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Not So Fast: I’d Like to Keep Asperger’s

I have fallen off the face of the blogging Earth for the last I don’t even know how long. I’ve had messages about my health and vitality, as though my silence has suggested that I have disconnected from breathing or working with individuals with ASD. Far from the truth. From the past six months I have been too busy to write anything beyond immediate, work-related items. That’s a nice way of saying I’ve been tired, and, if you’ve read my blog with any regularity, you know that I like to write when passionate, which is usually not when tired.

Over the past three months, I have had a recurring question, theme, concern presented to me: The changes in the DSM-IV-TR that will remove the diagnosis of Asperger’s Disorder in favor of a broader term, yet more diagnostically restrictive diagnosis of autism spectrum disorder. I have written on this topic long, long, long ago. So, why do I return to this topic? Well, to be honest, because about 75% of my clients have Asperger’s Disorder. And, this question KEEPS PLAGUING ME: What does this mean for my child?

I hate my answer.

I don’t know.

Sure, I could hypothesize.

But, will IDEA catch up? I don’t know. I doubt it. It was “just” reauthorized in 2006. In cyberworld, that’s centuries ago. In the legal world, that’s yesterday. For parents with kids with ASD, it’s forever.

Will insurance companies finally do something? Sometime before I die, perhaps. Might be quicker than the reauthorization of IDEA. Maybe someone should take me out. Just trying to expedite things.

If the hope is to stem the tide of increasing diagnostic numbers, not sure it will work. If the hope is to further complicate and bifurcate the ASD community, its focus, treatment, understanding, clarity, awareness, acceptance…. oh, I’m sorry, I have a point…. then, MISSION ACCOMPLISHED.

Yes, the criteria need revamping. We just “borrowed” from Autistic Disorder to explain Asperger’s. Not the smartest idea, but the diagnoses did get rolling.

But, we fought for Asperger’s and now we are going to kill it after 18 years? I’ve had pants, pets, and pairs of scissors longer than that. And, why are we killing it? It’s imperfect, but Hans Asperger had identified something different than Autistic Disorder. Autism is NOT Asperger’s. Yes, they are on the same spectrum, but they are not the same.

If you want my opinion, and I know you don’t, we would replace PDD-NOS with autism spectrum disorder, keep and revamp Asperger’s Disorder, and refine Autistic Disorder.

The APA didn’t ask me. though. Or any of my parents or clients about the loss of Asperger’s. It’s like ripping a bandaid off scraping the surface with sandpaper.

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Posted by on January 29, 2012 in ASD in the Grand Scheme

 

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Good-Bye Asperger’s, Hello TDD?

To say I am dumbfounded is a bit of an understatement. I’ve been reviewing the proposed changes to the upcoming DSM-V with regard to ASD. It is well-documented that the manual is likely to remove Asperger’s Disorder (299.80). Opinions are mixed on this omission. Some argue that the spectrum is the spectrum; that Asperger’s is like autism and that a diagnostic label doesn’t matter. Others argue, myself included, that leaving out AS is a mistake. Today, I stumbled across the DSM-V’s latest brilliant idea:

Temper Dysregulation Disorder with Dysphoria

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.

1.  The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.

2.  The reaction is grossly out of proportion in intensity or duration to the situation or provocation.

3.  The responses are inconsistent with developmental level.

B. Frequency: The temper outbursts occur, on average, three or more times per week.

C. Mood between temper outbursts:

1.  Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).

2.  The negative mood is observable by others (e.g., parents, teachers, peers).

D. Duration: Criteria A-C have been present for at least 12 months.  Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.

E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.

F.  Chronological age is at least 6 years (or equivalent developmental level).

G. The onset is before age 10 years.

H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences; see pp. XX).  Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.

I.  The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

Am I the only one who is worried about this? This is not to say that TDD is replacing AS. In fact, it appears that the presence of a PDD (AS, PDD-NOS, autism) is a possible rule-out (explanation) for TDD. My concern about this diagnosis relates to rationale. The DSM creators supposedly are removing AS because the diagnosis overgeneralizes. Well, if TDD isn’t overgeneralizing, what is it?
 
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Posted by on February 2, 2011 in ASD in the Grand Scheme

 

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