Is Asperger's overdiagnosed or underdiagnosed?

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It shows up differently in everyone. I'd trust the professional diagnosis that the person has enough autistic traits to be diagnosed.

Also I agree that it's under-diagnosed, especially in women

Overdiagnosed; especially when the apparently high number of people who self-diagnose is taken into account.

self "diagnosis" is not a diagnosis.

Do some research on women with Asperger's and you will amend your view on over-diagnosis.

I wish diagnosis was not viewed so black and white - though obviously that is a common feature of AS.

Many people are self-diag before they get actually diag. are they not Aspies if they dont follow through with a formal diagnosis?

That does not ring true for me.

The women's subforum is alien to me. I identify more with autistic men on wp. But I do identify with the few autistic women I have met in person.

I think overdiagnosis is significantly less of an issue than people seem to want to believe. I think it is more likely that people who need diagnoses to access services and treatments are missed than it is that too many people are covered.

The biggest evaluation system in the United States is the US Department of Defense, where I believe it is an automatic bar to service. They screen hundreds of thousands of young adults every year, and they run background checks that would at least pick up a DX that was told to the school district. I would expect an example by now.

I find this a really confusing topic since the objectives of diagnosis seem to vary so dramatically from one person or place to another. Even before you begin to broach what actually constitutes an ASD trait, you have this issue of the level of 'impairment'. Surely this is the wrong way round?

If you sprain your ankle and go to the doctor, you will be diagnosed with a sprained ankle irrespective of whether you managed to hobble to the doctor's office or had to be carried. Once the nature of the issue is established, then you begin to consider the level of impairment. E.g. are painkillers/anti-inflammatories required, and at what strength? Will a splint be needed or will a firm bandage do the trick? Should they provide you with a crutch, or do you already have access to one?

It should be the same for ASDs. First establish if a person fits the pattern of traits and diagnose them as either fitting or not fitting that neurological framework. Then at least they'll have a better understanding of who they are and how they work even if they seem to be doing fine for the most part. Then assess what further intervention is required, if any at all. In the case of the DSM-V, I would suggest that the impairment levels include a 'Level 0' which is to say that only very minor support or perhaps no support at all is required e.g. basic education as to the condition. Then people could be reassessed at intervals and move up and down these impairment levels throughout life so that appropriate support can be allocated at different stages.

I know this doesn't help solve the ongoing questions about where to draw the line between ASDs and non-ASDs, but I do think it's a real mistake to look at it from the perspective of impairment first and issue second. It distorts everything from the very start and leaves less room to objectively consider where to draw that line. In short, I don't know if the answer to the question is over- or under- because I'm not sure I understand exactly what is being diagnosed.

I realise that what I'm saying may seem to completely miss the point or sound like rubbish to many, but I have reasons for my point of view. However, I can't explain them without writing an even more unappetisingly long post so I think I'll wait to see what objections come up first .

Thats a great post. I like it.

The whole DSM model sucks. 30% of conditions are "not otherwise specified", 70% of the task force have conflicts of interest, the process lacked transparency throughout....................

The systemic problems are obvious and diagnosis must become about genes and brain scans not vague books written on subjective judgements on criteria that is ill defined and biased.

The problem is the DSM model and the organisations and interest parties involved. A radical rethink is required to the whole subject. Rather than "diagnosis" of such things ending "NOS" - in other words - they dont know. "Here is a useless label and I charge by the hour as I talk you through confusion on a by the hour model".