One of the most influential publications in Mental Health comes from the United States. It is called the Diagnostic and Statistical Manual of Mental Disorders (DSM). First published in 1952 by the American Psychiatric Association, the DSM is a guide on classifying mental disorders. It is used by Psychiatrists, Psychologists and General Practitioners in order to help them decide on the diagnosis a patient should receive. The DSM was needed in order to try to standardise the diagnostic process, making sure specific terms (anxiety for example) mean the same thing to different practitioners.
For numerous reasons, Autistic Spectrum Disorders (ASD’s) are difficult to diagnose accurately. In the UK and the US approximately 1 in 115 people are diagnosed with some form of ASD, but recent research suggests that the number of people who actually fall under the ASD umbrella is much higher. I won’t quote exact figures here because sources vary so much, but it is easy to imagine that if 1 in 115 are diagnosed, a considerable number of people also fall through the cracks in the system.
Children with ASD’s can be helped to a certain extent. There are therapies, which are helpful and can make be quite beneficial. I must emphasise that these therapies are by no means a cure, but young minds are incredibly adaptive and it is easy to see how the right interventions could help improve behaviours and symptoms in children. Providing this kind of treatment takes a lot of time and resources. In adults, who are simply less adaptive, there are no really effective treatments.
In the ever practical medical profession, there is always an argument about cost effective treatment – Outcome vs Resources. Getting a diagnosis as a child can be a very long winded affair and all too often, the first diagnosis, isn’t the last diagnosis. Trying to get a diagnosis as a teenager or adult can often take upwards of a year, in some cases several years, due to the limited resources available.
ASD’s have many symptoms, and all of them tend to share some symptoms in common, most notably, some impairment in social interaction. However the symptoms between different areas of the spectrum can be quite distinct, such as delays in language development in High Functioning Autism (HFA), something which doesn’t occur in Aspergers Syndrome; a small thing, which in the long term can produce extremely different experiences and symptoms in later life. In ADHD, once taught, social skills tend to be understood, not so with Aspergers or HFA.
In 2013 the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders is due to be published. A proposal for DSM-5, is that rather than diagnosing Aspergers Syndrome and High Functioning Autism as individual conditions, they grouped together with Persuasive Developmental Disorder into one Autistic Spectrum Disorder group. Under the proposal, there are also some exclusionary criteria, which are vague and involve not taking into account possible additional learning disabilities. Essentially this means if a child has a learning disability which also affects their ability to socially interact, the ASD diagnosis becomes irrelevant.
The agenda here seems not to be to address the lack of resources available to treat and diagnose Autism, but to change the criteria, reducing the number of people (especially children) who qualify for therapy. This seems to be a very political move, which pushes the agenda for high functioning people who require little from the medical profession, while at the same time excluding those who absolutely do require help.
DSM-5 will not be finalised until early 2013, so the exact wording hasn’t been agreed upon yet, so the exact impact is still unclear. However this proposal is extremely worrying. These are guidelines which rather than increasing much needed resources, will simply exclude people from eligible to seek those resources.
Related posts:
{ 1 comment… read it below or add one }
This is a terrible proposal. My son would certainly be one of those who would fall through the gaps due to his learning disability. His Autism does require therapy and at the moment we are lucky to be able to get it, especially Sensory Diet therapy. This is madness!
More resources need to be pushed into the ASD field! It is rediculous to change the guidlines to solve put a band aid over the problem!
God knows getting my son therapy for his autism was a uphill battle, I can’t even begin to imagine what parents like myself will do if these guidleines come through. Are we supposed to accept that some generic therapy is going to be acceptable for those who are on the spectrum for something which is so very diverse? Are we just supposed to accept that therapy which can improve the quality of our childrens lives simply isn’t available anymore because our children have a secondary condition?
What a disgusting situation.