DSM V Autism Classification Changes

DSM-VThe DSM-5, the Diagnostic and Statistical manual of Mental Disorders was released May 2013.  I see improvements and perhaps steps in the wrong direction. However, regardless of classification, the entire DSM manual used in psychiatry is a catalogue to symptoms, which are grouped into diagnosis, and from making those diagnosis, doctors can prescribe medications.  What is sadly missing is any effort to classify disorders based on their cause.  In the infectious disease world, you have strep, or TB, or HIV, etc. all based on the cause and thus treatment is generally targeting elimination of the cause of illness.   What is desperately needed in the world of psychiatry and mental health (and indeed much of medicine that involves chronic disease) is an effort to identify and catalogue illness and disease by its etiology (cause). 

In the new classification, children with a diagnosis of “autistic disorder”, “pervasive developmental disorder not otherwise specified (PDD-NOS)”, “Aspergers disorder”, and “childhood disintegrative disorder” will now be classified as ASD (Autism Spectrum Disorder). In the new DSM-V, instead of just the three areas of social, language, and repetitive movement impairments, there is now:
1.  Deficits in social interaction and
2.  Communication and 
3.  Repetitive and restrictive behaviors, interests, and activities (now includes unusual sensory behaviors like indifference to pain, excessive smelling of objects and visual perseverance of lights)

There are 3 levels of severity:
Level 1- Needs some support
Level 2- Substantial support
Level 3- Very substantial support  scored for both communication and interaction/behavior activities.

DSM-V now allows for dual diagnosis to include ASD/ADHD.

There is a new condition called SCD (Social Communication Disorder) for children who do not have repetitive or restrictive behaviors and thus don’t qualify for ASD.  This category will ultimately include many who in the past would have been diagnosed Aspergers or PDD-NOS. 

For a condition that now affects 1 in every 50 children, I would be much more excited if we were classifying those with the symptoms listed above as  ASD-Vitamin B-12 deficient, ASD-Heavy metal toxic, ASD-Chronic viral infection, ASD-Autoimmune triggered, ASD-Vaccine induced, ASD-MTHFR genotype,  etc.  

We have a long way to go before the numbers of affected children in this country can revert back to the 1 or 2 in 10,000 that it once was 60 years ago.  With some simple steps (vaccinate carefully and selectively, proper diet from prenatal on, take key supplements from prenatal on including Vitamin D, B-12 and folate, probiotics) and avoiding aspartame, GMO, and pesticides,  it is possible to get a lot closer to those preferred rates. 

Dr. Paul



  • Mason's Dad

    Dr. Paul,

    I may be naive in my understanding of autism, and if so, please forgive me.

    It seems to me like autism has become the “catch-all” diagnosis of the day for children who do not fit our social structure, much like ADHD was in the 1990s/2000s and “Hyperactivity” back in the 1980s. Being someone who saw a lot of their friends given Ritalin when I was a child, I am obviously very wary of these diagnoses.

    Has there been any study into whether or not Autism diagnoses (especially now that there is an “Autism Spectrum”) have increased due to nomenclature rather than an increase in the actual conditions exhibited by the children? For example, would a child be diagnosed ASD today when 30-40 years ago, they would just be considered “different”?

    I am very curious to hear your thoughts on this, as I respect you as our son’s pediatrician, and this has been the subject of many a debate between myself, my wife, and my friends.

    Thank you.

    ~ Shawn

  • In one way or another, every opinion on these great questions you ask, is correct. The wisdom comes in understanding what is really happenning and understanding that all these labels don’t really get at the underlying cuase of what is happenning to our children and why. The new classification is certainly more of a “catch-all” and I suspect will result in a slight increase in numbers (they are not in yet, but we will know in a few months to a year).
    What I think we are seeing is increased severity of disability AND increased frequency.
    30 – 40 years ago the rate of Autism (the severe kind with little or no language, hand flapping and no eye contact) was near zero. I didn’t see a single case even in the major training institutions of Dartmouth and UC San Fransisco and San Diego. We saw some mild forms that would fit ASD today, and a few “different” kids, but they were rare – maybe in the 1/10,000 range. Today I would put the severe autism cases at about 1/500 and the ASD rate (includes mild and some of the “different”) at 1/50 to 1/100.
    To say that we were missing these severe cases 30 – 40 years ago is absurd. You can’t miss a kid with no eye contact and no speech who is spinning in circles.
    Something is happening that is real. Those with ADD or ADHD are more severe today than their parents were. You’ll hear, “well I was that way and I didn’t need medication as a kid”. Sure, but you dear parent may have been very mild and your child cannot even focus enough to learn. (I’m not speaking to you personally here – but the that parent who is asking their child to buck up). Imagine asking a child with severe autism to buck up! That would be like asking someone with cancer to get over yourself and buck up, you can beat this if you just try hard enough.
    Our world and our environment (the water we drink, the food we eat, the vaccines we inject, the air we breathe, and the toxic load we are born with) has reached such a level that virtually everyone is affected. Those with genetic SNP’s (Single Nucleotide Polymorphisms) making it difficult to get rid of toxins or methylate properly are especially vulnerable. An example of that is those of us with the MTHFR defect. We can test for this and if you have it, you and your children will benefit from methyl-B12 and methyl folate replacement.
    Having said all this, let us love each and every child and realize that in most cases, the most affected are also the most intelligent – they just can’t express that intelligence yet. We need to do all we can to help their biochemistry and emotional spirit so they can reach their best potential and purpose for their lives.

    • Mason's Dad

      Thank you for the lightning-fast response! That is exactly the information I was looking for… as a layman I don’t have the background experience of many years of studying children, nor the time to go to the depth of research you have. I may be a scientist, but I’m a meteorologist, not a doctor!!! 🙂 I’ll be the first to admit that.

      You answered a question I’ve had for a long time, without my even asking. Regarding the severity of cases you’ve seen. So you’ve definitely seen more of the more severe cases. And you’ve outlined a lot of the possible/probable causes.

      I really appreciate your focus on causality. So important to me. Yes we can easily determine labels, but to determine causes and potential solutions…that’s much tougher. And much more important.

      Keep up the hard work, and fighting the good fight. We surely appreciate it.

      ~ Shawn

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