DSM-5 Changing Autism Spectrum Disorder Diagnosis

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The way in which Autism Spectrum Disorders, including Asperger's Syndrome, are diagnosed are going to radically change in May 2013. At the moment the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders ) criteria is being used to diagnose and categorise Autism Spectrum Disorders, within the Spectrum there are currently 2 main categories – Autism and Aspergers. With the new criteria of DSM-5 Apergers Syndrome, CDD (Childhood Disintegrative Disorder) and PDD NOS (Pervasive Development Disorder Not Otherwise Specified)will also fall into the general category of Autism Disorders/Autism Spectrum Disorders. The new proposed DSM-5 (DSM-V) will do away with Aspergers all together and they will all fall within one label – Autism Disorders with specific symptom identifiers.

http://isybeeautism.com/autism/dsm-5-changing-autism-spectrum-disorders-...

Comments

is this a problem?

As I understand it, in the DSM-III-R (before Asperger's Disorder appeared in the DSM-IV) a person with what we now call Asperger's Disorder could (should?) have been diagnosed with PDD-NOS. In Australia, we didn't use the PDD-NOS label much ... I can think of a few reasons for that.

Frankly, these labels used seem a quite arbitrary to me. I have seen people diagnosed with "mild autism" as kids who are profoundly disabled as adults. There seems to be a major area of imprecision between Asperger's and what is called informally (and misleadingly) "high functioning" autism (HFA). Several very reputable psychiatrists told me that in adults it can be very difficult, even impossible, to distinguish autism from schizophrenia.

People whose label changes from PDD-NOS to ASD will probably be better off (there may be less confusion). I understand people who have invested in an Asperger's sub-culture will not want this change ... but they too may be better off. The "Asperger's is mild autism" misinformation (they are all defined as "severe and pervasive impairment ...", there is no mild or moderate in the criteria) should be reduced through this change. The change might also undermine the nasty belief that some people have that "an Asperger's label is just an excuse to be naughty".

People can always use the ICD-10 versions if they prefer ... see http://a4.org.au/a4/PDDformal ... with terms like Childhood Autism, Atypical Autism, ...

Distinguishing autism from schizophrenia

Sorry bobb, but if your "several very reputable psychiatrists" sincerely believe it is very difficult or impossible to distinguish autism from schizophrenia then they shouldn't be practicing. I mean - seriously...??? While it is possible to have co-morbidity, the era of confusing the two conditions has long gone. Would these reputable psychiatrists care to add "refrigerator mothers" back into the equation while they are at it?

Schizophrenia

I was diagnosed with Schizophrenia, and was treated and medicated for years, all to no avail. I saw multiple professionals (and Im talking at least 10) and although there was some difference in opinion, the general opinion was schitzoid, I have been treated for everything from Bi Polar to schizophrenia and personality disorders. Its only been now that my son has been diagnosed with Aspi that I finally know what I am. So I dont doubt for a minute that certain aspects of the autism spectrum can be misdiagnosed by even the most experienced professional. Im my experience I could not explain what I was going through as I was so certain that I was so vastly different from everyone else that no one would ever understand even if I went into it with them, So I simplified my feelings into terms I thought to be more "normal", Still accurate but definately what I thought to be more in line with what I thought to be acceptable to others.

This obvioulsy will not apply to all cases but it certainly did to mine, and I now know I can't be the only one.

schizophrenia

The point you make is very valid - there is broad evidence of misdiagnoses of schizophrenia and other mental illnesses instead of Autism Spectrum Conditions (ASC). However, the literature suggests that this is due to uninformed health professionals who remain influenced by old and outdated Autism myths, despite the wealth of professional literature available to them. They do not have enough skill to flag the use of correct diagnostic tools, and they don't keep their professional knowledge updated, as all this information is out there.

Co-morbidity of ASC with some other mental illnesses is high, however some of these are avoidable conditions secondary to ASC (e.g. depression, substance use disorder, anxiety disorders). Other conditions relate to genetic traits not shared by everyone with ASC, and many conditions (including schizophrenia) have no higher prevalence in ASC populations than they do in normal populations.

