Aspergers diagnosis gone in draft of ICD-11

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ASPartOfMe
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12 Dec 2017, 1:35 am

New global diagnostic manual mirrors U.S. autism criteria

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The criteria are part of a highly anticipated update to the “International Classification of Diseases,” a diagnostic manual produced by the World Health Organization (WHO). The latest draft of the manual, dubbed ICD-11, collapses autism, Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS) into a single diagnosis of ‘autism spectrum disorder.’

This change mirrors the criteria in the ICD’s U.S. counterpart, the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), released in 2013.

The ICD-11 is scheduled to roll out in May 2018. The changes seem unlikely to provoke the controversy that accompanied the DSM-5 draft prior to its release

Autism features outlined in the ICD-11 fall into the same two categories as those in the DSM-5: difficulties in initiating and sustaining social communication and social interaction, and restricted interests and repetitive behaviors. Previous versions of each manual included a third category for language problems.

Both of the new manuals allow clinicians to diagnose autism alongside other conditions, such as anxiety or attention deficit hyperactivity disorder; previous versions instructed clinicians to choose one of these diagnoses.

But there are notable differences between the two manuals, too. The ICD-11 provides detailed guidelines for distinguishing between autism with and without intellectual disability. The DSM-5, by contrast, simply acknowledges that autism and intellectual disability can co-occur.

Both the DSM-5 and ICD-11 subsume childhood disintegrative disorder, a regressive condition that surfaces in late childhood, into the autism spectrum, despite its distinct features. The DSM-5 does not include regression as a criterion for an autism diagnosis, however, whereas the ICD-11 lists “loss of previously acquired skills” as a feature on which doctors can base a diagnosis.

“[ICD-11] is taking some of the better parts of DSM without falling into the same pitfalls,” says Fred Volkmar, professor of child psychiatry, pediatrics and psychology at the Yale Child Study Center, who was a vocal critic of the DSM-5.

Unlike the DSM-5, the ICD-11 does not stipulate that a person must have a certain number or combination of features to meet the threshold for autism. Instead, it lists various defining features and lets a clinician decide whether a person meets the bar.

But the way children play varies across cultures. The ICD-11 puts less emphasis on type of play and focuses more on whether children follow or impose strict rules while playing — a behavior that can show up in any culture. An insistence on rules and on imposing those rules on others could be a sign of inflexible thinking, which is common among people with autism.

(The DSM-5 also moves away from symbolic play, but does include some play-based criteria as “difficulties sharing imaginative play or in making friends; to absence of interest in peers.”)

Like the DSM-5, the new draft emphasizes the importance of testing for unusual sensory sensitivities, which are common among people with autism. It also alerts clinicians to the fact that some people on the spectrum try to mask their autism features.


To summerize what I have said before it was a mistake to make Aspergers a seperate diagnosis in the first place as the traits pretty much mirror each other. Doing so caused problems with Aspie elitism and more importantly the perception of Aspies not wanting to be associated with “real autistics”. Aspergers should have become a subset of Autism probably equvilant to “mild” autism. Subcategories are widely used for most other conditions and life in general Autism should not have been different. Just Autism without subcategories is a big confusing mess. With the elimination of Aspergers a lot time,energy and knowledge that was gained from Aspergers research was lost. Some of it could be used for Autism research but not all. Also lost was the positive effect on self esteem the explanation and “Aspie” indentity had. “Aspie” has survived but mostly as a neutral descriptor.

If anybody still has any hope(or fear) as many did when the DSM 5 eliminated Aspergers in 2013 that the Aspergers diagnosis would come back can forget about it. As predicted in the article I do not expect much of a fight to keep the diagnosis. There was a time before the DSM 5 went into effect that there were online petetions, blogs, “Aspie” associations speaking out against the elimination of the Aspergers diagnosis as well as some psychologists saying they would still use the DSM 4 but once the DSM 5 wnt into effect everybody for the most part rolled over. The ICD-11 is only going to make official what has been happening anyway. In areas of the world where the ICD manual is prominent a lot of clinitions have not been giving out Aspergers diagnosis in expectation of this change and to be in alignment with the dominent American DSM.

