The definition of autism is ever redefined. As doctors, researchers, and parents learn more and more about this neurodevelopmental disorder, it’s essential to reevaluate past knowledge and ideas. This is especially important with autism as it is not a simple on-off disease, but rather, encompasses a spectrum.
Ever Changing Spectrum
The extent of that spectrum is still in flux. Asperger syndrome is an example of how that is changing. The disorder was considered its own diagnosis from 1981 until the Diagnostic and Statistical Manual of Mental Disorders was updated to the fifth edition in 2013, when it was placed under autism spectrum disorder. However, the tenth edition of the International Classification of Diseases still considers Asperger syndrome to be its own diagnosis.
Even today, there is still uncertainty whether or not Asperger syndrome is separate from high-functioning autism or not.
Asperger syndrome was not the only diagnosis to be removed from the DSM V and shunted under autism spectrum disorder. Another condition, called pervasive developmental disorder-not otherwise specified, was removed as well. You can call it PDD-NOS for short.
Under the old system, PDD-NOS and Asperger syndrome were classified next to autism under PDD, pervasive developmental disorder. Also in that category were two rare disorders called Rett syndrome and childhood disintegrative disorder, which are unrelated in cause but similar in effect.
Autism, Asperger syndrome, PDD-NOS, and childhood disintegrative disorder were all combined under autism spectrum disorder in the DSM V. Rett syndrome was found to be a genetic disease which affects other parts of the body as well, and so was removed from classification as a mental disorder.
Replacing the Borderlands
On the edge of the autism spectrum, the DSM V introduced a different diagnosis. This one was called social (pragmatic) communication disorder. The replacement was controversial, and some researchers feared that the change would cause some children to not receive the diagnoses they need to get appropriate treatment.
Social communication disorder (SCD) is similar to autism in that it involves a disruption in the child’s ability to comprehend the semantic and pragmatic aspects of language. In other words, they have trouble understanding what people mean, and also have difficulty using language appropriately themselves.
Where the diagnosis differs is that children with SCD do not exhibit the restricted patterns of behavior common to children with autism, unlike PDD-NOS or Asperger syndrome. By attaching SCD to the edges of the autism spectrum, rather than enveloping SCD within autism, the authors of the DSM V attempted to provide help for children who have some but not all of the features of autism.
So, there are two different views on whether or not SCD as a diagnosis is helpful. Some even thought that the difference between SCD and PDD-NOS was a mere name change, and would not be a useful change. Has anyone actually compared the variables to see if the change was helpful?
South Korean Children
Thankfully, some researchers have.
Two groups have independently examined the question raised by the introduction of SCD, and the results are similar. Both used existing clinical data to retroactively examine children who had been tested before the change to the DSM went into effect.
The first group looked at children between seven and twelve years old in a South Korean community. There were 55,266 children in both regular and special education schools, as well as children who were not going to school because of a disability.
The researchers used the results of the Autism Spectrum Screening Questionnaire to make best-estimate clinical diagnoses based on the criteria from both the DSM IV and DSM V. The DSM IV criteria looked for pervasive development disorder (PDD) while the DSM V criteria looked for both autism spectrum disorder and SCD.
They found that 2.64% of the children met the criteria for DSM IV’s PDD, while 2.20% of the children met the criteria for the DSM V’s SCD and autism spectrum disorder. They broke PDD down into autism, Asperger’s, and PDD-NOS. Of those, 99%, 92%, and 63%, respectively, met the DSM V’s criteria for autism spectrum disorder.
The remainder of the children met the new SCD diagnosis, except for 5% of the children who previously would have been diagnosed with PDD-NOS; those children would have been diagnosed with another disorder, such as anxiety or hyperactivity, under DSM 5.
Their conclusion was that the DSM V’s autism spectrum disorder and social communication disorder did a good job of covering the individuals who could benefit from such diagnoses.
These South Korean researchers put out their results in the Journal of the American Academy of Child and Adolescent Psychiatry, back in May 2014. The title was A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample.
More recently, researchers went through a similar effort using data from a clinic in London specializing in social communication disorders. The children were age four to eighteen, and had visited between the years of 1999 and 2013. As such multiple questionnaires had been used, so the researchers developed an algorithm to apply the autism spectrum and social communication disorder criteria to the recorded results.
They not only examined whether the DSM V criteria would diagnose people, but also whether the symptoms of SCD formed a coherent base distinct from the autism spectrum. In other words, was the new diagnosis helpful?
They seemed to think so. The results of 1,081 children were examined, and from that 801 met the autism spectrum criteria. 88 of the children met the criteria for SCD. They also added to the algorithm the ability to signify if the child would have been diagnosed under the DSM IV rules. Almost half of the children who met the criteria for SCD would not have received any diagnosis under the DSM IV.
The researchers concluded that SCD covered children with autistic traits, but did not have strong enough traits to achieve a diagnosis of autism. It was their opinion that SCD therefore was an extension of the borderlands of the autism spectrum, and thus was beneficial for catching children who otherwise would not be diagnosed.
That paper was called Evaluating social (pragmatic) communication disorder and was published in the Journal of Child Psychology and Psychiatry, and Allied Disciplines.
Expanding the Borderlands
Pervasive developmental disorder, PDD-not otherwise specified, autism, and Asperger syndrome. It can be easy to see why the authors of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders simplified them all under autism spectrum disorder. In doing so they widened the spectrum, but also had to have a clear line between autism and those without.
They could have called that simplification well enough, but they added SCD into the mix. It is a good thing they did so, otherwise some children would have fallen through those cracks. Social communication disorder is not yet fully accepted as its own thing, but researchers from both England and South Korea believe it to be beneficial for the children.
There is still research to be done on SCD. It can be easy to see that children with the diagnosis may benefit from some aspects of traditional autism treatments, but there still has not been much research into their efficacy.
Doubt still remains whether or not SCD should be attached to the autism spectrum as well, with some researchers claiming that it might be possible it should be on the spectrum of language disorders instead.
Whether or not SCD is truly related to autism or if it a language disorder instead, researchers acknowledge that it is beneficial for the children so diagnosed. For now, it expands the borders of autism, though one day that land mass may migrate away.