DSM5's Most Fundamental Flaw? Combining The Autism Disorders Into One Disorder

Autism Advocate Ari Ne'eman Speaking At the National Press Club

My  son's severe Autistic Disorder is not the same 

autism disorder as Mr. Ne'eman's.

The DSM5  autism do-over, the New Autism Spectrum Disorder, will come into effect in 2013.  There is a further opportunity to offer public comment about the radical changes being forced upon the public but the DSM5 committees who have shaped the New ASD in the image of their own research biases have shown no inclination to acknowledge the merits of any of the many criticisms of their handiwork. It does not matter whether the criticism comes from expert professionals involved with shaping previous editions of the DSM (Fancis, Volkmar)  or a stumbling, ignorant, hysterical father (moi) of a severely autistic son who has lived first hand, 24/7 for 16 years,  with the realities of severe autism and who objects to the targeting of the intellectually disabled for exclusion from the New ASD. No matter the source the  DSM5 team has not flinched and has not deviated from their own research biased views of autism.  (The DSM5 team swears that the New ASD reflects solid autism research. DSM5 autism team member Catherine Lord though  has acknowledged that autism research tends to excluded those with intellectually disability  while also confessing that the real aim of the New ASD is to exclude those same intellectually disabled from autism diagnoses.) The biggest flaw is not the possible exclusion of some at the highest functioning end of the spectrum or the likely exclusion of many with intellectual disabilities.  It is the combining of disparate disorders into one.

The biggest flaw of the new DSM5 is the combining of the many autism disorders into one disorder when even the most ignorant, ill informed and irrational of persons dealing with autism ... parents ... can see that there are huge differences between those who  have fashioned careers as public spokespersons for all persons with autism and those who can not function in daily life.  

Ari Ne'eman is an intelligent, eloquent university graduate comfortable in discussing his vast knowledge of autism before assembled groups from the US to the UK.  This young man can hobnob with the intellectuals at the IACC, state and federal politicians in New Jersey and Washington and mainstream media representatives at the US National Press Club in Washington.  He appears to be very comfortable in front of media cameras. My son at 16 has accomplished much in terms of where he started but he is still working at a Dr. Seuss reading level, working with great effort to make a full sentence, lacks understanding of the world, engages in repetitive behavior that can end with self injurious behavior.

As a father of a low functioning autistic son I can not see the deficits that  resulted in an autism disorder for Mr. Ne'eman.  As an autism advocate who has worked with and met some higher functioning kids with Aspergers whose limitations are still noticeable I can not see those same limitations in Mr. Ne'eman. I do not believe that Mr. Ne'eman's professionally diagnosed autism disorder, or the autism disorders of the members of the corporate board oranized by the very high functioning Mr. Ne'eman have any similarity to my son's diagnosed Autistic Disorder or to those with Asperger's that I have met. Still Mr N. , like his ASAN board members presumably have diagnosed autism disorders. 

What is clear though is that Mr. Ne'eman's disorder is not the same autism disorder that I have seen in my real life, daily,  experiences as a father or as an autism advocate.  In the latter capacity I have met a number of persons with Aspergers whose diagnoses are clear to anyone who speaks with them but they are still different from my sons. They are also different from the severely autistic persons I have met on visits to psychiatric hospital facilities where they reside here in New Brunswick.

I am not suggesting that Ari Ne'eman does not have an "autism' disorder.  I am not qualified to say that and I recognize that and respect his professional diagnosis.  I am qualified, as an observant human being, to say that Mr. Ne'eman's challenges are not the same as my son or many others with Autism and Asperger's that I have met.  To me I see no signs whatsoever of a disorder of any kind in Mr. Ne'eman but again I realize I am not a qualified professional  and I assume that those who provided his diagnosis were capable professionals.  Mr Ne'eman's autism disorder though does not remotely resemble my son's or other persons I have met with autism and Asperger's disorders.

In the opinion of this humble dad the combining of the various autism disorders into one disorder is a fundamental flaw in the New Autism Spectrum Disorder. 

Autism in Russia: Pravda Misrepresents Asperger's as Autism

Like its mainstream media counterparts in the US and Canada the Russian news service Pravda is busy misrepresenting Asperger's as Autism.  In Autism: Life full of struggle and success there is mention of Asperger's as "an" autism disorder.  There is also acknowledgement of some of the challenges faced by persons with autism. But there is no mention of those who CDC Autism Expert Dr. Marshalyn Yeargin-Allsopp  described as the "vast majority" of those with actual Autistic Disorder diagnoses; those who have autism and intellectual disabilities. The article read as a whole, including the title,  portrays those persons with Asperger's, and persons "with some traits of autism and Asperger's" who have found employment with companies like Aspiritech as representative of persons with autism:

The son of the founder Moshe Vittsberga at some point had problems finding work due to Asperger Syndrome diagnosis. For this reason, the Aspiritech undertook to help people with autism.
 According to specialists, work with computers is well suited for autistic individuals. In addition, many high-end programmers are people with certain traits of autism or Asperger syndrome.

Among professions preferred for autistic individuals are accounting, librarianship, archival work and drawing, and art. Autistic individuals are good at archeology, paleontology, and museum work.
Some people with autism are good at jobs involving visual thinking - computer-aided design, architectural modeling, industrial design, etc.


For example, in 2008, a fellow of the Massachusetts Institute of Technology Wendy Jacob founded a studio where she worked with autistic individuals to create radically new art and design solutions in the field of interior design and the design of everyday objects specifically for people with autism spectrum disorders. This is the beginning of a niche market.


Autistic individuals are also good at work associated with fulfilling certain actions at certain times. Autistic individuals do not need a team and can work quite effectively in isolation.
However, work related to rapid processing of information in short-term working memory is not suitable for them. They should avoid such areas as history, political science, business, philology, or higher mathematics.

