I have the opposite opinion of the effect of the removal of AS as a separate condition in the DSM. Recognizing it as part of the autism spectrum indicates just how serious AS is. The three levels of the spectrum seem better than a multitude of names. There are, after all, significant differences even among aspies. Should we instead adopt dozens of different names for AS to account for the most significant of those differences? Personally, I favor simplification when practical.
I agree that just as a matter of accuracy in terminology, ASD is a better categorization. However, I think the problems arise more from the change in how ASD is diagnosed under DSM-V. It's not just an issue of the label.
Take a look at the DSM-IV criteria for Asperger's Syndrome (I've bolded certain differences):
(I) Qualitative impairment in social interaction, as manifested by
at least two of the following:
(A) 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
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by
at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)
(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
Now, ASD under DSM-V:
A. Persistent deficits in social communication and social interaction across multiple contexts,
as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by
at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
- Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
- These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.
Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
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I took interest in that last part since I was originally diagnosed with SCD.
This article pretty much sums up my thoughts on that issue.
Now, there are a number of ways in which the new ASD criteria are more descriptive--for instance, including sensory impairment which I would think is definitely a good thing. However, there is the quite glaring issue that someone needs to meet more criteria, in the eyes of the diagnosing clinician, to be diagnosed with ASD than with Asperger's--3 rather than 2 in social communication and 2 rather than 1 in restricted, repetitive patterns of behavior. This is not to mention Tony Attwoods hypothesis that the repetitive and restricted behaviors seen in ASD are actually a way of coping with high anxiety rather than a primary symptom of ASD. If you look further at
guidelines for applying the criteria and levels to ASD, you see that impairment in functioning (coincidentally, the part most relevant to whether people feel someone with ASD deserves support and benefits--the money question, in short) is the key issue in whether or not symptoms qualify as being indicative of ASD.
As for the studies I mentioned, I don't remember the ones I originally looked up, but these
have similar findings. They all found lower rates of diagnosis of ASD under DSM-5, especially for females and high-functioning people. I am not in a position to sort through it all--for one thing, I don't know what version of the DSM-5 criteria all were considering. As
this study explains, the first proposed DSM-5 criteria were much poorer at detecting ASD, and a lot depended on researcher's interpretation of the language. They sum up the current state of research thusly:
"The proposed change to a single ASD category, as well as the requirement that there must be a history of restricted and repetitive behaviors, has led some to believe that DSM-5 will make it more difficult for some individuals with PDDs to qualify for a diagnosis. The comprehensive review by Wing et al. of the proposed criteria articulates some of these concerns, explaining that DSM-5 could inadvertently exclude subgroups of affected people, including very young children, girls, and those with diagnoses of Asperger’s disorder (14). The introduction of “social communication disorder” in DSM-5 raises additional concerns that children currently diagnosed with PDDs will be misclassified with this disorder if they do not meet the DSM-5 requirement for restricted and repetitive behavior.
"In sum, from the existing empirical work, the sensitivity of the proposed DSM-5 criteria remains unclear. "
It seems to me a legitimate concern that the new criteria reduce diagnoses--and not just a reduction in false positives, but excluding many from the high-functioning end of the spectrum and those who are better at pretending to be normal (especially women). So I think Grumpycat's concern about people trying to get rid of Asperger's is legit--it's not just a name change.