JCPSLP
Volume 16, Number 2 2014
87
Invited paper
are available that provide comprehensive overviews of the
changes that have occurred in transitioning from DSM-
IV to DSM-5 (e.g., Autism Speaks, 2013; Paul, 2013).
The purpose of this commentary is not to repeat this
information, but to focus on those changes that are most
likely to impact on speech pathology policy and practice in
the Australian context.
In the lead-up to the release of DSM-5, there was a great
deal of speculation about the possible impacts of changing
the diagnostic criteria for ASD. My colleagues and I, for
example, noted that comparing the results of treatment
studies could become difficult if children were diagnosed
using different criteria (Vivanti et al., 2013). We noted that
the new criteria are likely to be more stringent, because (a)
there are fewer combinations of symptoms that can lead to
a diagnosis of ASD, (b) the ASD subgroup classification of
pervasive developmental disorder not otherwise specified
(PDD-NOS) for children with sub-threshold symptoms was
removed, and (c) children must now display a minimum
of two examples (instead of one) of repetitive, restricted,
or ritualistic interests and behaviours. Accordingly, we
raised concerns that children who do not meet the more
stringent criteria for ASD in DSM-5, but who would have
met criteria under DSM-IV, may no longer have access to
diagnoses-based funding, despite having identified social,
communication, and behavioural needs.
We also questioned whether there would be a shift in the
culture of ASD, whereby individuals who proudly identify as
having Asperger’s disorder may experience a sense of “loss
of identity” with the removal of the subcategories (autistic
disorder, Asperger’s disorder, childhood disintegrative
disorder, PDD-NOS) in the new DSM-5 criteria. These
concerns, as well as our enthusiasm for some aspects of
the changes, were echoed by others (e.g., Grzadzinski
et al., 2013; Mahjouri & Lord, 2012) and prompted
governments and service providers to consider their
responses to the proposed changes.
In Australia, the federal government Department of Social
Services, which is responsible for the provision of ASD-
specific funding packages to families, engaged in a national
consultation process with experts and stakeholders in the
field of ASD to formulate its policy response to the changes
in DSM-5. Presumably, the two most pressing needs at the
time of the consultation were to determine which diagnoses
of ASD would make a child eligible for ASD-specific funding
(e.g., the Helping Children with Autism Package) and what
funding support would be available to children who would
The purpose of this review is to discuss the
policy and practice implications of recent
changes to the diagnostic criteria for autism
spectrum disorder (ASD), as set out in the
Diagnostic and Statistical Manual
– 5th
Edition (DSM-5) of the American Psychiatric
Association. In Australia, government has so
far responded by accepting both the new, and
previous, diagnostic criteria, for the purposes
of determining children’s eligibility for
specialist ASD funding. Yet there is evidence
that some children who meet criteria for ASD
under DSM-IV, may not meet criteria under
the more stringent DSM-5 criteria, moving
forward. A summary of the changes most
likely to impact on policy and practice, as
well as the implications of the changes for
research and the culture of ASD, is
presented.
O
ur understanding of autism continues to evolve
based on scientific discoveries and changes in
society. Indeed, when we say a child has autism,
we simply mean that he or she displays a set of behaviours
that we judge to be consistent with those described in the
diagnostic criteria in use at the time. In Australia, the most
commonly used diagnostic criteria for autism are those set
out in the
Diagnostic and Statistical Manual
(DSM) of the
American Psychiatric Association (2013). These criteria
recently changed, with the transition from the fourth to the
fifth edition of the DSM, sparking renewed debate regarding
what autism is, and is not, as well as widespread interest
in the implications of these changes in criteria for research,
policy, and practice.
According to the DSM-5, autism spectrum disorder
(ASD) is a mental health disorder characterised by core
impairments in social-communication development and
behaviour, which affect individuals differently leading to
a spectrum of individual strengths and needs (American
Psychiatric Association, 2013). The everyday impact of
ASD for each person is described in terms of “severity
levels” that correspond to the amount of support he or she
requires to participate in everyday activities including life at
home, school, work, and in the community. Many resources
Changing the way we
diagnose autism
Implications for policy and practice
David Trembath
KEYWORDS
AUTISM
DIAGNOSIS
POLICY
PRACTICE
David Trembath
