Yaygın gelişimsel bozukluklardan otizm spektrum bozukluğuna geçiş: DSM-5'te karşımıza çıkacak değişiklikler

Amerikan Psikiyatri Birliği, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Basımının (DSM-5) Mayıs 2013te yayımlanacağını duyurmuştur.DSM-5de otizmle ilgili yapılması planlanan başlıca değişikliklere göre, DSM-IV-TRde Yaygın Gelişimsel Bozukluklar çatısı altında yer alan otistik bozuk-luk, Asperger Sendromu, başka türlü adlandırılamayan yaygın gelişimsel bozukluk ve çocukluğun dezintegratif bozukluğu tanı kategorileri yerine birleştirilmiş tek bir otizm spektrum bozukluğu tanısı kullanılacaktır. Genetik altyapısı nedeniyle Rett Sendromu bu tanıya dahil edilmeyecektir. Ayrıca, otizmspektrum bozukluğu tanısı alan bireyler arasında, bozukluğun yol açtığı zorluklar nedeniyle ihtiyaç duyulan desteğin düzeyine bağlı olarak derecelendirme yapılacaktır. Bu revizyonun arkasındaki temel gerekçe; otizmin, farklıgelişim alanlarında sahip olduğu belirtileri hafiften ağıra değişen çeşitli bireyle-ri kapsayan bir spektrum olarak daha iyi biçimde kavramsallaştırılmasıdır.Farklı alt grupları ayırdetmek yerine şiddeti belirlenmiş tek bir tanı kategorisinin kullanılması sonucu otizm tanısının özgüllüğünün arttırılması amaçlanmaktadır. DSM-5 taslağı ile ilgili dile getirilen en büyük endişe; planlanandeğişikliklerden sonra DSM-IV-TRe göre yaygın gelişimsel bozukluk tanısıalmış bazı bireylerin yeni sisteme göre tanı alamayabileceği ihtimali olmuştur.DSM-5'in yayımlanmasının ardından dünya ve Türkiye genelinde yeni otizmspektrum bozukluğu tanı ölçütlerinin kullanımına ilişkin klinik, yasal veeğitimsel düzenlenlemelerin hız kazanması beklenmektedir. Bu yazıda DSM-5ile birlikte gelmesi planlanan yeni otizm spektrum bozukluğu tanısı, tasarlnan revizyonun temelleri, kamuoyu ile paylaşılan taslağa yönelik genel eleştiriler ve değişikliklerin hayata geçm esinin ardından uygulamada karşılaşabileceğimiz bazı düzenlemeler kısaca gözden geçirilmiştir.

Transition from pervasive developmental disorders to autism spectrum disorder: Proposed changes for the upcoming DSM- 5

American Psychiatry Asso c iation has scheduled to release The Diagnostic andStatistical Manual of Mental Disorders, Fifth Edition (DSM-5) in May 2013.According to the main changes being proposed about autism, there will beone unified Autism Spectrum Disorder diagnosis in the DSM-5 classification.This unified diagnosis will eliminate the distinct diagnostic categories underPervasive Developmental Disorders in the DSM-IV-TR, namely autisticdisorder, asperger syndrome, pervasive developmental disorder-not otherwisespecified, and childhood disintegrative disorder. Rett syndrome will be excluded from autism spectrum disorder due to its genetic basis. In addition,severity of symptoms will be measured among individuals with autism spectrum disorder based on the support level required due to the impairment intheir lives. The basic rationale behind this revision is that it is better to con-ceptualize autism as a spectrum including various individuals whose symptoms in different developmental areas range from mild to severe. It is aimed toincrease the specificity of autism diagnosis by using one single diagnosticcategory with its specified severity rather than differentiating several subtypes.The major concern raised over the DSM-5 proposal has been the possibilitythat some of the individuals who were diagnosed with pervasive developmental disorder according to the DSM-IV-TR might not get a diagnosis in thisnew system. After the DSM-5 is released, clinical, legal, and educationalrearrengements regarding the use of new autism spectrum disorder diagnosticcriteria are expected to accelerate worldwide and in Turkey. This paper aimsto review briefly the upcoming autism spectrum disorder diagnosis planned toappear in the DSM-5, the rationale of the proposed revision, main critics tothe DSM-5 draft that has been publicized, and some of the regulations expected to occur in practice after the changes.

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