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Revised Autism Criteria in
New DSM Raises Concerns
The American Psychiatric Association’s new Diagnostic and Statistical Manual of Mental Disorders fifth
edition (DSM-5) includes significant changes in the criteria for diagnosing autism spectrum disorder that
have raised concerns among parents and advocates. Neelkamal Soares, MD, a UCLA developmental-
behavioral pediatrics specialist, discusses the revisions and their implications.
Why is the DSM important?
All diagnosticians — primary care physicians,
psychiatrists, specialists, psychologists,
educators, et al. — rely on the DSM for
diagnosing neurological and mental disorders.
Clinicians look at the DSM and match the
patient’s symptoms with the criteria for
diagnosis. It’s important to note that the DSM
does not provide any guidance on treatment;
it is left to the professional organizations or
physician groups to look at the evidence and
develop treatment guidelines. But defining
the diagnosis is important as a gateway to
treatment for insurance purposes, from the
public health perspective and for researchers.
It can also impact eligibility for public services
and self-identification for support groups and
What is different about DSM-5?
In the last 10 years, we have seen tremendous
advances in imaging, genetic and other
technologies that are allowing us to link
theory with actual physical findings in a
way we never could before. One of the major
changes involves a lifespan developmental
approach. This is an acknowledgment that
many disorders exist throughout the life of
an individual, but they express themselves
differently at different ages. It used to be
believed, for example, that autism was only
present in children; now we know that not to
be the case. We also now use questionnaires
and other instruments to determine the
severity of a disorder.
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