As anticipated by the speech-language pathology community, the newly released Diagnostic and Statistical Manual of Mental Disorders significantly changes descriptions of autism spectrum disorder, communication disorders and other disorders involving speech-language treatment.
Issued by the American Psychiatric Association in May, the fifth edition eliminates pervasive developmental disorder and its subcategories, instead creating a broader diagnostic category of "autism spectrum disorder" with varying degrees of severity. It also unveils the new social (pragmatic) communication disorder, which is distinct from ASD. And it makes other changes relevant to speech-language pathology relative to neurodevelopmental and neurocognitive categories, including the renaming and revision of expressive and mixed receptive-expressive language disorders.
The chart on the following pages highlights major changes for ASD and communication disorders; the complete version of the chart [PDF] includes changes to other areas relevant to speech-language pathology treatment: attention-deficit/hyperactivity disorder, intellectual disability, neurocognitive disorders, and specific learning disorder. The chart summarizes differences between DSM-5 and the input ASHA provided to the APA. It also considers some potential practice implications. (A caveat: The chart covers only a small portion of DSM-5 disorders and seeks to inform, not prescribe. For more detailed information, see the American Psychiatric Association's DSM-5 Development website.)
When reading the DSM-5 manual, be sure to go beyond the diagnostic criteria and read all sections, which cover such topics as diagnostic features, recording procedures, prevalence, development and course, risk and prognostic features, functional consequences, differential diagnosis, and comorbidity. Some diagnostic categories also include sections on gender, age and culture.
DSM-5 changes and refinements will have practice, research and training implications for years to come. Potential repercussions for reimbursement are discussed in DSM-5 Changes May Cause Billing Headaches.
ASHA would like to know how you think the changes in DSM-5 will affect your clinical practice. Will anyone still use the former subcategories of ASD? Will clinicians still use assessment instruments specific to the former ASD subcategories? What is the relevance of DSM-5 in school settings? Will organizations that use DSM-IV criteria transition to DSM-5 criteria? What do you do if you disagree with the new criteria? We also seek case studies that demonstrate impacts of the changes for a future Leader article. Please contact Diane Paul at firstname.lastname@example.org.
ASHA staff members Janet McCarty, Andrea (Deedee) Moxley, Froma Roth and Monica Sampson also contributed to this article. The complete DSM-5 chart that includes all SLP-relevant categories is available on the ASHA Leader Online[PDF]. An ASHAsphere blog post on this topic is at blog.asha.org.