The new Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V) will eliminate the diagnostic category of Asperger’s Syndrome, 16 years after its inception in the DSM-IV. “Asperger” symptoms will be combined with those of another mild form of autism to create a new category to be named.
I agree with judiciously reviewing the characteristics across the autism spectrum. Medical professionals have long questioned the efficacy of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS); the DSM-IV-Text Revision states that PDD-NOS can also be referred to as “atypical autism.” In simple terms, the essential features of PDD-NOS are severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or stereotyped behaviors, interests, and activities. The criteria for Autistic Disorder are not met because of late age onset; atypical and/or sub- threshold symptomology are present. In my practice, parents express confusion about this diagnostic category, what it means in relation to autism and AS, and how to operationalize it. Some replace PDD-NOS with AS, as they believe that school districts understand and provide services more readily for AS.
A review of Asperger’s Syndrome criteria might also be warranted. Individuals with AS are supposed to have “no clinically significant delay” in the development of age-appropriate self-help skills. Does your child with AS ask for help when needed, take a shower daily, brush his/her teeth without several reminders, and pick clothing appropriate to the weather? I find that skills of this nature are very challenging for all kids on the autism spectrum, especially those with AS who are expected to function at levels commensurate to their cognitive abilities. With regard to the former, more and more documentation indicates that individuals with AS need not be savants or geniuses. They may excel in one academic area with significant struggles in others.
Anyone who has an ASD or knows someone with an ASD can attest to the symptoms that could (or perhaps should) be added to the diagnostic criteria across the spectrum: handwriting challenges, sensory hyper- and hyposensitivity, personal hygiene struggles, and early menstruation in females to name a few. Feel free to respond to this article with your thoughts on what should be added, removed, or at least considered by the DSM-V.
The driving force for educational and therapeutic individualization has always been the understanding that no two individuals with ASD are alike; apparently, this has become a liability. It seems to me that in removing the Asperger’s Disorder diagnosis in favor of another category, we are eradicating the possibility of further diagnostic clarify in the DSM-V. Not to mention that we are making an invisible disability even more obscured.
Starting February 10, the public is invited to comment on the Asperger’s working group’s report on the DSM website.