DSM6? or something else…

Professor Amanda Kirby, CEO of Do-IT Solutions., Campaigner for Neurodiversity, Medic, Knowledge Translator, researcher.

Originally published as part of The Neurodiversity 101 LinkedIn Newsletter.

Understanding Neurodevelopmental and Cognitive Difficulties: New Insights for the 21st Century

In recent years, our understanding of mental health and neurodiversity has become more nuanced. Revealing complex interconnections between neurodevelopmental conditions and cognitive difficulties.

I was reading an interesting paper that challenges the constructs of DSM-5. The research discusses this and how we may need to reconsider our diagnostic categorisations completely creating new pathways to better understanding and supporting individuals experiencing a range of challenges. Please read it: https://osf.io/preprints/psyarxiv/7um9a

The above paper is a really important one as it shows the different ways we could potentially re-categorise… they regroup categories for example:

Social Communication Challenges and include in this written communication, disorganised speech, processing challenges. They also have a categorisation called altered sensation and attentional control and include in that symptoms excessive acquiring and saving, sensory sensitivity and fidgeting. The recatogorisation may feel uncomfortable for many of us as we are getting used to the boxes we have and we use. What they have done is to look at when we screen across conditions how symptoms really cluster together.

Remember diagnostic categories have come and gone over time…

Diagnostic criteria we use relating to most neurodivergent traits and conditions have changed over time a lot as well. e.g. “Diagnostic and Statistical Manual of Mental Disorders” (DSM), used often in the United States.

The second edition of the DSM, the DSM-II, published in 1968, defined autism as a psychiatric condition — a form of childhood schizophrenia marked by a detachment from reality.

All change…the DSM-III, published in 1980, established autism as its own separate diagnosis and described it as a “pervasive developmental disorder” and not part of schizophrenia.

Change again…The DSM-III when revised in 1987 broadened the concept of autism by adding a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) — and dropping the requirement for onset before 30 months.

The DSM-IV, released in 1994 and revised in 2000, was the first edition to use the term spectrum. This had 5 different versions of Autism – In addition to autism and PDD-NOS, it added ‘Asperger’s disorder,’ ‘childhood disintegrative disorder (CDD),and Rett syndrome.

All change again…the DSM-5(2013) introduced the term ‘autism spectrum disorder.’ The manual eliminated Asperger syndrome, PDD-NOS and classic autism, but debuted a diagnosis of social communication disorder to include children with only language and social impairments. Childhood disintegrative disorder and Rett syndrome were removed from the autism category.

Neurodevelopmental Conditions: Autism, ADHD, and Beyond

The neurodevelopmental spectrum covers conditions like Autism, ADHD, DCD( known as Dyspraxia), DLD, Dyslexia, Dyscalculia and some people include OCD, and Tic Disorders. Where the borders are is always contentious. I have written about this in a number of publications citing others work including the paper by Cleaton and myself. https://childhood-developmental-disorders.imedpub.com/why-do-we-find-it-so-hard-to-calculate-the-burden-of-neurodevelopmental-disorders.php?aid=23252

These conditions often share symptoms such as inattention, social communication difficulties, and repetitive behaviors. Many many studies over the last 20 years or so have shown that these symptoms may not just exist separately, but frequently co-occur. Previous research (behavioural and genetic) has long suggested these conditions are closely linked. But the emerging structural models of psychopathology are now providing a more integrated view of how these conditions intersect.

Cognitive Difficulties: A new perspective on Neurodiversity…

Cognitive challenges can manifest as problems with disorganised speech, written communication, and challenges with social engagement in a neurotypical world. For example, someone might struggle to find the right words in conversation or have difficulty understanding what they’re reading. These symptoms might stem from cognitive impairments or social communication difficulties, depending on the underlying causes. We sometimes lump them into dyslexia, or squeeze someone into DLD or Autism depending on the pathway of professionals available or what may provide the best support.

The overlap and why it matters

We bounce back and forth despite there being extensive research of the significant overlap between neurodevelopmental conditions and cognitive difficulties. Symptoms like disorganised speech, behavioural perseveration, and low social engagement could be seen as both neurodevelopmental and cognitive challenges.

This overlap suggests that the same symptoms may have different causes, making it difficult to differentiate between them. The implications are vast: better understanding these overlaps could lead to more accurate diagnoses and tailored interventions, improving outcomes for individuals with these challenges. It is this individual understanding rather than support by label that could make a real difference in outcomes.

Challenges with current systems,services and approaches

Unfortunately, many existing systems and services operate in silos and are a deficit model relying on a person being defined by what they can’t do, or have challenges with and don’t discuss strengths in the mix.. spiky profiles.

They are often focusing on one diagnosis at a time. This results in people gravitating towards specific diagnoses like Autism or ADHD because the services are more readily available, leaving other conditions, such as Developmental Language Disorder (DLD) or Developmental Coordination Disorder (DCD/Dyspraxia), underdiagnosed or under-supported.

The consequence?

Individuals’ overall needs are often not fully considered, leading to inequity in service provision. We still have a system that also makes people need one label to get ‘golden tickets’.

For example, a person with Autism may receive more comprehensive support (often seen as a “golden ticket”), while someone with DLD or DCD—despite having significant needs—may struggle to access adequate resources. The challenge is often when someone doesn’t fit neatly into the boxes on offer and so keeps missing out on support all together.. like goldilocks!

A call for future research and systemic change

The evolving understanding of neurodevelopmental and cognitive difficulties highlights the need for further research and a more integrated approach. It also recognises that we are all neurodiverse but not all neurodivergent.

We must move away from siloed services that prioritise certain diagnoses over others and focus on addressing the full spectrum of an individual’s needs. Creating equitable support systems across all neurodevelopmental conditions is essential for reducing disparities in care.

What does this mean for you?

Whether you’re an educator, employer, or health professional, understanding the overlap between neurodevelopmental and cognitive difficulties can help you provide more effective support. Tailoring your approach based on the unique needs of each individual is crucial (person centred approaches). As is advocating for systemic change that ensures all individuals receive the support they need, regardless of diagnosis. This takes into consideration other factors such as the environment they are in, other social challenges that may result in less opportunity to engage and means we are designing in an inclusive way.

Let’s embrace the complexity and individuality of each person. By doing so, we can create a world where everyone’s strengths and challenges are acknowledged and supported.

#Neurodiversity #CognitiveDifficulties #MentalHealth #Inclusion #SystemicChange #EquityInCare #HiTOP

Blog Author

I am Amanda Kirby, CEO of Do-IT Solutions a tech-for-good company that delivers thought provoking consultancy and neuroinclusive guidance and training. We have developed cutting edge web-based screening tools that have helped 10s of 1000s of people. We strive to deliver person-centered solutions relating to neurodiversity and wellbeing.

I am a mixed bag of experiences and skills, an odd ball… and have 25+ years of working in the field of neurodiversity.

I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity; parent and grandparent to neurodivergent wonderful kids and am neurodivergent myself.

Theo Smith and I wrote the UK award-winning book Neurodiversity at Work Drive Innovation, Performance, and Productivity with a Neurodiverse Workforce. My 10th book came out called Neurodiversity and Education in March this year. Excitingly, Theo and I have another book coming out next year!