Since the publication of new guidelines for diagnosing autism spectrum disorders (ASD) in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many have wondered whether they would lose their ASD diagnosis. A large study from South Korea has found that, for most people, autism diagnoses will not change. The findings are in contrast to a report from the Centers for Disease Control and Prevention (CDC) stating that as many as 20% of people with ASD could lose their diagnoses. The Korean study found that only eight percent would no longer be diagnosed with ASD and that the majority of those would likely be diagnosed with social (pragmatic) communication disorder (SCD) or ADHD.
The researchers evaluated clinical records of 292 children. The records were from a 2011 study in which nearly half of all South Korean children aged seven to 15 (over 55,000 individuals) were screened for autism. Of those, 1,214 were identified as having ASD and 292 participated in an in-person clinical assessment that included the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. For the new study, the researchers reviewed the 292 records, evaluating them against criteria found in the DSM-IV and the new DSM-5.
The clinical reviews resulted in only 22 children out of the 292 being reclassified as not having an autism spectrum disorder. Of the 22, 17 met the criteria for SCD, a condition characterized by social and communication deficits, but that lacks the autistic hallmarks of repetitive behaviors and narrow interests. The other five children who were re-classified fell under the criteria for anxiety disorders or ADHD. The elimination of the Asperger’s syndrome diagnosis has been a concern, but only five of those diagnosed with Asperger’s “lost” their diagnosis. Four of them met the SDC criteria and one the ADHD criteria. Significantly, 30% of the children who had a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) were reclassified, most with SDC.
The findings suggest that it is unlikely that people previously diagnosed with ASD will be adrift in the world of the DSM-5, assuming that clinicians carefully evaluate their patients. One important issue for ensuring that everyone receives appropriate treatment under the new guidelines will be learning more about social communication disorder. SDC is not as well-researched as autism and it is possible that it will not be taken as seriously by insurance companies, among others.
This research is published in the journal American Academy of Child and Adolescent Psychiatry.
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