Changes in DSM classifications affect families and schools

“We paid much more attention to post-traumatic stress disorder with what’s been going on with the armed forces,” says Kupfer. That includes information on diagnoses and treatment for PTSD from sports injuries, as well.It’s no longer politically correct to say one suffers from “mental retardation.” The new term, intellectual developmental disorder, has long been used by the World Health Organization's International Classification of Disorders. “We felt it was important to be aligned with what’s going on with the rest of the world,” says Kupfer. “We wanted to have this manual as harmonized with them as possible.”A main concern among parents with children diagnosed with Asperger’s disorder was the proposal to drop the term from the manual. While it has been eliminated, it will be incorporated under the new umbrella term “autism spectrum disorder,” says Kupfer. “We decided to place autistic disorder, Asperger’s, childhood integrative disorder, and pervasive mental development disorders under one umbrella of diagnoses to allow clinicians to make more precise set of decisions and assessments about the children.”View the list »
Dr. David Kupfer explains changes to the DSM 5.

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Revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM) were approved late in 2012. The classification revisions take effect now, in the spring of 2013.
The DSM had its last major revision almost two decades ago, in 1994. With the wealth of new scientific evidence on various mental illnesses and epidemiology, it was due time and necessary for the American Psychiatric Association to revise its current diagnostic system, APA president Dr. Dilip Jeste wrote in a statement.

While updating information is necessary to help patients receive medical and other needed services, not all the revisions and their implications are clear or straightforward. One of the more controversial changes may be eliminating the separate diagnosis for “Asperger’s Syndrome,” and placing it under the Autism classification.

Spring is typically the time of year in many states when special education annual review meetings take place in public schools. During these meetings, parents and school personnel working with special needs students meet to discuss educational plans for the child’s next school year. To continue to receive some special education services, often speech therapy, many students currently classified as having Asperger’s will need to have their diagnosis classification changed to Autism.

While many parents agree that the change of name for a disability category is inconsequential as long as their child receives the help needed in school, other parents may not want the change officially given to their child, often due to the stigma associated with the term “autism.”

Another issue involves insurance coverage for some services if students are not labeled with the new Autism diagnosis. Additionally, many school districts receive reimbursement from their state Medicaid coffers for related services (speech, occupational, and physical therapy, along with social work counseling) when children are classified with approved diagnoses. With education funds disappearing throughout the nation, Medicaid reimbursement funds can mean hundreds of thousands of dollars for some school district budgets, especially in urban areas where the tax base for school funding fails to meet budget needs.

Dr. David Kupfer, one of the major leaders of the task force group revising the classifications, gives more information about the DSM-5 revisions and what they mean for clinicians and patients.

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  • A main concern among parents with children diagnosed with Asperger’s disorder was the proposal to drop the term from the manual. While it has been eliminated, it will be incorporated under the new umbrella term “autism spectrum disorder,” says Kupfer. “We decided to place autistic disorder, Asperger’s, childhood integrative disorder, and pervasive mental development disorders under one umbrella of diagnoses to allow clinicians to make more precise set of decisions and assessments about the children.”
  • It’s no longer politically correct to say one suffers from “mental retardation.” The new term, intellectual developmental disorder, has long been used by the World Health Organization's International Classification of Disorders. “We felt it was important to be aligned with what’s going on with the rest of the world,” says Kupfer. “We wanted to have this manual as harmonized with them as possible.”
  • “We paid much more attention to post-traumatic stress disorder with what’s been going on with the armed forces,” says Kupfer. That includes information on diagnoses and treatment for PTSD from sports injuries, as well.
  • “Eating disorders affect people across the whole lifespan,” says Kupfer. But the task force group felt that there were children and adolescents being diagnosed with eating disorders not otherwise specified 50 percent of the time, he adds. New guidelines include more precise diagnoses criteria. Binge-eating disorder has become a main category section, for example.
  • The DSM-5 may be hefty, but for the first time next year, an electronic version will be available, including videos of assessments on patients, references, and more. “It’s very important to make sure patients and families really understand what’s going on,” says Kupfer. “So in many ways we’re trying to put things together that make it more user-friendly.”
  • While it will likely be some time before we can expect a DSM-6, it may only be a few years until a DSM-5.1 or -5.2, thanks to the expected digital version of the manual. “We don’t wait to wait another 19 to 20 years to have a new revision of the whole volume,” says Kupfer. “But if there is some unexpected consequence, which we can’t anticipate, we have an opportunity to fix something two to three years from now.”
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, Special Learning Needs Examiner

Barbara Mader has been a teacher in three states in the fields of speech therapy, special education, and reading. She has worked with students from pre-school through age 21. She also tutors for local districts and privately, primarily helping students with components of dyslexia improve their...

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