During the past 12-18 months, experts from a wide range of medical, mental health, and education-related disciplines have been called upon to serve as members of task force groups in guiding the revision of the Diagnostic & Statistical Manual (DSM). And during the past few months, more than 13,000 online comments and 12,000 emails and letters were sent by organizations (including NCLD) and from the general public. The good news is that the learning disability community has played an active and outspoken role in providing feedback.

The DSM is a book that offers diagnostic criteria and numerical codes that help pinpoint the features of hundreds of different types of disorders. It is used mostly by physicians (e.g., pediatricians, neurologists, psychiatrists), mental health professionals (e.g., social workers, psychologists) and related service providers (e.g., speech/language pathologists, occupation therapists) to name specific disorders and describe the characteristics of the disorders so decisions can be made about how to offer treatment, therapy, instruction, accommodations, and other types of support. Last revised in 2000, the DSM is undergoing a comprehensive revision, and the new DSM-5 is scheduled for publication in May 2013.

No one would disagree about the importance of identifying learning disabilities (LD) and other types of disorders or conditions (such as AD/HD) that result in barriers to learning. And no one would ever want to deny an individual with some special learning or behavioral need access to the specific types of instruction and support they need to be successful in school, at home, in the community, or in the workplace. The challenge for those who make the determination as to whether someone does or does not qualify as having a particular type of disability or disorder is made easier by guidelines provided through education law, civil rights law, and clinical practice (DSM). The problem is that these classifications don’t always “talk to each other” in meaningful ways. That’s why the current revision to the DSM is so important.

Why is it important for learning disabilities to be included in the DSM-5?

• It validates what we, in the LD community, already know: LD is real and not a made-up term that is used to excuse poor effort or low motivation or to explain diminished capacity for learning.
• It recognizes the many decades of science that prove that people with dyslexia and other disorders of learning are deserving of special types of instruction and support.
• It takes an important step in closing the gap between the terminology used in schools and medical settings to ensure that LD is recognized, and that needed services and accommodations are provided  

The final editing process for the DSM-5 has begun, and we won’t know for sure until May 2013 how such terms as “dyslexia” or “dyscalculia” will be included. But we have every reason to be encouraged, since specific mention of these terms was in the last posted draft. We pushed hard for the “language of learning disabilities” to be well represented throughout appropriate sections of the revised manual, and are hopeful that our specific recommendations were heard and will be incorporated into the new edition.  

There is no question that the DSM coding system will continue to be essential for the documentation needed by many professionals who provide services to children (and adults): it is included in their chart notes and it is needed for billing purposes (because insurance carriers determine eligibility for reimbursement based on recognized and approved diagnostic codes). Whatever the DSM-5 ends up looking like in terms of the organization and coding of disorders, the most important question for us to consider is this:

How can professionals making decisions, based on clinical judgment and assessment data, link DSM-5 classifications to meaningful instruction, related service delivery and intervention?

Look for updates from NCLD in the weeks and months ahead. What do you think?

Read The Washington Post story, “Asperger’s gone, dyslexia stays in first change to psychiatric manual in almost 20 years.”