Hi. My name is Stephanie, and today I want to talk to you about the new DSM
five text revision that just got released today.
That is, the day of this recording which is March 18th, 2022.
You might notice that this is a bit different, and that is that
I am not on screen today, and that's for good reason.
I do not feel well and I do not look well.
And I just wanted to be able to get this out to you guys.
So we're just going to be doing an audio based one today.
I apologize if that bothers you.
If you don't know, the DSM is the Diagnostic and Statistical Manual
for Mental Health Disorders, and it's published
by the American Psychiatric Association or the APA.
This is followed by the U.S.
and some other countries.
Basically, if we are talking about the diagnostic criteria
for autism here in the United States, this is what we're referring to.
This is what your clinician will refer to to see if you meet the criteria.
So hearing that autism was actually included in the revision was interesting.
And I've been waiting to see what it is.
People were saying, like, it's just being changed to clarify things.
And that could mean a lot of things.
So I've been patiently waiting, but it does seem a little bit
anti-climactic now that I have waited for some more information.
Today, we're going to be going
over the changes to autism spectrum disorder, intellectual disability,
ARFID, which we've talked about before, avoidant/restrictive food intake disorder,
some stuff like that.
And I feel like those are directly related the most
for the things that have changed in this latest text revision.
These are fact sheets
that were available on the American Psychiatric Association's website.
So, I'm going to read the fact sheet really quick.
And then there's also a little bit more insight from an article
by Spectrum that helps explain a little bit more.
In the upcoming text revision of the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders, DSM-5 TR, the diagnosis
of Autism Spectrum Disorder is revised from the DSM five diagnosis.
In addition to text changes throughout the disorder's description,
which reflect updated literature and advances in knowledge,
the most noticeable change is to the diagnostic criteria
specifically criterion A.
Now, hearing that I was like, What?
What are we changing?
This sounds pretty significant.
A lot of the changes in language are pretty universal for the DSM-5-TR.
They basically went through and
wanted to be more culturally relevant and sensitive.
You can read more about that if you would like to on your own.
I don't see it as super, super relevant to us today.
Rationale for Change.
Criterion A phrase, "as manifested by the following," was revised
to read "as manifested by all of the following"
to improve the intent and clarity of the wording.
The revision by the work group was consistent with the intent
of the DSM-5 workgroup for Autism Spectrum Disorder
to maintain a high diagnostic threshold by requiring all of the following
and not any of the following, as could be mistakenly inferred
from the previous wording of the criterion.
Well, first, I was kind of worried, right?
So it was like, did we misread something?
Did we not understand something?
So, I wanted to go check what it said, initially.
They haven't updated the particular wording on the CDC's website for this.
So, this is what it used to say.
To meet diagnostic criteria for ASD according to DSM-5, a child
must have persistent deficits
in each of three areas of social communication and interaction.
Plus, at least two of the four types of restricted repetitive behaviors.
A, persistent deficits in social communication
and social interaction across multiple contexts,
as manifested by the following currently or by history.
So they must have in each of the three areas, which is A1, A2, and A3.
There's nothing here that would have implied
that you could even just not have
all of these subsets of Criterion A, but they were very concerned about that.
So basically they just tweaked to add all of the following just to make sure
that the standard was correct or . . .
high enough, which was kind of weird, but something a little more interesting
that was changed as mentioned in this Spectrum article.
So, they say that the second change swapped out
a single word describing the specifiers that can accompany an autism diagnosis,
whereas the DSM-5
wording instructs clinicians to specify if a person's autism is, quote, associated
with another neurodevelopmental, mental, or behavioral disorder, end quote.
The DSM-5-TR version reads, quote, associated
with a neurodevelopmental, mental, or behavioral problem, end quote.
It still instructs clinicians to use additional diagnostic codes whenever
appropriate, but it no longer requires specifiers to be diagnosable conditions.
The second change now makes it possible for clinicians to indicate
co-occurring problems such as self-injury that don't rise to a level of disorder.
I think that's quite interesting and kind of leads me to reading
a little bit more about the addition
of a diagnostic code for suicidal behavior and the non suicidal self-injury.
So we do know that obviously mental health is a big issue for autistic people.
