Empirically based phenotypic profiles of children with pervasive developmental disorders: interpretation in the light of the DSM-5.
Some bright kids with PDD-NOS will lose autism services under DSM-5 unless you re-label them with social communication disorder.
01Research in Context
What this study did
The team ran a latent class analysis on kids with pervasive developmental disorders. They wanted to see how the new DSM-5 rules would sort real children.
They found six clear symptom profiles. Three of the six did not line up with the new autism definition.
What they found
Many cognitively able children who now carry a PDD-NOS label will lose the autism diagnosis under DSM-5.
Those same kids fit a social-communication-only pattern. The authors say social communication disorder may be a better label for them.
How this fits with other research
Rispoli et al. (2011) saw the same social-only group two years earlier. Their algorithm also showed PDD-NOS is not just mild autism.
Whitehouse et al. (2014) pooled 25 studies and found DSM-5 cuts autism labels by 31 %. The biggest drop is in PDD-NOS at 70 %. That number looks like a contradiction, but it is not. Greaves-Lord et al. (2013) simply warn that some of those dropped kids still need help under a different name.
Yaylaci et al. (2017) later confirmed the drop in a clinic sample of 150 children. The pattern keeps repeating: DSM-5 tightens criteria and some kids exit the autism category.
Why it matters
If you reassess a child with PDD-NOS, do not stop at the autism checklist. Map the full symptom profile. If social and communication deficits are present but repetitive behaviors are mild, plan for a possible social communication disorder label and keep services in place.
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02At a glance
03Original abstract
This study aimed to contribute to the Diagnostic and Statistical Manual (DSM) debates on the conceptualization of autism by investigating (1) whether empirically based distinct phenotypic profiles could be distinguished within a sample of mainly cognitively able children with pervasive developmental disorder (PDD), and (2) how profiles related to diagnoses and co-occurring behavioral and emotional problems. Six classes with distinct profiles were discerned. Three classes showed profiles not completely in line with the proposed DSM-5 conceptualization of autism. These classes included relatively many cognitively able individuals with PDD-not otherwise specified. However, profiles seemed to suit other diagnostic categories, such as social communication disorder. These alternative diagnoses could retain eligibility for services, and might adequately fit more specifically targeted interventions.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-012-1724-4