In reading articles on the fact that Asperger’s syndrome and autism will be merged into autism spectrum from mild to severe in DSM5 very little is said about why this is happening.
Two reasons I’ve seen are being more scientific, and trying to apparently jettison AS because it is felt it is overdiagnosed and has too much stigma as a bullshit diagnosis and is no longer taken seriously.
This seems like a bad idea for two reasons, one which is not everyone is a trained mental health professional up to date on modern theory, and another which is that the treatment needs of autism and AS are very different.
Sure but there are other conditions you could say the same thing about.
It seems very much like trying to lump transexuals and cross dressers under one definition, inevitably when you say oh John? He is XXXX people will then ask but do you mean he considers himself to be a woman or enjoys dressing as a woman?
Autism has a distinct meaning to the lay person, I predict a bumpy process in trying to change that.
I didn’t I said definition, a definition that requires an instant followup question for clarity is silly. Even worse when you are trying to alter existing definitions that make much more sense.
But it sounds silly, unless the intention really is to say some milder AS cases should not be diagnosed at all under the new scheme. And won’t some other or obscure diagnosis just become the new AS? They seem to be trying to fix incompetence at the wrong part.
No, honestly, you won’t. You can be a very high functioning autistic person but not have the defining characteristics of Asperger’s. I know some of both. The Aspies are always extremely intelligent, but lack social nuances, coming off as very cold and logical. One AFA I know was practically the exact opposite: very warm, but almost seemed mentally handicapped.
The thing is…Asperger’s IS related to autism, but it’s not autism per se.
Exactly like the way a learnign disabilty is related to mental disabilty, but it’s not mental disabilty per se.
I do think there’s a difference between high functioning autism vs Asperger’s. Aspies seem to be extreme nerds…and again Aspergers syndrome seems to occur on a spectrum as well.
Like I knew a kid who had HFA…He wasn’t just an extreme nerd…he was IMPAIRED…He could talk and carry on a conversation, but his preoccupations were really weird…his favorite topic was the strechiness of the skin on his arms. You’d see him walking around campus poking at his arms. He would follow girls around campus and once walked in on his RA when she was changing. I remember one time he was carryign on a conversation with a comedian while he was doing his spiel, and Stretch had NO idea he wasn’t supposed to do somethign liek that. I had a friend who attended a school for the blind. Most blind schools cater to kids with multiple issues, so they serve some pretty odd kids…My friend said that Stretch made THOSE kids look NORMAL!
IMO, it’s because Autism is such a wide-ranging “bucket” that it can be stretched to encompass Aspergers with barely a pause, and since the diagnoses are right next door anyway, it makes sense to stick them together. The alternative would be to carve up every different way of having Autism into it’s own little Aspergers-sized chunk, and we really know nowhere near enough about the underlying causes of the different types of Autism to do that.
As an example - for about 6 months this year there were two kids with Autism diagnoses in my son’s preschool class, him and another little boy (J). Daniel didn’t speak more than a word at a time until he started speech therapy just before 3 - J had a wide-ranging vocabulary from an early age. Daniel would glom on to an activity and repeat,repeat,repeat until he was pried away with difficulty - J would wander round the room touching each activity for a few seconds and not being engaged by anything. J would repeat phrases insistently and LOUDLY - Daniel would freeze and go quiet. In many ways, they were the opposite of each other - but they both had the same diagnosis. Put all their impairments side by side and you could easily construct a diagnosis of Aspergers rather than Autism simply by picking some from column A some from column B.
In that context, having one particular pattern of Autism Spectrum impairments labelled “Aspergers” and everything else “Autism” (or “PDD-NOS” which I think is going away too) makes no more sense than, say, dividing Asia into “Thailand” and “Everywhere Else In Asia”. All the elements of an Aspergers diagnosis could be used to support an Autism diagnosis if they were in a slightly different pattern, and you can have “Autism” and be no more impaired than someone else with “Aspergers”. It’s really a historical quirk that Aspergers still has its own diagnosis, because that particular pattern of impairments happened to be studied quite early on in the study of Autism Spectrum disorders
Clearly, however, the psychiatric profession disagrees with you and agrees with Farmer Jane. They have concluded that the diagnoses should be merged. Are you better informed about these conditions than the people who have spent their careers dealing with people who suffer from them?
The debate between the “lumpers” and the “splitters” has raged throughout the history of the DSM and all its versions since autism was first included in DSM-III and even preceding it.
