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May 2012



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Earlier this year, the Autistic Self Advocacy Network and the Autism Society of America issued a joint statement discussing the proposed changes. Concerns arose from suggestions that not all those currently diagnosed would retain a diagnosis once the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual was released.

Now that the final public comment period has opened, you can comment on the proposed changes that will combine several diagnoses into one unified autism spectrum category. We view community involvement and representation as a vital part of developing meaningful criteria that reflect our needs. The deadline for submissions is June 15 leaving little time to delay.

To comment, you must register then navigate to the ASD draft criteria page to submit. Here are our suggestions when you consider what to include in your public comment:

  • *APA should revise the requirement in the ASD draft criteria’s social communication domain (A) that an individual meet 3 of 3 listed criteria. This sets an overly restrictive standard and will likely lead to greater challenges in accessing diagnosis for adults, racial and ethnic minorities, women and girls and other under-represented groups. Independent analysis of the draft criteria have confirmed the overly restrictive nature of this requirement. APA should revise this requirement to require only 2 of 3 criteria to be met, either shifting this requirement across the lifespan or introducing the greater flexibility specifically for adults in recognition of the greater difficulties in identification which exist for the Autistic adult community.

  • * APA should clearly communicate that individuals should be assessed for diagnosis without regards to any mitigating measures, such as learned behavior or other adaptive coping mechanisms, they may have developed to help navigate the world. This is consistent with the way in which the Americans with Disabilities Act is interpreted according to the recent ADA Amendments Act of 2008, which worked to ensure that people with less visible disabilities could retain coverage under the ADA. APA should consider revising part (C) of the draft criteria to reflect this. Currently, (C) acknowledges that characteristics of ASD may not be noticeable until later in life due to greater social demands in adolescence, but does not yet take note of the fact that many Autistic adults utilize adaptive coping mechanisms which may make it more difficult for them to access diagnosis, even as we are still substantially impacted by being on the autism spectrum and would benefit from the services, self-understanding and accommodations diagnosis provides.

  • * APA should consider linking the diagnosis of Social Communication Disorder under ASD, helping to address both concerns that individuals on the autism spectrum may be inappropriately placed within the SCD diagnosis and the benefits of greater linkages of diagnoses in research and practice. There are multiple structures which could accomplish this goal, ranging from classifying SCD as a type of ASD-Not Otherwise Specified to describing SCD as a sub-type of ASD utilizing a similar structure to that which has been applied within the ADHD diagnosis.

  • * APA should proceed with the development of a unified, single ASD diagnosis, reflecting the reality that the application of the various ASD diagnosis (Autistic Disorder, PDD-NOS and Asperger’s) is inconsistent and often utilized as a means of denying access to appropriate services. However, in doing so, APA should act with caution to ensure that all individuals covered under the DSM-IV diagnoses will retain coverage in the revised unified diagnosis.

  • * APA should consider incorporating motor and movement issues within domain (B) in recognition of the growing body of research which finds these issues as common across ASD.

  • * APA should clarify and expand upon its use of examples, while making clear that such lists of examples are non-exhaustive and that an individual not possessing the examples APA utilizes should not disqualify them from access to diagnosis. APA should consider providing examples specific to adults and adolescents, to better acknowledge that the characteristics of ASD differ across the lifespan. APA should also consider providing more specific examples on varying presentations for women and girls and racial and ethnic minorities.

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