DSM-V plans to drop Asperger's, it's just Autism with severity

[ensabah6]

http://www.associatedcontent.com/article/2695965/dsmv_aspergers_syndrome_to_be_eliminated.html?cat=5

The Proposed Changes to the DSM Will Move the Category of Asperger's Syndrome in with Autism


In a draft released February 10, 2010, the American Psychiatric Association's DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) has proposed to eliminate the diagnosis of Asperger's Syndrome
and instead group it together with Autism.

I am looking at the thread on Asperger's and I wonder if anyone knows that Asperger will disappear in DSMV, and be replaced by autism with severity scale. The scientific committee believes Aspergers is just high functioning autism and should be diagnosed as such.

 

[zoobyshoe]

Evo started a thread about this change a few weeks ago, so I was aware of it, yes.

I think the medical community should drop psychiatry and let neuro-psychiatrists handle all the things now considered "mental illness".

 

[ensabah6]

Evo started a thread about this change a few weeks ago, so I was aware of it, yes.

I think the medical community should drop psychiatry and let neuro-psychiatrists handle all the things now considered "mental illness".

Have neuro-psychiatrists any evidence that Asperger's is distinct from autism? APA decided that there are no differences.

 

[zoobyshoe]

Have neuro-psychiatrists any evidence that Asperger's is distinct from autism? APA decided that there are no differences.

What I'm alluding to is that the APA has no idea what causes any condition in the DSM. They treat exclusively by trial and error. Were all these conditions to be handled by neurologists there would be much more rigorous research of the organic causes.

 

[ensabah6]

What I'm alluding to is that the APA has no idea what causes any condition in the DSM. They treat exclusively by trial and error. Were all these conditions to be handled by neurologists there would be much more rigorous research of the organic causes.

disorders ranging from bipolar to depression to schizophrenia to autism are.

I personally think Asperger is a valid subtype within ASD

 

[nismaratwork]

Lets be clear, the DSM is a tool for Psychiatrists and Psychologists to codify something for insurance purposes. No one should pay it any mind if they are a professional, except a the tool it is. The DSM is a reflection of what is accepted in committees, not the leading edge of psychology or neuroscience.

 

[ensabah6]

Lets be clear, the DSM is a tool for Psychiatrists and Psychologists to codify something for insurance purposes. No one should pay it any mind if they are a professional, except a the tool it is. The DSM is a reflection of what is accepted in committees, not the leading edge of psychology or neuroscience.

What would be leading edge science on autism and asperger's?

 

[nismaratwork]

What would be leading edge science on autism and asperger's?

Current studies, especially in functional imaging and neurobiology.

 

[ensabah6]

Current studies, especially in functional imaging and neurobiology.

What do these current functinoal imaging studies say about the DSM framing of autism and Aspergers, and dropping aspergers and subsuming it under Autism, or using a severity designation?

 

[zoobyshoe]

Lets be clear, the DSM is a tool for Psychiatrists and Psychologists to codify something for insurance purposes. No one should pay it any mind if they are a professional, except a the tool it is. The DSM is a reflection of what is accepted in committees, not the leading edge of psychology or neuroscience.

Well put.

 

[nismaratwork]

What do these current functinoal imaging studies say about the DSM framing of autism and Aspergers, and dropping aspergers and subsuming it under Autism, or using a severity designation?

They don't bother with the DSM in the first place, it's meaningful research not the work of a decade by a committee. In this case, where to place it is not important; the cause and mechanism are important. Your usage of the word "subsume" would seem to indicate that you believe Aspergers, (which clinically is already regarded as ASD, is somehow being glossed over or demoted. In reality, the paperwork is just catching up with the best guesses out there by psychologists, and imaging of autistic brains, a cohort of which Aspergers seems to be a part. Certainly there has not been enough research yet to give anything like definitive answers, which is ALSO the point.


Zoobyshoe: Thank you!

