Editorials

New recommendations on autism spectrum disorder

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2456 (Published 09 May 2011) Cite this as: BMJ 2011;342:d2456
  1. Peter Szatmari, director
  1. 1Offord Centre of Child Studies; McMaster University and Children’s Hospital, Hamilton, ON, Canada, L8N 3Z5
  1. szatmar{at}mcmaster.ca

Shifting the focus from subtypes to dimensions carries potential costs and benefits

Annabella Bluesky/SPL

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) interim report on autism spectrum disorder was published recently (www.dsmv.com; 26 January 2011). On the basis of a review of the literature, the views of experts, and the requirements of developing a diagnostic manual that satisfies many stakeholders, the Neurodevelopmental Work Group has made several bold and perhaps controversial recommendations. One is to eliminate the term “pervasive developmental disorder” and replace it with the more commonly used “autism spectrum disorder.” A second is to eliminate the various subtypes that were previously described, including Asperger’s disorder. This has been perhaps the most contentious decision because many people with a diagnosis of Asperger’s disorder do not see themselves as having autism and are concerned that they will be denied recognition and services if Asperger’s disorder is eliminated.

The reasons for the work group’s decisions are threefold. Firstly, it is difficult to apply the criteria for the subtypes of pervasive developmental disorder in a systematic way; secondly, most children who are diagnosed with Asperger’s disorder would meet criteria for autistic disorder; and thirdly, the risk factors for autistic disorder …

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