Autism, Asperger, and Social Communication Disorder

;Jennifer Wright writes at SFARI:

Most of the children who would lose their autism diagnosis under the diagnostic criteria released last year will fall under the new category of social (pragmatic) communication disorder (SCD), reports a large study of Korean children. The study was published last week in the American Academy of Child and Adolescent Psychiatry1.

SCD is a condition that includes severe social and communication deficits but lacks the repetitive behaviors and restricted interests seen in autism.

It is unclear exactly how the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released amid controversy in May last year, will affect people with autism, despite a plethora of studies addressing the issue.

On 22 January, researchers at the U.S. Centers for Disease Control and Prevention (CDC) reported that as many as 20 percent of people found to be on the autism spectrum using previous criteria would lose this designation with the DSM-5.

In contrast, the Korean study — which the journal rushed into publication the following day — suggests that only 8 percent of children would show a change in diagnosis under the DSM-5. More than three-quarters of these children had a diagnosis of pervasive developmental disorder-not otherwise specific (PDD-NOS), the mildest and arguably least clearly defined autism diagnosis in the DSM-IV.

Unlike the CDC study, these findings rely on careful clinical review of each child’s records and consider several diagnostic categories in both editions of the DSM, says lead researcher Young Shin Kim, associate professor at the Yale Child Study Center in New Haven. “We got rid of every possible variance, which might bring in differences in the diagnosis,” she says.

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One of the most controversial changes in the new guidelines is the consolidation of three autism spectrum diagnoses in the DSM-IV — autistic disorder, Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS) — into a single label of autism spectrum disorder in the DSM-5.

While the guidelines were still being debated, there was widespread concern that individuals with Asperger syndrome would lose their autism diagnosis. But for many, the final version of the DSM-5 allayed fears that children with an existing diagnosis of autism would no longer qualify for services.

The findings of the Korean study should further reassure people that this is unlikely to happen, says Kim: Only 5 children diagnosed with either autistic disorder or Asperger syndrome under the DSM-IV lost that diagnosis with the DSM-5. Four of those children meet the criteria for SCD and the fifth for ADHD.

“The good news is that people with Asperger syndrome should not have to worry, because they are going to be diagnosed with [autism spectrum disorder],” says Kim. “The problem lies with PDD-NOS, because they do not meet the criteria for repetitive behavior and restricted interests.”