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autism in context…

January 23, 2012

One of the first topics we cover in Research Methods is that science does not occur within a vacuum – and this is especially true for psychological science. Recently, there has been a flurry of news stories about how certain mental health disorders are diagnosed, with a lot of debate focused on the diagnostic criteria for autism. This is occurring now because a revision of the Diagnostic and Statistical Manual (DSM), THE reference for psychiatrists and mental health professionals to diagnose mental health disorders, has been underway for years. The DSM is currently in its fourth (although revised) edition, and the fifth edition promises to make some important changes. (An overview of the revision is available here.) The changes are intended to increase the reliability and validity of the diagnoses that are made – essentially, the goal is to avoid false positives (diagnosing someone with a disorder who is actually healthy) while not excluding individuals from a diagnosis who do have a legitimate need for clinical intervention. It seems as though this should be a fairly straight-forward, empirically grounded process (the ideal), but there are a lot of other pressures playing into it – you can read a good summary of some of those issues here: Redefining Autism For DSM-V. The diagnostic criteria for autism have been arguably “loose” in past editions of the DSM, reflecting a very healthy debate about exactly what autism is.

In recent years, these has been an increase in the diagnosis of autism (MSNBC has a series of stories related to the increase – always worthwhile to see how the popular press approaches a subject, and they don’t disappoint with the title “Autism: The Hidden Epidemic?”). This increase has been accompanied by a debate – is the increase due to an increased prevalence of the disorder or does it reflect that the diagnostic criteria are too broad, resulting in lots of false positives? Depending on how you answer that question, you will see the proposed revision to the DSM in a very different light. For those that see an increase in prevalence – the revision may exclude many people who would benefit from clinical intervention. For those that see an increase in false positives – the revision represents a better diagnostic tool that will increase the reliability and validity of the identification of individuals with autism.

I am not a clinical psychologist. I am not an expert in autism. I am however interested in this debate because (a) it is important that we get diagnoses of mental health disorders right and (b) it nicely illustrates how the science of autism diagnosis is contextualized. This revision will have very real impact on families – possibly how they view the behaviors of a child that does not play the way other children on the playground do or what access they have to clinical or education services to assist them in working with that child. This revision will have a very real impact on healthcare groups – facilities and organizations may see funding disappear if the number of individuals with autism shrinks because of tighter diagnostic guidelines. The revision will impact researchers, teachers, and many others. I point this out to my students because sometimes when we are working our way through topics like “construct validity” or “false positives” in class, it may all seem rather academic and they might not see the importance of what they are learning.

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2 comments

  1. Nice post, Dr. C-P. There certainly is an important debate about whether decreased diagnoses due to the changes in DSM5 would be good or not. But I just wanted to point out that there is *also* a debate about whether the DSM5 actually *will* reduce the number of people eligible for an ASD diagnosis, including from the venerable Cathy Lord herself…


    • I was hoping you’d chime in (to help correct/clarify/add to the post), and you make a good point. Thanks.



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