Changes to Aspergers Syndrome in the DSM-V

The latest Diagnostic and Statistical Manual, Fifth Edition (DSM-V), published by American Psychiatric Association, was released in May 2013. As you probably already know, the DSM-V significantly revised the diagnostic category under which Aspergers and autistic disorder previously fell in the DSM-IV-TR.

Specifically, in the DSM-IV-TR, Pervasive Developmental Disorders was the diagnostic category that included five disorders: autistic disorder, Rett’s disorder, childhood disintegrative disorder, Aspergers disorder, and pervasive developmental disorder not otherwise specified. Each of the five disorders had their own specific criteria used to make a diagnosis.

The DSM-V contains the newly-created diagnostic category of Autism Spectrum Disorder. The essential features of this category are persistent impairment in social communication and social interaction (Criterion A) and restricted, repetitive patterns of behavior, interests, or activities (Criterion B). Criterion C relates to the symptoms’ presence from early childhood and Criterion D requires that the symptoms limit or impair everyday functioning. Criterion E relates to ruling out the role of intellectual disability or global developmental delay in explaining the occurrence of Criteria A and B.

Criterion A: Persistent deficits in social communication and social interaction

• Deficits in social-emotional reciprocity
  • Examples: abnormal social approach to others; failure of back-and-forth conversation;  reduced sharing of interests, emotions, or affect; failure to initiate or respond to social interactions
• Deficits in nonverbal communicative behaviors used for social interaction
  • Examples: poorly integrated verbal and nonverbal communication; abnormalities in eye contact and body language; deficits in understanding and use of gestures; total lack of facial expressions and nonverbal communication
• Deficits in developing, maintaining, and understanding relationships
  • Examples: difficulty adjusting behavior to suit various social contexts; difficulties in sharing imaginative play or in making friends; absence of interest in peers

Criterion B: Restricted, repetitive patterns of behavior, interests, or activities

• Stereotyped or repetitive motor movements, use of objects, or speech
  • Examples: simple motor stereotypies; lining up toys or flipping objects; echolalia; idiosyncratic phrases
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior or nonverbal behavior
  • Examples: extreme distress at small changes; difficulties with transitions, rigid thinking patterns, greeting rituals; need to take same route or eat same food each day
• Highly restricted, fixated interests that are abnormal in intensity or focus
  • Examples: strong attachment to or preoccupation with unusual objects; excessively circumscribed or perseverative interests
• Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
  • Examples: apparent indifference to pain/temperature; adverse response to specific sounds or textures; excessive smelling or touching of objects; visual fascination with lights or movement

The DSM-V specifically states, “Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder” (p. 51).

Furthermore, for those individuals who have marked deficits in social communication but do not otherwise meet the criteria for autism spectrum disorder, the DSM-V states that these individuals should be evaluated for social (pragmatic) communication disorder. You can read about the essential features of this disorder here.

By Loree Primeau, PhD, OTR, FAOTA, Executive Director, Autism Community Network

Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), American Psychiatric Association, 2013.