Suicide is the number two reason for the shorter
lifespan than the general population reported for autistic people.
So obviously that's of concern for us.
But we also often experience what would be considered non suicidal self-injury.
So that might be stims that aren't exactly productive, can cause harm or whatever,
or being frustrated and doing things that are harmful to our bodies that
most people wouldn't be doing.
But it's not because we
are trying to cause an end to our life or anything like that.
So I do think this is an important distinction.
So let's go ahead and look at this.
In the upcoming fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders Text Revision (DSM-5-TR), diagnostic codes were added
for suicidal behavior and non suicidal self-injury in section two of DSM-5-TR,
"other conditions that may be a focus of clinical attention" chapter.
Rationale for Change.
The other conditions that may be a focus of clinical attention chapter includes
conditions, behaviors, and psychosocial or environmental problems
that may be a focus of clinical attention or otherwise affect the diagnosis,
course, prognosis, or treatment of an individual's mental disorder.
The conditions, behaviors, and problems listed in this chapter
are not mental disorders.
The inclusion of codes for suicidal behavior and non-suicidal self-injury
in DSM-5-TR is meant to draw attention to the scope of additional issues
that may be encountered in routine clinical practice and to provide
a useful, systematic listing to clinicians in documenting these issues.
This addition will help improve documentation of these behaviors
which can serve to estimate risk factors for future suicide attempts or death.
These codes can also help clinicians record these types of behaviors
when occurring with other mental health conditions.
Finally, adding these codes will encourage research targeting
their treatment specifically rather than simply addressing these behaviors
as symptoms of an associated condition such as major depressive disorder.
So, I do think that's interesting, especially for autistic people and others
who tend to have issues with NSSI
because I think it's a bigger issue than just being like, Oh, that's autism or Oh,
that's mental disorder, or trying to lump that into other types of behavior.
They do have a note on the DSM-5-TR and diagnoses for children.
Basically, they're saying here they emphasized that similar
to any medical issue, no child should ever be diagnosed
without a careful, comprehensive evaluation.
And no medication should be prescribed without equal vigilance.
Parents play an integral role in this process,
as many of the DSM criteria require that symptoms be observed by them
or other individuals who interact regularly with the child.
So they're saying there's more precise criteria on a lot of these.
Existing criteria have been updated to provide more precise descriptions,
reflect scientific advances, clinical experiences.
Then we just have the autism spectrum disorder
changed to manifested by all of the following
to make sure it's clarity's improved, maintaining a high diagnostic threshold.
And I just don't feel like it's as big of a deal
as they're trying to make it to be.
But that's just me.
In the Spectrum article, they say there are no data,
but the impact has probably been minimal, says Catherine Lord, distinguished
professor of psychiatry and education at the University of California, Los Angeles.
Hopefully, almost everybody making diagnoses got the message
eventually that all three were required, even if it was slightly unclear.
It seems like more of a theoretical concern, Carpenter agrees.
I've never heard of someone going by the any definition.
And I agree, like, because if you read the whole entire thing,
it's pretty clear that, that you have to have all three of them.
But it is what it is.
They changed it, felt it was important.
Another thing
I think that might be interesting to look over is the intellectual
disability change, which is actually now intellectual developmental disorder.
Rationale for change.
The term intellectual developmental disorder is used to clarify the disorder's
relationship with the World Health Organization's
International Classification of Diseases 11th Revision, which is the ICD 11,
classification system, which uses the term disorders of intellectual development.
The equivalent term "intellectual disability" is placed in parentheses
for continued use.
So, it still can be used as intellectual disability,
but they are moving to change it to intellectual developmental disorder.
So this is kind of a shift basically.
DSM five TR includes in the diagnostic features section
updated text that removes a phrase contained in the DSM
five that appears inadvertently to change the diagnostic criteria
for intellectual disability to add a fourth criterion.
There are not four criteria,
but they are worried that it could be read that way, basically.
Another change in the same section
include revising the DSM five text to communicate the idea that
although one should not be bound narrowly to the 65 to 75 IQ score range,
the diagnosis would not be appropriate for those with substantially higher
IQ scores.
And Intellectual Developmental disorder or intellectual disability
was updated as a term in other conditions.
