Sunday, June 9, 2013

Thoughts About DSM-5 and Neurodevelopmental Disorders



It was just delivered in the mail, my brand new copy of the DSM-5. After all the reviews and discussion, I don’t think there are surprises about what’s in it, so much as questions. Some questions are potentially life changing, like: “How will the changes impact diagnosis rates?”, and “Will support services change for those previously diagnosed?” (A pressing concern for the Asperger’s community.) Other questions are less crucial, but still important to many, like: “For how many years will people use terms like Asperger’s and ADD?” (Considering that ADD, as opposed to ADHD, wasn’t even in the 1994 version, my guess is these terms will be used for a long time, especially since Europe will still use the term Asperger’s. Still, I renamed my earlier incarnation of this blog from Coach for Asperger’s as soon as I heard what the APA was planning. Other terms were already working their way out of common usage, like Intellectual Disability replacing Mental Retardation, so the DSM-5 will just move things along.)

The new DSM-5 does more than just update the mental disorder map, it seismically shifts the landscape, with ripples that impact treatments, services, insurance, and education. As an example, the new category of Social (Pragmatic) Communication Disorder is a vast unknown to clinicians like me, since I can’t predict how often I’ll see clients with that diagnosis, nor if it will be used extensively to re-diagnose those who no longer fit into other categories. Helen Tager-Flusberg, in the Simons Foundation Autism Research Initiative special report on the DSM- 5, wrote an interesting review of the history of Social (Pragmatic) Communication Disorder from a research perspective, while John Elder Robison, on his Psychology Today blog, takes his straight-forward and practical analysis and discusses the issue that “we need to make a decision about what services will support people with the new diagnosis.  Otherwise we risk doing that population a great disservice – giving them a diagnosis that leaves them nowhere, with no indicated services or therapy.”     

Simon Baron-Cohen also raises the issue of services for those with SCD, but in general praises the new DSM for its combination of social and communication symptoms into one category, as well as the addition of severity levels and intellectual impairment specifiers for autism. Within the same special report, Ari Ne’eman talks about the advantages of merging Asperger’s, PDD-NOS and Autism Spectrum, and how they could result in more school and Medicaid services for those formerly identified with Asperger’s. 


But far beyond these practical matters, are people: individuals, families, couples, from supportive self advocacy groups, like ASAN and GRASP, to parents support groups in so many communities, and even to how a wife thinks about her own husband’s emotional processing. Personal stories will be different, because of the words written in a 947 page book.  How will the new DSM-5 impact you?