Monday, March 1, 2010

What's in a Name? Making Sense Out of the Proposed Changes for Mental Retardation and Autism in the DSM-5

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published two years from now. The American Psychiatric Association (APA) has asked for public comment on the proposed changes to labels and diagnostic categories for mental retardation and autism. The APA is proposing that the term "mental retardation" be changed to "intellectual disability." They are also advocating that the diagnostic use of Asperger's and pervasive developmental disability (not otherwise specified) be discontinued and labeled as "autism spectrum disorders."

It seems that about every ten years society goes through a vocabulary change as words become stigmatized and associated with unwanted connotations. This was the case decades ago, for example, with the association of the word, "mongoloid" and people with Down Syndrome. The term was not originally meant to be used with people with Down Syndrome, but became associated with the Syndrome and offensive to many people in its use.

I think that the term "mental retardation" varies in its use from state to state, but was still an official code for disability on an individual education plan in the school districts I was working at last year. I think it is interesting that people continually become sensitive to labels and want to change them. Changing the labels, however, does nothing to change the disabilities. We have the same clients, students, friends and family members no matter what we use to describe their disabilities. I think that the recommendation to use "person-first" terminology when discussing people with disabilities was a great step in the right direction. (e.g., "Jane" who has mental retardation versus "Jane" is mentally retarded, autistic, etc.) Changing from "mental retardation" to "intellectual disabilities," however, seems to be semantic window dressing. The APA is apparently changing the label in order to conform with the terminology from the Department of Education. It almost seems like we keep giving in to political correctness instead of getting the public to recognize people for their individuality and humanity instead of their label. We are all labeled in multiple ways every day, but do we let the labels define us?

I will gladly go along with the APA in trying to avoid disparaging thoughts or talk about people with disabilities, but I do have to wonder when society will be able to get past the immaturity of assigning negative connotations to words. Hopefully, we can focus on the people and not the labels in the future.

The change from using the labels for Asperger's or PDD seems to be much more practical in nature. The APA is trying to make it easier for schools and doctors to get help for children by including Asperger's and PDD in the autism group for funding and services. They are also recognizing that it is difficult to assign labels on a spectrum disorder. Every child with autism has different attributes of the disorder which makes it impossible to accurately assign a single label.

The APA news release can be found here.

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