Collapsing the Spectrum--And Expanding it Again: DSM Considerations

The DSM-V Neurodevelopmental Disorders Workgroup has posted a report from their April meeting with some of their considerations for changes to the Pervasive Developmental Disorders section. No final decisions have been made yet according to the report, but the recommendations, if taken, do present a departure from current criteria--and language.

The first two items from the report:

1) The Workgroup is considering a change in DSM-V that would replace the Pervasive Developmental Disorder (PDD) category with the title "Autism Spectrum Disorders" (ASD). The change would utilize a single diagnosis for the disorders currently entitled: Autism, PDD-NOS and Asperger disorder...

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2) To better reflect the symptomatology and clinical presentation of ASD, changing the three current symptom domains (social deficits, communication deficits and fixated interests/repetitive behaviors) to two (social communication deficits and fixated interests and repetitive behaviors) is also being considered.

So, only one ASD, not three PDDs. Only two categories for criteria, not three.

The third recommendation is this:

3) Symptom severity for ASD could be defined along a continuum that includes normal traits, subclinical symptoms and three different severity levels for the disorder.

The report then goes on to give an example of one possible model for this continuum.

It's good that some of the deep issues with the current criteria (e.g., from the report "Separation of ASD from typical development is reliable and valid, while separation of disorders within the spectrum is variable and inconsistent.") are being addressed with the simplification made in points 1) and 2). But is it possible that the same problems will just resurface again from point 3)? In other words, while separation of ASD from typical development may be reliable and valid, mightn't separations of severity within that spectrum be variable and inconsistent? Thinking here especially of the high degree of variability in "severity" that often exists across an individual's life span, depending on age, available support, and a huge number of other possible factors.

Also, what will such a classification system do to the sorts of opportunities that are made available to individuals? How to stay away from the "self fulfilling prophesy" problem of because a person is given a "more severe" label, others to have low expectations of them, and therefore they are not given any opportunity or encouragement to exceed those expectations? Or, alternately, how to stay away from the issue that a "milder" label could prevent a person from accessing support they need for survival?

So many questions that directly effect so many of our lives from a bunch of words thrown together by a bunch of people few of us will ever meet--

What do you think of these three points being considered for the new version of the DSM?