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June 12th, 2013 meeting: results of DSM-5. What does it mean for those with Asperger’s

May 23, 2013

We discussed the new Diagnostic and Statistical Manual of Mental Disorders, DSM-5, which may exclude as many as 40% of previous autism spectrum disorder patients on the older DSM IV criteria (Pervasive Developmental Disorder-Not Otherwise Specified [PDD-NOS], Asperger syndrome, Autism) if new stricter criteria are approved by the American Psychiatric Society in this May 2013.

Fortunately DSM classification is not mandatory for most clinicians unless specifically required by their institutional settings. In fact, the International Classification of Diseases (ICD) is the only classification system approved by HIPAA (Health Insurance Portability and Accountability Act) – not the DSM. As such, ICD codes meet all insurer-mandated and HIPAA coding requirements.( ).

But those 40% potentially excluded now or in the future may not have the same education benefits, disability insurance, job accommodations or mental health service reimbursement with a diagnosis of a social communication disorder.

To see the US Autism and Asperger’s Association Position Statement in full follow this link: and then come to our meeting to discuss the latest.

Well, as of this week May 24th, 2013, PDD-NOS, Asperger syndrome and autism are no more and here are the criteria for Autism Spectrum Disorder (ASD) that take their place:

DSM-5 criteria for autism spectrum disorders

An individual must meet criteria A, B, C and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D. Symptoms together limit and impair everyday functioning

Needless to say the Asperger’s or ASD’s in the group were disgusted after the discussion. The objection was the negative language in the description of the DSM5 criteria. It is obvious to the highly functioning among us that our strengths are much like that of the highly intelligent and we have similar quirkiness. It is only when our limitations interfere with social functioning and obtaining or keeping a job that we need help.  Others were concerned that some on the future ASD (Autism Spectrum disorder) may be excluded from psychological, social, disability services Asperger syndrom or or Pervasive Developmental Disorder patients would have received in the past. 

ICD-9 Code:

Pervasive developmental disorders 299- >

  • Broad term for disorders, usually first diagnosed in children prior to age 4, characterized by severe and profound impairment in social interaction, communication, and the presence of stereotyped behaviors, interests, and activities. Compare DEVELOPMENTAL DISABILITIES.
  • group of disorders characterized by delays in the development of socialization and communication skills; typical age of onset is before 3 years of age; symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns; AUTISM is the most characteristic and best studied PDD; other types of PDD include ASPERGER SYNDROME, Childhood Disintegrative Disorder, and RETT SYNDROME; prefer NTs where possible.

Specific code icon 2013 ICD-10-CM  

  • On October 1, 2014 ICD-10-CM will replace ICD-9-CM in the United States, therefore all ICD-10-CM diagnosis codes should only be used for training or planning purposes until then.

2013 ICD-10-CM Diagnosis Codes > Mental, Behavioral and Neurodevelopmental disorders F01-F99> Pervasive and specific developmental disorders F80-F89 > Pervasive developmental disorders F84-

Pervasive Developmental Disorder, unspecified

Autism, autistic(childhood) (infantile) F84.0 atypical F84.9 Delay, delayed development R62.50pervasive F84.9 Disability, disabilities intellectual F79 with autistic features F84.9 Disorder(of) – see also Disease pervasive, developmental F84.9 developmental F89 pervasive F84.9

Diagnosis Code F84.5

  Asperger’s syndrome

  • F84.5 is a billable ICD-10-CM code that can be used to specify a diagnosis.

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