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The Elimination of the Asperger’s Diagnosis

There is a lot of confusion regarding the new Diagnostic and Statistical Manual of Mental Disorder’s (DSM-5) revision to exclude Asperger’s. Hopefully this post will clarify some things…

Taking into account the most up-to-date research, diagnostic criteria in the DSM are revised periodically by a team of professionals. Here are a few of the main changes in the DSM-5 that specifically apply to autism spectrum disorders:
  • Sensory behaviors are included in the criteria for the first time (under restricted, repetitive patterns of behaviors descriptors).
  • The terms used in the DSM-4 are autistic disorder, Asperger’s disorder, childhood disintegrative disorder and PDD-NOS (pervasive developmental disorder not otherwise specified). In the DSM-5, when people go for a diagnosis, instead of receiving a diagnosis of one of these disorders, they will be given a diagnosis of “autism spectrum disorder.”
  • The emphasis during diagnosis has changed from giving a name to the disorder to identifying all the needs someone has and how these affect his or her life.
  • The triad of impairments has been reduced to two main areas: (1) social communication and interaction; (2) restricted, repetitive patterns of behavior, interests, or activities.
  • Also, there are “dimensional elements,” which should give an indication of how much a person’s disorder affects him or her. This should help to identify how much support the individual needs.



The DSM-5 has eliminated Asperger’s as a separate diagnosis and weaves it into Autism Spectrum Disorders with severity measures within the broader diagnosis. In this revision, the individual must meet the criteria in sections A, B, C and D below to receive a diagnosis of Autism Spectrum Disorder:

A. Deficits in social communication and interaction not caused by general developmental delays (the individual must have all 3 of the following areas of symptoms present):
  1. Deficits in social-emotional reciprocity; failure to have a back and forth conversation
  2. Deficits in nonverbal communication (e.g., 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 parents (this may include trouble adjusting behavior to suit different social contexts, difficulties with imaginative play and making friends, and a lack of interest in others)

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

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

D. Symptoms collectively limit and hinder everyday functioning.

If your child currently has a diagnosis of Asperger’s – this will not change. In the DSM-5, people will get a diagnosis of “autism spectrum disorder” rather than any of the current DSM diagnostic terms.  The term “Asperger’s” may still be used colloquially by diagnosticians (e.g., for a diagnosis of autism spectrum disorder with similarities to Asperger’s). Also, many people identify closely with the term Asperger’s and may continue to use it in everyday language.

Overall, the changes to the diagnostic criteria are helpful. They are clearer and simpler than the previous DSM criteria. Including sensory behaviors in the criteria is very practical, because many young people with autism have sensory issues which affect them on a day-to-day basis. The emphasis on identifying the full range of difficulties that the person has during the diagnosis process is also convenient.

The DSM criteria are medically-based, and a diagnosis is given when “symptoms together limit and impair everyday functioning.” The criteria create the foundation for diagnostic tools, for example:
  • ADI (Autism Diagnostic Interview)
  • ADOS (Autism Diagnostic Observation Schedule
  • DISCO (Diagnostic Interview for Social and Communication Disorders)

These and other schedules are used to collect information in order to diagnose whether someone is on the autism spectrum or not. Therefore the criteria form the basis for the diagnosis, but the diagnostician’s judgment is very important.

The DSM-5 is an American publication. Most diagnoses in the UK are based on the International Classification of Diseases (ICD), published by the World Health organization. The current ICD (ICD-10) is virtually the same as DSM. The next version of the International Classification of Diseases (ICD-11) is due to be published in 2015. The authors of the ICD will consider the changes made to DSM-5, but their descriptions are often slightly different. Currently, there are no plans to change the label of Asperger’s during the next revision.

Diagnoses using the DSM criteria should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. If a person gets a diagnosis of an autism spectrum disorder, it is likely to mean that he or she would benefit from support or services. However, the diagnosis is not directly linked to whether someone is eligible for support and services. Decisions over support and services are generally made by social service agencies and education professionals (often based in the local authority). The DSM-5 introduces levels of severity into the diagnostic process, to indicate how much support a person who receives a diagnosis may need. 

It is possible that fewer people – particularly at the higher-functioning end of the autism spectrum – will be diagnosed as having autism spectrum disorder in the DSM-5. However, the DSM team believes that this is not the case. Diagnoses should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. Diagnoses will be given where symptoms cause impairment to everyday functioning. Many individuals with Asperger’s and high-functioning autism may continue to meet the proposed diagnostic criteria for autism spectrum disorder.

