DSM-5 and autism spectrum disorders--two decades of perspectives from the JCPP.

The newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, will be published in less than a year and anticipation is high. The changes to the Pervasive Developmental Disorders (PDD) criteria are likely to be among the most extensive of the revisions to the manual, as well as among the most contested. Worries about loss of diagnosis and service eligibility are common, especially among parents. Some have felt that the proposed changes are confusing, even capricious, or poorly justified (e.g., Ghaziuddin, 2011). The rationale for combining the individual PDD diagnoses into a single category of Autism Spectrum Disorder (ASD), when we hear so much about the heterogeneity of autism, has been questioned. Rather than referring to ‘‘autism’’ as a unitary condition, many researchers now refer to ‘‘autisms’’ in the plural (Boucher, 2011) so the DSM-5 proposal to lump rather than split can seem perplexing. But in fact the proposed changes have a clear empirical basis, resulting from extensive literature reviews and secondary data analyses undertaken by the DSM working groups. JCPP, with its 50-plus year history of tracking changes in child and adolescent psychiatry and psychology (Berger & Hersov, 2009; Rutter, 1999), has published a number of papers of direct relevance to the DSM revisions. A comprehensive search of the Wiley-Blackwell database turned up 535 papers on PDD/ASD from the period between the first edition of JCPP in 1961 to today. Of these, 158 papers were specifically on diagnostic or classification issues. It is likely that the work of contributors to JCPP was in the minds of the Neurodevelopmental Disorders working group as the DSM-5 criteria were developed In this Virtual Issue, I have selected a dozen papers from the Journal that trace the changing conceptualizations of the PDDs over the last two decades, highlighting the evolution of the Asperger Syndrome classification, and raising several of the diagnostic issues that were ultimately addressed by the proposed DSM-5 criteria. As I hope this editorial will make clear, the changes are anything but capricious or arbitrary. It was not difficult to find a dozen papers from JCPP alone that were supportive of the new DSM criteria. Quite the reverse, it was challenging to find those that supported a ‘‘DSM-as-usual’’ approach. To ground this within the appropriate context, I begin with a list (not exhaustive) of the proposed changes to the criteria: • Change in name from Pervasive Developmental Disorder to Autism Spectrum Disorder • Creation of a single diagnosis, Autism Spectrum Disorder, rather than a category containing five individual diagnoses