Since the DSM V has come out several things have changed. First, the DSM V dropped both Aspergers and PDD NOS as a diagnosis. The symptoms of Aspergers have been added into the spectrum resulting in new autism spectrum diagnosis. Here is the reasoning for the change:
One of the most significant changes is that the separate diagnostic labels of Autistic Disorder, Asperger’s Disorder, and PDD-NOS will be replaced by one umbrella term “Autism Spectrum Disorder.” Further distinctions will be made according to severity levels. The severity levels are based on the amount of support needed, due to challenges with social communication and restricted interests and repetitive behaviors. For example, a person might be diagnosed with Autism Spectrum Disorder, Level 1, Level 2, or Level 3. The DSM-V revision website says the reasons for using the umbrella term of “Autism Spectrum Disorder” are 1) the old way isn’t precise enough—different clinicians diagnose the same person with different disorders, and some change their diagnosis of the same symptoms differently from year to year, and 2) autism is defined by a common set of behaviors and it should be characterized by a single name according to severity (http://www.autism.com/news_dsmV).
There are several struggles that we have with the changes in the DSM 5 mentioned above. First, the above paragraph assumes that the debate was settled that Aspergers was just another form of autism. The DSM 5 was delayed due to being tied up into court due to the changes in Aspergers. What brought things out of court was the DSM 5 allowing for Aspergers to be a grandfathered in diagnosis if an individual was diagnosed with this disorder prior to the DSM 5 being released. As one psychologist who worked on the DSM 5 stated, “The focus group for the DSM 5 autism spectrum had determined that Aspergers was not a different diagnosis; however, the grandfathered clause makes it very confusing. Is it or is it not a valid condition?”
Secondly, the main reason given in the paragraph above states that it was dropped due to clinicians who would use the same DSM IV criteria and yet came up with different diagnosis. Show me a diagnosis that does not happen with. Diagnosing is an art, not a science and the DSM is very specific that a diagnosing any disorder involves gathering information in the areas of but not specific too: history, family, symptoms, behaviors, various environments, length of time for symptoms, drug use and/or history of use, environmental factors, social factors, developmental history, culture, various questioner tools, etc. Due to the long term ramifications that a diagnosis can have on a person’s life, diagnosing is a meticulous art. One look at most children’s diagnosis who are in the long term foster care system reveals dozens of differencing diagnosis over the years. When I have asked kids in the system, “Do you know what your diagnosis is?” The reply I generally hear is: “You name it. I’ve had the diagnosis!” Why is Aspergers and PDD NOS the area that experts want to suddenly tighten. Remember, these camps of thought have never gotten along since Leo Kanner and Hans Aspergers published their findings. Diagnosing is strengthened by further training and experience, not tightening a diagnosis. Over the last several decades, there has always been “a popular go to diagnosis” (Bipolar, borderline personality disorder, antisocial, generalized anxiety, ADHD, DID, etc). The point is, over diagnosis and/or “sloppy diagnosis” is across the board. For years I have worked with clinicians who suspect a particular diagnosis, give a 10 question test, and the test results equal the diagnosis void of the attention to the above mentioned areas. One of the most difficult parts of diagnosing is that there are overlapping symptoms from one diagnosis to another. For instance, psychosis can be a component of: PTSD, schizophrenia, Bipolar, drug use, or a psychosis diagnosis in general.
Thirdly, just because the DSM does not acknowledge a diagnosis does not mean it is not a valid diagnosis or condition. It is illegal for a mother to ingest substances knowingly while pregnant. Many children are taken by child protective services every year due to the damage we know occurs to the child; however, it was not until the DSM 5 that any support was given to the diagnosis of: “fetal alcohol/drug affected”. This has also been true for dozens of diagnosis which have been brought in (PTSD and more sever forms of it, gender dysphoria, etc.) and taken out (homosexuality) by the DSM study groups.
Fourthly, Aspergers is a diagnosis that the rest of the world acknowledges. Canada has done extensive genetic studies in the last decade; England has entire boarding schools set up for the treatment of Aspergers and autism; Austrailia has furthered the understanding of the effects of Aspergers and how to treat it. In other words, decades of research have studied differences between autism and Aspergers and it has been well documents by countries all over the world. The World Health Organization (DSM manual that the rest of the world uses) still has Aspergers as one of the three diagnosis of the autism spectrum.
One of the main differences between receiving the diagnosis of autism and Aspergers, is that individuals who receive Aspergers are generally relieved by the diagnosis. The diagnosis has been seen as the missing pieces about who they are which they have been spending their whole lives looking for. Since the DSM 5 has come out, individuals who were diagnosised with Aspergers have been suddenly thrown into a very confusing world that they do not understand. One teenage girl stated, “Since the autism spectrum has come out, my teachers tell me that my Aspergers means I have a “social disorder” and that’s it! It is so much more than just social problems. Aspergers also affects how I think and feel as well!”
Fifthly, the DSM 5 added gender dysphoria to move more in line with the World Diagnostic Manual; however, as mentioned above, the World Diagnostic Manual also includes Aspergers. Aspergers is now seen as “simply just a social disorder”. Like autism, Aspergers is neurological condition which affects far more than just the social aspects of a person. It also affects their thinking, emotional processing, nervous system, sensory processing and collection, and gastrointestinal system.
Even though the DSM V eliminated Aspergers there is still good reasoning to continue to use it. Treatment options: One of the most important things to understand about treating both of these conditions is that there are both similar characteristics but different treatments. Applied Behavioral Analysis (ABA) is the most empirical evidence based treatment developed from Skinners behavioral concepts by the Canadians. Although this is not the only treatment for autism and Aspergers, it is highly effective in helping to focus on specific areas of a child’s needed development in order to help the child continue to grow. Another therapy is the American Floor Time where the therapist allows the child with autism directs therapy according to the child’s lead. Both of these therapies are generally direct towards younger children. Research has shown that the younger autism is diagnosed, the better the effect of treatment. In regards to teenagers and adults, treatment becomes more cognitive behavioral, communication, and social skills oriented; however, research is still looking at whether ABA can still be effective. Regardless of the age, functional assessments can be very helpful tools to assist in addressing certain and specific behaviors.
Unlike popular comments, Aspergers does not have high and low functioning. Low functioning autism is only there due to the individuals’ inability to interact and communicate with the world around them. This is not true for Aspergers. Generally speaking, above average to high IQs are attached to individuals who have Aspergers.