The removal of Aspergers Syndrome from the Diagnostic and Statistical Manual of Mental Disorders has been controversial, because it is commonly used by health insurers, researchers, state agencies, schools, and people with the disorder.  Many parents – and professionals – are concerned that eliminating the Asperger’s diagnosis will prevent mildly affected children from being evaluated for Autism, which may result in the ineligibility of much needed services.


Comments:

•    Anonymous said... I am in Liverpool uk, and I often find it really hard to get professionals to take his needs seriously, he can often seem very typical and many people tell me that there is nothing to be concerned about. It's not until they spend some time with him that they can see more of what's going on and how he finds little things so difficult.
•    Anonymous said... I found an autism "center" in monroe. Gonna try as and get info from them. My heart just breaks for parents and the autistic children who are in the dark about autism. Thanks to you, Stephanie  and Patrick, for making me see how awesome these kids are. I hope to at least be able to help the patients we have learn more.
•    Anonymous said... I found it hard having teachers and school psychologists get to have the final say (without going to due process, that is) on whether my son needed certain interventions. The people who deal with Asperger's and HFA every day can make suggestions, but the school doesn't have to follow them...never mind that they have seen fewer total aspie students than our medical providers, and studied asperger's less (or not at all...I met a special ed teacher once who found out my son had Asperger's and asked me to explain it to her). We need a new model of educational intervention.
•    Anonymous said... I have to say, I'm glad they have changed the diagnosis to ASD, I was so sick of people saying to me, "its only aspergers, or it's just aspergers" so I was kind of relieved when we got the diagnosis letter and it said ASD.
•    Anonymous said... I'm in BC and, while my guy has Aspergers, the diagnosis states ASD. It's hard with Aspergers isn't it, at first glance many seem neurotypical and hard to have their special needs taken seriously. I'm worried my guy will lose funding as seems so high functioning but a deeper look show his needs r actually quite high.
•    Anonymous said... Our local council in Cornwall UK are using DSM4
•    Anonymous said... sadly, many with Aspergers will no longer meet the criteria for Autism based on the changes. Boo.
•    Anonymous said... This scares me but knew it was coming.
•    Anonymous said... What is the difference if you dont mind me asking between asd and Aspergers
 

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Assisting the Peer-Rejected Student: Tips for Teachers of Kids of the Spectrum

Playing and conversing with classmates is a daily routine for school-aged kids. But children with ASD (Aspergers, High Functioning Autism) are often isolated and rejected by their peers. Their problems making and keeping a “buddy” are exacerbated by their poor social skills.

The sensitive educator should realize that kids go to school for a living. School is their job, their livelihood, and their identity. Thus, the crucial role that teachers play in the youngster's social development and self-concept should not be under-estimated. Even if a youngster is enjoying “academic success,” her attitude about school will be determined by the degree of “social success” she experiences.



There is much that the educator can do to promote social development in the special needs child. Kids tend to fall into four basic social categories in the school environment:
  1. Children who, although not openly rejected, are ignored by peers and are uninvolved in the social aspects of school.
  2. Children who have successfully established positive relationships within a variety of social settings.
  3. Children who “fit-in” with a peer-group based on common interests, but seldom move beyond that group.
  4. Children who are consistently rejected, bullied and harassed by peers.

Many children with ASD find themselves in the rejected/bullied subgroup. Their reputations as being rather “odd” plague them over the years. It is important for the educator to assist the youngster’s peers in changing their view of this boy or girl.

Discipline is a rather ineffective method of correcting bullying or rejecting behavior. For example, if the teacher disciplines Michael for insulting Ronnie, she only increases Michael's resentment of Ronnie. But, the teacher can increase Michael’s level of acceptance in several ways. Here’s how:

1. Assign the youngster to work in pairs with a “socially skilled” youngster who will be accepting and supportive. Cooperative activities can be especially effective in the effort to include the rejected youngster in class. These activities enable the youngster to use her academic strengths while simultaneously developing her social skills.

2. Assign the rejected youngster to a leadership position in class wherein his peers become dependent on him (e.g., line leader). This can serve to increase his status and acceptance. However, understand that this may be an unfamiliar role for the student, and he may require some guidance from the teacher in order to ensure success.

