Aspies to be demoted to Autistics.

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Yes. This is true of many people with Asperger's diagnoses. The overlap between Asperger's--the many people who fit criteria for Asperger's as well as for classic autism, and thus should have been diagnosed with classic autism because it takes precedence--is one of the reasons why the spectrum is being merged.

The aloof/active-but-odd distinction is really not a sharp dividing line. There are "aloof" people who developed speech on time and have normal self-care skills; there are "active-but-odd" people who are still non-verbal. You could divide the spectrum by any number of criteria, and you'd keep getting different subgroups entirely dependent on which criteria you were using. There just aren't any dependable clusters of traits that reliably occur together. The smallest reliable cluster is the Spectrum itself, and even that has fuzzy edges.

If you have a boyfriend, you most likely wouldn't be "aloof". Well, that's if said BF is ok with you never interacting with him at all, and you turn it all away.

"Passive" is generally the term described for the group I mentioned, which means doesn't initiate, but accepts approaches. I forgot to mention that. These people also tend to have the old label, "HFA" (Kanner's without MR).

The behaviors are, with the common label for each (if you type them into Google or something, the full text of each will probably show up somewhere; it's in lots of books, though it originated with Wing):

Aloof; most common; usually Kanner's (HFA or LFA)
passive; rare; mostly HFA, sometimes AS as children
active but odd; second most common; typical AS
formal and stilted; rare; most mild form of AS

Repetitive behaviors tend to fall down the list the same too, i.e., typical "parts of objects" down to narrow interest (doesn't matter the age).

Yes - both Verdandi and I are Passive, and that's why we end up with a lot of issues because our diagnoses are Asperger's, but we're passive instead of active-but-odd.

You'll note the first three things I listed in my description combine to "doesn't initiate, but responds" (as well as the fact that I've used the word passive, and the 4 subtypes already in this thread) - this has been how I've been my entire life. Where I'm at now I try to initiate with my boyfriend in order to not make him initiate everything, fail miserable, and only irritate him with my special interests until he's tired of hearing about autism or other special interests.


However, even without the aloof/passive/active-but-odd/formal-and-stilted way of thinking about it (which is a way that at least groups people into groups that are more meaningful, though there are likely still problems with the groups), over 40% of people who are diagnosed with Asperger's should be diagnosed with classic autism with how the DSM-IV diagnostic criteria were written. 40% of people with Asperger's weren't passive. Passive is the rarest of the 4 subtypes if I remember correctly - even formal and stilted was more common than passive.

Last edited by Tuttle on 11 Dec 2012, 12:08 am, edited 1 time in total.

I changed from aloof to passive, after I understood what communication was.

My repetitive behaviors changed from manipulating objects to researching topics, after I gained verbal skills.

I tend to initiate with people I live with, like family currently. Most of the time, even with people I like speaking to relatively frequently, they have to initiate to get interaction going.

It also helps that the people I currently talk to are okay with me going on about my interests, at least in text.

I think you have a good point about these social differences being more meaningful. I wonder what other things would work as well.

I usually think I should have been diagnosed with autism, which is why I want a more complete evaluation. I just keep procrastinating on setting one up on account of the complexity (Step 1: Find out where I can go and contact them. Step 2: Meet with my new PCP and discuss getting a referral so I can access paratransit transportation. This also requires a letter from said PCP explaining why I need this ride. Step 3: Arranging the ride with the previous requirements met).



I agree with this. I've seen descriptions of subgroups that cross diagnostic lines fairly easily, but are not acknowledged directly as subgroups in a diagnostic sense.

http://simonsfoundation.s3.amazonaws.co ... ontact.pdf

Kanner did not describe a high functioning outcome in any of the children in his paper. And while Kanner didn't describe all his cases like you described in your description of modern day autism, they were not that far off per some of the descriptions of the children's inability to connect with the world and insistence on sameness. The word meltdown wasn't used by Kanner but temper tantrums, and destructive behavior was described in some of his case studies linked above.

I think it is possible that you may have mistaken some of the descriptions of the outstanding abilities of the parents of the children described in Kanner's paper, as in Kanner's actual paper linked above, "Disturbances of Autistic Affective Contact", there where 11 case studies of children where 3 of the children remained mute, and among the 8 who could speak, some of whom spoke after a language delay, they were not reported to convey any meaning to others in their speech. One of the children was described as having a language regression, similar to what is described in regressive autism, today. All the children were described as having severe language impairments. This is information is summarized by Kanner on page 243 of Kanner's paper from the link above.

And in a followup report of the children as adults, from the link below, it shows only 2 adult outcomes that could be reasonably considered "high functioning" outcomes, even for the one individual, Alfred, that was measured as having exceptional IQ, that ended up in a school for brain damaged individuals. If modern day therapies would have been available at the time, perhaps some of the other cases could have had better outcomes than institutional care. Kanner did not identify an expectation of high outcomes for any of the 11 case studies, in his paper.

