Only 2 require ruling ASD out: reactive attachment disorder and the new social (pragmatic) communication disorder. There are now very few disorders in DSM-5 that cannot be codiagnosed with ASD. DSM-5 presents a new opportunity for documentation to more thoroughly reflect the targeting of these specific symptoms within an individualized treatment plan. These and many other impairments (eg, sleep, feeding, anxiety, pica, self-injury) are frequent targets for both pharmacologic and behavioral treatment. DSM-5 acknowledges that some diagnoses should not be made if the impairments "are better explained by" 2(pp156,203) ASD, but these distinctions can be difficult to make, especially for clinicians less familiar with ASD.ĭSM-5 wording for 3 disorders (attention-deficit/hyperactivity disorder, language disorders, developmental coordination disorder) was changed to facilitate codiagnosis. Or the individual with ASD who repetitively sorts or lines up toys "just so" in pursuit of a circumscribed interest rather than to reduce unwanted intrusive thoughts (ASD rather than OCD). However, in other cases, ASD may color the presentation of the co-occurring disorder, such as the individual with ASD who cannot articulate social anxiety, but who is visibly distressed in social situations with unfamiliar children (ASD and possible social anxiety). In some cases, the 2 conditions can be easily recognized, such as in the individual with ASD who articulates social anxiety and fear of negative appraisal (ASD and social anxiety) or the individual with ASD who describes intrusive thoughts about germs and compulsive hand-washing (ASD and obsessive-compulsive disorder ). Much more research is needed to determine how ASD may affect the presentation of co-occurring disorders, especially those with behavioral overlap. Of course, disorders not listed in the table can, and do, co-occur with ASD, especially in the areas of anxiety, mood, learning, sleep, elimination, and food intake. Table 1 lists the disorders in DSM-IV-TR and DSM-5 that specifically name ASD within the criteria, either for differential diagnosis or for guidance about co-occurring diagnoses. The changes in DSM-5 are an important step in reducing this risk in ASD. Furthermore, when co-occurring conditions are not well accounted for in research studies, our ability to detect signal from noise is hampered. 1 Such failure to recognize co-occurring symptoms as separate conditions can restrict the types of interventions made available to patients. When a patient’s presentation is viewed only through the lens of ASD, we run the risk of diagnostic overshadowing or the misattribution of physical or emotional symptoms to the developmental disorder. These revisions may fundamentally change how we conceptualize ASD, because we will be better able to identify co-occurring conditions for research, clinical care, and even insurance coverage. However, in considering the ASD revisions, the changes to diagnoses throughout DSM-5 also warrant discussion, because they give clinicians new tools for diagnosing the co-occurring conditions often seen in ASD. To the Editor: Much attention has been drawn to the changes within autism spectrum disorder (ASD) criteria in DSM-5. DSM-5 and Autism Spectrum Disorders: The Changes You Haven’ t Heard About Yet
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