Friday, December 30, 2011

Asperger's Spectrum Disorder in the DSM-5: Why the Concealment?

One of the great DSM-5 puzzles to this father of a severely autistic son is the use of the label Autism Spectrum Disorder to describe what appears to be little more than a tweaked version of the DSM-IV's Asperger's Disorder.  The APA's DSM-5 team has replaced Autism with Aspergers, removed the most seriously intellectually disabled to the General Developmental Disorder category and further diluted the requirements for an autism diagnosis. Why not be open and transparent about the Aspergers substitution for Autism and the removal of the intellectually disabled from the Autism category?

The APA has purportedly merged the three Pervasive Developmental Disorders into one Autism Spectrum Disorder.  It would appear to be much more accurate though to refer to the new combined disorder as Asperger's Spectrum Disorder.  There is no signficant difference between the DSM-IV Aspergers Disorder and the DSM-5 Autism Spectrum Disorder. The DSM-5 converts autism into Asperger's by:
1) Collapsing three requirements for an autistic disorder into two for the DSM-5's new "Autism" Spectrum Disorder. The two categories are the two main requirements for a DSM-IV Asperger's Disorder diagnosis: qualitative impairment in social interaction and restrictive, repetitive and stereotyped patterns of behavior, interests and activities.  The spoken language deficits  of the DSM-IV'S communication category are subsumed under social communication eliminating spoken language impairment in itself as a diagnostic feature of autism.

2) Precluding an Autism Spectrum Diagnosis for persons with Intellectual Disabilities. Mandatory Criterion A in the DSM-5's brave new Autism Spectrum Disorder which precludes an ASD diagnosis where accounted for by "general developmental delays" which is the DSM-5 diagnostic terminology for Intellectual Disability. Mandatory Criterion A's.  
The Asperger's Spectrum Disorder masquerading as Autism Spectrum Disorder will accomplish three things:

1) It will further impair "autism" research. The 1994 DSM-IV autism changes are still being used to explain dramatic increases in autism diagnoses. The 2013 DSM-5 changes could permanently impair our understanding of autism causes and increases. This will prevent any serious epidemiological based research into possible environmental causes including substances, air, drugs, diet and water supplies, vaccines and vaccine ingredients,  affecting the pre-natal environment.

2) It could reduce public service costs for children with autism disorders by removing the most challenging cases of autism disorders: very low functioning intellectually disabled autistic children. The possible expansion on the other end of the Asperger's Spectrum may offset this reduction or may be affected by more serious emphasis on impairment of daily functioning levels in the DSM-5 era.

3) Legitimization of claims by very high functioning persons with current autism disorder and Asperger's diagnoses to speak on behalf of those most severely affected by autism.  The Neurodiversity movement is based for the most part on persons from this group and tends to be very supportive of efforts to  resist any serious environmental focused autism research including vaccine autism research.

The DSM-5 debates currently raging, spearheaded by Dr. Allen Frances,  will have no impact on the Asperger's (Autism) Spectrum Disorder category in the DSM-5. It is a fait accompli. Current autism research tends to exclude, for matters of convenience of the researchers involved, use of severely autistic study participants. The mainstream media reports serious tragic incidents involving the severely autistic but its features invariably focus on high functioning autistic\Asperger's\savant success stories. 

When looking at challenges the mainstream media tends at most to look at the social awkwardness of those with HFA\Asperger's. The recent Amy Harmon NYT "navigating love" feature is the perfect example of this aspect of MSM representation of autism.

Asperger's Spectrum Disorder is already with us; having unofficially taken over the  Autism label. Why the APA feels the need to officially hide that fact in the DSM-5 is puzzling.


Bullet said...

There should be something about the use of language, but it should not be restricted to something like number of words said, but rather to how the language is used as well. Because otherwise what you would then get is a situation where someone like me, who is obviously very articulate on line, but who has very significant problems initiating talking (as well as other issues) in real life being classed as more severe in terms of language abilities than my older son, who is hyper verbal but has difficulties with understanding, with appropriate use of language and who frequently uses echolalia.
The language also needs to come into DSM V to stop the situation where my youngest son, who has only a handful of single words, would be classed as less severe than my oldest, because he is better at non verbal communication. Albeit on his own terms.

farmwifetwo said...