 

[ensabah6]

They don't bother with the DSM in the first place, it's meaningful research not the work of a decade by a committee. In this case, where to place it is not important; the cause and mechanism are important. Your usage of the word "subsume" would seem to indicate that you believe Aspergers, (which clinically is already regarded as ASD, is somehow being glossed over or demoted. In reality, the paperwork is just catching up with the best guesses out there by psychologists, and imaging of autistic brains, a cohort of which Aspergers seems to be a part. Certainly there has not been enough research yet to give anything like definitive answers, which is ALSO the point.


Zoobyshoe: Thank you!

DSM is stating that there is no Asperger's, not Autism spectrum disorder. Most Asperger's will be relabeled high-functioning autism. If committee makes its recommendation based on hard science, then its decision is grounded in hard science. Do MRI and neurobiology support Asperger's as just autism?

 

[nobahar]

They don't bother with the DSM in the first place, it's meaningful research not the work of a decade by a committee. In this case, where to place it is not important; the cause and mechanism are important.

Surely they go hand in hand?
When doing research the participants are surely selected on the basis of a diagnosis, deduced via the symptoms?
If your doing a study into bipolar "disorder" (using the word loosely), you need a group of participants diagnosed as bipolar. In the case of mental health issues, its largely through observations of behaviour by the psychiatrist, family members and by self-reports. Not be any biological means that would be fairly unambiguous. This is not to say that diagnosis using the current method is not going to be successful, but it may well be that the criteria for diagnosis may have some difficulties: too broad for instance, and the particular disorder may actually encompass a number of disorders; this would probably be a confounding variable in a study. I remember reading a book about mental health issues which identified a number of studies suggesting the diagnosis of Schizophrenia is too broad, and consequently studies, including biological ones, often yielded 'peculiar' results, because the participants did not share the particular ‘variable’ of interest.
Sorry if my post is a little confusing, I'm not particularly good at articulating my thoughts!
Hopefully an example will help:
If you were looking into the neurobiology of Schizophrenia, you may find the participants, who were included on the basis of a 'classical' diagnosis, show differences. Since Schizophrenia has various manifestations, there may be a connection between the observations in the experiment and the particular symptoms exhibited. This may suggest different aetiologies and inform improvements in the diagnostic process.
Just my thoughts...

 

[nismaratwork]

DSM is stating that there is no Asperger's, not Autism spectrum disorder. Most Asperger's will be relabeled high-functioning autism. If committee makes its recommendation based on hard science, then its decision is grounded in hard science. Do MRI and neurobiology support Asperger's as just autism?

They do seem to be similar, but it's hard enough to conclusively identify autism with nothing but imaging. This goes to nobahar's first point, which is in fact, no they do not go hand in hand. The jury is still out in the scientific end, but the jury is NEVER out for the DSM.

Remember when homosexuality was in the DSM? It is not the core of psychology, just a reflection of what a committee and insurance companies will accept.

 

[nismaratwork]

Surely they go hand in hand?
When doing research the participants are surely selected on the basis of a diagnosis, deduced via the symptoms?
If your doing a study into bipolar "disorder" (using the word loosely), you need a group of participants diagnosed as bipolar. In the case of mental health issues, its largely through observations of behaviour by the psychiatrist, family members and by self-reports. Not be any biological means that would be fairly unambiguous. This is not to say that diagnosis using the current method is not going to be successful, but it may well be that the criteria for diagnosis may have some difficulties: too broad for instance, and the particular disorder may actually encompass a number of disorders; this would probably be a confounding variable in a study. I remember reading a book about mental health issues which identified a number of studies suggesting the diagnosis of Schizophrenia is too broad, and consequently studies, including biological ones, often yielded 'peculiar' results, because the participants did not share the particular ‘variable’ of interest.
Sorry if my post is a little confusing, I'm not particularly good at articulating my thoughts!
Hopefully an example will help:
If you were looking into the neurobiology of Schizophrenia, you may find the participants, who were included on the basis of a 'classical' diagnosis, show differences. Since Schizophrenia has various manifestations, there may be a connection between the observations in the experiment and the particular symptoms exhibited. This may suggest different aetiologies and inform improvements in the diagnostic process.
Just my thoughts...