What has been disturbing to me is almost 5 years after the fact is the paucity of research into what effects the subsuming of Aspergers into autism has actually had. Does anybody remember all the “Aspie” groups promising to closely monitor the effects of the change? The most bitter pill for me to swallow is that the Aspie elitists/supremacists got what they wanted. They favored the getting Aspergers out of the manual because without Aspergers being in the manual they could define “Aspie” however they pleased. “Aspie” or Aspergers the collequel terms pretty much mean socially ackward person with above average intelligence.

That all said what’s done is done and there are things I like in the upcoming ICD. Best of all is the diagnostic recognition of masking. On this issue it is clear that #ActuallyAutistic people were listened to. So many clinictions do not get this so hopefully having it “official” helps. 70+ years after Kanner described it the diagnostic recognition of regression is long overdue. The attempt to eliminate cultural differences in behavioral observation is a good step. I do not know if is possible to do but it is worth the try. I am glad they also recognized sensory sensitivities. I have an open mind about creating more emphasis on intellectual disabilities or not. I do have qualms about it causing similar divisions and elitism that Aspergers caused. And we will not have to use the caveat about Aspergers being an official diagnosis in many parts of the world anymore. :D

For the future like sensory sensitivities I would like to see more things now considered co morbids recognized as Autism traits. Subcatogories coming back is a must. They should be labeled after dominint traits such as “sensory sensitivity autism” etc. A lot of this will depend on future research.


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Trogluddite
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12 Dec 2017, 11:46 am

Hopefully, this will make diagnosis a bit more standardised here in the UK. At the moment, it seems that there is a very inconsistent usage of DSM-IV and DSM-V categories. I was diagnosed a couple of years ago now, and my assessment was quite close to the things noted above for ICD-11; e.g. my formal diagnosis is ASD, and the assessment took into account masking and sensory issues. However, I know of other people who have been diagnosed with Asperger's more recently than me, and seemingly without reference to those traits.

I don't think the changes will provoke much controversy in the UK, as access to healthcare and benefits (welfare) are primarily based on the presentation of clinical need rather than on specific diagnostic labels. I get the impression that it was much more controversial in the USA due to the way that healthcare insurers frame their coverage in terms of the DSM's diagnostic categories, potentially leaving people "undiagnosed" in the eyes of their insurer when the categories are changed.


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12 Dec 2017, 12:27 pm

I like that they mention masking. This will make a huge difference for a lot of women and a lot of the men who do it.

Trying to avoid cultural pitfalls is also great.

Like a lot of people, I find the division between Asperger's and autism forced. It seems like the ICD will be better than the DSM, though. It's really good that they are learning from it.

Seems I'm in the last wave of people being diagnosed with Asperger's. I feel like a dinosaur :ninja: :mrgreen:


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12 Dec 2017, 2:20 pm

Why do some criticize those with Asperger's who don't want to be associated with other autistics? Is "aspie elitism" a real thing?

I don't think not wanting to associate with another group here is done out of spite for that group, but we just want to be free from having to associate with something else if we feel it causes us problems.



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12 Dec 2017, 3:20 pm

"Socially awkward with above average intelligence" describes me well. I'm not sure though that that in itself qualifies me to see myself as a "colloquial aspie". Social awkwardness/social interaction difficulties are certainly my primary issues. A certain degree of rigidity/liking things the same/antipathy to change-yes, but perhaps not to diagnosable levels. Special interests-that's debatable. A limited number of interests is more to the point. Low cognitive empathy -yes.
It's very questionable whether I'd fill the criteria for a diagnosis, but surely there should be something to describe/diagnose those of us with primary social difficulties even if it isn't aspie or asd ?
Certainly social awkwardness can result in a high measure of social disability.



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12 Dec 2017, 3:37 pm

Trogluddite wrote:
.
I don't think the changes will provoke much controversy in the UK, as access to healthcare and benefits (welfare) are primarily based on the presentation of clinical need rather than on specific diagnostic labels. I get the impression that it was much more controversial in the USA due to the way that healthcare insurers frame their coverage in terms of the DSM's diagnostic categories, potentially leaving people "diagnosed" in the eyes of their insurer when the categories are changed.


Everything is much more politicized and weaponize in the USA. And the insurance companies drive the American Psychological Association which writes the DSM

Hollywood_Guy wrote:
Why do some criticize those with Asperger's who don't want to be associated with other autistic? Is "aspie elitism" a real thing?

I don't think not wanting to associate with another group here is done out of spite for that group, but we just want to be free from having to associate with something else if we feel it causes us problems.


