Translated picked this up reg the changes in diagnosing ASD
Psykiatrin förändrar synen på autism och adhd
Psychiatry changes the view of autism and adhd
"The Bible of Psychiatry", DSM, has been redone. The old criteria for adhd and autism are about to be replaced by new ones. But what are the differences, and what do they mean for those who already have a diagnosis?
It is not possible to see if anyone has adhd or autism. Unlike many bodily conditions, it is also not possible to take a blood sample to get an answer. Instead, in order to make a diagnosis of neuropsychiatric disability, you look at how an individual behaves and what they experience.
In order for psychiatric practitioners to be able to make a diagnosis, they use the text Diagnostic and Statistical Manual of Mental Disorders, or DSM. There are all requirements that must be met in order to get a certain diagnosis.
- It is often called the bible of psychiatry, it is a collection of all psychiatric diagnoses and the criteria required to fulfill the diagnoses. It gives us who work in psychiatry a common language and the opportunity to make diagnoses in the same way.
So says Adam Helles who is a psychologist in child and adolescent psychiatry in Gävle and who also researches on autism. In his work he investigates patients and puts a diagnosis on the one who meets the criteria for, among other things, adhd and autism. The goal of setting a diagnosis is for people to get the help and support they are entitled to.
In 2013, a new version of the psychiatry Bible came out. It is called DSM-5 and is slowly being incorporated into Swedish care. 2018, you will probably only start from the new criteria when diagnosing.
- What will be the biggest differences for autism in the future?
- It's a whole new idea. One has gone from four different diagnoses to a single: autism spectrum state, he summarizes.
The four previous separate diagnoses were called autism, asparagus syndrome, disintegrative disorder in children and atypical autism. The fact that they are merged is due to the fact that the state of knowledge has changed as a result of new research.
- The last 10-15 years of research have shown that with the old criteria we can find those that are within the autism spectrum, but which of the four diagnoses you put is a bit too random for you to be happy with it.
For example, Adam Helles mentions that it was previously difficult to distinguish between Asperger's syndrome and high-functioning autism. Since the criteria have been so unclear, the choice of diagnosis has sometimes been arbitrary.
- Whether or not you have been diagnosed with aspergers syndrome or autism has not had so much to do with the patient, but instead has been about what a particular doctor or psychologist prefers.
So far, Adam Helles thinks that the changes are good. The four previous diagnoses have more similarities than differences, and therefore there are no points in keeping them apart.
Already diagnosed remains
One consequence of the merger is that asperger's syndrome disappears. However, it is nothing to worry about if you already have a diagnosis.
- All the changes apply to how to make new diagnoses. People will not get rid of their diagnosis if one already has one, says Adam Helles.
According to Adam Helles, the change can still affect the person who already has the diagnosis, in another way. When the concept of aspergers becomes less common, it can be harder for the group that today identifies with the label.
- The change on the social plane we are talking about a little about. It's a great community, the aspie world. There is an empowerment movement, where you emphasize the right to be in their own way.
He is supported by Anne Lönnermark at the Autism and Asperger Association.
- There is some concern not to find their context in the new system. Many with Asperger's syndrome identify strongly with the diagnosis, she says.
More difficult to get autism diagnosis
There is another change in the criteria for autism spectrum states in the DSM-5 that has been criticized. Getting the diagnosis of autism spectrum conditions is likely to be more difficult than getting any of the old diagnoses. Most studies suggest that approximately 10-20% of those who today receive one of the autism diagnoses would end up outside if one used the new criteria.
- The person who has clear difficulties will get a diagnosis according to DSM-5, but if they are milder, it is not certain that you fit in, despite the great impact in everyday life, says Adam Helles.
Does that mean that some may end up next door and not get the help they need?
- Yeah. We have not seen the consequences yet, but the risk exists.
Adhd criteria are fine-tuned
Also for adhd, the criteria are updated in the DSM-5. However, the differences will be smaller than for the autism area.
- For adhd, it's not as revolutionary, but rather fine-tuning. The basic criteria are exactly the same, says Adam Helles.
The "fine breathing" that has been done is primarily intended to simplify diagnosis throughout life. The previous criteria were focused on children.
- The behavior examples that existed before were in the same way that you have difficulty sitting still, and instead jump around. After all, it is like that child with adhd does. For adults, it may rather be
The transition to DSM-5
• Diagnostic and Statistical Manual of Mental Disorders is a standard tool in psychiatry, and contains diagnostic criteria for various psychiatric illnesses.
• The latest edition, DSM-5, came out in English in 2013, and in the Swedish year the following year.
• Officially another diagnostic tool is used in Swedish care. It's called ICD-10 (International Statistical Classification of Diseases and Related Health Problems).
• In practice, however, most of the DSM criteria are also used here. For example, the ICD manual lacks good criteria for adhd.
Changes in the area of autism:
• The four diagnoses of autism, Asperger's syndrome, disintegrative disorder in children and atypical autism are merged under the umbrella term autism spectrum state.
• The diagnosis for each individual will contain assessments of how much impact
in everyday life is.
• The previous three main categories of autism (social contacts, communicative skills and repetitive behaviors) have been merged into two: socio-communicative skills deficiencies and repetitive behaviors.
Hope this makes some sence