On the case of Schizophrenia there are common markers, but the classical diagnosis is incredibly easy to make in a clinical setting. The same cannot be said of ASDs. In the case of Schizophrenia there is a single disorder, and some satellite disorders which are clearly defined. With a bit of training, the difference between someone who is manic with psychotic features and someone who is Schizophrenic is obvious. Autism just isn't that straightforward. Autism covers a spectrum, and the diagnosis is never based on imaging, but clinical studies and observation over time.

Schizophrenia is one thing, even if the mechanisms are not all known, and the cause is unknown. Autism is a spectrum of disorders which are poorly understood in every way.

 

[nobahar]

With a bit of training, the difference between someone who is manic with psychotic features and someone who is Schizophrenic is obvious. Autism just isn't that straightforward. Autism covers a spectrum, and the diagnosis is never based on imaging, but clinical studies and observation over time.

Schizophrenia is one thing, even if the mechanisms are not all known, and the cause is unknown. Autism is a spectrum of disorders which are poorly understood in every way.

I cannot say whether everyone diagnosed with schizophrenia all 'share' the same mental health issue (I'll call MHI, to save writing!), but there have been papers arguing that the diagnosis is too broad; and those diagnosed with Schizophrenia do not share a MHI in common.
It gets confusing I feel because, as you seem to suggest (correct me if I'm mistaken), these are simply labels. To be honest, I'm not sure if I agree or not. I would certainly not condone a Szaszian opinion, though.
I still feel that they do go hand in hand, in the sense that one is used with the other or to determine the other. Although that has its pitfalls...
N.B. I hope you don't think I'm being confrontational. I'm genuinely interested in this conversation.

 

[nismaratwork]

I cannot say whether everyone diagnosed with schizophrenia all 'share' the same mental health issue (I'll call MHI, to save writing!), but there have been papers arguing that the diagnosis is too broad; and those diagnosed with Schizophrenia do not share a MHI in common.
It gets confusing I feel because, as you seem to suggest (correct me if I'm mistaken), these are simply labels. To be honest, I'm not sure if I agree or not. I would certainly not condone a Szaszian opinion, though.
I still feel that they do go hand in hand, in the sense that one is used with the other or to determine the other. Although that has its pitfalls...
N.B. I hope you don't think I'm being confrontational. I'm genuinely interested in this conversation.

I find this very interesting, not confrontational. I don't think these are just labels, I believe there is something very much in common, but not with the certainty you see in the DSM. For Schizophrenia, I personally believe that one diagnosis is appropriate, provided that it is the correct diagnosis. After all, there are other mental illnesses which can have similar features or presentation, including schizophreniform disorders. There is an element of pure labeling however, when you go deeper and realize how individual even a fairly uniform disorder such as Schizophrenia can be for the patient! Some people live decent lives, or troubles lives that still work for them, while others cannot or will not be helped at this time.

Putting Aspergers as its own disorder is unjustified, but then, so is placing it within the Autism Spectrum. The science really is still out on the issue, but again, the DSM never is. That is a HUGE disconnect.

 

[ensabah6]

I find this very interesting, not confrontational. I don't think these are just labels, I believe there is something very much in common, but not with the certainty you see in the DSM. For Schizophrenia, I personally believe that one diagnosis is appropriate, provided that it is the correct diagnosis. After all, there are other mental illnesses which can have similar features or presentation, including schizophreniform disorders. There is an element of pure labeling however, when you go deeper and realize how individual even a fairly uniform disorder such as Schizophrenia can be for the patient! Some people live decent lives, or troubles lives that still work for them, while others cannot or will not be helped at this time.

Putting Aspergers as its own disorder is unjustified, but then, so is placing it within the Autism Spectrum. The science really is still out on the issue, but again, the DSM never is. That is a HUGE disconnect.

The most common argument in eliminating Asperger's and replacing it with Autism, is that low-functioning non-speaking autists at childhood can learn language and when they do, their presentation is identical to early-language speaking Asperger's.

The DSM early language delay or no language delay isn't helpful if the patient is an adult.

 

[nismaratwork]

The most common argument in eliminating Asperger's and replacing it with Autism, is that low-functioning non-speaking autists at childhood can learn language and when they do, their presentation is identical to early-language speaking Asperger's.

