More thoughts on prevalence & DSM-V

Here are two more reviews/discussions of the CDC prevalence report from sources I believe to be intelligible, authoritative, and well-meaning, as opposed to fear-mongering, uninformed, and unskilled).

The Autism Science Foundation describes the basics of the report in cogent language and provides a little education along the way, helping the reader understand what is being measured and what is not as well as the potential sources of error.

This DSM-V field testing report from Autism Speaks’ Dr. Geri Dawson is a helpful letter describing the types of studies going on, as parents had hoped, to sort out what the practical effects on diagnosing children are going to be.

The obvious fear from parents is that this chain is not only possible, but deliberate:

DSM-IV => too many ASD findings => too many $$$ for services => desire by insurance companies and districts to spend less => DSM V tighter criteria => fewer diagnoses => reduced services from schools under IDEA (insurance still a mixed bag at best in spite of state mandate laws).

Descriptions of the studies being done to identify empirical differences as opposed to theoretical ones will help shed light on the situation, and the results will hopefully speak for themselves.

On a related note, let’s all recognize that the main reason the DSM criteria are controversial is because of the unholy[?] link between the ICD codes assigned to the diagnoses and the insurance coverage. The tightness of the linkage between the specific diagnoses and IDEA eligibility is something I’ll have to review in a future post; it normally applies only to children over 5 where the generic “preschool disabled” classification is no longer used and children are specifically classified.

If coverage for therapies and treatments were not affected, improvements in classifying different “phenotypes” of autism would be beneficial as parents and professionals narrowed in on likely effective treatments more readily and information sharing was improved because of closer connections between studies and specific diagnoses. But that’s just how I think about things. We’ll have to see what happens.