DSM-5 Autism Shell Game

WordNet Dictionary  

Noun

1.

shell game - a swindling sleight-of-hand game; victim guesses which of three things a pellet is under Synonyms: thimblerig

The DSM-5 treatment of autism amounts to little more than a shell game with autism, which once referred essentially to autistic disorder being replaced with Asperger's Disorder.  Look at the description of A 09 Autism Spectrum Disorder in the DSM-5 which is referred to in the DSM-5 as a proposed revision for the DSM-IV Autistic Disorder:

A click on the DSM-5 A 09 Autism Spectrum Disorder tab for DSM-IV refers the reader to Autistic Disorder as set out in the DSM-IV leading one to think that the new Autism Spectrum Disorder is in fact just a modified version of the DSM-IV's Autistic Disorder:

The most obvious difference is in paragraph 2 which refers in the introductory line to qualitative impairments in communication. One of the sub-paragraphs which assists in fulfilling that requirement for meeting an Autistic Disorder is "delay in or total lack of the development of spoken language".  The narrowing of communication deficits from general communication deficits to social communication deficits is not just a revision, it is a re-definition of autistic disorder.  Removing this important characteristic from "autism" constitutes an essential change from Autistic Disorder, at least from the perspective of this father of a son with autistic disorder who has had both delays in language development and a lack of full language development.

As can be seen in the DSM-IV description of Asperger's Disorder removing any reference to general language delay or development renders the new Autism Spectrum Disorder much more like the DSM-IV description of Asperger's Disorder which states in paragraph D that there is no clinically significant general delay in language. The only reference to language deficit in the new ASD is in the reference to social communication, a specific not general language deficits. Again, I am a humble parent and small town lawyer not an Ivy League educated psychologist or psychiatrist but I have to assume that language and general communication developments are among the most fundamental aspects of any human's development. To remove the general language and communication deficits from Autistic Disorder and substitute social communication deficits appears to me to be a straight forward substitution of Aspergers for Autistic Disorder in defining the New Autism Spectrum Disorder in the DSM-5.

Consistent with substitution of Asperger's Disorder for Autistic Disorder is the exclusion of persons from Autism Spectrum Disorder diagnosis where the mandatory social communication and social interaction deficits required under criterion A are "accounted for by general developmental delay". I have commented on this exclusion several times and I see no other reasonable interpretation of the exclusionary language in Criterion A of the new Autism Spectrum Disorder. Criterion A effectively brings to the DSM-5's new Autism Spectrum Disorder criteria D and E of the DSM-IV's Asperger's Disorder description ... no clinically signficant delay in language and no clinically signficant delay in cognitive development.

A reasonable interpretation of the DSM-5's new Autism Spectrum Disorder is that it essentially substitutes Asperger's Disorder for Autistic Disorder. Asperger's Disorder IS the New Autism Spectrum Disorder of the DSM-5.  The language of the DSM-5 which purports to show Autism Spectrum Disorder as a revision of the DSM-IV's Autistic Disorder is misleading, whether intentional or not, and it helps conceal  under which shell the "autism pellet",  in the new DSM-5 is located. The DSM-5 new Autism Spectrum Disorder is located under the DSM-IV's Asperger's Disorder. 

The DSM-5's new Autism Spectrum Disorder is no more than a glorified shell game with low functioning, intellectually disabled autistic persons and their families the unwitting victims. The new Autism Spectrum Disorder would be more accurately described as Asperger's Spectrum Disorder with the many severely affected, low functioning, intellectually disabled autistcs of the DSM-IV excluded.. 

Asperger's is the New Autism: No Intellectually Disabled Allowed in the DSM-5's New Autism Spectrum Disorder

"the autism umbrella has since widened to include milder forms, says Dr. Marshalyn Yeargin-Allsopp, a medical epidemiologist at the Centers for Disease Control and Prevention. For example, it now includes Asperger syndrome, where the sufferer is socially impaired, but experiences typical language development. Another difference between past and present autism diagnosis involves the presence of intellectual disabilities, adds Yeargin-Allsopp. During the 1960s and 1970s, the vast majority of those diagnosed with autism had an intellectual disability but today, only about 40% have one."

Dr. Marshalyn Yeargin-Allsopp, Canadian Medical Association Journal,CMAJ • July 13, 2010; 182 (10). First published June 7, 2010; doi:10.1503/cmaj.109-3274  


Dr. Yeargin-Allsopp's description of the diminution of autism's vast majority, those with intellectual disability, is noteworthy today as we await the commencement of the DSM-5 era and the complete elimination from any autism diagnosis of persons with intellectual disabilities. That accomplishment will be achieved by the DSM-5's New Autism Spectrum Disorder definition and diagnostic criteria which expressly exclude an ASD diagnosis in instances of general developmental delay:

The New Autism Spectrum Disorder in the DSM-5 will eliminate any debates over the exent of intellectual disability amongst those with autism spectrum disorders.  The new definition will complete the process begun in the DSM-IV of diminishing the rates of ID amongst those with autism by changing the definition of autism to exclude those with intellectual disability.   The formula is simple and straight forward.  To be diagnosed with autism a person must meet all 4 criteria, A, B, C and D.  Criteria A requires the presence of "persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays".   If a person suffers from "general developmental delay" that will account for persistent deficits in social communication and social interaction across contexts and the person will not meet the mandatory Criterion A and will not  receive an autism spectrum diagnosis under the new DSM-5.

General developmental delays is a reference to the DSM-5 diagnostic category of Intellectual Developmental Disorder (IDD) which is described as including a current intellectual deficit and a deficit in adaptive functioning.  IDD is further described in two of the mandatory criteria for meeting and IDD diagnosis  as including deficits in general mental abilities. IDD mandatory criterion B refers expressly to impaired functioning in areas of daily life including communication and social participation.  An IDD diagnosis then would account for deficits in social communicaiton and social interaction and preclude an Autism Spectrum Disorder diagnosis under the DSM-5

 The exclusion of an autism diagnosis for persons who are generally developmentally delayed is a substantive change from the DSM-IV  which did not exclude an Autistic Disorder diagnosis in persons who suffered from  general developmental delay, intellectual disability or mental retardation:

The exclusion of persons with Intellectual Developmental Disorders from the New Autism Spectrum Disorder does have a precedent in the DSM-IV.  It is found in the DSM-IV's Asperger's Disorder which states in Criterion E that "there is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills".  And there it is "no cognitive development delay" from the DSM-IV Asperger's Disorder criteria becomes not accounted for by general developmental delay in the DSM-5's Autism Spectrum Disorder.   Asperger's becomes the New Autism in DSM-5 World.

