What are the pros and cons of the APA’s plan to change the diagnosis of Aspergers to autism without the current separations?

By Mark Hutten, M.A.
In February 2010, the American Psychiatric Association released a draft of the possible revisions to the Diagnostic and Statistical Manual of Mental Disorders or DSM. The current version, the DSM-IV, contains somewhat complicated diagnostic criteria for Autism Spectrum Disorder, which includes Autism, Pervasive Developmental Disorder-Not Otherwise Specified, Aspergers, and includes reference to Rett’s Disorder or Childhood Disintegrative Disorder.

The AMERICAN PSYCHIATRIC ASSOCIATION plans to revise the category of Pervasive Developmental Disorder, simplifying the criteria and removing the distinctive divisions. With this revision, there will no longer be a diagnosis of Aspergers or PDD-NOS. All individuals who meet the criteria will be given a diagnosis of Autism Spectrum Disorders. The reasoning for these changes is to create a more consistent diagnosis, and a spectrum-type diagnosis may solve the problems of inconsistency. This will eliminate the need to diagnose an individual based on the severity of the condition.

Two individuals with the diagnosis of PDD-NOS may have dissimilar abilities. The same is true for two individuals diagnosed with Autism, or with Aspergers. Because these diagnoses are all part of the larger spectrum, you will find differing abilities throughout. The AMERICAN PSYCHIATRIC ASSOCIATION feels the new DSM-V criteria will create a uniform diagnosis for individuals on the Autism Spectrum.

Some experts and individuals are not in agreement with the proposed revisions. There are definite pros and cons to the proposed changes in the opinions of medical professionals and the public, including those directly affected by these revisions. Here are the most common pros and cons.

Pros—

• All related health problems can be recognized and treated. Individuals with Autism Spectrum Disorder often suffer with anxiety, gastrointestinal problems, seizures, and sensory integration dysfunction, along with Autism.

• More services could be available for all levels of ability. Most services require a diagnosis of classic Autism, leaving out the mildly affected individuals.

Cons—

• Some individuals believe that the less affected individuals will not want the stigma of Autism placed on them. Aspergers carries a more neutral connotation than Autism.

• Some individuals feel that milder cases of Autism Spectrum Disorder, those normally diagnosed as PDD-NOS or Aspergers, are more likely to be missed or not to qualify for the new ASD diagnosis.

• To the person affected by Aspergers, the diagnosis is part of who they are, and changing that to Autism may be extreme and cause anxiety.

Many individuals with Asperger’s Syndrome are comfortable with, and even embracing of, their diagnosis of Asperger’s Syndrome. It can even be a sense of identity and pride. To take this away and just “lump” individuals in the much broader Autistic Spectrum category is a mistake. Also over time, the general public is slowly becoming to hear about and understand (at least a little bit) what Asperger’s Syndrome is. So if the diagnosis is lost in a broader Spectrum – this understanding level will need to start all over again. Finally on a practical level what about all the support groups, practitioners, authors, resources, educational programs etc, that are all specifically set up to help individuals with the diagnosis of Asperger’s Syndrome? They will all have to change or cease to exist – which can only impact negatively on the lives of individuals with Asperger’s Syndrome and their families.

Because of the division of agreement, the AMERICAN PSYCHIATRIC ASSOCIATION has posted the proposed revisions online at www.DSM5.org The public will be able to post comments on the website until April 20, 2010. The AMERICAN PSYCHIATRIC ASSOCIATION will include the voice of the public in the final decision on whether these revisions become permanent.


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