Should Asperger’s Syndrome Be Eliminated As A Diagnosis?
Soon, Asperger’s Syndrome will no longer exist as an official diagnosis.
Due to be published in May 2013 is a new edition of the Diagnostic and Statistical Manual (DSM), the primary manual used by mental health clinicians to provide a formal diagnosis of autism and related disorders.
In the new DSM-V, the separate diagnostic labels of Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) will be replaced by one umbrella term: Autism Spectrum Disorder.
Further distinctions will be made according to the severity of the condition. The severity levels are based on the amount of help people need due to challenges with social communication, restricted interests and repetitive behaviors.
For example, a person might be diagnosed with Autism Spectrum Disorder, Level 1, Level 2 or Level 3.
These revisions have been made with the hope that the diagnosis of autism spectrum disorder will be more specific, reliable and valid.
But is this change a good idea? Will it provide more accuracy? Will it add more value and consistency to the diagnostic process? Will it clear up current confusion about the distinction between autism and Aspergers?
Opinions among mental health professionals, including Aspergers psychologists, and in the autism and Aspergers communities vary. Here are pros and cons about this coming change.
Arguments For The Proposed Changes
- Educational services for those with Aspergers are often less extensive than for those with a classic autism diagnosis, even though Aspergers can be just as challenging. For example, in California and Texas, people with a traditional autistic disorder qualify for some state services, while those with Aspergers do not. Bringing all types of autism under the same category would make it harder to justify a difference in services.
- The new criteria in the DSM aims to reduce the inconsistency in the way Aspergers, PDD-NOS and autism are currently diagnosed. This would make for more consistent and accurate research findings about autism.
- The new severity scale should help clarify the currently vague and misused ideas of high functioning and low functioning autism. It would become a more consistent means of acknowledging the different ways in which autism impacts someone’s life, rather than defining people by what disorder they have.
- The new DSM will list not only the core issues that characterize a given diagnosis but also an array of other health problems that commonly accompany the disorder. For autism, this would likely include anxiety, attention disorders, seizures, and sensory differences like extreme sensitivity to noise.
Recognition of these health problems will encourage clinicians, including Aspergers psychologists, to evaluate and treat the whole patient, not just autism itself.
Arguments Against The New Changes
1. The changes to DSM risk an erosion of the autism spectrum at the higher end with higher functioning individuals not qualifying for a diagnosis because they don’t meet the criteria for autism.
- Dropping Aspergers as a diagnosis may dissuade people who see autism as a stigma from being evaluated.
- Although eliminating the subcategories of autism, such as Aspergers, may broaden access to services, it could have the opposite effect. Higher functioning children and adults are likely to be perceived as having a mild condition and less deserving of services.
- For many with Aspergers, the diagnosis is part of who they are, and changing that to autism is, for them, the loss of a meaningful identity, one that has generated a tremendous self-help movement. As Temple Grandin, a professor and prominent autism advocate has said, the size and voice of the Aspergers community are reasons enough to leave the diagnosis in place. (New York Times, 2009)
- Joining conditions into one diagnosis means using one term to describe a huge range of functioning. This may mean treatments will become less, rather than more, sensitive. The risk is in promoting a one-size-fits-all treatment for those on the autistic spectrum.
The Future of Asperger’s Syndrome
Will the elimination of Aspergers have an overall positive or negative effect? Right now, no one knows for sure. The best we can do is keep in mind the pros and cons of this change and pay careful attention to what actually happens when it goes into effect.
As an Aspergers psychologist, my best guess is that Asperger’s Syndrome is here to stay. It has now become a part of our vocabulary, used not just by lay people but also by clinicians and researchers. More and more, people are aware of what Aspergers refers to. Furthermore, it is a term marking a distinct identity for many children and adults who have sought networks of support, friendship, and collaboration with like-minded people. This identity and its associated movement is not likely to go away soon.
As an Aspergers psychologist, I want to ensure that my interventions meet the unique needs of each individual.
To learn more about the upcoming changes, see the DSM-V revision website.
Dr. Kenneth Roberson is an Asperger’s psychologist in San Francisco with over 30 years of experience. To ask a question, or schedule an appointment,
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