The DSM early language delay or no language delay isn't helpful if the patient is an adult.

It is useful when you take a patient's history.

 

[ensabah6]

It is useful when you take a patient's history.

if a patient is speaking clearly now, but the history shows delay in speech and language, is the pt autism or AS?

I am sympathetic to your position, btw. One parent wrote that 2 kids one as the other autism, one dreams of college, the other life-long assisted living.

http://www.child-psych.org/2010/02/autism-and-aspergers-in-the-dsm-v-going-beyond-the-politics.html

Autism and Asperger’s in the DSM-V: Thoughts on clinical utility

Written by Nestor Lopez-Duran PhD on Monday, February 15.2010

"For example, recently a doctoral intern and I sat in supervision to discuss a case of a teenage boy who could be described as having a “perfect” Asperger’s profile, fitting both the student’s schema and the DSM-IV criteria; except for one thing: the client had a documented history of language delays. There was no question about the diagnosis: If the teen had a history of “language delays’ the diagnosis is autism. My student then asked me, so if this is HFA, how does Asperger’s look like? I replied, just like this.

Therefore, in clinical settings, HFA and Aspeger’s disorder look mostly identical, assuming the clinician follows DSM guidelines. But the most important question is whether the current diagnostic difference is clinically useful. When debating the Autism vs. Asperger’s diagnostic question, I have always asked my students and supervisors whether the diagnostic difference would change anything regarding our approach to the case. This is the most critical question: would our recommendations or conclusions change based on the final diagnosis that we provide (autism vs. Asperger’s)? The answer is usually, if not always, no. Given identical clinical profiles, the recommendation for treatment, school accommodations, parental interventions, and so forth, would be the same for two adolescents who only differ on the presence or absence of language delays in early childhood. The provision of a diagnosis of autism vs. Asperger’s may lead to different political/personal/social consequences, but clinically, the current DSM-IV distinction between these two conditions, and the research that has come out of this distinction, has not informed or improved our clinical practice (e.g., selection of treatment, assessment, prognosis, etc). This is likely one of the main reasons that led the DSM committee to suggest the merger of Asperger’s and Autism."

 

[nobahar]

I suppose, whether or not Asperger's should be amalgamated with Autism, there is a need to have a diagnosis for the purposes of treatment. It can hardly be put on hiatus whilst it is determined whether or not the two should be considered under a single heading.
I don't have any extensive knowledge of the treatments, but there appears to be differences, and so they need to be differentiated for this reason; whatever name you attribute to them. Surely for that reason it is irrelevant what name is used (although for that reason only, as far as I can see).

 

[ensabah6]

I suppose, whether or not Asperger's should be amalgamated with Autism, there is a need to have a diagnosis for the purposes of treatment. It can hardly be put on hiatus whilst it is determined whether or not the two should be considered under a single heading.
I don't have any extensive knowledge of the treatments, but there appears to be differences, and so they need to be differentiated for this reason; whatever name you attribute to them. Surely for that reason it is irrelevant what name is used (although for that reason only, as far as I can see).

The current 2010 proposal is to call Aspies, "mild autism" "subclinical" or "normal"

 

[nismaratwork]

if a patient is speaking clearly now, but the history shows delay in speech and language, is the pt autism or AS?

I am sympathetic to your position, btw. One parent wrote that 2 kids one as the other autism, one dreams of college, the other life-long assisted living.

http://www.child-psych.org/2010/02/autism-and-aspergers-in-the-dsm-v-going-beyond-the-politics.html

Autism and Asperger’s in the DSM-V: Thoughts on clinical utility

Written by Nestor Lopez-Duran PhD on Monday, February 15.2010

"For example, recently a doctoral intern and I sat in supervision to discuss a case of a teenage boy who could be described as having a “perfect” Asperger’s profile, fitting both the student’s schema and the DSM-IV criteria; except for one thing: the client had a documented history of language delays. There was no question about the diagnosis: If the teen had a history of “language delays’ the diagnosis is autism. My student then asked me, so if this is HFA, how does Asperger’s look like? I replied, just like this.