Autism Speaks has long been aware of the APA intention to remove persons with intellectual disability from consideration for autism spectrum disorder diagnoses. Autism Speaks rarely mentions intellectual disability as an autism concern.   It has already been busy presenting Asperger's to the public as Autism  with the promotion of the careers and influence of John Elder Robison and Alex Plank.

Autism Speaks also helped fund the Korean "autism" prevalence study of Roy Richard Grinker who has been busy recasting Asperger's as autism and who went looking for "autism" amongst Korean students who functioned well in Korea's highly structured school environments.  No intellectually disabled were included amongst Grinker's findings of  large numbers of previously unknown autistics.  Of course Professor Grinker, the APA and "Autism Without Intellectual Disability Speaks" will have to readjust their autism prevalence numbers once the DSM-5 officially takes effect.  They will have to revise their autism rates downward to reflect the removal of persons with DSM-IV Autistic Disorder and intellectual disability from the DSM-5's Autism Spectrum Disorder.  Asperger's is the New Autism. 

High Intelligence Is Not a "Common Characteristic" of a Child with Autism

An article by Jennifer Luchesi Long at Carlsbad Patch makes the following statement about children with autism:

The following are some of the common characteristics of a child with autism:


Easy irritability with changes in routine and expectations.
Difficulty reading facial expressions.
Difficulty reading social cues and understanding social norms.
Poor eye contact.
Uncomfortable with affection, including any kind of physical touches.
Overstimulated by noises, smells and light.
Fixation on a certain subject, topic or idea.
Highly intelligent.


(Underlining added for emphasis)

No references are provided for the author's assertion that high intelligence is a common characteristic of children with autism. The claim that high intelligence is a "common characteristic" of autism is a misrepresentation of autism disorders which include Asperger's Disorder, PDD-NOS and Autistic Disorder.

Some persons with Asperger's Disorder are highly intelligent, others with Asperger's are of average intelligence.  By diagnostic definition there is no cognitive impairment in persons with Asperger's. There are also some persons with high functioning autism who are highly intelligent.

With respect to Autistic Disorder and  PDD-NOS the Canadian Psychological Association stated in a 2006 brief to a Canadian Senate committee that 80% of persons with these two autism spectrum disorders have intellectual disabilities.  That information is consistent with United States Centers for Disease Control and Prevention surveys which indicate that between 41 and 44% of persons on the entire spectrum have intellectual disabilities. These figures contradict the claim that high intelligence is a common characteristic of children with autism.

"Autism" has become, in the public mind, the autism of a few very high functioning persons with Asperger's and high functioning autism some of whom are prominent in the mainstream media.  The realities of those with severe autistic disorders are  increasingly obscured by these success stories. There are many low functioning autistic persons living in dependent care who do not have movies made about them, do not play in rock bands and run successful businesses, do not have families of their own and do not build careers as public speakers telling the public  what "autism" is. Some autistic children and adults do not understand the risks posed by daily life phenomenon such as automobile traffic or backyard swimming pools.

The romanticization of autism  impairs public understanding of this serious neurological disorder.

Autism and Intellectual Disability: More Denial, More Stigma, This Time In Alabama

In Children with Asperger's could lose diagnostic identity we see still more evidence, this time in Alabama,  of the stigma attached to the fact that the vast majority of persons with Autistic Disorder, unlike those with Aspergers Disorder diagnoses,  also have intellectual disabilities or cognitive impairments. Once again the story tells of concerns held by some that those with Aspergers will be stigmatized by being lumped in with those with Autistic Disorder in the DSM-5  New Autism Spectrum Disorder. In expressing these concerns the subjects interviewed contribute to the stigmatization of those with Intellectual Disability generally and specifically to the many persons with Autistic Disorder and Intellectual Disability:

"It's difficult to say where Asperger's ends and autism begins," Mulvihill said.


That difficulty - and the stigma attached to autism - is partly why some adults with Asperger's are not happy about the proposed change in the DSM, Crane said. While those individuals on the high-functioning end of the autism spectrum might show only slight symptoms, those on the other end of the spectrum are profoundly affected by the disorder.


Being classified as autistic can make it even more difficult for high-functioning individuals to develop relationships with their peers.


Crane said despite their various challenges, autistic children are highly intelligent.


"These kids are definitely the scientists of tomorrow," said Crane, who established the Riley Center after her son was diagnosed with autism. "They're brilliant. That's why early intervention is so important."

The comments by Crane of the Riley Center are a perfect example of the denial that is so prevalent in any public discussion of Autistic Disorder. The main difference between Autistic Disorder and Aspergers is in the area of intellectual disability.  By definition in the current version of the DSM-IV a person with "autism" criteria AND Intellectual Disability will be excluded from an Asperger's Disorder (DSM-IV, Diagnostic Criteria for Asperger's Disorder  299.80)  diagnosis (as set out on the CDC web site):

"E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

I have written frequently on the refusal of so many parents, professionals and persons with very high functioning autism disorders to acknowedge the high rates of intellectual disability in persons diagnosed with Autistic Disorder as that disorder is currently diagnosed in the DSM-IV.  The 2006 Canadian Psychological  Association brief to a Canadian Senate committee examining autism stated that:

"Symptoms and Impairments:

• Cognitive impairment is present in about 80% of persons diagnosed with Autism and general intellectual functioning is most often below average. Persons diagnosed with Asperger’s Disorder have average to above average intellectual functioning."

The CPA figures with respect to Autism (Autistic Disorder) appear consistent with the CDC figures with respect to the entire autism spectrum:

"Data show a similar proportion of children with an ASD also had signs of intellectual disability than in the past, averaging 44% in 2004 and 41% in 2006."

The 41-44% figure for the entire spectrum includes those with Aspergers diagnoses who, by definition, do not have intellectual disabilities or cognitive impairment.  They are also approximate the numbers provided set out in the ICD-10 for persons with respect to Childhood Autism F84.0:

"F84.0 Childhood Autism

A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder occurs in boys three to four times more often than in girls. 
...
All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases."(Bold highlighting added - HLD) 

These figures contradict the denial of intellectual disability inherent in Crane's generalizations that "autistic children are highly intelligent", "these children are definitely the scientists of tomorrow"and "they're brilliant".  Such statements deny the reality of the close association between Autistic Disorder and intellectual disability and are clearly reflections of the stigma attached ... not to autism per se ... but to intellectual disability.  It is the connection between autism and intellectual disability that creates concern for many with Asperger's Disorder about merging Asperger's and autism in the DSM-5.  It is that frequently expressed and highly publicized concern that contributes to the stigmatization of those many persons with Autistic Disorder and Intellectual Disabilities. 

