My comment to the DSM5 Organization/Autism Spectrum Disorder

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aghogday
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13 Jun 2012, 8:04 pm

I registered and sent a comment to the DSM5 Organization, just a few minutes ago, and met their deadline for comments/June 15 for their last open session for comments before final revision.

In attempting to reconcile some issues I had with their current definition, as well as concerns well thought out and addressed by the ASAN organization, I attempted a compromise of sorts.

I don't have any credentials, so it's not likely my comment will carry much weight, but here it is:

Quote:
Non Verbal communication impairments are a mandatory requirement in the revised DSM5 basic criteria for Autism Spectrum Disorder, but Verbal communication impairments, per developmental delays or the lack of ability to speak, while not included in Autism Spectrum Disorder in the basic DSM5 criteria, are addressed in general terms per levels 2 and 3 of severity, Currently, verbal delays are part of the way that autism is screened among children, as well as in children with the loss of verbal language in regressive autism, so it is very relevant at this point per an autism spectrum diagnosis.

It's highly unlikely that those two elements are going to be taken out of the screening process for Autism Spectrum Disorder, so while it is has never been a mandatory criteria requirement for a diagnosis of an autism spectrum disorder, never the less, it is a core symptom of some subgroups of autism spectrum disorders that aren't going away, if the DSM5 stays with their decision to exclude that existing criteria as part of the basic criteria of autism spectrum disorder.

Since verbal and non-verbal communication impairments are addressed as separate required impairments in severity levels 2 and 3, there is an acknowledgement of the issues as they currently exist among those in subgroups diagnosed with autism spectrum disorder whom lack the ability to speak, but not a specification of them as verbal communication impairments severe enough in those subgroups where a child cannot speak at all.

Motor skills developmental delays and verbal delays/lack of spoken language are part of what has been defined as autism disorders and will continue to be part of what is defined as autism spectrum disorders in both the ICD10 and Gilberg criteria for autism spectrum disorders. These developmental delays are currently very much a part of what defines subgroups of individuals with autism spectrum disorders along with hypo/hyper-reactive sensory input issues that are all, in part, biologically determined per a pervasive developmental disorder, instead of externally observable behavioral impairments, potentially influenced by the interaction with the social/cultural environment at levels required to meet the guidelines of the criteria in the DSM5 criteria for a diagnosis of Autism Spectrum Disorder.

From the DSMIV criteria for Autism Disorder:

"1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime"

This is the major criteria discarded from the criteria for DSMIV Autism Disorder that has been part of the criteria for the disorder since 1980, in the DSMIII. Per the DSM5, revised criteria, it appears that in the future that this defining symptom among some subgroups of individuals diagnosed with Autism Spectrum Disorders will be considered a co-morbid symptom, per the basic criteria, rather than an inherent part of autism currently commonly observed in subgroups of individuals with the disorder, as currently described in the basic criteria of Autism Disorder, in the DSMIV.

The severity levels remedy this issue, in part, however the DSM5 basic criteria for Autism Spectrum Disorder does not match severity levels 2 and 3 per the nomenclature that is used that addresses verbal and communication impairments as separate identified characteristics that are a requirement in severity levels 2 and 3.

Non-verbal communication impairments are identified as impairments of Social Interaction in both Autism Disorder and Aspergers in the DSM IV. Communication impairments are a separate category in Autism Disorder.

A solution to maintain consistency could be to keep the four criteria associated with Social Interaction, currently common to a DSM IV diagnosis of Autism Disorder and Asperger's Syndrome, and require 2 out of 3 of those criteria, excluding the non-verbal communication impairment criteria.

An additional subcategory under the general category of Social-Communication could be created for the criteria of non-verbal communication impairments currently listed under the DSM5 Social-Communication category and add the verbal communication impairment criteria quoted above, per verbal delays and the lack of spoken language. 1 out 2 of these criteria under the general category of Social-Communication, per this 2-element sub-category of Social-Communication, could be required.

It's highly unlikely that an individual with autism without the ability to speak is going to have skills in non-verbal communication that are not clinically impaired, so in virtually every case a non-verbal individual with autism would meet both criteria. And for those with verbal abilities per spoken language, they would still have to meet the criteria of non-verbal communication impairments.

The 2 out 3 requirements for the remaining social interaction criteria, as they currently exist, in the DSMIV, common to both Aspergers and Autism Disorder, added as the second sub-category under the general category of Social-Communication would allow leeway in part for the concerns of the ASAN organization, at least per the concern, for those that have adapted well enough to develop and maintain friendships, in young adulthood.