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• W2037192114 abstract "PERVASIVE DEVELOPMENTAL DISORDERS (PDD) consist of five subtypes (Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder and Pervasive Developmental Disorder, Not Otherwise Specified [PDD-NOS]) as defined in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) published by the American Psychiatric Association (APA) in 1994.1 The fifth edition of DSM (DSM-V), which will replace DSM-IV, is scheduled to appear in 2013 and its development and drafts are posted on the APA homepage.2 According to the latest DSM-V draft, the group of PDD in DSM-IV is reorganized as a single category of Autism Spectrum Disorder (ASD) placed as one of six subgroups under a new upper group of Neurodevelopmental Disorders, while the International Classification of Diseases 11th Revision (ICD-11),3 due by 2015, has not provided a draft of its ASD criteria, which are probably similar to those in DSM-V. ASD includes four DSM-IV PDD subtypes (Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder and PDD-NOS) with Rett's Disorder excluded due to its known genetic basis. Reasons for those amendments, based on PDD studies up to now, are summarized as follows. First, the differentiation of PDD from non-PDD conditions can be made reliably and validly, while the differentiations between PDD subtypes are not necessarily so. Second, symptomatologic and genetic studies have indicated that it is better to consider autism as a spectrum ranging from persons with severe autism, at its extreme, to very non-autistic persons at its opposite, than a group of autistic subtypes. Third, it is more advantageous to employ a single category of ASD than to employ individual autistic subtypes in treatments and etiopathophysiological studies of autistic conditions. The latest draft diagnostic criteria for ASD2 consist of four criteria (A to D). Criterion A for the ‘social communication deficits’ domain consists of three items, all of which must be met to satisfy this criterion. Criterion B for the ‘fixated interests and repetitive behaviors’ domain consists of four items, of which at least two must be met to satisfy this criterion. Criteria C and D concern ‘symptoms existing in early childhood’ and ‘symptoms impairing functioning,’ respectively. To diagnose ASD, all of the four criteria must be met. The four criteria are comprehensible and usable by clinicians experienced in diagnosing PDD. To measure severity of ASD symptoms from case to case and over time in an individual case, DSM-V proposed ASD severity criteria of levels 1 (mild), 2 (moderate) and 3 (severe) in the two symptom domains of ‘social communication’ and ‘fixated interests and repetitive behaviors.’ According to these criteria, for example, level 3 needs to satisfy such levels of impairments in both domains but not in either one. This is a problem that needs to be addressed, because the severity of the two domains does not necessarily correlate well, rather it is in discord. One solution may be to measure severity levels separately in the two domains and to define the overall severity in the composite score of the two ratings. After diagnostic and severity criteria for ASD are finalized based on field trials in the USA, studies to develop rating scales and semi-structured interviews for diagnosing ASD should proceed. In many non-English-speaking countries, studies to develop domestic-language versions of ASD diagnostic and severity criteria, domestic-language versions of original English rating scales and semi-structured interviews for diagnosing ASD, and original domestic-language versions of such instruments will proceed in substantial periods of time after DSM-V publication. Other than those studies, it is quite important to consider how to harmonize PDD and ASD, especially in non-English-speaking countries where reliable and valid domestic-language instruments to diagnose ASD would come much later than in English-speaking countries. In this respect, the most practical solution is to continue using DSM-IV and to regard conditions diagnosed as Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorder or PDD-NOS according to DSM-IV as ASD. This is important for maintaining diagnostic consistency in clinical and research activities. The alternative practical solution is to use any existing instruments, including screening scales,4-8 rating scales9-12 and semi-structured interviews,13-17 which have cut-offs or criteria for PDD, and to regard cases judged as PDD according to those instruments as ASD by excluding Rett's disorder from them. This latter solution requires studies to set cut-offs or criteria for the mildest form of DSM-IV PDD or PDD-NOS, even in established instruments for diagnosing typical autism if they have no such cut-offs or criteria. DSM-V ASD will be accepted as a concept representing autistic conditions worldwide. However, PDD subtypes, except for Rett's disorder in DSM-IV, will continue to have importance as concepts representing autistic conditions in the foreseeable future, as was the case in Infantile Autism in DSM-III, which had been used long after the proposal of Autistic Disorder in DSM-III-R, a less well-defined and broader concept than Infantile Autism. Besides developing new instruments for diagnosing or screening ASD, it is important to study the utility of existing diagnostic or screening instruments for PDD in diagnosing or screening ASD to facilitate the transition from PDD to ASD smoothly in clinical and research fields." @default.
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• W2037192114 date "2011-12-01" @default.
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• W2037192114 title "How to deal with the transition from Pervasive Developmental Disorders in DSM-IV to Autism Spectrum Disorder in DSM-V" @default.
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