"The outstanding pathognomonic characteristics were viewed as (a) the children's inability from the beginning of life to relate themselves to people and situations in the ordinary way, and (b) an anxiously obsessive desire for the preservation of sameness." This is quoted from the link below, close to what dillogic described and is similar to what Hans Asperger's described but the serious nature of language impairments in all of the children Kanner descried, did make a substantial difference in expectation of outcomes as opposed to what Hans Asperger's described in his case study of 4 children.

http://www.neurodiversity.com/library_kanner_1971.html

aghogday, I've read Kanner's and Asperger's papers, and I think that Tuttle's description is fairly accurate - the two doctors described very similar populations, they did not identify entirely separate populations with separate symptomology. They have a different focus, and thus different emphasis, on particular symptoms, but this doesn't seem to define stark, easily explained differences.

Also, outcomes of Kanner's patients include college attendance and other so-called "high functioning" outcomes. Not in every case, but definitely not confined to a particular functioning level or excluded from a particular functioning level.

Possibly the issue is that you are thinking Asperger described a "higher functioning" population?

What people currently think of Asperger's Syndrome is "higher functioning" than Asperger described, just like what people currently think of classic autism is "lower functioning" than Kanner's average population.



Also, possibly another issue is that you are not taking into account that "high functioning" doesn't mean "good outcome", "fully independent life", or "not having speech delays"?

I don't think most people have actually seen the full text of the DSM-IV-TR, as it is pretty hard to find on the internet, but diagnosing professionals that use the DSM-IV-TR do have access to it and I suspect that most use it considering the basic criteria doesn't provide that many details. These diagnostic characteristics of both disorders from the DSM-IV-TR are listed below in the links and it is likely that there will also be similar information in the DSM5, that will also be hard to access on the internet. It is noteworthy that behaviors, including self injurious behaviors, are included in the associated features section and will likely be included in a similar section in the DSM5, that the general public may not have easy access to.

The fact that Kanner identified that all the children studied in his case studies did not convey useful meaning in spoken language, is the current hall mark of difference (not the only difference) between the two described disorders in the DSMIV-TR, per severity of condition, among the criterion options in the communication section, and is what is left out of the basic criteria in the DSM5, although generally addressed in severity level 3. But, it is also possible that it will be addressed in the diagnostic characteristics or associated features in the DSM5, if not in the basic criteria. I think it is very possible that the DSM5 could have included a verbal impairment in conveying meaningful language optional element in the social communication category, but their intent seemed to be to require all three as mandatory requirements, which would not have been possible in that same category, considering that this is one element that is not considered as part of Asperger's syndrome, even with the verbal development delay option identified in the Gillberg criteria.

https://sites.google.com/site/gavinboll ... for-autism

https://sites.google.com/site/gavinboll ... -aspergers

Also too on the point from Vernandi about diagnosing from history for adults, the ASAN organization submitted their request that an alternate option using past history for diagnosis before potential adaptations were made in adulthood, however the most recent public revision of the DSM5 does not include that option as linked below. The ASAN suggestion is also linked, and it sounded like that might have been what Verdandi was thinking about when Verndandi referred to that general idea if I understood Verdandi correctly.

https://sfari.org/news-and-opinion/news ... -disorders

http://autisticadvocacy.org/wp-content/ ... _final.pdf

Another point, is my understanding is that there could be the possibility that the published final revision of the DSM5, could include different information, from the last revision published before the final comments were allowed last spring. As far as I know none of the actual final revisions for any of the disorders in the DSM5 have been released to the general public, and considering it is a manual that will likely make a hundred million dollars plus, over the sale of that manual, I don't suspect anyone may become privy to it, until it is released in the spring of 2013. If anyone has a reference to clarify that I would be interested in seeing in it.

I've agreed that some of the general symptoms were similar, but it was not an accurate statement that only one person in Kanner's study was non-verbal or that most of the individuals were described as "high functioning". The adult follow up study I linked, identified two individuals with "high functioning" outcomes, but the other outcomes were not identified as such. And, Kanner specifically identified in his paper that three of his case studies were mute, and none of his case studies were able to convey meaningful spoken language to others in childhood, on page 243 in the link I provided to his paper. The language impairments he described, in all of his patients are not identified as criteria or clinical features of language impairment in Asperger's syndrome, other than a developmental delay in language in the Gillberg criteria.

While there is no adult follow up from Hans Asperger's 4 case studies, he identified an expectation of high outcomes in his work that was translated by Uta Frith in her book, in 1991. Kanner did not identify this expectation in his work from the case studies he observed:

http://en.wikipedia.org/wiki/Hans_Asperger




And while there was no follow up for Hans Asperger's case studies, the outcomes of Hans Asperger's actual patients followed up in adulthood were much different, as a whole, than the follow up on the patients from Kanner's case studies, for over 30 of those patients described as interviewed in the link below, with other highly successful individuals that were once Hans Asperger's patients with "autistic psychopathy" described not likely able to meet a diagnosis of the Asperger's disorder in adulthood.

http://www.post-gazette.com/stories/new ... ce-415053/

None of Hans Asperger's case studies were identified as not being able to convey meaningful spoken language. That is a substantial difference that all 11 case studies for Kanner identified as not being able to convey meaningful spoken language. It doesn't negate the meaningfulness of the similarities of symptoms, but it is not a difference that can be pushed aside as a non-substantial difference in that major area of life functioning in spoken communication if one compares the actual case studies of both men. The fact that the latest public revision of the DSM5 Autism Spectrum Disorder left it out of the basic criteria, but identified a description of the lack of spoken language in severity level 3, is interesting to me. They haven't completely disregarding the significance of Kanner's descriptions of the inability to convey meaningful language in his case studies, or the realities of what is most currently identified and described as the ability for "functional" spoken language in up to 25% of children on the spectrum.

Hans Asperger's has been described in childhood with some of the same characteristics in those children that he studied. While he carried no diagnosis, he was likely the first real self-advocate and perhaps the greatest self-advocate/advocate for "autistic" individuals. A tradition carried on through Uta Frith, Lorna Wing and Tony Atwood and even Simon Cohen Baron, in the acknowledgement of the potential for positive outcomes and advantages of difference described as inherent in the condition for some. Not likely that any of those individuals are too far removed from Han's Aspergers description of "autistic psychopathy". At least in part, it became a "special interest" in life for all those individuals.

From the excerpts on this page, several are able to convey meaningful language, although that language is fairly idiosyncratic:

https://ballastexistenz.wordpress.com/2 ... torically/

Han's Aspergers and Kanner are not here to ask, so we can only go by what they both identified and described in their actual work in the early 40's. I can't copy and paste from Kanner's paper I linked to but his description of all of his case studies were that they could not convey meaningful language to other people, neither those that were mute, or the eight that could speak, as specifically described by Kanner on page 243 of his paper I linked to.

On the other hand the quote provided below again from Han's Aspergers work describes an obviously positive expectation of functioning outcome, in a description of his case studies as fulfilling their role in society better than anyone else.

At least from the follow up studies from Kanner's case studies of "autistic disturbances of affective contact", that I linked as compared to actual interviews from Asperger's patients from the 50's through the 70's (all of who could convey meaningful language) that he identified as having "autistic psychopathy", the functional outcomes as described were objectively better for Asperger's patients than Kanner's patients in his case studies.

What perhaps is more interesting is the functional outcomes in young adults diagnosed with PDD NOS, Asperger's, and Autistic Disorder in recent research have been identified and described as having similarly poor functional outcomes. Are there factors that have changed in culture that influence that over the last several decades? I suspect there is that potential. Hans Asperger's was never concerned about a "Tsunami of young autistic adults" finding no social roles in young adulthood. Quite the opposite expectation described by him, quoted below. If Kanner expected positive functional outcomes, he didn't identify them in his paper.



I agree that a diagnosis of Autistic disorder, Asperger's syndrome, or PDD NOS doesn't guarantee functioning levels high or low, on a case by case basis. The most recent research supports that hypothesis. And, per individual experience functioning levels are in part a subjective experience that can only be fully identified by the individual.

It's unfortunate though that Asperger's expectations for his "autistic psychopathy" patients appear to no longer be panning out, as a whole, for individuals diagnosed with any form of autism, under current DSM-IV-TR guidelines. Maybe Austria was an easier culture to adapt to back in those days. Maybe the US too. It definitely was for me, in more ways than I can count.

I have also read Kanner’s early paper on autism. In my opinion aghogday summarized the paper fairly accurately. Both Verdandi’s and Tuttle’s interpretations on the other hand are in my opinion inaccurate and downplaying certain differences.

Asperger was doing his writing trying to keep these children from being killed by the Nazis - of course there was a positive potential written in the paper.

You have to take the situation into account. It actually influences the writing a lot and is one of the biggest differences - everything Aperger wrote was very positively influenced, very 'this is how they can be good for society', everything Kanner wrote was very clinical. It's because Asperger was writing specifically taking the Nazis into account, in the middle of a war, rather back in the US.

Last edited by Tuttle on 11 Dec 2012, 11:54 am, edited 1 time in total.

Only having read Kanner's paper doesn't let you compare the two papers.

Kanner didn't describe people who are the "only socially akward" that people think of as Asperger's Syndrome today.

Asperger didn't either.

Its not only about what Kanner did and didn't describe - its also about what Asperger did and didn't describe.

There were differences in the patients they described, but as a whole they'd mostly fall into HFA today.

What Asperger described and the stereotype for Asperger's today are not the same - he described people much closer to what Kanner described than the people who are "so much higher functioning". He just wrote it in a far more positive manner.