The US National Institute of  Mental Health states with respect to Autism Spectrum Disorders in the section  titled Problems That May Accompany ASD:

"Mental retardation. Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language subtests."

What is interesting about the NIMH comment is that it ties mental impairment to language disabilities, another area that distinguishes Autistic Disorder from Asperger's Disorder in the DSM-IV.  It is a relationship that is glossed over by those who wish to disavow the obvious relationship between autism and intellectual disability.  By contrast an Italian study, published in the Journal of Intellectual Disability Research has expressly underlined the relationship between autism and intellectual disability:

Abstract

BACKGROUND: In 1994, the American Association on Mental Retardation with the DSM-IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD-10. Prevalence of PDD in the general population is 0.1-0.15% according to the DSM-IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments.

METHOD: Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) seems to be a very good instrument for classifying and diagnosing PDD.

RESULTS: The application of the PDD-MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%.

CONCLUSIONS: The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID. (bold highlighting added -HLD)

The denial of the Intellectual Disability connection to autism, as in Autistic Disorder, will be completed in the DSM-5 and will result in further stigmatization of those with Autism and Intellectual Disability.  It will also contribute to the trend to conduct "autism" research excluding persons with autism and intellectual disability the "vast majority" of those with autism as it is currently defined. The study reports in these cases tend to generalize their findings to the entire autism spectrum of disorders despite the exclusion of intellectually disabled autistic subjects.  The informed, mature  and enlightened approach of studying the connection between autism and intellectual disability suggested by the authors of the Italian study will never see the light of day.

The intellectual disabilities of so many with autism, and the very serious challenges they face,  will simply be ignored for fear of stigmatization. The Alabama example is only one of many examples of such stigmatization. 

There will be more.

What Autism Spectrum? Research in Autism Spectrum Disorders Has Often Excluded Children with Severe to Profound Intellectual Disabilities

 The recent "autism" brain scan study from the UK is a notorious example of an alarming reality in the world of autism research - the severely autistic are excluded from autism research. In that study autistic persons with intellectual disabilities were intentionally excluded and 16 of the 20 participants in the study actually had Aspergers diagnoses. The study press releases should have more accurately hyped the potential of the brain scan process involved to assist in diagnosing Aspergers. Of course that distinction will be moot once the DSM5 reduces the Pervasive Developmental Disorders to one Autism Disorder, expands the number of very high functioning persons who will be considered "on the spectrum" and removes those with Autistic Disorder and Intellectual Disabilities from the "spectrum".

The efforts of the DSM5 committees to remove intellectual disability from Autistic Disorder are assisted by studies like the brain scan study which already exclude the vast majority of persons with Autistic Disorder who also have intellectual disabilities.   That study is far from unique as indicated in the comments of well known autism researcher and DSM5 panel  member Catherine Lord Ph.D. in Social Policy Report, Autism Spectrum Disorders Diagnosis, Prevalence, and Services for Children and Families:

"Variability, at least in terms of IQ and ASD symptoms, has not been as significant a factor when comparing across research-recruited samples. Numerous studies have combined samples from different research labs where distributions were very similar. However, research in ASD has tended to use overwhelmingly White, middle to upper middle class samples, and has often excluded children with multiple disabilities and/or severe to profound intellectual disabilities". [underlining added -HLD]


Aspergers Disorder will become the New Autism Spectrum Disorder in the DSM5 which will emphasize social and communication deficits but will do away with the implicit references to intellectual disability in the current DSM. The vast majority of those with Autistic Disorder today, the 75-80 % of those with Autistic Disorder who also have intellectual disabilities will, as in the research studies which have led to the New Autism Spectrum Disorder in the DSM5, simply be excluded.

It's OK, It's Politically Correct to Stigmatize Persons on Intellectual Disabled, Low Functioning End of the Autism Spectrum

"The stigma of autism is fading fast. One reason is that we now understand that autism is a spectrum with an enormous range. Some people with autism are nonverbal with profound cognitive disabilities, while others are accomplished professionals.

...

People who now have a diagnosis of Asperger’s can be just as socially impaired as those with autism. So Asperger’s should not be a synonym for “high functioning.” Likewise, people with autism who are described as “low functioning,” including those without language, can have the kinds of intelligence and hidden abilities that are associated with Asperger’s — in art, music and engineering, for example — and can communicate if given assistance.

...

We no longer need Asperger’s disorder to reduce stigma. And my daughter does not need the term Asperger’s to bolster her self-esteem. Just last week, she introduced herself to a new teacher in her high school health class. “My name is Isabel,” she said, “and my strength is that I have autism.”

NYT Times Op-Ed, Disorder out of Chaos,  February 9, 2010, Roy Richard Grinker, Anthropologist,  father of a daughter with Asperger's

The stigma of autism is fading fast for those with Aspergers disorder who, by definiton, do not have intellectual disabilities, and who can be quite successful in many fields of endeavor.  The original stigma against those with autism who are intellectually disabled continues and is in fact promoted by people like Professor Grinker who essentially argue that persons with Aspergers should not feel stigmatized by inclusion in the autistic disorder category in the DSM 5 because we know that people with autism are really quite intelligent.  The stigma feared by those with Aspergers who express concern, and spokespersons like Grinker,  is clearly the stigma of being associated with the intellectually disabled.   

The NYT and Professor Grinker do not urge anyone to refrain from such fears  on the basis  that there is nothing wrong with being placed in a disorder category with persons with intellectual disabilities.   Instead,  in 2010 they try to imply that persons with autism disorders don't really have intellectual disabilities at all.  This is a falsehood, perpetuated by successive revisions of the DSM including the DSM 5.  In 2010 it is OK, it is in fact politically correct to stigmatize the intellectually disabled members of the autism spectrum in order to make some persons with Aspergers feel comfortable about formal inclusion in the autistic disorder category.