Aspie elitism and supremacist is a real thing but only represents a small percentage of self described Aspies. While all might not mean that the guiding principle behind it is the idea that the autistics are "others" and often "lesser" a form of ableism. If I said I do not want to associate with black people not out of spite but because statistically blacks have a higher rate of crime and that causes me as a white person problems WP and most other sites would ban me and my remarks would get me universally condemned. I do not see too many people with Stage 0 cancer going around saying association with Stage 4 cancer people cause Stage 0 cancer people problems. Stage 0 cancer, Stage 4 cancer is still cancer, very few people have a problem with that I do not know why Autism has to be different.

Yes "low functioning" autistic have very different needs then Aspies but the traits/symptoms are the same and the severity is different. Besides low and high functioning and mild and severe do not accurately describe the real world of Autistics, we are often clueless in skills we are expected to know and gifted in things we are not expected to be.

firemonkey wrote:
"Socially awkward with above average intelligence" describes me well. I'm not sure though that that in itself qualifies me to see myself as a "colloquial aspie".

Colloquial is not used to sub categorize a word, it describes a type of term.
Merriam-Webster wrote:
used in or characteristic of familiar and informal conversation

As Aspergers is no longer going to be a formal diagnosis it is colloquial term. Even formal diagnosis are used in a colloquial ways, "I feel OCD today".


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12 Dec 2017, 4:50 pm

Still gives me the same feeling or sense as when people who say African-Americans who are successful are "selling out" or "acting white". I'm sorry, but that's ridiculous. People somehow get angry because people achieve and are successful despite skin color that isn't a factor in success to begin with. /defining a person's level of success by their in-born traits/



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12 Dec 2017, 5:13 pm

Hollywood_Guy wrote:
Still gives me the same feeling or sense as when people who say African-Americans who are successful are "selling out" or "acting white". I'm sorry, but that's ridiculous. People somehow get angry because people achieve and are successful despite skin color that isn't a factor in success to begin with. /defining a person's level of success by their in-born traits/


If successful blacks do not have an issue with associating with lower class blacks it SHOULD not be a problem.

My original point was that the DSM IV by making Aspergers a separate diagnosis instead of a subcategory of autism gave license or validation to actual aspie elitists and supremacists. The people I am talking about write things like "Aspies are more evolved, the next stage in human evolution", "It is good for those nonverbal low functioning Autistics who s**t their pants and bang walls but not for Aspies like me"


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12 Dec 2017, 6:35 pm

Well, saying "I have Asperger" instead of "I am autistic" was easier because other people tend to see autistics as the "nonverbal low functioning Autistics who s**t their pants and bang walls". Even saying you have "high functioning autism" doesn't help much with the stereotypes because people lack knowledge. And pretty much everyone associates Asperger "socially awkward person with high intelligence" which is good. It's not elitism or anything. It's just making the social life easier. It's better for people to think you are smart but awkward (as long as you really are) than assume you are stupid and potentially aggressive just because they use stereotypes.



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12 Dec 2017, 7:52 pm

Kiriae wrote:
Well, saying "I have Asperger" instead of "I am autistic" was easier because other people tend to see autistics as the "nonverbal low functioning Autistics who s**t their pants and bang walls". Even saying you have "high functioning autism" doesn't help much with the stereotypes because people lack knowledge. And pretty much everyone associates Asperger "socially awkward person with high intelligence" which is good. It's not elitism or anything. It's just making the social life easier. It's better for people to think you are smart but awkward (as long as you really are) than assume you are stupid and potentially aggressive just because they use stereotypes.


I do not like both the ret*d "Autistic" stereotype type and the Aspergers stereotype. While there are people on the spectrum that fit the stereotypes most of us don't. The ret*d Autistic stereotype is going to cause you problems because people will greatly underestimate you if you call yourself "autistic" . But the awkward genius Aspergers stereotype while more flattering is going to cause you problems in a different way because people will overestimate your abilities. People will think you are are an excuse making lazy bum who just needs to try harder or you will be associated with what people believe to be a fake disease, a scam designed to get the hardworking taxpayers to pay money to rude people that do not need any help because they are so smart. There are probably thousands of posts on WP from people being accused of the things I just mentioned.

I call myself Aspie and Autistic because that was how I was diagnosed and I believe I fit the diagnostic definitions of both.


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