Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and may make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.
The definition is under review by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders. The DSM, as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions.
The study results, presented Thursday at a meeting of the Icelandic Medical Association, are still preliminary but offer the latest and most dramatic estimate of how tightening the criteria for autism could affect the rate of diagnosis. Rates of autism and related disorders such as Asperger’s syndrome have increased since the early 1980s, to prevalence rates as high as 1 in 100 children in some places. Many researchers suspect that these numbers are inflated because of vagueness in the current criteria.
“The proposed changes would put an end to the autism epidemic,” said Dr. Fred R. Volkmar, director of the Child Study Center at Yale University School of Medicine and an author of the new analysis.
Experts working on the new definition strongly questioned the new estimate.
“I don’t know how they’re getting those numbers,” said Catherine Lord, a member of the task force working on the diagnosis.
At least 1 million children and adults have a diagnosis of autism or a related disorder, such as Asperger’s syndrome or “pervasive developmental disorder, not otherwise specified” – or PDD-NOS. People with Asperger’s or PDD-NOS endure some of the same social struggles as those with autism, but do not meet the definition for the full version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder. Hundreds of thousands of people receive state-backed special services to help offset the disorders’ effects.
About a quarter of those identified with classic autism in 1993 would not be so identified under the proposed criteria.
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