New Diagnostic Manual Drops Asperger Label
On May 18-22 , the American Psychological Association, known as the APA, will convene its annual meeting. This year’s meeting, held in San Francisco, is notable; the fifth version of the Diagnostic Statistical Manual, known as the DSM, will be formally adopted and released.
First established in 1952 by the APA, the Diagnostic Statistical Manual has been the dubbed the psychiatric clinicians’ “bible.” It is used in the diagnosis of mental disorders including attention-deficit/hyperactivity disorder, autism, schizophrenia, personality disorders, and mental impairment. Since that time, the manual has received extensive updates and edits, each time resulting in a revised version.
In 1994, the fourth version of the DSM was released, and it has been used for the past 20 years to define the criteria in the diagnosis of autism and Asperger disorder. The revised DSM-V will modify the diagnostic criteria of autism, and, in doing so, it will remove the label of Asperger syndrome completely. In the DSM-IV, the label of “autistic disorder” was one of five labels under the broader diagnosis of pervasive development delay (PDD). Asperger Syndrome was another of the five.
What distinguished the two in diagnosis was primarily whether or not a child exhibited deficits in communication. Children with autistic disorder had to have “marked impairments” in three areas: communication, social interaction and restricted interests; and these symptoms had to manifest prior to the age of 3. This trifecta of deficits, C (communication), S (social impairment) and I (restricted interests), in varying degrees, came to be known as a spectrum disorder.
The diagnosis of Asperger syndrome in the DSM-IV required deficits as manifested through restricted interests and social impairments, but, unlike autistic disorder, communication deficits were not included. Children with Asperger syndrome could not have a language delay or a delay in cognitive development. Given their verbal ability and deep focus on a particular subject(s), children with Asperger syndrome are frequently undiagnosed until school age when the demands of the social environment become so great and the differences in behaviors more marked. It is the social aspects of language, the idioms, the body language, hidden jokes and the inability to read facial expressions, which impair and impede the ability to form and maintain relationships for children and adolescents with Asperger.
The new diagnosis, autism spectrum disorder (ASD), categorizes autism along a broad spectrum with deficits in only two core areas, restrictive and repetitive interests and a combined category of communication and social interaction.
Asperger syndrome was considered by many to be the “higher-functioning” version of autism. Under the DSM-V, the label ASD will carry with it a designation of the severity of the deficits as denoted by a numerical assignment of 1, 2 or 3, with 3 being the most severely impacted. Additionally, the recognition of dysfunction in the sensory processing system is included as part of the defining characteristics of the disorder. Symptoms for ASD are no longer are limited to 3 years of age for onset; instead, “symptoms must be present in early childhood but may not fully manifest until social demands exceed limited capacities.”
Many support the new categorization of autism spectrum disorder, citing an improved specificity of the disorder that allows greater diagnostic precision, the recognition of sensory processing issues among the ASD population, and clear levels of severity to describe how much the disorder impacts children and individuals. This better frames the selection of educational models/interventions and instructional practices.
However, the revision is not without its critics.. As reported by the U.S. Autism and Asperger Association, “Dr. Fred Volkmar, a renowned autism expert, the director of the Yale Child Study Center, and a Yale School of Medicine researcher, stated that with the proposed DSM-5 changes, only 45 percent of individuals with an autism diagnosis today would retain that diagnosis.”
Many believe this narrowed label, without five sub-categories, will reduce the identification of children with ASD thus impacting the increasing rates of autistic disorder and Asperger syndrome. Opposition can also be found among those adult individuals with Asperger syndrome and parents of children with Asperger syndrome. Often self-described as “Aspies,” many individuals with Asperger syndrome embrace the diagnosis assigned to them, and they celebrate their label within a culture of “neurodiversity.”
Those with the label of Asperger today will still have the label next week after the formal adoption of the DSM-V. When re-evaluated for a continuing diagnosis or services, as is scheduled every three years in special education, it is likely the diagnosis for children with Asperger syndrome would be removed and either changed to ASD or dropped without the assignment of another label. The long-reaching implications of these revisions remain to be seen.
– Dr. Keely Camden is the dean of the College of Education at West Liberty University and an associate professor of education. She is a former special education teacher.