Professor Roy Richard Grinker, and the New York Times which gave him their podium, assert that autism disorders are disorders only in the sense that persons carrying an autism disorder diagnosis are socially awkward.  They make light of the very harsh realities faced by persons with severe, low functioning autistic disorder diagnoses.  While Professor Grinker,  with a high functioning, intelligent, if socially awkward daughter, feels comfortable in assuring us that "people with autism who are described as “low functioning,” including those without language, can have the kinds of intelligence and hidden abilities that are associated with Asperger’s"this father of an intellectually disabled, low functioning 14 year old boy with severe Autistic Disorder does not buy what the Professor is selling.  Professor Grinker's opinion, rosy at it is, informed as it is by his high functioning daughter's Asperger's Disorder, is not substantiated by professional literature or anecdotal evidence concerning Autistic Disorder.

I  know first hand the realities of living with, raising and caring for a severely autistic child, now well into adolescence.  As an advocate I have represented parents of severely autistic children trying to cope with the realities of severely autistic children while the good professors and others who promote autism as a strength prattle on with their powerful media megaphones like the NYT in hand.  As an advocate here in New Brunswick, Canada I have visited with severely autistic persons living in psychiatric hospital facilities.  The good Professor's rose colored,  Autism as Asperger's, glasses obscure his understanding of the harsher realities faced by the severely autistic to the detriment of those most severely affected by autism who need society to understand those realities before their lives can be changed for the better.

The Professor apparently doesn't follow news of autism as closely as he follows news of Aspergers.  If he did he would know of people like  Keith Kennedy lost in mid-west woods for a week, James Delorey who wandered off to his ultimate demise in a Nova Scotia snow storm, the child who died in a neighborhood pool recently,  the young man arrested by police at a  hospital that refused him admittance because of his autistic behavior  who informed the arresting officer that he was a good boy,  and those who are lost in local traffic . Or he might know of those severely autistic children like my son Conor who was fortunate to survive a busy neighborhood street because a truly good Samaritan stopped his vehicle before traffic stopped my son's life and took him to a local convenience store where I was able to locate him, whole and healthy with chips and candies in hand,  after calling 911.  

If the good Professor knew the realities of severe autism disorders he would know of the middle aged woman living in a New York residential facility who was  repeatedly, severely and physically abused by staff until caught on camera and saved by a conscientious staffer.  The  abuse had gone of for some time but the woman, severely autistic, was unable to communicate her situation to the facility and may not have known she could do so.  

The myth that even non-verbal autistic persons have Aspergers like intelligence is promoted in stark defiance of the professional studies done to date.  The Canadian Psychological Association, which embodies in its membership at least as much knowledge of the autism spectrum as that which can be attributed to Anthropology Professor Grinker,  stated in its 2006 Canadian Senate submission that ""Cognitive impairment is present in about 80% of persons diagnosed with Autism and general intellectual functioning is most often below average"  The  CPA figures, which expressly included only autism and excluded  Aspergers from the 80% figure,  mirror very closely two successive surveys conducted by the CDC in the US.  CDC  Autism and Developmental Disabilities Monitoring (ADDM) Network gathered data in  2004 and 2006  that indicated between 41 and 44% of persons on the autism spectrum (including persons with Aspergers who, by definition are not intellectually disabled or cognitively impaired) also suffered from intellectual disability.

Professor Grinker, proud father of a daughter with Aspergers,   does not mind reassuring people with Aspergers that their inclusion in the DSM 5's autistic disorder category will not result in their stigmatization by association with intellectually disabled persons with autistic disorder.  This proud father of an intellectually disabled son with autistic disorder does mind.  I mind very much and I strenuously object to this  stigmatization of intellectually disabled autistic persons like my son.  For me, such stigmatization is not politically correct.  It is offensive and  unacceptable.  

Obama Disability Nominee Ne'eman Says Curing Autism Disorders is Morally Reprehensible

The Autism Action Network has called for its American readers to contact their Senators to voice their opposition to US President Obama's disability council nominee Ari Ne'eman. I wish them success although from what I understand the nomination is unlikely to be disturbed.  This Canadian father of a severely autistic son  is very disappointed that Mr. Ne'eman will ultimately be approved and will be in a position to influence autism policies in the US and consequently around the world.  

I have followed with great interest the US Health Care debate and President Obama's historic struggle to bring health care to all Americans.  I am perplexed that the great US health care president would, at the same time, appoint  to an important disability council  a very high functioning person with Aspergers who does not believe that autism is a medical disability or disorder and  is opposed to curing autism spectrum disorders.  

Mr. Ari Ne'eman does not view autism disorders as disorders in a medical sense  notwithstanding his own medical diagnosis of Aspergers Disorder.  Nor does he restrict himself to  rejecting a cure for himself, or for other very high functioning persons with Aspergers Disorder.  He tells the world that all autistic persons do not want to be cured.  

The Autism Action Network has gathered a number of Mr. Ne'eman's more outrageous and offensive statements:

"June 10, 2008 on Good Morning America, Neeman said, "We do not think to aim for a cure is the right approach to take."

 

December 10, 2009 interview with the CBC, "Autism is currently viewed as a disease of the medical model---Something to be cured or eliminated. That doesn't reflect how we view ourselves, that doesn't reflect our realities."

 

In his essay Equality Demands Responsibility, 2006, Ne'eman wrote, "But if we are to demand equal legitimacy, if we are to assert that a 'cure' is not only unnecessary and undesirable but morally reprehensible, then we must accept for ourselves equal responsibilities.""

This very high functioning gentleman does not seem troubled by his Aspergers disorder but there are many low functioning persons with severe Autistic Disorder who do suffer. Some never survive to the age of 12, the age at which Mr. Ne'eman apparently received his Aspergers diagnosis. Some are lost forever in local traffic, neighborhood pools or snow storms. Some require intensive therapy to prevent dangerous self injurious behavior.  Some live their lives in institutional and residential facilities  dependent on the care of strangers.  The young university student with  a very mild variety of Aspergers disorder opposes curing those with more severe, restrictive types of autistic disorders and purports, with no common experience and no legitimacy,  to speak on their behalf.