Therefore, in clinical settings, HFA and Aspeger’s disorder look mostly identical, assuming the clinician follows DSM guidelines. But the most important question is whether the current diagnostic difference is clinically useful. When debating the Autism vs. Asperger’s diagnostic question, I have always asked my students and supervisors whether the diagnostic difference would change anything regarding our approach to the case. This is the most critical question: would our recommendations or conclusions change based on the final diagnosis that we provide (autism vs. Asperger’s)? The answer is usually, if not always, no. Given identical clinical profiles, the recommendation for treatment, school accommodations, parental interventions, and so forth, would be the same for two adolescents who only differ on the presence or absence of language delays in early childhood. The provision of a diagnosis of autism vs. Asperger’s may lead to different political/personal/social consequences, but clinically, the current DSM-IV distinction between these two conditions, and the research that has come out of this distinction, has not informed or improved our clinical practice (e.g., selection of treatment, assessment, prognosis, etc). This is likely one of the main reasons that led the DSM committee to suggest the merger of Asperger’s and Autism."

Well, to the bolded portion, I would still differentiate between "developmental delay *language* not otherwise specified" and the other features of Aspergers, such as a history of difficulty in social milieu. Beyond that, I think nobahar has the point; what is there to treat in an adult with no current symptoms?

If there are other symptoms that cannot be distinguished from Autism... that's a tough one. For the rest of your post, I appreciate that very much, for all the effort it's still dark in this region of neuroscience and psychology.

 

[nismaratwork]

The current 2010 proposal is to call Aspies, "mild autism" "subclinical" or "normal"

Normal... sometimes psychology seems not to learn the lessons of the past. *groan*

 

[ensabah6]

Personally I think Aspergers should be kept as a distinct SUBTYPE of Autism, with redefinition (i.e active but odd social interest, sophisticated intellectual interests, good language use) since
1- it allows for genetic studies to be done,
2- allows scientific research and MRi and brain imaging studies.

If the causes of AS differ from Autism, then placing them together would make as much sense as placing Rett syndrome, Tuberous sclerous, erlos-danos syndrome (Jenny Mcarthy's son original diagnosis was autism, now it's this) hypothroidism, selective mutism, childhood disintegrative disorder under autism.

 

[Nicolas001]

According to me Aspergers syndrome is a form of autism, both is a life-long developmental disability that affects social and communication skills. Like autism, Aspergers syndrome is caused by a biological difference in the brain's development as same like autism and even people with Aspergers syndrome share many of the same characteristics as those of people with autism.

 

[nismaratwork]

According to me Aspergers syndrome is a form of autism, both is a life-long developmental disability that affects social and communication skills. Like autism, Aspergers syndrome is caused by a biological difference in the brain's development as same like autism and even people with Aspergers syndrome share many of the same characteristics as those of people with autism.

Hmmm, what's the biological difference in development that you're referring to? In addition, by your logic you've made the autism spectrum far too inclusive. For thread-necromancy this isn't the best post I could have hoped for.

 

[Nicolas001]

Hmmm, what's the biological difference in development that you're referring to? In addition, by your logic you've made the autism spectrum far too inclusive. For thread-necromancy this isn't the best post I could have hoped for.

Biological difference that I mentioned was a brain disorder that impairs verbal and non verbal communications which is usually observed in an Aspie.

 

[nismaratwork]

Biological difference that I mentioned was a brain disorder that impairs verbal and non verbal communications which is usually observed in an Aspie.

I'm asking what observed structural changes you're talking about, because that would be breaking news. None of the ASD's have been shown to be what you describe... it's more complex and harder to identify.

 

[Yanick]

I don't know a great deal about this area, but even in Nursing School I didn't like Psychiatry/Psychology and felt that it was/is too 'soft' of a science with too much subjective data being used to come up with these rules and guidelines which must be adhered to in the clinical setting. Even speaking to the other Medical Residents, PA's etc, it always astounded me how hand wavy the diagnosis process seems to be.