Unfortunately for us, people seem naturally cued to link our unusual behaviours to already stigmatised and socially unacceptable, or "threatening", conditions. It is too easy for lazy and unskilled practitioners to assume "bad" behaviours are due to schizophrenia, substance abuse etc as opposed to understanding them as natural responses to ASC symptoms or secondary conditions. There are many psychometric assessment tools quite capable of delineating ASC from other disorders. It should also be recognised that medical qualifications do not make one immune to holding erroneous or prejudicial beliefs, or discriminating against patients.

There is another take on this situation, which is linked more to social psychology. There appears to be some resistance to de-stigmatising Autism within some (not all) education and medical professions. Any diagnosis or intervention which is NOT based on extreme abnormality is rejected by some professionals. This may be linked to their psychological or material needs (e.g. feeling needed; reinforcing their social identities as "saviours"; acquiring and using power; or making money), which perhaps interacts with the failure of tertiary institutions to adequately educate them. I suggest that these factors are also associated with the tendency for some education and health professionals to downplay the needs of high functioning individuals in favour of those of more "needy" lower functioning individuals. Upshot - it isn't about us, it's about them.

So my point was, and remains (as a researcher who specialises in this) - any psychiatrist, pediatrician, or psychologist who misdiagnoses ASC as another condition should seriously think about their professional qualifications and/or personal and professional motivations. There is no excuse except ignorance, and unfortunately this situation seems likely to persist.

Yes - this is a problem

Although the DSM-IV TR may be considered problematic by some, it was a positive step in the history of Autism Spectrum Conditions (ASC). The benefits of teasing out the different categories and criteria of ASC is not limited to diagnostics, which in turn directs quality of life improvements. Differentiation of autism endophenotypes enables understanding of the entire spectrum.

Endophenotype understanding is vital, for example,for ASC females who may remain largely undiagnosed or misdiagnosed. It is also vital to all people on the spectrum who have common co-morbid conditions, such as auto-immune disorders. With any reduction in diagnostic categories there will likely follow reductions in ASC diagnoses (see http://www.nytimes.com/interactive/2012/01/20/us/redefining-autism.html). A reduction in diagnoses will decrease or delay research into co-morbid condition expression in ASC by limiting the research populations. That equates to potential delay in interventions for co-morbid conditions such as auto-immune disorders in people with ASC. That compounds the tragedy of not receiving ASC support due to the retrograde diagnostics of DSM-V. Not receiving support for ASC is one thing - delaying critical research on auto-immune disorders and other debilitating conditions within ASC groups is an entirely different aspect few people stop to consider.

I have encountered many people (particularly parents) who continue to dispute Asperger's as part of the Autism Spectrum at all, whether through denial, ignorance, or stigma. Although somewhat understandable, this blind denial has not helped anyone. The DSM-IV TR may not have been perfect, but it was better than the proposed DSM V.

Don't underestimate the power of the APA and DSM in Australian and global diagnostics, regardless of the existence of the ICD-10.

One Families View

We have 2 children on the spectrum One is a high functioning Autistic and one is an Aspie and at 9 and 13 respectively I can tell you that our family is unanimously horrified that the DSM V is going to lob them altogether. Our boys have very separate identities and the differences in their Autism is definitive. Anyone who has ever stuggled with the difference or proported non differences between Aspies and High Functioning Autistics should meet them!

Our wish would be to have the powers that be come and walk a week or two with our family to see those differences in an everyday setting to see how important it is to maintain the differences in the 'labels'.

The label of Aspergers has been very helpful in giving our 13 year old an identity and an understanding of his personality..........one that is separate to his very different brother.

I hope and pray that there is lots more thought before the changes are cemented. What are other families thinking. What will it do to our Aspies diagnosis'?

PS Anyone who would put Aspergers down as mild impairment needs to get out there more. Our autistic boys world is black and white. Yes or No. Right or Wrong. Our Aspie lives in a world where there are 100 shades of grey and no easy answers to his questions about right and wrong.