One of the great DSM-5 puzzles to this father of a severely autistic son is the use of the label Autism Spectrum Disorder to describe what appears to be little more than a tweaked version of the DSM-IV's Asperger's Disorder. The APA's DSM-5 team has replaced Autism with Aspergers, removed the most seriously intellectually disabled to the General Developmental Disorder category and further diluted the requirements for an autism diagnosis. Why not be open and transparent about the Aspergers substitution for Autism and the removal of the intellectually disabled from the Autism category?
The APA has purportedly merged the three Pervasive Developmental Disorders into one Autism Spectrum Disorder. It would appear to be much more accurate though to refer to the new combined disorder as Asperger's Spectrum Disorder. There is no signficant difference between the DSM-IV Aspergers Disorder and the DSM-5 Autism Spectrum Disorder. The DSM-5 converts autism into Asperger's by:
1) Collapsing three requirements for an autistic disorder into two for the DSM-5's new "Autism" Spectrum Disorder. The two categories are the two main requirements for a DSM-IV Asperger's Disorder diagnosis: qualitative impairment in social interaction and restrictive, repetitive and stereotyped patterns of behavior, interests and activities. The spoken language deficits of the DSM-IV'S communication category are subsumed under social communication eliminating spoken language impairment in itself as a diagnostic feature of autism.
2) Precluding an Autism Spectrum Diagnosis for persons with Intellectual Disabilities. Mandatory Criterion A in the DSM-5's brave new Autism Spectrum Disorder which precludes an ASD diagnosis where accounted for by "general developmental delays" which is the DSM-5 diagnostic terminology for Intellectual Disability. Mandatory Criterion A's.
The Asperger's Spectrum Disorder masquerading as Autism Spectrum Disorder will accomplish three things:
1) It will further impair "autism" research. The 1994 DSM-IV autism changes are still being used to explain dramatic increases in autism diagnoses. The 2013 DSM-5 changes could permanently impair our understanding of autism causes and increases. This will prevent any serious epidemiological based research into possible environmental causes including substances, air, drugs, diet and water supplies, vaccines and vaccine ingredients, affecting the pre-natal environment.
2) It could reduce public service costs for children with autism disorders by removing the most challenging cases of autism disorders: very low functioning intellectually disabled autistic children. The possible expansion on the other end of the Asperger's Spectrum may offset this reduction or may be affected by more serious emphasis on impairment of daily functioning levels in the DSM-5 era.
3) Legitimization of claims by very high functioning persons with current autism disorder and Asperger's diagnoses to speak on behalf of those most severely affected by autism. The Neurodiversity movement is based for the most part on persons from this group and tends to be very supportive of efforts to resist any serious environmental focused autism research including vaccine autism research.
The DSM-5 debates currently raging, spearheaded by Dr. Allen Frances, will have no impact on the Asperger's (Autism) Spectrum Disorder category in the DSM-5. It is a fait accompli. Current autism research tends to exclude, for matters of convenience of the researchers involved, use of severely autistic study participants. The mainstream media reports serious tragic incidents involving the severely autistic but its features invariably focus on high functioning autistic\Asperger's\savant success stories.
When looking at challenges the mainstream media tends at most to look at the social awkwardness of those with HFA\Asperger's. The recent Amy Harmon NYT "navigating love" feature is the perfect example of this aspect of MSM representation of autism.
Asperger's Spectrum Disorder is already with us; having unofficially taken over the Autism label. Why the APA feels the need to officially hide that fact in the DSM-5 is puzzling.
