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meet criteria for ASD under DSM-IV, but not the more stringent DSM-5. The consultations were conducted in each state and territory in the middle of 2013, with a final report published at the end of the year (Department of Social Services, 2013). With regard to diagnosis and funding, in essence, nothing has changed since the release of DSM-5. The government’s policy response has been to declare that children may receive funding through the Department of Social Services if they have a “conclusive” and “acceptable” diagnosis of either autism, autism spectrum disorder, autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or PDD-NOS. Notably, the DSM-IV diagnosis of Rett’s disorder is no longer seen as a mental health disorder (like ASD) following the identification of its genetic basis, and children with Rett’s disorder now receive funding through the alternative “Better Start” package. Essentially, for the purposes of funding, children can be diagnosed with “autism” based on the criteria published in the third edition of the DSM (American Psychiatric Association, 1994) onwards, highlighting the relevance of the core symptoms of ASD, which have remained unchanged over time, in determining eligibility for funding. Accordingly, this policy decision means that there has so far been little impact on practice with regards to diagnoses and funding of speech pathology services for children with ASD and their families. But what impact have changes in the diagnostic criteria had on the availability of services to children presenting with sub-threshold ASD symptoms, who did not meet the specific criteria for autistic disorder under DSM-IV, but rather one of the broader autism spectrum sub-classifications (e.g., Asperger’s disorder, PDD- NOS)? Research to date indicates that approximately 10% of children previously diagnosed with ASD using DSM-IV, would not meet the DSM-5 criteria, particularly those with PDD-NOS (Lohr & Tanguay, 2013). Instead, these children with sub-threshold ASD symptoms are most likely to be diagnosed with the new diagnostic label of social communication disorder under DSM-5, which does not attract specialist funding for services. Given that diagnosticians in Australia are currently free to choose whether they use DSM-IV or DSM-5 for the purposes of determining eligibility for funding (Department of Social Services, 2013), it is possible that the same child presenting with the same needs at two different diagnostic assessments, could leave one assessment with a diagnoses that confers specialist funding and the other without, simply based on the criteria used. Presumably, this opens the gate for inconsistent application of diagnostic criteria within and across diagnosticians, with clinical and ethical implications. The Department of Social Services has indicated that they will review their policy regarding support for children diagnosed with social communication disorder in late 2014, once data regarding the rate of diagnosis and support needs become clearer. Despite concerns regarding the impact on research, a non-systematic review of the recent studies in the Journal of Autism and Developmental Disorders and other key journals in the ASD field reveals no reference to the DSM-5 changes posing a major barrier to conducting research or interpreting findings. In fact, the changes have coincided with increasing calls (e.g., Trembath & Vivanti, 2014) for a greater focus on individual differences in ASD research,

with less reliance on broad diagnostic labels and a greater focus on the each person’s individual strengths, needs, and learning profile. Tightening the criteria to exclude children with sub-threshold ASD symptoms (many of whom would meet the criteria for social communication disorder) may have some impact on research, as presumably, the inclusion of children with sub-threshold symptoms in treatment studies leads to greater treatment effects. It remains to be seen whether researchers will move quickly to adopt DSM-5 criteria in acknowledging this issue, and whether journals will adopt standards regarding participant diagnoses. At the time of writing, a PubMed search using the term “social communication disorder” revealed no clinical trials, suggesting that research examining the nature and outcomes of this disorder is still in development. In looking forward to the next 12 months and beyond, it is difficult to predict what future impact the changes in diagnosis will have on policy and practice. In Australia, the National Disability Insurance Scheme is currently being trialled in a number of sites, with the view to full rollout in 2016–18. It is likely that the advent of this scheme will see diagnosis-specific funding (e.g., the Helping Children with Autism Package) replaced with the comprehensive scheme. Yet the mechanisms by which funding under the NDIS will be allocated are still being developed. If the scheme is based on needs, rather than diagnosis, it may be tempting policy-makers to look to the new severity ratings described in DSM-5 for guidance as to the level of funding required. Participants in the Department of Human Services consultation process last year expressed clear opposition to any such approach (Department of Social Services, 2013), and the sentiment is echoed in the research literature (Vivanti et al., 2013). The Department has acknowledged work currently underway at the Karolinska Institutet Center of Neurodevelopmental Disorders (KIND) to develop a core set of descriptors for ASD that will provide a universally accepted framework for describing individual functioning within the International Classification of Functioning, Disability and Health (ICF Research Branch, 2014). Similar core sets are available for individuals with other developmental disabilities (e.g., cerebral palsy) and so have the potential to provide a consistent and useful approach for measuring individual needs. It also remains to be seen what impact, if any, the changes in diagnostic criteria may have on the “culture of autism”, particularly for individuals who identify themselves as having Asperger’s disorder. Presumably, it is the explanatory power of the diagnosis of ASD in helping people understand themselves and others that may confer a sense of self-understanding and identity, rather than the diagnostic label itself. To date no research has been published examining the possible impact of changes in the diagnostic criteria on sense of self-understanding and identity among individuals with ASD. However, it would seem likely that just as diagnosticians may continue to choose which criteria they feel are most suitable to describing individual strengths, needs, and learning profiles, so will individuals with ASD who choose to share their diagnosis with others. It is perhaps worth noting that speech pathologists have always highlighted the importance of focusing on the strengths, needs, and learning profiles of each child, adolescent, and adult with whom they work. Accordingly,

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JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology