On May 17th, the American Psychiatric Association announced the release of the fifth edition of the Diagnostic and Statistical Manual, the first major revision in almost 20 years to this, the “bible” of modern psychiatry.
Some of the changes: Initial diagnoses of what was Asperger’s Syndrome will now be made under the larger umbrella of Autism Spectrum Disorder. Note that this will only apply to people being evaluated for the first time. Also, it does not mean that Asperger’s as a descriptor will necessarily go away; it will only be eliminated as a DSM-V diagnostic category.
There will be a new diagnostic category, called Social Communication Disorder. Dr. Amy Weatherby is the first speech-language pathologist to serve on the DSM-5 board and helped to craft the language of this newly defined category. It highlights those with social communication/social pragmatic challenges who do not exhibit the more “restricted, repetitive patterns of behavior, interests, or activities” which has been one of the diagnostic hallmarks of ASD. Here’s the official criteria:
A. Social Communication Disorder (SCD) is an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.
B. The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination.
C. Rule out Autism Spectrum Disorder (ASD). Autism Spectrum Disorder by definition encompasses pragmatic communication problems, but also includes restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed.
D. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).
My initial reaction is that the criteria seems extremely subjective. I can see many, many children who are socially awkward, or have behavior issues being diagnosed with this. If a diagnostician can’t go into the home for a meaningful period of time (and they can’t), how does one effectively differentiate between social language issues which are the result of some interpersonal family issues, and an actual disorder? How does one effectively determine that social issues are the result of what a child can’t do, versus what a child doesn’t want to do? And even if a child isn’t able to effectively use social language, is it always because of a disorder, or is there an environmental component as well?