Tuesday, February 16, 2010

DSM-5 Diagnostic Changes Autism Asperger's

As I mentioned yesterday the draft version of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) has been released by the American Psychiatric Association. DSM-5 will be the first changes made in diagnostic criteria for psychiatric disorders in 10 years with final publication occurring in 2013 after field trials in real world situations. The draft is available for review at www.dsm5.org with opportunity for public comment until April 20 of this year. There are several proposed diagnostic changes some of which already are controversial. I talked about the substance abuse changes yesterday and today I would like to talk about Autism and Asperger's Disorder.

DSM-5 proposes the elimination of the designation Asperger's Disorder which is to be subsumed by the new category of autistic spectrum disorders with a range of severity. There has already been complaints by those with Asperger's and those who work with patients with this disorder. Asperger's Disorder like autism is characterized by severe sustained impairment in social interaction and development of restricted patterns of behavior, interests, and activities. Unlike autism there are no delays or deviance in language acquisition nor delays in cognitive development and it is not like autism often associated with mental retardation. Characteristically patients with Asperger's appear odd to others. They frequently do not pick up on social cues, their interactions are one sided, focused entirely on their own interests with little empathy or understanding of the other as an individual. They may be intensely focused on one topic, with exclusion of all other interests. But unlike autism the desire for social interaction is present. They just don't know how to do it. Often they are loners, not always because of their own wishes but due to peer's inability to tolerate them.

Some in the field are objecting to placing Asperger's in a category of autistic spectrum disorders because of the potential for increased stigma as well as changes in research funding. I do not know the science behind the proposed change but I can understand how those with no language difficulties cognitive impairment would want to be considered in a somewhat different way than those who have these more severe impairments. I wonder what the ongoing public comments will be on this issue.

Thought for the day

May I show kindness and compassion today.

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