Adaptation of Diagnosis from Autism Spectrum Disorder to Social Communication Disorder in Adolescents with ADHD.
DSM-5’s stricter rules can shift older kids from autism to Social Communication Disorder while their ADHD and social needs stay the same.
01Research in Context
What this study did
Tsai et al. (2020) followed one teen who had carried both Asperger’s and ADHD labels.
Under the new DSM-5 rules the team re-checked every symptom. They wanted to see if the youth still met autism criteria or fit somewhere else.
What they found
The teen no longer had enough restricted and repetitive behaviors for autism. He kept his ADHD diagnosis and moved to the new label Social Communication Disorder.
How this fits with other research
Wong et al. (2016) saw the same pattern in preschoolers: about nine out of ten kept their autism diagnosis, but the ones who lost it were strong in social-communication yet light on repetitive behaviors.
van Timmeren et al. (2016) warned that DSM-5 can miss some toddlers who really need help; the teen case shows the rules can also move older kids out of autism even when social issues stay.
Dellapiazza et al. (2021) found that kids with both ASD and ADHD show more social impairment than ADHD-only peers; the target teen still has ADHD plus social problems, just under a different name.
Why it matters
If you reassess teens who were diagnosed years ago, check restricted and repetitive behaviors first. Without enough of them, the child may now qualify for Social Communication Disorder instead of autism. Update the treatment plan to match the new label, but keep addressing social skills and ADHD supports either way.
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02At a glance
03Original abstract
Here, we describe a case in which an original diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Asperger's syndrome was later adapted to social communication disorder, to meet the new guidelines. First, separate diagnostic labels of autism disorder, Asperger's disorder, and PDD-NOS have been replaced by one umbrella term "autism spectrum disorder". Second, the new DSM-5 criteria are more stringent than the old criteria. For example, observation of a higher number of symptoms is necessary to meet the criteria, such as restricted interests and repetitive behaviors. Third, the communication and social interaction domains are combined into one, titled "social/communication deficits." Finally, requirement of a delay in language development is no longer necessary to establish a diagnosis of autism.
Journal of autism and developmental disorders, 2020 · doi:10.1007/s10803-019-04265-w