DSM V changes.. How do you feel?

Post Reply New Topic

Curious how this community feels about lumping Asperger's into one big pot with all the other spectrum disorders?

I think I like it because there are so many differences with individuals with an AS diagnosis. There are so many overlaps in several of the ASDs. And don't they all pretty much share one big list of characteristics?

I know that some feel strongly in the other direction. Honestly, I don't really feel passionate about it one way or the other. We have lots of reading on it and articles that I dont quite get. And I'm not really all that interested in specifics. I'm mostly interested in how it may or may not affect those in my family on the spectrum.

I hear there's even a small movement to get ADD added to the ASD spectrum. *shrug* I find that a bit odd, but I guess I can kind of get it.

I think I prefer to keep them separate. I was all for a lumping of them together until I read a book that explained the differences that generally occur between Aspergers and Classic Autism. It is not just a matter of functioning because each one is a spectrum in themselves (both on the autism spectrum of course). These differences are enough to warrant a separate label for each condition, so people can better understand themselves and their challenges. I want them to get them separate, but maintain them all as ASDs/PDDs.

I feel it would be a step backwards and is not scientifically justified. There is a very interesting paper which highlights all of the known differences between AS and HFA/ASD which delves into various brain imaging studies. Unfortunately, I cannot obtain permission to reprint it here and most of you would only be able to access it from a university computer or by using a credit card.

There is a link to the abstract here:
http://www.sciencedirect.com/science/ar ... 6711000171


The article is

Research in Autism Spectrum Disorders
Volume 5, Issue 3, July-September 2011, Pages 984-989
Brief report: Should Asperger syndrome be excluded from the forthcoming DSM-V?

Nils Kalanda, a Lillehammer University College, Gudbrandsdalsvegen 350, 2624 Lillehammer, Norway

They seem the same to me, and I'm all for reducing confusion and making things simple.

They're similar enough that I don't see a point to maintaining different diagnoses so long as people receive the services and support they need.

As for the current criteria, I posted a thread not too long ago that linked to multiple studies showing that it is virtually impossible for anyone to meet the criteria for AS if you take the criteria as written - AS specifies that you should not diagnose anyone with AS if they meet the criteria for autism. Most people diagnosed with AS actually meet the criteria for autism.

I guess if there is a point in terms of treatment and services to distinguish the respective diagnoses... but as it stands, it is simply more difficult to get services if you have AS than if you are diagnosed with autism. I am not sure where PDD-NOS stands in that, but diagnosis of people with PDD-NOS is remarkably inconsistent as well - it seems like a lot of adults get diagnosed with that instead of AS when their history supports a diagnosis of autism.

I could see a point to making a distinction akin to "ADHD-C, ADHD-HI, ADHD-PI," etc. in that the same basic condition has several manifestations based on which symptoms are clinically prominent.

The book Littlelily refers to has this paragraph (split into smaller paragraphs because that is easier on my eyes):

it is very, very odd, in my humble opinion, that the DSM-5 proposes a change in relation to asperger's syndrome.

this change isn't reflected in the ICD-10... to which the DSM-5 is aligning right now...

and this change is not proposed for the upcoming ICD-11, to which the DSM-5 is going to align in the years thereafter, as far as i know........

so..

what is the point of this asperger debate in the DSM-5?? i simply don't understand.

will it mean that there are no more aspies in the USA and other countries that still use the DSM - while in the rest of the world, there will be aspies?

odd.




EDIT:

link to asperger's syndrome in the ICD-11 alpha:

http://apps.who.int/classifications/icd ... _2_F84_3_5

One question, do all you aspies actually want to be lumped into the same category as me? I belong to an asperger's support group, and most people there know that I am different from most of the rest of the group. We all belong to the same spectrum, and I get along with all of my aspie companions, but there are differences. I would be all for lumping asperger's and classic autism into the same diagnosis if it actually meant that aspies could get services. However, I am a classic autie, and I still get ZERO services - ZILCH! This is a really hard question to answer.

I'll summarize the noted differences between AS and ASD as described by the paper.
My own comments will be in parenthesis.

Intelligence and IQ profiles:

Those with AS more often than not are found to have a high verbal IQ and lower performance IQ with respect to children with PDD-NOS and children with HFA. Children/Adults with AS tend to do well on things like digit span and poorly on coding.
(A more recent study yielded results that contradict this notion, however this may be due to a paradigm shift caused by diagnostic procedures)

The paper notes that those with AS have unique communication skills which differ from those with a diagnosis of autism.

Individuals with AS demonstrated a social categorization of active but odd, while those with HFA demonstrated a social style of aloof and passive. The article acknowledges there may be overlap in this area but still maintains the AS group exhibited a distinct social impairment pattern not seen in the HFA group.

A recent study found that in those with autism, cortical folders in the left frontal areas of the brain had an abnormal structure, while these anomalies were absent in those with AS.

Another brain imaging study found that those with HFA had severely reduced cortical inhibition, while this was not seen in those with AS.

The paper also points out that over 14 genes have been associated with AS and it has not yet been determined whether AS is genetically different from autism. The authors of the paper conclude that making any changes to the DSM with respect to AS and autism would be premature in light of scientific evidence suggesting the possibility of neurobiological and genetic differences and lack scientific evidence justifying a change.

I believe most of the muddling comes from sloppy diagnostic techniques and this causes a compounding effect which has ultimately produces a paradigm shift.

In fact, one of the only reasons that the changes to the DSM have been suggested is because clinicians have come to realize that diagnostic criteria are inconsistently applied, resulting in the above situation (and they likely find this to be an embarrassment as it reflects how far removed their field is from the standards and methods of other medical fields, so they are trying to cover it up rather than improve their standards)

Did you know most people go into psychology not because they have an interest in it but they think it's an easy thing to major in?

Did you know most people go into psychiatry not because they have an interest in it because they think it's the easiest way to get a Dr attached to the front of their name and an MD attached to the back?

Perhaps I'm wrong in thinking this but I'm of the opinion that a professional should know more about their field than the person with AS who fixates on that field as a special interest.

i think its a good idea

LOL at psychology being an easy major. there might be some truth to that

I'm for the merge but for selfish reasons. I fall between the diagnostic cracks. You could call me anything from severe Asperger's to moderate classic autism... depending on how you look at it.

I don't mind either way whether or not Asperger's gets combined with classic Autism, etc. Asperger's is already seen as a form of autism anyways, so calling it all Autism Spectrum Disorder makes logical sense to me. It's all a spectrum, really. It depends on the severity. I don't think someone with a smidgin of common sense is going to assume that if a person has a dx of ASD, then they have the same abilities as another person with the same dx.

I don't know where this information about psychiatry and psychology being "easy" is coming from, but it sounds a bit insulting to me.