My youngest has A through D and is still considered to be severe - moderate in a "safe" (school/home) setting. Out in public he cannot speak nor hear... he simply watches. You have to be part of the inner circle to get him to talk to you - such as it is since it's very broken and 1 to 3 words usually in length phrases. He doesn't seem to hear outsiders.

So, I don't see what the problem is?? Does your son not flap?? He watched a horse go by yesterday from the kitchen door laughing, bouncing, flapping and grabbing at his clothes. He was very excited. It took mine until 5 to line his cars up in a row and then I took a picture of it.

We had full regression btwn ages 2 and 3.

Paperclips and all things steel are our fav thing to chew on... have been for years... magpie - hides them too.

We've had echolalia since the beginning. Which if you read the books on my goodreads pg on ACC the assumption is that it takes the place of "one word" in their speach. Since a couple of years ago I decided to use it as speech and discovered that tidbit to be true.... you have to communicate to get communication.

Social skills are poor - to be kind. But in school and with his bro he is finally able to tell them "NO" when they take the toy he is playing with.

Our gross motor skills are better than most but we've had a lot of playground time, taken bowling and swimming lessons.

Much research has been done to prove that the delayed level of those with autism is unknown. I find it frightening that the severe end of the spectrum isn't taught to communicate just "trained". I find it even more frightening that most of the disabled are "trained" after watching a Man with Down's - from bowling - supposedly working in Zellers a couple of weeks ago sorting rasors while his "worker" sat on a chair and stared at him. That's not working... that's disgusting. It's "assumed" they cannot speak nor learn to work. IMO that's cruel at best. This way they cannot "assume" someone with autism cannot be taught like they do now.

Otherwise it would be ID. So, I have no issues with the changes... and it does pull my eldest off the dx list but that's coming this spring anyways.

Anonymous said...

There is a very clear cut line between Classic Autism, PDD-NOS and Aspegers. It was such a disrecptful strike at Autism when this happened. My son has Classic Autism, but high functioning. He is talking now, and is no where near severe like other Classic Autism children. That doesn't mean he will live on his own as an adult, but only time will tell. Aspergers and PDD-NOS children usually grow up to enjoy college, employment, marriage etc.

Classic Autism children are always hindered in this way.

Usethebrains Godgiveyou said...

what is ID? When I got my degree in MR 30 years ago, Dr. John made us memorize the definition at that time. I don't know if this would be of any help.

"Significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period." Sub-average was 2 or more standard deviations from normal.The IQ percentage has been fluid, and changing, but around 70.

If you'd like to know my first Spanish lesson...

Anonymous said...

APA is a PROFESSIONAL SUPPORT GROUP. It exists to forward the needs of it's members, NOT the patients. Members prefer the power of "gatekeeper" without the complications of "difficult" and intractible (no silver bullet mircale cure) cases.

joan said...

My grandson who is 14 years old was diagnosed with severe autism at 2 years old. He is non verbal and attends a very good school for autism for the past 9 years. When he was first diagnosed, I thought that intellectual disability came with the autism territory as well as sensory issues,communication, no immitation etc. Since I have been looking at the Autism Speaks Network, it seems that those with high functioning autism or Aspergers are the main focus. My grandson's type of autism is only about 7% of the autism spectrum. Some people who say that they have autism respond on the autism speaks forum very well and often argue about vaccinations. My grandson can't do that. Why is this all under one umbrella? I do not like the term "low functioning" I think it sounds disrespectful and discriminatory. He has classic autism because we don;t really know what his IQ is or what he thinks about or what he is capable of. All we know is that when something interests him, he is very perceptive.

Anonymous said...

I am autistic and i don't think they even begin to understand autism ...I there are so many versions of autism aspergers is just more of a very left brain version.

Bella Rossi