Monday, April 5, 2010

Changes in DSM Prompt Controversy

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will not be published until 2013, but the discussion about the proposed changes to the new manual is already animated. The DSM V has been released in draft form by the American Psychological Association (APA) and for the first time the drafting committee is accepting public feedback on the latest adaptations. And feedback is what they are getting, both positive and negative.

One major proposed change is to create ‘Autism Spectrum Disorder’ and eliminate separate diagnoses for conditions such as Asperger’s syndrome. Instead, individuals will be diagnosed on the Autism spectrum, which Asperger’s will fall under. This proposed change has elicited many responses from the Asperger’s community, according to a recent NPR story.

"The intent is to try to make the diagnosis of autism clearer and to better reflect the science," says Catherine Lord, director of the University of Michigan Autism and Communication Disorders Center. Lord is part of the group that decided to consolidate autism-related categories, including Asperger's.

But the change is going to be hard for some people with Asperger's, says Michael John Carley, executive director of the Global and Regional Asperger Syndrome Partnership in New York and author of Asperger's From the Inside Out. "I personally am probably going to have a very hard time calling myself autistic," says Carley, who was diagnosed with Asperger's years ago. Many people with Asperger's take pride in a diagnosis that probably describes some major historical figures, including Albert Einstein and Thomas Edison, Carley says. Under the new system, those people would represent just one extreme of a spectrum. On the other extreme is "somebody who might have to wear adult diapers and maybe a head-restraining device. This is very hard for us to swallow," he says.

The change makes a lot of sense, says Roy Richard Grinker, an anthropologist at George Washington University who has studied autism in various cultures. Eliminating the Asperger's diagnosis won't mean that people in that category will lose access to services, Grinker says. That's because "almost anybody with an Asperger's diagnosis also could qualify for what is called autistic disorder," he says, adding that the change could make it easier for some parents to get help for a child with Asperger's. Right now, states including California provide services to children with autism but not those with Asperger's, Grinker says. "So removing Asperger's really removes what is a false barrier to parents getting care for their kids."

(Hear the story at:

Another proposed change is the addition of 'temper dysregulation with dysphoria' (TDD), a category created to prevent a diagnosis of bipolar disorder in children who don’t meet all the criteria but warrant some type of treatment. Again, this proposal has been met with mixed reactions.

“Temper dysregulation with dysphoria is proposed to prevent misdiagnosis of children who have bursts of rage and can be moody, anxious and irritable. Such children are often diagnosed as having bipolar disorder and treated accordingly, sometimes with powerful medications. The diagnosis of bipolar "is being given, we believe, too frequently," said Dr. David Shaffer, a member of the work group on disorders in childhood and adolescence. In reality, when such children are tracked into adulthood, very few of them turn out to be bipolar, he said.”

(See article at:,0,2650262.story)

But others worry that kids with normal temper tantrums will be labeled as TDD, which can cause serious ramifications. Critics argue that [TDD] would only compound the problem of over-treatment. “They are close to treating the children like guinea pigs. I think that's appalling and outrageous," said Christopher Lane, author of "Shyness: How Normal Behavior Became a Sickness." "The APA should be moving to prevent such controversial practices, not encouraging them, as it is doing here." (See article at

The APA committee is taking feedback on the proposed changes until April 20th through the website We also want to know what you think about the proposals. Will TDD cut down on children being diagnosed with bipolar disorder, which has seen an exponential increase in recent years? Will the elimination of Asperger’s syndrome as a separate diagnosis help more children get treatment?

~ Mindi Wisman, NEN Research Associate