DSM-5 on the right track with autism

A new study indicates that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), was on the right track when it changed its autism symptom structure. The study, which is the first to compare the DSM-5 structure to other models in toddlers, concludes that the new structure supports a diagnosis of autism spectrum disorder (ASD) in children aged as young as 1 year.

The study, led by researchers from Florida State University, looked at 237 toddlers aged between 12 and 30 months and diagnosed with ASD. The investigators assessed the children using 4 models: 1) the new DSM-5 model, which added the 2 new symptom domains of social communication/social interaction and restricted, repetitive interests and behaviors; 2) the DSM-IV model, which is comprised of 3 domains (ie, communication, social interaction, and restricted, repetitive interests and behaviors); 3) another validated model by van Lang and colleagues with 3 domains (ie, social communication, stereotyped speech and behaviors, and play skills); and 4) a model comprised of 1 symptom domain.

The study found that the DSM-5 symptom structure was the most useful and applicable, while the model with 1 symptom domain was the least appropriate. Specifically, the changes to the DSM-5 model that made it a better fit were that it added 1 new symptom (hypo- or hyperreactivity to sensory input/unusual sensory interests), removed 2 symptoms (delay in expressive language and impaired functional play skills), and reorganized some symptoms. For example, it categorized stereotyped and repetitive language with stereotyped and repetitive behaviors. Also, it combined several communication and social Interaction symptoms.

The study concluded that the new 2-domain model is appropriate for children aged as young as 12 to 30 months, which is important because it is the age at which symptoms begin to emerge.

The Centers for Disease Control and Prevention recommends screening all children for developmental delays and disabilities during well-child visits at 9, 18, and 24 or 30 months, with possible additional screening for children born prematurely or of low birth weight. In addition, all children should be screened specifically for ASDs during well-child visits at 18 and 24 months.

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