Mr. Ne'eman speaks about "our" views, "our" realities, how "we" view "ourselves".  My son has an Autistic Disorder diagnosis, assessed with profound developmental delays. He is severely autistic.  Mr. Ne'eman the high functioning young university student with Aspergers, and the abilities to interact regularly with the New Yorker magazine, the NYT and Canada's CBC AND negotiate socially in Washington DC political circles  does not know how my son thinks or views himself. Mr. Ne'eman does not have any knowledge whatsoever of my severely autistic son's realities.  When he claims to speak on behalf of all persons with Autism Spectrum Disorders he is misrepresenting himself, and autism disorders, to the world.

Personally, I find Mr. Ne'eman's opposition to curing the autism disorders that afflict so many children and adults to be morally reprehensible and I am very disappointed in US President Obama for appointing him to a position from which he can influence the lives of so many persons with autism disorders.

Removing Severely Autistic from the Autism Spectrum

The DSM 5 promotes the stigmatization of low functioning persons with autism disorders by excluding any reference to cognitive  or intellectual disabilities in its description of  the new categories of autism spectrum disorders.  The mainstream media has long ensured that such stigmatization prospers in the popular culture by focusing on stories of great feats by some persons with Aspergers and Autism while steadfastly ignoring the plight of the severely autistic persons living in institutional care.  In a similar vein every protest by even a handful of persons with  Aspergers and High Functioning Autism,  of "negative" depictions of autism, depictions of the realities of life faced by the severely autistic, is promoted as enlightened self advocacy by a largely autism ignorant mainstream media.

The mainstream media continues its obsession with high functioning autism and Aspergers  in discussing the autism changes in the DSM 5 with article after article about how the changes will affect those with Aspergers.  Some of that attention to the potential impact  on persons with Aspergers is certainly warranted but not to the point of refusing to  consider the impact of the DSM 5 changes on those at the severely affected, low functioning,  end of the autism spectrum, those with Autistic Disorder and Intellectual Disabilities.  

The fact that between 75 and 80% of persons with  autistic disorder, as it is currently called, the category comprised of the original pre-1994 DSM change  "autistics", also have intellectual disabilities is hidden completely  from sight in the DSM 5.   One of the signposts of stigmatization is when it is not considered polite to mention some persons or topics in polite company and the DSM 5 has ensured that the stigmatization of persons with autistic disorder and intellectual disability will continue.  

The DSM 5 pretends that ASD and ID  are unrelated, that delay or inability in understanding language is not itself  indicative of a cognitive or intellectual deficit, and  by pretending that the 75-80% of persons with cognitive disorders AND assessed  intellectual disabilities is just an amazing coincidence, one not needing discussion; one not needing  mention in the diagnostic  manuals used by psychiatrists, psychologists and general practitioners.  It is only a matter of time until persons with Autism Disorders and Intellectual Disabilities are officially excluded from the Autism Spectrum of Disorders category of the DSM.

The mainstream media has responded to the proposed changes by obsessing over the impact on those with Aspergers and, with few exceptions, ignoring the impact of the changes on the lower functioning persons with autism, those with intellectual and cognitive deficits.  The headline of one an AP article (which is one of the more balanced articles on the autism changes) highlights the media focus in reporting DSM 5 autism changes:

Proposed autism diagnosis changes anger "Aspies"

This humble blogger, and father of a 14 year old son with Autistic Disorder and profound developmental delays,  was interviewed and quoted by Lindsey Tanner  in the above noted AP article.  I appreciate her effort to provide some balance to the discussion but even that article, as the headline indicates, is focused primarily on the impact on "Aspies" of the DSM 5 autism changes.  Few other media articles showed that much balance. Not a single article focused on what  impact the changes would have on those most severely affected by autism disorders.  

Both the DSM 5 and the mainstream media have adopted a perverse triage system when it comes to discussing autism disorders. The highest priority is given to examining the impact of  official diagnostic labels and criteria on those least impaired by autism disorders first and foremost and examine the impact on those most affected later ... if ever.

The DSM has, in the DSM IV and DSM 5, been changed to expand the definition of autism to include those with Aspergers, those at the high functioning end of the autism spectrum of disorders.  Some at the high functioning end do not consider their condition to be a medical disorder even though they embrace medical terms like Autism and Aspergers. Meanwhile the original autistic persons of the DSM III are increasingly stigmatized, rendered invisible by failure to mention the most salient and disabling features of their disorders ... their intellectual disabilities and cognitive impairments.  The stigmatization of intellectual disabled, low functioning autistic persons is clearly illustrated in the Lindsay Tanner/AP article;

Liane Holliday Willey, a Michigan author and self-described Aspie whose daughter also has Asperger's, fears Asperger's kids will be stigmatized by the autism label — or will go undiagnosed and get no services at all.   Grouping Aspies with people "who have language delays, need more self-care and have lower IQs, how in the world are we going to rise to what we can do?" Willey said.

The expansion of autism in the DSM IV and DSM 5 to include more and more persons barely impacted by autism will result in more identifcation of autism with giftedness in the public mind and the severely affected will be even more completely removed from public discussions of autism. It is only a matter of time until those with autism and intellectual disability are officially removed from the autism spectrum completely.  It will probably happen officially  in the DSM 6 but it is already well under way. 

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Parents Stand by Son with Aspergers Convicted of Conspiring to Murder Them

The Independent UK reports that the parents of Christopher Monks, a 25 year old man with Aspergers Disorder who plotted with an internet friend to kill them stood by their son on sentencing and asked the court to show leniency.

The internet "friend" returned to the Skarnes home after visiting earlier in the day and attacked the parents who fended him off when he attempted to attack the father in his bedroom with a large kitchen knife.

""The pair were convicted despite the fact that Monks’s father, also Christopher, and his wife Elizabeth have fully supported their son, who was adopted at the age of 10 months. They argued that his condition meant he was unable to separate fantasy from reality and that he had never intended to have them murdered.

.......

Sentencing the pair at Preston Crown Court, Mr Justice McCombe said he felt for Monks’s parents. “No court could fail to be moved by the unstinting love they have for their son,” he said. “In their own words in a letter sent to me they say ‘Whatever sentence is passed, we will serve it with him’.”

But he added both men continued to present a “significant” risk of harm to the public. “I recognise that Mr and Mrs Monks find this difficult to accept but the court has a duty to protect the public and ensure that they are not released into the community until that risk is eliminated.”"

