Legal & Planning

The Legal Impact of DSM-5: Will It Affect Children With Aspergers?

Psychiatrists, psychologists, and medical doctors use the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association to diagnose mental disorders and intellectual disabilities.  The DSM is an important tool not only to diagnose, but having a DSM diagnosis is often required for insurance coverage, and to access special education and/or state-sponsored programs.

Asperger's Syndrome will no longer be a diagnosis

The board overseeing the DSM has recently approved several revisions that will be published in the newest edition, DSM-5, in May 2013.  One of the major, and most controversial revisions is to remove the diagnosis of Asperger’s Disorder and instead categorize those symptoms under the Autism Spectrum Disorders (ASD) umbrella.  Other revisions are also expected, including revisions to the Learning Disabilities category; however, specific details are not available at this time. While those on the task force involved in revising the diagnostic criteria for ASD say their goal was to improve accuracy in diagnosis and not to prevent children from accessing services, it is unclear how this change will affect the interpretation of statutes tied to current DSM diagnostic categories.  The task force stressed that anyone with a prior diagnosis of Asperger’s Syndrome under the DSM-4 criteria would still meet the diagnostic criteria for ASD under the new DSM-5 criteria.

Every state is different

Using the autism insurance mandates approved in many states as an example, several states restrict the diagnoses covered under their mandate to ASDs only.  While most states tie coverage to the most current edition of the DSM (which would automatically be DSM-5), other states either tie coverage to a specific edition of the DSM or do not tie coverage to the DSM at all.

What are the ramifications?

For statutes that limit coverage to only certain diagnoses but tie the definition to the current version of the DSM, the change has the potential to broaden the scope of individuals covered under the mandate as those sometimes previously excluded, like Asperger’s or PDD-NOS, may now be included under the general diagnosis of ASD.  However, statutes that list covered diagnoses but do not tie coverage to the DSM risk confusion as diagnoses like PDD-NOS and Asperger’s syndrome fade from use. Finally, statutes that refer to diagnoses in a specific edition of the DSM risk confusion in determining whether individuals diagnosed under the new diagnostic criteria fit the old definitions referenced in the statute.  It is unclear whether insurers would deny coverage based on an old diagnosis, require a new diagnosis using new criteria, or challenge the applicability of the mandate to a class of people previously not covered.

Be Prepared

As the new edition of the DSM becomes available, parents are encouraged to discuss with their child’s school, current providers, and insurance carrier to determine how the change might affect their child’s access to services and programs. It is possible that this revision may lead to revisions in laws, program eligibility, and insurance coverage.  However, it is too early to speculate the total impact that may occur once the revisions take effect.  Only after the new diagnostic criteria become more prevalent will we begin to see the legal implications of the revisions.