Could new psychiatric guidelines change the standards for autism diagnosis?

A new study published in The Journal of American Psychiatry has found that a new definition of autism, slated for inclusion in the next official Diagnostic and Statistical Manual of Psychiatry from the American Psychiatric Association (APA), will exclude about 10 percent of patients who have been diagnosed with autism in the past.

This contradicts previous studies that have found 45 percent or more of the patients now considered autistic would no longer be diagnosed as such.

Here, we have at least three problems.

First, well-meaning psychiatric researchers apparently differ by more than 400 percent in their estimates of how many patients will no longer be considered autistic (who once were considered autistic).

Millions of Americans who receive needed health care services because they are suffering with what had been described as autism by the APA could lose those services because a committee has decided to rewrite the definition of the condition

This is not reassuring to members of the public, who look to psychiatric authorities for some level of accuracy and consistency—especially where conditions as severe as autism are concerned.

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Second, a shift in the criteria for the diagnosis of autism in a way that jettisons between 10 and 45 percent of those currently with the diagnosis potentially means that millions of American children were told they had the condition when they did not — because they or the condition itself were not well understood. This ought to give every patient seeing any psychiatrist very significant pause about whether to accept any diagnosis he or she receives.

Third, medical specialties—psychiatry included—should not be in the habit of shifting their diagnoses every time a new diagnostic manual is published by its trade guild (here, the APA).  It seems impossible to believe the pace of psychiatric knowledge is so far outstripping every other medical specialty that its diagnostic manual must be constantly revamped (resulting, by the way, in millions of dollars in revenue to the APA), with new conditions added every few years and others dispensed with.

Rather than the pace of discovery, it could be argued that what is shifting is the way organized psychiatry eyes third-party reimbursement or keys its diagnoses to match up with available medications.

The stakes are very high, indeed.  Millions of Americans who receive needed health care services because they are suffering with what had been described as autism by the APA could lose those services because a committee (at the APA) has decided to rewrite the definition of the condition.

And this, of course, brings up an interesting fourth problem:  If 10 to 45 percent of those Americans diagnosed with autism based on the criteria in the Diagnostic and Statistical Manual actually do not have the disorder — but received treatment meant for those who do have it — do those individuals have a legal claim against the APA for promulgating inaccurate information upon which clinicians across the country relied?

Just think about the implications if the criteria for depression are revised and millions of Americans learn they were treated for that illness when they should have been treated for something else.

See, like every medical specialty, psychiatry relies for its credibility on it staying close to the facts—to truth. And if the official diagnostic manual can be rewritten with every new edition having new disorders and canceling old ones, then something is just plain wrong with that manual and the perspective of the folks creating it.

Now, more than ever, people seeking care from psychiatrists are going to have to seek out the ones who have a very firm vision of how to expertly and determinedly deploy psychotherapy, medication and other treatment modalities to conquer the particular symptoms they suffer, and to advocate for them as individuals, not to satisfy the APA’s official diagnosis and treatment recipe book—which keeps changing, anyhow.