3. Attempt to determine specific interests, hobbies or strengths of the rejected youngster. This can be accomplished through discussions, interviews or surveys. Once the teacher has identified the youngster's strengths, celebrate it in a very public manner. For example, if the child has a particular interest in Indian wood carvings, find a ‘read-aloud’ adventure story in which an Indian plays an important role in the plot. Encourage the youngster to bring a couple of his Indian wood carvings to class and show how they were made. By playing the expert role, a rejected youngster can greatly increase his status.

4. Board and card games can be used to foster social development in class. These activities require children to utilize a variety of social skills (e.g., voice modulation, taking turns, sportsmanship, dealing with competition, etc.). These activities can also be used to promote academic skills. Since games are often motivating for children, this activity can be used as positive reinforcement.


 

5. Educators at the high school level must be particularly aware of the teen that is being rejected by peers. During the teenage years, it is very important that the youngster be accepted by his peers. The rejection suffered by teens with social skill deficits often places them at risk for emotional problems.

6. The child with social skill deficits invariably experiences rejection in any activity that requires children to select classmates for teams or groups. This selection process generally finds the rejected youngster in the awkward position of being the "last one picked." Avoid these humiliating situations by pre-selecting the teams or drawing names from a hat.

7. The educator can assist the youngster by making him aware of the traits that are widely-accepted and admired by his peers (e.g., when a particular child converses, extends invitations, gives compliments, greets others, laughs, shares, smiles, tells jokes, etc.).

8. The educator needs to recognize the critical role that the youngster's mom and dad – and even siblings – can play in the development of social competency. Ask the youngster’s mother or father to visit school for a conference to discuss the child’s social status and needs. School and home must work in concert to ensure that target skills are reinforced and monitored. Social goals should be listed and prioritized. Focus on a small set of social skills (e.g., making eye contact, sharing, and taking turns) rather than trying to deal simultaneously with the entire inventory of social skills.

9. The educator should demonstrate acceptance of - and affection for - the rejected youngster. This conveys the constant message that this youngster is worthy of attention. The educator can use her status as a leader to increase the status of the youngster.

10. The socially incompetent youngster often experiences isolation and rejection in his neighborhood, on the school bus, and in peer-group activities. The educator can provide this child with a learning environment wherein he can feel comfortable, accepted and welcome. Coming to school every day can become a helpless event for some kids on the spectrum – unless they succeed at what they do. Educators are shields against that helplessness.




 
 
Comments:

•    Mama said... I have always known this but getting teachers to get on board in public schools is nearly imposible. I'm so happy that Mark Hutten has brought this up. Sincerely, Marie Donily
•    Unknown said... Hello, this website has become one of our most informative sites for information. Our 13-year-old was just "transferred" to an alternative behavior school because of lack of understanding on teachers' parts. Now he is feeling punished because lack of understanding of his diagnosis
•    MartinKids said... I actually have the opposite problem- my 2nd grade son is receiving wonderful support and has plenty of 'playmates' at school. However, all of the children on our block have ostracized him and taunt him whenever he goes out in front(often in front of me!) The parents are either contributing to the stigma or are totally clueless. I would LOVE to read an article on how to handle this situation!
•    MartinKids said... I have the opposite problem with my 2nd grade son. He receives excellent support and has made several playmates at school. However, all of the kids on our block have ostracized him almost since we moved in. They ignore him and taunt him whenever he plays out front (even in front of me!) and their parents either seem to contribute to his stigma or are totally clueless. He seems to be handling this rejection well now, but I worry about how this treatment will affect him in middle school. I would LOVE to see an article offering tips for this situation!
•    Kelly said... You may not get this reply as I see you posted over three years ago but I'm having the same problem. Did you figure anything out?
•    MartinKids said... Unfortunately nothing ever resolved, just time went on, the two families we had the most issues with moved away and the new families have much younger children. My son does not interact very much with the kids that are left as he homeschools now and and they attend public school. Sadly, by the end of fourth grade he was already starting to be excluded and treated differently, so we pulled him out to homeschool him with his siblings. The kids in our main social group are more accepting of him, although he only has one good friend the others don't pick on him. Even more disappointing is his involvement with Boy Scouts, the adults were actually super caring and willing to accommodate his needs but the boys excluded him.:( I am incredibly thankful for our homeschooling friends who love him and have taught their children to be kind even if they aren't super close to him. :)

 

Obsessive-Compulsive Disorder in Aspergers Children

There are many conditions associated with Aspergers and High-Functioning Autism. In this video, we look specifically at obsessive-compulsive disorder, and its treatment:





My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

My Aspergers Child - Syndicated Content