November 2008
Susan Swedo, M.D.
The Neurodevelopmental Disorders (ND) work group’s discussions have focused on three areas:
1) Possible modification of ADHD criteria to allow for co-morbidity of autism and ADHD (currently excluded). The ADHD & Disruptive Behavior Disorders Work Group has agreed to consider this possibility.
2) Discussion of the validity of Rett’s disorder as a separate disorder and inclusion of a new modifier within the Autism Spectrum Disorders (ASD), which might include genetic and medical disorders and other biologically-definable conditions.
3) How to address Pervasive Developmental Disorders – Not Otherwise Specified (PDD-NOS). The individuals currently diagnosed with PDD-NOS may still be described in DSM-V, but the work group will discuss whether they can redefine ASD in such a way that the PDD-NOS diagnosis isn’t necessary, as this diagnosis currently captures a very heterogeneous group of individuals.
The ND Work Group will be seeking additional feedback from advisors and other experts prior to “finalizing” any recommendations.
Questions still under active discussion for ASD include:
1) How to describe the “spectrum” of disorders now known as ASD (e.g., how many domains will define the disorder);
2) What is the specificity of repetitive behaviors in ASD and how might they be better defined;
3) Whether Childhood Disintegrative Disorder (CDD) is a unique and separate disorder, and if so, what are its defining characteristics;
4) Whether autism is a life-long diagnosis or whether it is possible to recover/remit to the point where the diagnosis is no longer applicable;
5) Whether Asperger’s disorder is the same as “high-functioning autism”;
6) How the DSM-V can alert clinicians to common medical comorbidities (including genetic disorders, epilepsy/EEG abnormalities and sleep, or GI problems) and potential biomarkers;
7) How to include consideration of severity and impairment in diagnosis (currently defined as “qualitative impairments”) and how to integrate these with the overall structure of DSM-V; and
8) How/where to discuss cultural influences on diagnosis (e.g., Korean use of reactive attachment disorder rather than ASD to avoid family stigmatization).
The following issues are being evaluated by subcommittees of the ND work group: core criteria and domains; CDD and regression; genetics and biomarkers; Asperger’s disorder; and the Gender, Lifespan and Cultural Study Groups. Secondary data analyses are underway to address each of these areas.
The Neurodevelopmental Work Group is also charged with examining definitions of intellectual disabilities and learning disabilities. Two subcommittees are addressing these issues – Intellectual Disabilities (ID) and Learning Disabilities (LD). Advisors have been chosen for these subcommittees and new definitions of the LDs and IDs are being examined by a multi-disciplinary, internationally representative committee.