the self-regulating qualities that are an integral part of the child’s sensory-seeking routines.
Click here AC and Levels of Support for a Quick Reference Chart connecting the DSM-5 changes to my Descriptive Triangle framework.