Autistic Disorder or Autism
For someone to be diagnosed with “Autism” or “Autistic Disorder” using the current diagnostic manual (The Diagnostic and Statistical Manual of Mental Disorders IV, published by the American Psychiatric Association), the person needs to meet two of the criteria mentioned in post on social differences, at least one of the differences listed in the post on communication/imagination, and at least two of the behavioral differences. The delays need to have been present before age three (though it might not have been realized at that time). Of note here, you will often hear people say their child has “high functioning autism” or HFA. This is a term we often use, but it is not an “official” diagnostic term. It generally implies that the autistic person’s IQ is in the normal range, and that the person has use of spoken language.
For a person to be diagnosed with Asperger’s Syndrome, they need to meet two of the criteria regarding social differences and one of the criteria of behavioral differences. The criteria on communication/imagination is omitted, and in fact, if there was a significant delay in language development this precludes a diagnosis of Asperger’s Syndrome. Additionally, there can be no major delay in cognitive development or in the development of self help skills, adaptive behavior or curiosity about the environment. Since only 3 “symptoms” need to be present, it is easy to see that this diagnosis is easier to give. However, one of my pet peeves it that clinicians sometimes just are not carefully looking to see if other criteria are met. I will often see someone that another clinician has diagnosed with Asperger’s Syndrome and find out that the child didn’t talk until they were four (which should have meant they didn’t mean the criteria for Asperger’s). I also find that many clinicians and families find the diagnosis of autism more stigmatizing than the diagnosis of Asperger’s, so they are more likely to prefer the latter even if the actual diagnosis of Autistic Disorder (autism) would be more accurate. Research is currently not supporting a true difference among those diagnosed with the high functioning form of Autism and those diagnosed with Asperger’s Syndrome. I personally think it is silly to omit the criteria about language for those with Asperger’s Syndrome, as it would be rare in my opinion for someone with Asperger’s not to have some observable difference in their conversational skills!
Now we get to even weirder terminology. Autism and Asperger’s are grouped under the unfortunate title of “Pervasive Developmental Disorders.” This leads us to the third category of “Pervasive Developmental Disorder, Not Otherwise Specified” commonly abbreviated at PDD.NOS. To be given this diagnosis the individual must have differences noted in a least two of categories (social, language/imagination, and behavior), and the person must NOT meet the criteria for Autistic Disorder or Asperger’s Syndrome. Brother! I have to say I have often seen here the same problem noted for Asperger’s. Due to either clinical sloppiness or stigma issues, children are sometimes given this diagnosis when really if the situation had been investigated more closely they would be seen to have autism. The true idea though of this diagnosis, is to make clinical note that these issues are of clinical significance but that the person doesn’t fit neatly into another category. Also, for the lay person’s benefit, it is good to note that the diagnostic fudging that occurs with the “NOS” category happens throughout the DSM. For instance, we have “Major Depressive Episode” and “Depressive Disorder NOS”, and “Generalized Anxiety Disorder” and “Anxiety Disorder, NOS.”
Autism Spectrum Disorder
The American Psychiatric Association is revising the diagnostic categories in the upcoming DSM V, which is going to be published in May of 2013. Click to read the new proposed criteria for their new diagnosis of Autism Spectrum Disorder. They are proposing the elimination of the terms of Asperger’s Syndrome and PDD.NOS. Personally, I find the new diagnostic term and criteria much easier to understand and apply, but there is a lot of controversy about this pending change.
In my next post I’ll talk about some the other differences that can be seen for those on the autism spectrum, but which currently aren’t part of the diagnostic criteria.
Question: What is your opinion about the proposal?