The article illustrates just how much many parents of children with Autism Spectrum Disorders love their children no matter how severe the challenges they present.

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Autism Reality On The Last Day of the Decade:The Autism Spectrum Concept Has Been Harmful, Part I

On this last day of this decade, as we prepare for 2010, and all that the next decade will bring,  it has become apparent that a major autism development of the last decade has been the growth of the Autism Spectrum concept.

The growth of  the Autism Spectrum concept has caused considerable harm to the interests of many persons severely affected by  Autistic Disorder, especially the 75-80% of persons with Autistic Disorder who are intellectually disabled or cognitively impaired. For these severely autistic their life realities are obscured and even hidden by the Autism Spectrum and by some high functioning, high profile media attractive persons who define autism in the public mind.

The Autism Spectrum concept has created confusion  about what constitutes "autism".  Some members of the public, talk show hosts, and  comics, joke about autistic persons as spoiled children who would have been given a good spanking back when they were kids. These people obviously do not see the children with Autistic Disorder who bite themselves, chew the insides of their cheeks, bang their heads until they cause injury, starve themselves out of aversion to food tastes and textures or wander away from their homes, some to be lost forever.  They see some very high functioning persons with no readily apparent disabilities who are "on the autism spectrum".

Yes, the mainstream media publishes reports when an autistic child or severely impaired adult goes missing. When an autistic Nove Scotia boy disappeared before a snow storm, and died of hypothermia, the media and Canadians reacted with genuine compassion and feeling for the poor boy and his family. But even then there was little in depth coverage of how many autistic children, and adults, go missing or the steps that have to be taken to ensure that others do not. Even the tragic death of  the young Nova Scotia boy did not prompt the mainstream media to thoroughly explore the harsher realities of autism disorders.

By contrast the media has been obsessed with promoting images of very intelligent, high functioning persons "on the spectrum" as the expression is used today.  CBC has many times featured Michelle Dawson, a person with "autism",  who excelled in the  challenging work environment of Canada Post and is now an autism researcher. CNN on several occasions featured  Amanda Baggs, a  very intelligent person who did not have an autism diagnosis earlier in life and who attended a school for intelligent,  gifted youth.

Today Alex Plank and Ari Ne'eman are the newer faces of  the "autism spectrum", two very intelligent young University students with Aspergers Disorder who tell the world what it is like to be Autistic, who take it upon themselves to tell the world that Autistic People do not want to be cured.   Mr. Ne'eman is an obviously intelligent gentleman with very highly developed communication and organizational skills.  He functions and operates very well in the complex world of Washington politics  and communicates regularly with the most influential media institutions in the world.  To the general public, and to the mainstream media,  Dawson, Baggs, Plank and Ne'eman are what they see when they close their eyes and visualize what it is like to be  "autistic".

It is no wonder that sufficient funds are not made available to support autism research, to find causes of, and cures for,  autism disorders.  The public  does not see the harsher realities of autism. They do not see lengthy, repetitive  features about the life of individual autistic persons with Intellectual Disability or autistic adults living in institutional care. The public sees a very positive image of autism, the one at the very highest end of the "autism spectrum".  As a general rule that is all that they see.

It is not an image that would necessarily generate much funding to find cures for autism disorders.  Especially when the media savvy persons at the high functioning end of the "autism spectrum",  tell the world that WE, referring to people "on the autism spectrum", including those with Autistic Disorder and  cognitive impairment, including those autistic adults living in the care of others,  do not want to be cured.

Without the "autism spectrum" concept, widely used today, a person with mild Aspergers would not be able, with a straight face,  to claim to speak on behalf of the severely disabled autistic persons whose harsher impairments, he or she,  does not share, and whose lives bear little resemblance to their own. The "autism spectrum" concept may have some useful diagnostic purposes, but it has also caused harm. It has helped keep the realities of the severely autistic, the 75-80% of persons with Autistic Disorder who are also intellectually disabled, the autistic children who hurt themselves, the adults living in institutional care, out of sight and mind.

There is a natural media, and human, tendency to want to see things in a positive light.  The media loves the high functioning end of the "autism spectrum" and ignores the harsher realities at the low functioning end of that same spectrum.  The autism spectrum concept itself allows them to do so with a clear journalistic conscience.

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Autism Reality NB Reviews Alex Plank's "Autism" Reality Video

Alex Plank a young man with an Asperger's diagnosis, apparently a very, very mild version of Aspergers, has produced a video called "Autism Reality". The video can be accessed at Static Vox.

In the video, posted on a Facebook thread started by Lisa Jo Rudy on which I participated, Mr. Plank mentions the autism spectrum a few times. And he includes interviews of some nice young people agreeing with Mr. Plank that autism is a "good" thing.

I offered the following video review on the FB discussion thread:

"Autism Reality Alex?

With respect, the autistic children like the boy who died recently in Nova Scotia, like my son who went missing, walking through dangerous traffic, the many who are never found safe might disagree. The autistic children who injure themselves with dangerous head banging, severe biting, chewing on their cheeks or starving themselves because of extreme taste and food texture aversions might disagree. The non verbal autistics living in institutional care might have a different perspective. I am glad though that you paid lip service to the concept of a spectrum of autism in your production. And I hope you, Ms Chew and Ms Rudy don't mind me mentioning some of these other autism realities.

Other than that it is a nice video, lots of good communication, good social interaction, lots of high functioning skills like driving, attending busy, crowded events, good video production skills and no behavior challenges. And of course there are no cognitive impairment issues. Good idea not to confuse the viewing public with that whole "comorbidity" thing.

Two suggestions if you ever edit the video though. One, maybe you could mention the fact that the autism spectrum refers to a spectrum of "disorders". Two, maybe you could add the dates that Einstein and Van Gogh received their autism diagnoses.

Harold Doherty

AutismRealityNB

PS. I like the "autism reality" bit"

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Autism Priorities and the DSM V: Media Ignores Invisible, Severely Autistic in DSM V Discussions

The invisible autistics, the severely autistic, those with Autistic Disorder, profound developmental delays, cognitive and intellectual deficits, those who can not live independently, who live on hospital wards and in large, antiquated psychiatric institutions do not make regular appearances in the New York Times and its junior Canadian cousin the Globe and Mail. Nor do they appear regularly on the various CBC television and radio shows that have fawned over Michelle Dawson, Amanda Baggs and more recently Ari Ne'eman.