Which of course include autism spectrum disorder.
Regarding ARFID or avoidant restrictive food intake disorder,
which many autistic people have reported dealing with,
they have changed for more accuracy and clarity.
Rationale for change.
Criterion A was edited to eliminate the text,
quote, as manifested by persistent failure to meet appropriate nutritional
and or energy needs, end quote.
The edit was made to eliminate an inconsistency in the criteria
in which criterion A contained the clause, quote, as manifested
by persistent failure to meet appropriate nutritional and or energy needs,
end quote, but A4 allowed Criterion A to be met by, quote,
marked interference with psychosocial functioning,
end quote, which does not require a failure to meet nutritional needs.
The updates in the DSM five TR should help the clinical and research
communities better implement the criteria in a more accurate and consistent manner.
So if I'm reading this correctly, they're saying they took out basically
the text that would require a failure to meet nutritional needs,
which was conflicting with A4, which would let it be
met by marked interference with psychosocial functioning.
So from my understanding, you can have a persistent failure to meet
appropriate nutritional and or energy needs as a way of meeting the criteria.
But you also can meet it by the marked interference
with psychosocial functioning, and you don't have to have both.
Some other things
I noticed on the site were some things that they called emerging measures.
The APA is offering a number
of emerging measures for further research and clinical evaluation.
These patient assessment measures were developed to be administered
at the initial patient interview and to monitor treatment progress.
They should be used in research and evaluation
as potentially useful tools to enhance clinical decision making
and not as the sole basis for making a clinical diagnosis.
Instruction, scoring information, and interpretation guidelines are provided.
Further background can be found in the DSM-5-TR.
I found two that kind of seemed interesting.
There's a clinician rated severity of autism
spectrum and social communication disorders.
It looks like a very short form in which they kind of check off
what level of autism this might fall under.
And it looks like they can kind of use this as a way to kind of see progress or
if things have changed over time, but it's literally just . . .
two sets of information.
I don't think it's like amazingly useful.
But it's for stuff in the past seven days.
This might be useful for people who need a different support level.
If things have changed in life and they're kind of fluctuating in
how much support they need, this might be a useful form.
Another one is rating
non suicidal self-injury, which I just found kind of interesting.
I did find that if I'm reading these properly,
I might not fall under like the best place
just because this is actually experienced by the individual in the past year.
But you can find these on the APA's website.
I'm not going to go over them too much.
I just wanted to kind of
touch on those real quick because I found them interesting.
There aren't super significant changes that are extremely relevant to the autism
community at large, in my opinion, when it comes to this text revision.
We do see some language change and maybe some more clarification
that can help with people who might not meet diagnostic criteria
for other kind of issues that they're experiencing as an autistic person.
So really, there's nothing to worry about.
I know some people were very concerned that they were going to like
completely change everything.
And I am sure there will be conversations
about the criteria again,
whenever there's another version of the DSM.
But for now, it just looks like we're clarifying to make sure
that all criteria are met, which it was kind of already specified there.
And there's a new place for different types of behaviors
that could be harmful to one's self And now intellectual
disability is intellectual developmental disorder.
And ARFID looks like it changed to not have to absolutely
include the failure to meet appropriate nutritional and or energy needs.
So that is kind of the overview that I thought was relevant to us.
If you're interested in kind of the language changes
they made to address issues and stuff like that, I encourage you to go
search it up and look at the APA's website
and kind of some of the changes that they did in other areas.
This is just what I thought was probably the most relevant for us,
and especially on our channel, because these are kind of things
that we have touched on before.
Thank you so much for watching.
I hope that you enjoyed this video and I hope you found it a little bit helpful.
And now you're kind of up to date
on what's going on, and there's no reason to like freak out or be afraid
and just some information that might be helpful to you.
So I hope you enjoyed it.
If you did go ahead and drop a like
and let me know your thoughts about all of this in the comments below.
Did you even know that there was a text revision coming out?
Did you think that maybe it was going to be more or less?
Let me know all of your thoughts in the comments below.
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thank you to my Spinny Stimmy tier patrons,
Jack Varney and Philip Noah.
Thank you so much for watching.
I hope that you have a wonderful week, and I'll see you in my next video. Bye.