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Congratulations

As manifested by all the following (...). Let be a comma when placed in a particular place. Whether it is two words. What is certain is that the changes felt may be great, for the importance they represent. And why is that?


DSM 5 is nine years old. It is true, in 2013 came the current revision of the diagnostic and statistical manual of mental disorders. But this March and in preparation for the entry into the 2nd cycle (kidding) of the DSM, a new update was made. That's right, we now have DSM 5 TR.


This is no longer the first time this has occurred. When DSM IV came out in 1994, it took about six years, before DSM-IV-TR was published in 2000.


Basically, DSM-5-TR is a text revision of DSM-5 and includes revised text and new references, clarifications of diagnostic criteria and updates to existing codes. It introduces a new disorder, called Prolonged Bereavement Disorder, as well as codes for suicidal behaviour and non-suicidal self-harm. DSM-5-TR is based on updates to the scientific literature since the publication of DSM-5 in 2013 and involved the help of more than 200 experts refers the re-writing of the manual.


This new version, includes changes to the definitions of autism and intellectual disability that experts say will further clarify existing diagnoses.


The manual's entry for intellectual disability will now be called "Intellectual developmental disorder (intellectual disability)" to align more closely with the World Health Organization's classification system, which uses "Intellectual developmental disorders". Disorder of intellectual development will also include revised language to communicate that while the diagnosis "should not be limited to the IQ score range of 65-75, the diagnosis will not be appropriate for those with substantially higher IQ scores."


A second change aims to clarify potential misunderstandings of a diagnostic criterion. The fifth edition in 2013 required a diagnosis of autism to include "persistent deficits in social communication and social interaction in various contexts, as manifested by the following: deficits in social-emotional reciprocity, in nonverbal communicative behaviours used for social interaction, and in developing, maintaining and understanding relationships." This latest revision changes the figure to read "as manifested by all of the following" to eliminate confusion about the inclusion of one, two or three of the deficits described.


In addition, it has also been added in this latest revision that sensory issues should present as a core symptom of the diagnostic criteria for Autism Spectrum Disorder. This is because sensory issues on the autism spectrum are reported at all stages of life and in a wide variety of cognitive functioning profiles, in addition to affecting daily functioning and academic performance. Being that these sensory symptoms are present in a variety of forms including sensory hypersensitivity, sensory hyposensitivity, sensory avoidance and sensory seeking.


Another change seen exchanges a single word describing the "specifiers" that can accompany a diagnosis of autism. While the DSM-5 wording instructs health professionals to specify whether a person's autism is "associated with another neurodevelopmental, mental or behavioural disorder", the DSM-5-TR version says: "associated with a neurodevelopmental, mental or behavioural problem". In addition to also being allowed for health professionals to indicate existing problems derived from co-occurrences, such as self-injurious behaviours.


Just like in 2013 when the DSM 5 came out, when there was no longer a certain set of different diagnoses but all grouped under the same umbrella with the designation Autism Spectrum Disorder. There were many who felt that the removal of the designation Asperger's Syndrome could leave out some of the people with these characteristics. However, what we have seen is that there has been an increase in the number of diagnoses made. This is despite the fact that a large number of people continue to be diagnosed in late adulthood.


However, this review published this March does not introduce such a large number of changes. Those proposals meet the needs for clarification that have been raised over the past nine years. And as such, what is expected is precisely a greater clarification and response given to people. Will we stop here? Certainly not. Because if we observe, the word autism entered the DSM as diagnosis in 1980. And autism already existed as a condition since 1943. As you can see changes will continue to happen. Besides, the DSM is not the Absolute Truth about autism. Even though it has its weight represented on several levels. It will be necessary to continue to want to celebrate the years and to be able to reflect about all this and preferably with everyone involved, autistic people included.


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