In the big, mainstream media discussions, and opinions about the proposed changes to the developmental disorders section in the DSM V nothing has changed. Ari Ne'eman and other barely autistic, very high functioning persons with Asperger's Disorder continue to receive all the considered attention of the big media while the severely autistic remain, as always, invisible. There is scant mention in any of the mainstream media commentaries of those whose lives are most severely restricted by autism disorders. The Globe and Mail breathes hot air about "a culturally rich autism" while ignoring those severely autistic persons living in institutional care throughout Canada.

Plus ça change, plus c'est la même chose

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Redefining Autism: Should the Autism "Spectrum" Concept be Abandoned?

Should the concept of an autism "spectrum" of disorders be abandoned?

The DSM III originally included strict criteria for Kanner's infantile autism. These strict criteria were relaxed in the DSM III-R which "broadened the concept of autism to include children who, although socially impaired, are not pervasively unresponsive to others(1)". Another huge expansion took place with the DSM IV inclusion of Asperger Disorder in the Pervasive Development Disorders category: "Asperger Disorder is characterized by the same types of social impairments seen in autism plus the development of very bizarre intense interests such as bus timetables, insects, meteorology, cartography, etc. It is distinguished from autism by the presence of normal cognitive development and the absence of clinically significant language delay. In other words, children with Asperger Disorder have normal IQ and usually are speaking in phrases by three years of age.(2)"

The PDD's have in common usage become referred to as Autism Spectrum Disorders and from there it has become common to refer to all forms of PDD's as "Autism". The expansion of the autism "spectrum" has been cited each time an increase in rates of autism diagnoses is reported. When my son was initially diagnosed in 1998 the figure of 1 in 500 persons having "autism" was commonly cited, then 1 in 250, 1 in 166, then 1 in 150 and soon the CDC is expected to fall in line with the UK figure of 1 in 100. Each time the estimate changes the expansion of the criteria for defining "autism" is trotted out to argue against the existence of a real increase in autism.

The expansion of the diagnostic criteria of "autism" disorders have become a useful tool for public health officials who wish to maintain the position that autism is entirely genetic, that there are no environmental causes and especially that autism can not be triggered by vaccines. It helps in justifying the enormous disparity in funding genetic autism research compared to environmental autism research. In 1999 Teresa Binstock reported the "it's gotta be genetic" paradigm of autism research funding. Ten years later Irva Hertz-Picciotto states that the discrepancy is still between 10 or 20 to 1 in favor of genetic over environmental autism research funding. The expanded definition explanation has been used, used again, and again in justifying the argument that there is no real increase in autism increase, that autism is entirely genetic.

The expanded definition of autism to include High Functioning Autism cases and Asperger Disorder creates confusion in the public mind over what constitutes autism and leads to conflict amongst persons affected by "autism". To many members of the public an autistic person is someone like Michelle Dawson, a former Canada Post postal worker who excelled in a very complex work environment, went on to become a researcher, appear before the highest court in Canada, before Human Rights Tribunals and in countless media interviews. They do not see the autistic person who can not speak OR communicate with assistive technology. The public does not see the persons with Autistic Disorder living their lives in institutional care.

Persons with Asperger and HFA often react to what they call negative depictions of autism which they no longer consider to be a medical disorder, equating autism with left handedness or homosexuality as differences not disorders. The recent anger amongst persons with HFA and Asperger Disorder over the "I Am Autism" video is directed at the depiction of some of the harsh realities that often accompany Autistic Disorder. These people do not want to be associated with intellectual deficits, serious behavioral issues or serious family or societal expense. It hurts and offends some with HFA and Aspergers to be compared to people with severe Autistic Disorder, people like my son.

The "spectrum" concept that helps create confusion also helps create some confusion in autism research. Researcher Dr. Laurent Mottron works almost exclusively with HFA/Asperger subjects and his research often been aimed at demonstrating the innate abilities of persons with HFA/Asperger Disorder. Historically Dr. Mottron was conscientious about pointing out that his subjects were persons with HFA/Asperger Disorder as opposed to persons with Low Functioning severe Autistic Disorder. Some recent studies have not made that distinction clear and his studies are also interpreted by many as applying to "autism" generally. It is difficult to compare autism studies or data over extended periods of time because of the different ways in which autism is referred to in the research literature with some making clear distinctions between low functioning Autistic Disorder and those with HFA or Aspergers while others simply refer to Autism.

One of the most bizarre consequences of the expanded definition of autism in the DSM-III R and DSM-IV is the attempt by some persons with Asperger Disorder to extinguish the right and responsibility of parents to speak on behalf of their autistic children or to seek treatment and cure for their children. The "Autism" Self Advocacy Network is led by Ari Ne'eman a very high functioning person with Asperger Disorder whose disorder would not have been included in the "autism" spectrum in the DSM-III or the DSM-III-R.

Why Mr. Ne'eman and his followers are not content to call themselves the Asperger Self Advocacy Network is not clear. Why this very high functioning person with Asperger Disorder feels that it is legitimate for him to speak on behalf of all persons with Autism Disorders of any type and declare that they do not want to be cured is not clear. Why he, and his followers, feel it necessary to lobby against any negative depiction of autism is not clear. Why he, and his followers, feel that they have the right to dictate to parents that they should not seek to treat or cure their own children of a severe neurological disorder is not clear.

What is clear is that the Pervasive Development Disorder category of the DSM has morphed into the Autism Spectrum and from there to "autism" and this has not been helpful.

Maybe it is time to abandon the Autism "Spectrum" and establish two separate categories with Autistic Disorder comprising classic autism while HFA and Aspergers Disorder are placed together in one category .... Aspergers Disorder.

Or perhaps a better solution to the Autism Spectrum confusion would be to abandon the spectrum concept altogether by removing HFA and Asperger Disorder from the DSM leaving only Autistic Disorder as a category for those with severe or low functioning autism. Many persons with HFA and Aspergers argue that they do not have a medical disorder at all. Maybe it is time to acknowledge their arguments, remove Asperger Disorder from the DSM, and go back to the DSM III criteria for Infantile Autism or Autistic Disorder.

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