If one considers the key deficits for the phenotype that gets grouped as autism to be the combination of impairments in social interactions, impairments in communication, and narrow repetitive patterns of behavior, then a spectrum of conditions fits in that group the differences between which can be somewhat arbitrary. That certainly was the perspective of the person who, in the 90s, drove the use of the term Asperger Syndrome to describe a group of her patients similar to Asperger’s initial series that few had ever heard about, and proposed that there was a spectrum of autism that included several different subtypes - Lorna Wing. (see pg 115) The concept was that classic autism and Asperger Syndrome are both within a continuum of social impairments with different profiles of cognitive and language development. She noted that the impairments formed clusters that blended a bit, and proposed that dividing the spectrum according to the nature of the social impairment: “aloof”; “passive”; “active but odd”; and “loners.” The debate has been ongoing since with concerns expressed that lumping the spectrum together implies a stronger connection between different phenotypes than may be justified and concerns that the spectrum concept results in excessive labeling of social skill atypia as “autistic spectrum.”
The splitters won out in DSM-IV (and the ICD-10) trying to distinguish Asperger Syndrome from the Pervasive Developmental Delays (PDD) group that they put autism within with what many clinicians and other academics felt were arbitrary distinctions; DSM-V is the lumpers fight back.
What gets called “high functioning autism” and Asperger Syndrome are different only in terms of language development. (And many, if not most, with Asperger Syndrome have some subtle language difficulty as well, with language pragmatics, perhaps a tendency to speak in an"overly formal" way, and atypical prosody. ) High intelligence is not a criteria for the Asperger diagnosis. The social skills deficits, the uneven cognitive skill set, the tendency to be better at memorization and the concrete than in mastery of abstract concepts, the preference for routine and sameness, even the combination of being hypersensitive to some stimuli and hyposensitive to others … all tend to be common between them.
Of course part of the problem is that the is no clear separation between autism and high functioning autism and Asperger Syndrome and socially odd but otherwise normal. Where does red become orange or pink or orange become yellow? If we have to call something either red or yellow we will have difficulty labeling amber and salmon in fully meaningful ways. And if labeling someone “red” gets services that “yellows” don’t, what do you think will happen with many shades of orange?
The labels are arbitrary boxes that we squeeze the variety of people into for our convenience. To the degree that a label provides an accurate short-hand that captures the key aspects of what we are talking about it aids communication and suggests approaches (educational approaches and social intervention ones). To the degree that a label gains access to services that are helpful that would otherwise be unavailable having a label is an advantage, one that some need and would flounder without. And deciding where to draw the line of who deserves those services is both arbitrary and difficult.
Some will. And some will not be diagnosed with anything and some will be diagnosed with other disorders which are a better fit… There may be a stigma to AS as a bullshit diagnosis , but its not nearly the stigma that other diagnoses have. I have no doubt that there are parents trying to get their children a diagnosis of AS or ADHD in order to get them accommodations in school who would never seek a diagnosis of autism or ODD even if it resulted in the same accommodations. It has nothing to do with AS itself- it’s just that along with any stigma as a bullshit diagnosis, there’s also a perception that a diagnosis of AS is practically confirmation of a genius level IQ and there are certain people who will do anything to gain an advantage or special treatment.
Look at these examples from the Job Accommodation Network website
Those accommodations might be necessary for a person diagnosed with AS, but they will certainly not be necessary for someone without a diagnosis who simply prefers to communicate in writing, or who simply has no initiative. I could see why those people might seek an AS diagnosis, but doubt they would seek an autism diagnosis.
Doesn’t that happen with many diseases? If you are diagnosed with Hodgkins Disease, you still have to clarify what stage and what kind. For example, stage 3B, nodular sclerosing. if you have lung cancer, what stage? Small cell or non-small cell?
And you make those labeling distinctions based on an understanding of the pathophysiology and/or prognosis and treatment implications. For Hodgkins we have that understanding and a clear separation between normal and the disease. We have neither at this point for autistic spectrum disorders.
But both groups do lack social nuances. If you consider where the ‘disorder’ part comes in, it’s that. Severely autistic children may lack outright empathy whereas an Aspie may just miss the obvious and may not be able to understand everyday social cues or emotions.
It’s not always so clear-cut. Look at Temple Grandin, who has autism but functions more like someone with Aspberger’s.
I really don’t think it matters much if the disorders are put in the same over-reaching category, since they were both Pervasive Developmental Disorders, anyway. And Aspberger’s is quite over-diagnosed imho. Or maybe it’s just the internet, where anyone with a keyboard and a search engine can declare his odd personality that of an Aspie.
I don’t know what AFA is.
edit: I am more concerned that autism gets all the play in the DSM but isn’t treated for what it really seems to be: a debilitating multi-system overload. There’s too much focus on the behavior of the child and not what ails him.
