DSM-5 Changes SLP-Relevant Disorder Categories: What You Need to Know

reprinted from the ASHAsphere, June 18, 2013
by Diane Paul, PhD, CCC-SLP, is ASHA’s director of clinical issues in speech-language pathology

 The speech-language pathology community has been abuzz for months about the pending release of the new Diagnostic and Statistical Manual of Mental Disorders because of expected changes to autism spectrum disorder and other communication disorders involving SLPs.

 And indeed, the fifth edition, issued by the American Psychiatric Association last month, significantly changes ASD and several other SLP-relevant categories—and also unveils the new social (pragmatic) communication disorder.

 As most SLPs well know, DSM is the standard classification of mental disorders used in clinical and community settings in the United States and other countries. The new edition is available first in print, with an electronic version to be offered later this year.

 Here are some of the major changes in the category of Neurodevelopmental Disorders that are relevant to the work of speech-language pathologists:

  Intellectual disability (Intellectual developmental disorder)

• Replaces the term “mental retardation” with “Intellectual disability (Intellectual developmental disorder).”
• Relies more on adaptive functioning rather than on specific IQ scores.

 Communication Disorders

 Changed from expressive and mixed receptive-expressive language disorders to include:

• language disorder
• speech sound disorder
• childhood-onset fluency disorder
• social(pragmatic) communication disorder

 Autism spectrum disorder (ASD)

• Eliminates pervasive developmental disorder and its subcategories (autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder, pervasive developmental disorder-not otherwise specified). Instead, children meeting the criteria will be given a diagnosis of “autism spectrum disorder” with varying degrees of severity.
• Omits criterion related to the development of spoken language.

 Specific Learning Disorder

• Combines diagnoses of reading disorder, disorder of written expression, mathematics disorders, and learning disorder not otherwise specified.
• Recognizes the need to use a variety of culturally and linguistically appropriate assessment tools and strategies and does not require use of a standardized measure.
• Does not include oral language.
• No reference to modalities of language.

 Changes in the section on Neurocognitive Disorders pertinent to the speech-language pathology field include the following:

• Dementia is considered a major neurocognitive disorder.
• A less severe cognitive impairment is considered a mild neurocognitive disorder.

We were fortunate to have SLPs involved in developing some of the diagnostic criteria in DSM-5. Amy Wetherby was a member of the DSM-5 neurodevelopmental workgroup and chaired a subgroup on communication disorders. Mabel Rice, Nickola Nelson and I worked on this group. ASHA responded during the three public comment periods. 

Click here for a table summary of the criteria/major changes, ASHA's comments and potential practice implications.

Now that the new edition is out, ASHA has assembled a DSM-5 response team coordinated by me and composed of Janet McCarty, Andrea (Dee Dee) Moxley, Froma Roth and Monica Sampson. We are developing resources to guide members and consumers on the changes, including at least three articles in upcoming issues of The ASHA Leader. The articles will include:

• A comparative analysis of what ASHA recommended and what DSM-5 includes, with clinical implications for SLPs.
• Coding implications for reimbursement.
• Case studies to demonstrate how the changes will affect people with speech, language, communication and cognitive disorders.

ASHA also will communicate with consumers about what the DSM-5 might mean to them through podcasts, media interviews and other dissemination vehicles. A critical message we want to convey is that SLPs will continue to provide needed services, which are based on assessment of communication strengths and needs, and not on specific DSM-5 diagnostic labels.

 ASHA would like to know how you think the changes in DSM-5 will affect your clinical practice. We also are seeking case studies that demonstrate impacts of the changes for a future Leader article. Please contact Diane Paul at dpaul@asha.org