DSM-IV TR (current standard)
DSM-5 (May, 2013)
"Pick Six"
"All Four Required"
Impaired social interaction (two required)
Reciprocity, nonverbal behavior, relationships, shared interests
Impaired social and communicative interaction (all three required)
Reciprocity, nonverbal behavior, relationships (shared interests, etc)
Plus one of the following communication skill problems required
Eye contact, language, initiate/sustain interactions, imaginative play
Plus any two of the following required
Eye contact, language, initiate/sustain interactions, imaginative play
Body language, understanding, tolerance for change, symbolic play
Ritualized patterns, focus on details
(no language impairment required for Asperger's Disorder)
(no cognitive impairment required for Asperger's Disorder)
Plus one of the following repetitive behavior patterns
Routines, stereotypic, restricted interests, sensory, preoccupations
Plus two of the following repetitive behavior patterns
Routines, stereotypic, restricted interests, sensory, preoccupations
Plus Onset before age 3
And impairment of social or language or symbolic/imaginative play
Plus Onset in early childhood (not necessarily before age 3) or later
And symptoms together limit and impair everyday functioning
Not Rett's Disorder or Childhood Disintegrative Disorder
Not just General Developmental Delay
© 2012 Steve Kossor
Permission to duplicate is granted to parents and their advocates
www.ibc-pa.org
www.TreatmentPlansThatWorked.com
www.OurCaseManager.pro
610-212-0738
The primary purpose of diagnosis is to classify and categorize a person to establish
a rationale and justification for treatment funding. A person’s treatment plan is not
defined by their diagnosis. If it were, then only one treatment plan would be needed
to treat any person with autism. We all know the truism “If you’ve met one person
with Autism, you’ve met one person with Autism.” so it is obvious that diagnosis
has relatively little to do with responsible, ethical treatment planning.
The highlighted section is the DSM-IV TR standard for diagnosing “autism” which is
the current standard defined by the American Psychiatric Association in its
Diagnostic and Statistical Manual of Mental Disorders, version IV (Text Revision).
Note that many state Medicaid Plans explicitly reference the DSM-IV diagnostic
criteria so that they may require the use of DSM-IV criteria to establish the “medical
necessity” of a treatment plan under Medicaid, while the PRIVATE insurance
industry adopts the DSM-5 standard.
1
The highlighted section is the proposed DSM-5 definition of “autism spectrum
disorder” which is expected be the standard as of May of 2013 for diagnosing
“autism spectrum disorders” according to the American Psychiatric Association in its
Diagnostic and Statistical Manual of Mental Disorders, version 5.
2
The highlighted area summarizes the DSM-IV TR standards by identifying key
disability areas. Some people have referred to DSM-IV as a “pick six” standard
which seems to be more liberal than the “all four required” standard seemingly set
by DSM-5. Both of these perceptions of the DSM standard are oversimplified,
incorrect and misleading.
Circle the concepts in the highlighted section below the DSM-IV TR standard. You
can check to make sure that the highlighted concepts are actually contained in the
DSM-IV TR standard directly above.
Note that, under DSM-IV TR the child’s condition must have had an onset before
age 3. DSM-5 sets no such limit on the age of the child; this is a significant
improvement.
3
Now, circle the exact same words in the highlighted section below the DSM-5 standard. You can
check to make sure that the circled concepts are actually contained in the DSM-5 standard directly
above.
You will notice that all of the DSM-IV TR standards are incorporated into the DSM-5 standards – and
that DSM-5 actually includes standards that were overlooked in DSM-IV. Thus, DSM-5 is actually a
better definition of Autism spectrum disorders than DSM-IV. It is also more aligned with the world
standard of diagnostic classification (the International Classification of Diseases version 10 or ICD10).
The biggest difference between DSM-IV TR and DSM-5 is that DSM-5 requires the condition to “limit
and impair every day functioning.” Under DSM-IV TR, it is possible to diagnose “high functioning
Autism” (sometimes called “Asperger’s Disorder) that does not limit and impair every day
functioning. However, if a person’s functioning is not limited or impaired, then the existence of a
clinical syndrome or disabling condition is debatable – the person may not be “normal” but if they are
not impaired, there is no need for a diagnosis because there is no need for funding to treat their
“condition.”
Note that the extent to which a condition serves to “limit and impair every day functioning” is a
continuum. It is not required that the condition “severely” impairs functioning, but some level of
limitation and impairment is obviously necessary in order to justify the diagnosis of any disorder.
This is the Diagnostic and Statistical Manual of Mental Disorders, and is used to determine if funding
for the treatment of mental disorders is appropriate. Autism Spectrum Disorders in DSM-5 are, just
as in DSM-IV TR, mental disorders. If they were not, it could present grave consequences for
treatment funding through Medicaid’s EPSDT program and any number of recently passed state laws
mandating funding for the treatment of Autism Spectrum Disorders.
4