You obviously have the answer to your question already, Keith, but I can't help but comment (at length, sorry
) on what's happened.
AdamR is right that there has been a lot of resistance to this move to eliminate the Asperger's Disorder diagnosis. One of the most compelling arguments appeared in a paper by McPartland, Reichow & Volkmar called "Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder", published in the Journal of the American Academy of Child & Adolescent Psychiatry in January 2012, almost a year and a half before the DSM-V was officially released in May 2013. In the paper, the authors estimated that
up to 75% of individuals currently diagnosed with Asperger's would no longer be considered on the spectrum under the new criteria. Their final conclusion:
"Proposed DSM-5 criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively able individuals and those with ASDs other than autistic disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research."
Read that very carefully. It matters. Many prominent figures in the international Asperger's arena agree with this summary wholeheartedly. Imagine if 75% of the members here, who share the same traits, struggles, and experience of life as the rest, to varying degrees, were suddenly gone from our community. Imagine people who have argued in these forums that others shouldn't self-diagnose falling into the excluded group and being invalidated, themselves. Remember the process you went through to discover you were an Aspie, and the relief you felt once you had a
name for what you'd been living. Kind of makes you stop and think.
If the consolidation of four diagnoses into one is meant to move the medical community "more towards catering to individual needs, recognizing that individuals are...well, individuals," as wyverary said it, it seems more than a little counterintuitive. What looks more likely is that it was an effort to address the increasing prevalence of all ASDs in the U.S. by narrowing the criteria. As a longtime student of social justice, I know this isn't a new strategy. The U.S. government and affiliated institutions have a well established history of skewing numbers in their favor by purposeful exclusion. The fewer individuals they have to recognize, the less money and effort they have to put into a class of people.
The APA states that the change was made because, "Researchers found that these separate diagnoses were not consistently applied across different clinics and treatment centers" **. When I mentioned this to my psychiatrist, she
laughed out loud and said "That could be said of almost any mental health condition. Diagnosis is always subjective to some extent." For the record, she thinks the DSM-V change was a huge mistake.
I would urge all Aspies who feel they have sound arguments for reinstating Asperger's as a distinct diagnosis to write thoughtful letters to the chairwoman of the APA working group that made the controversial decision:
Susan Swedo, MD
National Institute of Mental Health
Magnuson Clinical Center, Room 1C250, MSC 1255
Bethesda, MD 20814 USA
[email protected]
If you live outside of the United States (or not) and are concerned that the World Health Organization may also eliminate Asperger's as its own dx, go to this link and register for participation in the ICD revisions process by clicking "Register to Become Involved":
WHO | World Health Organization
Climbing of my soapbox....
(**
http://www.dsm5.org/Documents/Autism Spectrum Disorder Fact Sheet.pdf )