ChildsWork News, Jan. 24, 2012: Talking About the New Autism Diagnosis

Unless you’ve been cut off from the news for the past couple of days you have likely heard the big news about the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its new definition of Autism Spectrum Disorders (ASD). As the headlines tout, the new definition, which is far narrower than the previous definition in DSM-4 will exclude many people from an ASD diagnosis. The implications of this new definition are more complicated than many people first believe, as Nirvi Shah explains in our first article. As we wait for the full results of the study by the Yale Child Study Center to surface in the coming months, it is important to remember that a medical diagnosis is not all that is used to distribute educational services. In fact, on the heels of the Yale study, another group of researchers at Johns Hopkins have found that many cases of mild ASD are actually misdiagnoses. Based on the National Children’s Health Survey of 2007, researchers at the Bloomberg School of Public Health have discovered that many children “outgrow” their ASD diagnosis, as explained in this morning’s second article. What does this mean for the future of ASD and special needs education in America? As the director of the Yale study explains to The New York Times, the new definition of ASD would “nip” the surge in autism diagnosis “in the bud.” As more and more children are labeled as autistic each year, maybe redefining the disorder is a step in the right direction to figuring out exactly what this “spectrum” of problems really is… New Autism Definition Could Exclude Many from Diagnosis By Nirvi Shah writing for Education Week’s On Special Education A proposed new definition of autism could exclude many people now classified as having the disorder. News reports from around the country say that the definition of the disability is being reassessed by a panel appointed by the American Psychiatric Association. The group is wrapping up work on the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, which The New York Times reports is the manual's first major revision in 17 years. The Times talked to Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and an author of a new analysis designed to weigh the potential effect of the proposal. He said the changes would narrow the diagnosis so much that it could effectively end the autism surge. "We would nip it in the bud," he told The Times. The proposed change would consolidate the autism spectrum, which now includes people with Asperger syndrome and pervasive developmental disorder, not otherwise specified (PDD-NOS). They and those now diagnosed with autism would all be under one label—autism spectrum disorder. The Times said under the manual's current criteria, a person may qualify for the diagnosis by exhibiting six or more of 12 behaviors. The proposed definition would require people to exhibit three deficits in social interaction and communication and at least two repetitive behaviors—a narrower interpretation. In the new analysis, Dr. Volkmar and others used data from a large 1993 study that were used to develop the current criteria. They focused on 372 children and adults who were among the highest functioning and found that overall, only 45 percent of them would qualify for the proposed autism spectrum diagnosis by the definition now under review, The Times said. Some advocates told The Times they fear the effects of the new definition, should it become final later this year. "If clinicians say, 'These kids don't fit the criteria for an autism spectrum diagnosis,' they are not going to get the supports and services they need, and they're going to experience failure," Lori Shery, president of the Asperger Syndrome Education Network, told The Times. I asked whether the change, if it takes effect, means that all the students who receive special education services now based on a diagnosis of Asperger syndrome or PDD-NOS would suddenly lose those services. Not exactly, Sonja Trainor, a senior staff attorney at the National School Boards Association, told me. She said to keep in mind that medical or other diagnoses are different from a determination about whether a student needs special education services at school. Federal special education law—the Individuals with Disabilities Education Act—doesn't rely solely on the Diagnostic and Statistical Manual of Mental Disorders, Ms. Trainor said. "That diagnosis may have some bearing, but it's not the sole determining factor," she said. Autism Overdiagnosed? Possibly, Because Many Children Seem to ‘Outgrow’ It By Christian Nordqvist writing for Medical News Today Autism Spectrum Disorders (ASD) come with several neurodevelopmental signs and symptoms which overlap other conditions - it is possible that some early ASD diagnoses are wrong, especially among children who no longer meet the criteria for ASD as they get older, researchers from the Johns Hopkins Bloomberg School of Public Health wrote in the journal Pediatrics. The authors add that it is not easy for doctors to diagnose between several possibilities early in life. Andrew W. Zimmerman, MD. and team set out to determine what the relationship might be between co-occurring conditions and changes in ASD diagnoses. They gathered information from the National Survey of Children's Health 2007, and found that those who still had a diagnosis of ASD tended to have either severe or moderate learning disability or developmental delays, compared to those whose initial ASD diagnosis was changed when they got older. The authors were comparing children who had had a diagnosis of ASD at age 3 to 5 years with the same children when they were older who still had an ASD diagnosis, and those who did not. Those aged 6-11 years with a current ASD diagnosis - these patients were more likely at an earlier age to have had a speech difficulty, or/and severe or moderate anxiety, compared to their counterparts whose diagnoses subsequently changed. Those aged 12-17 years with a current ASD diagnosis - these patients were found to be more likely to have severe or moderate speech problems or (mild) epilepsy (seizures) compared to those who no longer have an ASD diagnosis. Hearing problems - those with past hearing problems are more likely to still have an ASD diagnosis later on, compared to those who did not have hearing problems, the authors added. Multiple co-occurring conditions - those with multiple co-occurring conditions when they were small are more likely today to still have an ASD diagnosis, compared to the other children. Multiple in this text means at least two. In an Abstract in the same journal, the authors concluded: "These findings suggest that the presence of co-occurring psychiatric and neurodevelopmental conditions are associated with a change in ASD diagnosis. Questions remain as to whether changes in diagnosis of an ASD are due to true etiologic differences or shifts in diagnostic determination."