The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the publication’s first major revision in over twenty years, includes changes that have caused a stir in the psychiatric community. Among these changes, the DSM-V now combines the autism spectrum disorders into a single category and includes the newly created disruptive mood dysregulation disorder.
The newly classified autism spectrum disorder now includes autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder – not otherwise specified (PDD-NOS), and Asperger syndrome. According to Autism Speaks, autism spectrum disorder emerges between the ages of 2 and 3 and is often associated with intellectual disability, difficulties with motor coordination and attention, and other health issues such as sleep and gastrointestinal disturbances. Individuals with autism spectrum disorder can display incredible proficiencies in visual skills, music, math, and art.
The Centers for Disease Control and Prevention estimates that approximately 1 in 88 children has been identified as having an autism spectrum disorder, with five times as many boys being identified with autism spectrum disorders as girls: While 1 in 252 girls will be diagnosed with an autism spectrum disorder, 1 in every 54 boys will be diagnosed with some form of autism spectrum disorder.
The changes included in the DSM-V are likely to impact these children in the form of possible diagnoses reclassification and modification through stricter diagnosis criteria. The Autism Research Institute explains that more symptoms must be present in order to meet the new criteria for the area of fixated interests and repetitive behaviors. Furthermore, the DSM-V no longer recognizes a requirement of a delay in language development for a diagnosis of autism spectrum disorder.
Because of these changes as many as 75% of individuals diagnosed with Asperger’s syndrome could lose their diagnosis, according to Talk About Curing Autism. Additionally, approximately 80% of individuals with PDD-NOS could lose their diagnosis. With the loss of their diagnoses, individuals with Asperger’s syndrome and PDD-NOS could potentially lose their services if programs change their requirements to include re-diagnosis.
Conversely, the changes should not affect the education of children currently diagnosed with Asperger’s syndrome, PDD-NOS, or childhood disintegrative disorder because schools are required to provide services based on need, not diagnosis, under one of the categories in the Individuals with Disabilities Education Act (IDEA).
The IDEA includes ten categories under which students can receive special education accommodations: mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, and specific learning disabilities.
In order for a child to receive services under IDEA, the child’s educational needs must fall into one of the ten categories and it must be demonstrated that the child requires special education and related services.
In addition to combining the autism spectrum disorders into a single category, the DSM-V eliminated the diagnosis of pediatric bipolar disorder and created, in its place, a new category called disruptive mood dysregulation disorder.
Disruptive mood dysregulation disorder is marked by intense outbursts, inconsistent with development, and irritability in young children. In order to classify as disruptive mood dysregulation disorder, the temper outbursts must occur, on average, three or more times per week.
The adoption of disruptive mood dysregulation disorder comes in light of the increase in the diagnosis of childhood bipolar disorder, which often results in young children being placed on powerful antipsychotic medication. According to the Agency for Healthcare Research and Quality, adverse side effects of antipsychotic medication include excessive weight gain, head pain, dizziness, drowsiness, abnormally low blood pressure, trouble breathing, suicidal ideation, depression, kidney failure, and diabetes.
The Agency for Healthcare Research and Quality reports that hospital stays for children, aged 1 to 17, with bipolar disorder increased 434% between 1997 and 2010.
While the new category attempts to combat the rising issue of sometimes falsely diagnosing children with bipolar disorder, many individuals are concerned that the new category of disruptive mood dysregulation disorder may also be applied overbroadly and may cause the diagnosis of children with a mental disorder simply because they are prone to temper tantrums.
While individuals may have to adjust to the changes contained within the new edition of the DSM, the changes will, hopefully, help better diagnose both children and individuals who experience mental disorders.