An overview of the DSM IV to 5 changes for autism and Asperger's

While writing this, the publication of the DSM 5 is drawing near. And as a regular on this forum I?ve seen a lot of people being unclear about their condition. Some need a diagnosis and are being told by therapists that Asperger?s Syndrome will disappear and as such don?t need a diagnosis since? well.. in a month it doesn?t exist.

People are getting stressed out since they are thinking they will not be aspies and/or will not receive services anymore.

Simply put; it?s bulls**t.

For people new to the entire deal of autism, Asperger?s and PDD-NOS. These things won?t disappear. Everything will be clumped into a single category. Yes the label Asperger?s as a separate thing will disappear. But it doesn't mean you're less autistic.

The following is an excerpt of the DSM 5, as it is, presumably going to look like in the next few years from may 2013 on.

Individuals must meet the criteria in sections A, B, C and D to receive a diagnosis of Autism Spectrum Disorder .

(A) Deficits in social communication and interaction not caused by general developmental delays. Must have all 3 areas of symptoms present.

1. Deficits in social-emotional reciprocity; failure to have a back and forth conversation.
2. Deficits in nonverbal communication such as abnormal eye contact and body language or difficulty using and understanding nonverbal communication, and lack of facial expressions or gestures.
3. Deficits in creating and maintaining relationships appropriate to developmental level (apart from relationships with caregivers). This may include trouble adjusting behavior to suit different social contexts, difficulties with imaginative play and making friends, and a lack of interest in other people.

(B) Demonstration of restricted and repetitive patterns of behavior, interest or activities. Must present two of the following.

1. Repetitive speech, repetitive motor movements or repetitive use of objects (echolalia, idiosyncratic phrases).
2. Adherence to routines, ritualized patterns of verbal or nonverbal behavior, or strong resistance to change (insists on eating the same food, repetitive questioning, or great distress at small changes).
3. Fixated interests that are abnormally intense of focus (strong attachment to unusual objects, restricted interests).
4. Over or under reactivity to sensory input or abnormal interest in sensory aspects of environment (such as indifference to pain, heat or cold, negative response to certain sounds or textures, extreme smelling or touching of objects, fascination with lights or spinning objects).

(C) Symptoms must be present in early childhood (May not become apparent until social demand exceeds limited capacity).

(D) Symptoms collectively limit and hinder everyday functioning.

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And that?s all there is to it.

This is the DSM IV diagnostics sheet for autism

(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)

(A) qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

(B) qualitative impairments in communication as manifested by at least one of the following:

1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play

(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

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I went ahead and crossreferenced symptoms of both versions below


This also means that in the new version A3, B1, B2 and B4 are left out. Most communication issues as well as sharing "excitement" aren't among the traits to diagnose autism anymore. And while autism in general is also marked by a delay in communication (mostly speech), it also marks that people on the spectrum with Asperger's don't suffer from this to the extreme. So all in all I don't know if it would exclude aspies as such. Also, III is totally absent in DSM 5. But if you qualify in DSM IV, you most likely will qualify in DSM 5 as well. Unless the factors left out were pivotal.

I actually think that the new criteria, and the elimination of certain sub-categories makes it more clear that people actually qualify. You're either on the spectrum or not. It's often believed that Asperger's syndrome is a mild for of autism. I disagree, and for that it might be good there is a catch-all category.

Does it exclude people, because they don't have trait X? Obviously, but I don't think it should be taken as no problem at all. It clearly is. It just happens that you're not autistic, but you can very well be impaired in speech or have a sensory integration disorder.

I do worry however that some services will try really hard to claim "there is no such thing as Asperger's" and for that I think everyone should arm themselves (figuratively speaking) and refer to it being a form of autism and not let them discard you as not suffering from anything. It could mean some individuals need to be reassessed, but if you already have documentation I don't think it's weird or unfair to take legal action, especially in parts of the world where healthservices are really expensive. I don't think it's fair to force someone to make expenses for a new diagnosis just because the rules of the game changed a bit. Going from version 4 to 5... you're still playing the same damn game, it's just an updated version. And that's what services need to understand.

Furthermore, there has been some debate if it scales. Is everyone with Asperger's a mild case? I beg to differ. The only thing that set me apart from having Asperger's instead having High Functioning Autism was that there were no significant delays in speech... in fact, I could talk way before the appropriate age. And they removed that criteria for a big part. My communication has always been weird, and probably always will be. Being able to speak doesn't neccesarily make someone more or less autistic. How your brain handles these interactions does. And if there was a thing here or there that wasn't corresponding with the Asperger's diagnosis, it would've been PDD-NOS.

PDD-NOS isn't a mild thing in every case either. Some people can have a severe form. Just like there's severe aspies, and less severe people with "classic" autism.

I don't think people should worry if they're being perceived as mild. There are 3 levels of severity proposed. But as far as I know (and if anyone knows more about this, please comment), there aren't even guidelines in regards to severity and has to be assessed per individual basis. So anyone telling you "Asperger's is mild, so you don't need services" is trying to get out of offering services as such. There is no scale as such at the moment. I do predict that in the near future there will be revision of DSM 5 with such a scale though.

Hope this clears up some stuff for anyone slightly stressed out about the changes in diagnostics tools.