The Diagnostic and Statistical Manual of Mental Disorders (DSM) was revised and released a fifth edition in May of 2013. Included in the changes that were made to the DSM-5, is the dissolution of the diagnoses of PDD-NOS and Asperger’s Disorder which both previously fell under the umbrella term for Autism Spectrum Disorders (ASD). Individuals with social communication impairments are now being diagnosed with Social (Pragmatic) Communication Disorder (SCD). Characteristics of this newly added category include skill deficits related to the use of social language and interpersonal skills without demonstrating or having had a history of restricted interests or repetitive behaviors.
In the past, individuals with PDD-NOS and Asperger’s Disorder fell into the category of ASD and therefore qualified for ABA services to address skill deficits through private insurance and public educational programs. Persons who have been diagnosed prior to 2013 are still eligible to continue services as previously being offered; however, now due to the changes made to the DSM-5, individuals who are now being diagnosed with having the same level of impairment and who exhibit the same characteristics will no longer qualify for the same type of services as before. Although a specific treatment has not been identified, currently, those being diagnosed with Social (Pragmatic) Communication Disorder are eligible for speech and language services as the diagnosis is defined specifically as a communication disorder; however ABA and other interventions are no longer accessible. Although speech and language services are available, the nature and level of service provision might prove to be inefficient in treating these individuals and addressing global delays. The American Hearing and Language Association (ASHA) website states “while it is ideal to address all skill areas concurrently, this is not always possible due to a number of factors, including time constraints and the patient’s/client’s unique needs.” So where does this leave families and individuals who are now being diagnosed with this disorder?
More than two years after the revision, there is an increasing number of questions pertaining to how these changes in diagnoses are affecting the lives of individuals with the earlier diagnosis of ASD and the new diagnosis of SCD. Researchers are questioning if the changes will affect the growing prevalence rate of autism, the eligibility of clinical services and the transition process from child to adulthood. Although researchers are already investigating how these changes in the diagnoses affect continued eligibility and service provision there are a limited number of studies related to identifying the clinical and non-clinical long term effects of the changes to the DSM. Autism Speaks is working in collaboration with the Centers of Disease Control and Prevention, and are funding a study comparing the DSM-IV and DSM-5 criteria in a large ethnically diverse, community-based sample of children in South Carolina. This is in addition to a study comparing the two sets of criteria with children in South Korea. Furthermore, Autism Speaks has developed surveys for parents and professionals in order to evaluate the effects of this modification in the real world.
Rachel LaPiana, M.S.Ed., BCBA, is a Board Certified Behavior Analyst (BCBA) with over 10 years of experience working with children with autism and other developmental disabilities. She is a certified special educator with credentials both in New York and California. Rachel has worked hands on with a wide age range of students from birth through 18 years of age. She specializes in the Verbal Behavior methodology to teaching children with autism and has presented at a number of conferences, including at the annual conference for International Association for Behavior Analysis. Rachel is the ABA Training Coordinator for QSAC.
Childmind Institute (2015). Social Communication Disorder What is it? Retrieved 2015, from http://www.childmind.org/en/health/disorder-guide/social-communication-disorder
Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. (2014). Journal of Neurodevelopmental Disorders, 6, 41-41. Retrieved 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258293/
Social Communication Disorders in School-Age Children. (n.d.). American Speech-Language- Hearing Association. Retrieved 2015 from www.ASHA.org