After almost two decades, the psychiatric diagnostic manual is being revised and re-published next year and there are a lot of changes in store.
In this manual, called the Diagnostic and Statistical Manual of Mental Disorders (DSM), all psychiatric conditions are classified and defined.
The manual is published in the U.S. by the American Psychiatric Association and is used by psychiatrists and other mental health professionals in many places around the world.
Because the manual provides common language and terms used so widely, much time and collaboration goes into making changes.
Although we still have a year before the next version of the DSM comes out, discussion is well underway concerning proposed revisions.
One of the more dramatic and controversial areas of proposed change is in the area of Autism and learning disorders.
Currently, a child exhibiting autism-like symptoms could be diagnosed with autism, Asperger’s or pervasive developmental disorder —not otherwise specified.
Those creating the new diagnostic manual suggest recent research indicates these three conditions could be eliminated and replaced with a single diagnostic entity—autism spectrum disorder.
According to research, there is a lack of agreement from one clinician to another in how the current diagnoses are being used or criteria being applied.
One study published in November of last year in the Archives of General Psychiatry found significant differences in clinical diagnoses of the specific autism spectrum disorders.
The same study found variation among treatment centres in how diagnostic information was weighted as well as in threshold cut offs.
Since there is significant variation in how autism diagnoses are being made, the group evaluating criteria for the new diagnostic manual concluded there is no evidence to support keeping the three disorders as separate entities.
The recommendation to combine the separate diagnoses into one, has spurred both positive and negative reaction from patients and their families as well as health care professionals.
Some groups of patient and family advocates do not want the disorders to be combined and are expressing concern the changes may result in the unique needs of some patients being unrecognized.
In response, the working group for the revisions to the DSM say that it is just as likely now for an individual to get a diagnosis of autism in one clinic and Asperger’s in another.
The hope is that the new classification will have specific criteria in place that allow clinicians to identify differences presented by individual patients.
Other groups are happy with the proposed change because a diagnosis of autism spectrum disorder could mean their children receive school funding or have some services covered that may not be under the current diagnostic guidelines.
Changes are also proposed for the classification of other learning disorders and I will discuss those at more length in the next couple of weeks.