Death of the Syndrome

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Yes this is a very good point. Trait based constructs in psychology are notoriously poor at predicting behavior following developmental changes. At best they can identify trends,

The labels such as HFA or AS cannot reliably predict if an individual will react or respond in a consistent manner to situational changes or events. This includes coping strategies, language acquisition or socialisation skills.

You seem to have misunderstood what I tried to say. I think I didn't claim that you or ThetaIn3D claimed anything. I tried to say that because behavioral diagnoses are completely arbitrary (made up by committee as T. Grandin well put) and based on an arbitrary construction called typical, to have at least some validity the diagnoses are usually based on clusters of behaviors, not to individual characteristics. Because of this nature of behavioral diagnoses, most people have at least some feature(s) in some diagnostic manual or in some study linked to a certain syndrome or “illness”. For example I can browse through psychiatric manuals and find several traits in most of the trait lists, but that doesn’t mean I’d be diagnosed with those “illnesses”. Your statement about slippery slope argument in relation to the arbitrary nature of diagnoses, I don't understand. If you please, do clarify what you mean with that small step and to what it is leading.

The part about visuo-spatial skills in my post is a reply to ThetaIn3D, to whom I wanted to clarify that these traits aren't only tied to certain diagnoses, but are universal. Autism is a cluster of certain behaviors, that then together make the distinction. In that particular study they found out that as they looked HFA and AS persons as groups there was a significant difference between verbal and visual strategies within those groups. So these groups differed statistically in this matter. But everyone within those numbers is still of course an individual and the pattern isn’t the same in all persons. The same statistical method is the basis of also those studies that suggest that these groups are the same in relation to some other feature(s).



In my post my whole point was to emphasize that the whole range of autism (not just HFA or AS), is based on these similarly arbitrary and fuzzy distinctions that don't really fit into "reality". Autism exists only in relation to an arbitrary construction called “typical”. That distinction between typical and having ASD isn’t any clearer or more natural than the distinction between HFA and AS.

Individuality and not fitting neatly in to arbitrary categories covers every existing phenomenon, in which categorizations are made, e.g. gender and disorders. It isn't specific only to the autism label or HFA or these studies, for within all labels we are individuals and none of us probably fits into any such label perfectly. That doesn’t still in my opinion mean that (high functioning) classic autism or ASD wouldn’t be good diagnostic tools for clinicians to refer to a certain group within the behavioral diversity (e.g. ASD) or within the autism spectrum (HFA). Such an argument would actually hold them from using any labels at all (I'd like that!). So if we use not fitting into "reality" as a statement against distinction between HFA and AS, we can as easily use it against the distinction NT – AS or autism – neurotypical.


I agree



but if you here refer to HFA/AS with these two groups, I don’t see the reason to obsess on these categories specifically, for the real fuzziness isn’t actually between them (e.g. a diagnosis of autism with a clear speech delay or not), but in that large grey area where an arbitrary category called typicality gradually becomes an arbitrary category called autism.



Most of the studies indicating that they are similar conditions are actually using the very same statistical methods. But it just shows that no matter the category, it is never clear and is doomed to exist outside "reality".


I said that these studies highlight the diversity of views and ways to see - even within the scientific community. With that I mean that even the studies seem to show how there are different and even oppositional views existing side to side. With agendas I mean that when we start to look things through a desire, we want to pick of course only those studies that back up our views or see those specialists as incompetent, who don’t agree with us. That goes both ways.

I personally don’t have any passion for these autism labels or any DSM for that matter, but I sometimes find the argumentation here a bit too one-sided, which is the reason why I want to bring out also other ways of looking at things. I hope I made my points clearer.

I'm very interested in studying the cognitive differences between people with and without language delay.

I would disagree about it being a long history of a distinction between early infantile autism and autistic psychopathy. It is hard to see any big differences between Kanner's early infantile autism and Asperger's autistic psychopathy. Both studied kids who was on a spectrum in skills, and both studied kids who did have good verbal and cognitive skills. In Kanner's early infantile autism studies we find kids who are on pair with the kids Asperger studied. This similarity has been a challenge to the researchers after Kanner and Asperger; and one would find as many who disagree with the thesis of differences as one would find of those who agree with it. One of the main arguments has been that the kids Kanner studied had impaired language and cognitive skills, but his writing in this regards show that this was not the case for some of them: "The astounding vocabularity of the speaking children, the excellent memory for events of several years before, the phenomenal root memory for poems and names, and the precise recollection of complex patterns and sequences bespeak good intelligence in the sense in which this word is commonly used." (Kanner, 1957, p. 742). Despite that Kanner studied a spectrum of kids with and without language abilities, he named the condition of all 'Early infantile autism'.

DSM-5 is the result of dimensional nosological thinking. There is two ways in which the argument that Kanner and Asperger studied the same type of kids may be made. One is to take the old Autistic disorder and remove Asperger disorder, another is to do use a dimensional approach and define Autism as a spectrum, including the range of kids both Kanner and Asperger found. The former is an example on the Aristoelian logic of either/or, where the latter is more of a fuzzy logic with the possibility to be one place between 0 and 100% autistic. With regards to the original works by Kanner and Asperger, the dimensional approach seems to best include the works. With regards to the said differences, the dimensional approach may also work until more research on differences versus similarities is available throught is securing of the existence of differences in kids with pervasive developmental disorders.