I saw this TED talk the other day and it astounds me that these types of tools are still not the mainstream tools used to evaluate patients with developmental delays/mental health disorders etc. Instead the whole field is based on people's opinions of observed behaviors.

http://www.ted.com/talks/aditi_shankardass_a_second_opinion_on_learning_disorders.html

 

[nobahar]

I don't know a great deal about this area, but even in Nursing School I didn't like Psychiatry/Psychology and felt that it was/is too 'soft' of a science with too much subjective data being used to come up with these rules and guidelines which must be adhered to in the clinical setting. Even speaking to the other Medical Residents, PA's etc, it always astounded me how hand wavy the diagnosis process seems to be.

I saw this TED talk the other day and it astounds me that these types of tools are still not the mainstream tools used to evaluate patients with developmental delays/mental health disorders etc. Instead the whole field is based on people's opinions of observed behaviors.

http://www.ted.com/talks/aditi_shankardass_a_second_opinion_on_learning_disorders.html

Could you some up the 'types of tools', I'm interested to know but don't want to watch the whole talk!

 

[Yanick]

In a quick summary. They took kids who were diagnosed as autistic or developmentally delayed and hooked them up to an EEG and found that many of the children were not really autistic but were having seizures (probably simple partial seizures, not the type most people associate with seizures). These seizures actually mimicked the symptoms of autism and the kids were labeled and treated as such. A couple of months of seizure meds and the kids are in regular classes in school, karate classes etc. I think she mentions that something like (don't quote me on the exact number) 50% of the children diagnosed as autistic, really have this type of seizure disorder which is absolutely treatable.

The talk doesn't get any deeper than that really, its really more of a plea by the speaker to get this info out there (IMO). Check it out, its only 7 minutes long.

 

[nismaratwork]

In a quick summary. They took kids who were diagnosed as autistic or developmentally delayed and hooked them up to an EEG and found that many of the children were not really autistic but were having seizures (probably simple partial seizures, not the type most people associate with seizures). These seizures actually mimicked the symptoms of autism and the kids were labeled and treated as such. A couple of months of seizure meds and the kids are in regular classes in school, karate classes etc. I think she mentions that something like (don't quote me on the exact number) 50% of the children diagnosed as autistic, really have this type of seizure disorder which is absolutely treatable.

The talk doesn't get any deeper than that really, its really more of a plea by the speaker to get this info out there (IMO). Check it out, its only 7 minutes long.

The softness of Medicine and Psychology isn't a big problem when the people involved are aware of the limitations, and take steps to ameliorate the dangers inherent in misdiagnosis. You need to accept that art and practice as well as the science of these disciplines, and that means something less than absolute confidence in areas such as neurobiology (barring a giant tumor or the like). Too few people do this, and so we have over-diagnosis, misdiagnosis, and a public that is about as functional as a pithed frog in terms of being able to recognize these issues.

 

[bobze]

The softness of Medicine and Psychology isn't a big problem when the people involved are aware of the limitations, and take steps to ameliorate the dangers inherent in misdiagnosis. You need to accept that art and practice as well as the science of these disciplines, and that means something less than absolute confidence in areas such as neurobiology (barring a giant tumor or the like). Too few people do this, and so we have over-diagnosis, misdiagnosis, and a public that is about as functional as a pithed frog in terms of being able to recognize these issues.

And let's not forget that we live in a country (we'll I actually don't know what country you live in ) where years of poor doctor-patient relationships and communication have driven patients to seek medical knowledge and results from people like the "caped-crusader of autism"...Jenny MaCarthy...Forget medical school, I want my advice from someone who's hosted an MTV show!

 

[mugaliens]

There are a few things in the DSM-IV-TR which I think are pure bunk.

The DSM-5 plans call for changes to aspergers, bipolar, personality disorder, PSD, schizophrenia, and somatoform disorder. Unfortunately, none of the proposed changes involve removing the bunk.

Amazingly, the DSM-5 committe had to sign non-disclosure agreements, thus shoving the entire process into secrecy! No transparency, no opportunity to redress before it goes to press. Furthermore, 70% of the members have direct ties to the industry, raising severe questions of bias.