Personal I have found both the texts of Leo Kanner and Hans Asperger to describe me well, and find the label of autistic to be best since it make available more literature to understand myself and to teach others about my condition.

Source:

Kanner, L. (1957). Child Psychiatry. (3rd edition). Illinois: Charles C Thomas, Publisher.

I think the argument made by Perry and others is that they see a cluster along one part of the spectrum that they think of as Aspergers and a different cluster along another part of the spectrum that they think of as Kanner type or the older Autistic Disorder. I don't see any disagreement that these are part of the autistic spectrum. The disagreement is about whether it's useful or not to use "Aspergers" as an indicator of certain symptoms and a certain region of the spectrum. And this is complicated because I don't think there is any disagreement that these clusters have overlap and soft edges.

If we are thinking about nosology, I think the NIMH response to the DSM V is indicative of the likely future: when the diverse etiologies and pathogeneses of various autisms are known, the symptomatic nosology will fade and useful new categories will emerge. It's possible that at that point Aspergers will still be a useful term. The evolution of Rett Syndrom is an interesting case to consider in parallel.

I don't know. Verdandi makes a good case. I respect the people who have told me that they perceive a meaningful and useful distinction in Aspergers... Time will tell.

Yeah, it will be interesting to see what subgroups of autism will emerge in future from the NIMH approach.

I agree.

When you listen to scientific presentations on the matter, they already seem to have many informal labels for different autisms, e.g. based on genetic markers. In my opinion labels, like in the case of Rett syndrome or Fragile X, can at times be more beneficial than harmful. Those labels help people, like parents, to understand the condition and its typical developmental trajectories. Still within those labels everyone is of course an individual with individual strengths and needs.

Is it dead yet?

I don't know if anyone has pointed this out... but

The National Mental Health Institute rejected the DSM-V

http://www.dailykos.com/story/2013/05/1 ... ects-DSM-V

I suspect that the NMHI only will have fruits from some decades ago, at best.

The NIMH response is just physicalisms response to DSM-5 and does not indicate much about the likely future. As long as there are a range of other strong traditions and different opinions in philosophy of mind, a classification which only support monistic physicalism will have its downsides. The symptomatic nosology may still be useful with the application of a common philosophical foundation which show how the different class of disorders has evolved, and this philosophical foundation does not need to be about physicalism.

These possibilities does not make any foundations for using the term asperger about one part of a scale. asperger was removed on the basis that neither clinical workers or researchers was able to differentiate clearly about aspergers disorder and autistic disorder. Where many psychiatrists would give a person autistic disorder, others could give the same person an asperger disorder label and vice versa. Because of the uneven feature set of skills in both asperger disorder and autistic disorder, to differentiate them in each individual case was a challenge. As long as the term asperger is based upon a hypothetical difference between the work by Hans Asperger and Leo Kanner, the etymology would prevent it to be useful in other senses than that, and any future developments would much more likely construct a new label for a group of a persons who does clearly differentiate from the rest of the uneven autistic spectrum.

I also respect people who want the Asperger distinction to be made, but for my own part I have not found a different between Hans Asperger's work and Kanner's work and I fit with both the descriptions of Asperger and Kanner. The best help for me and others in my situation is a spectrum label of autism. For those who clearly see the usefulness of a distinction a label in addition to the spectrum label of autism may be an idea, and something which I think APA would take into account if it proves to be enough evidence for such a distinction.

I think so

Aspergers will continue to be used as an unofficial label much like HFA.

And there is nothing wrong with that. We have used ADHD as an unoffical label in Norway for ages despite that such label does not exist in the ICD-10 (which is the official manual here) and is never written in any official papers.

I study HFASD people/brains all together in same study, so make no distinction of AS vs. HFA vs. PDD-NOS in this research, but do record specific diagnoses in case something interesting reveals itself about one diagnostic group compared to another, but probably distinct trends cut across diagnostic groups.

I think you are right, in a way, but I also think it's inevitable that the NIMH approach, once it's driving a lot of research spending, will yield a lot of new information. I believe the mind is an expression of the body, although it has it's own mechanics--and as the means of that expression are revealed, many relationships will become clear and this will call for revisions in classification. It's not unlike the Ailurus Fulgens story with reasonable but incorrect prior classification as ursidae or procyonidae and then a new understanding emerging with DNA analysis--or the changing understanding of planets with objects like Pluto, Eris, Quaoar, Haumea, Makemake at one end and super jupiters pushing toward brown dwarfs at the other.

Don't you think we will have a much better understanding of the elements of the autistic spectrum in 10 or 20 years? I find it hard to imagine that such new understanding will not have an impact on nosology.

In the 20 years that we have had something called Aspergers, a number of clinicians have formed a view that it is a useful description for a cluster of observed symptoms. I think the problem is that it's not a thing with defined edges but more an attractor in a chaotic system. Those who tell me this say that abandoning the name is a mistake and they won't do it because it will continue to be useful for them--but they are not talking about rigid criteria that will infallibly solve edge cases. Nor are the talking about etymology and the original notes of Kanner and Asperger--they are talking about the pattern they have been defining and using to help diagnose people for a generation. Maybe they are wrong, but maybe their classification is more useful from their perspective and less useful from other perspectives.

Regardless of how these debates unfold, we will all be autistic and have to find ways of explaining what that indicates to ourselves and others with meanings appropriate to our needs.