<p>The latest edition of the DSM does away with Asperber’s diagnosis. What will this mean for those students who gained access to important educational programs with the now obsolete diagnosis? Do schools view Asperger’s and Autism as different? What happens now?</p>
<p>"Here are some of the biggest changes:</p>
<ol>
<li>Autistic disorder will become autism-spectrum disorder. That spectrum will incorporate Aspergers syndrome, which generally involves milder forms of autisms social impairments and previously had its own code number (299.80). To guide clinicians, the DSM will include specific examples of patients meeting criteria for the different disorders making up the spectrum, from autistic disorder to Aspergers, childhood-disintegrative disorder and pervasive developmental disorder (not otherwise specified). Combining autism and Aspergers is especially controversial partly because autism can be so much more serious than Aspergers. Although some autistic people function extremely well (the livestock expert Temple Grandin has helped change her field), others affected by the disorder need lifelong care for basic needs. The change will likely cause considerable debate, however, since the diagnosis is a requirement for access to some of the educational and social services that make up this care, and its not clear yet how the change in definition will affect such eligibility in the future."</li>
</ol>
<p>I guess I always thought Asperger’s was simply a different name for autism. I’m not sure how it would change student access to services unless the threshold for being diagnosed is elevated. I always assumed different degrees of impairment existed.</p>
<p>As far as I know, Asperger’s will be considered under the “Autism Spectrum Disorder” category and still recieve educational services. Of course, every child is different, and the specific needs of the student should be listed on the IEP or 504 plan. Naturally, every parent will need to be vigilant so that the teachers are aware of a child’s stregnths and needs. The “label” insures that the child received services, but it doesn’t say a lot about the student.
The bigger issue will be describing this socially. As far as the school is concerned- the “label” is basically the legal gateway to getting services and accommodations. Socially, this is difficult as ASD is a wide spectrum. In this case, (IMHO)use the description that fits the child best as most people aren’t going to look at a DSM, and AS has become a more familiar term.</p>
<p>"The bigger issue will be describing this socially. As far as the school is concerned- the “label” is basically the legal gateway to getting services and accommodations. Socially, this is difficult as ASD is a wide spectrum. In this case, (IMHO)use the description that fits the child best as most people aren’t going to look at a DSM, and AS has become a more familiar term. "</p>
<p>That is a really good point - I hope you are right Pennylane. Does society-at-large view “Asperger’s” and “Autistic” as the same?</p>
<p>I was diagnosed with high functioning autism a couple of years ago and I am reasonably sure they chose that diagnosis in anticipation of these changes. I was told my diagnosis was HFA, but to look for resources for people with Asperger’s because those would be what would apply to me. Most of the people I know even with Asperger’s are not as high functioning as I am… which is interesting, because many of them are panicking about these changes for fear that people will think they must be mentally impaired-- they’re afraid to have the same diagnosis as me. Labels are kind of funny like that sometimes… and not “haha” funny. I think society DOESN’T view asperger’s and autism the same, and that is really misguided because the distinction really isn’t what most people think it is. Try and research what the diagnosic differences are between the two, it gets really confusing… I think I could have gone to 10 different doctors and gotten a wide variety of diagnoses.</p>
<p>I think that distinction between is the label changing, or is the diagnostic threshold changing, is what is upsetting a lot of people. I think a lot of people think they must be losing their diagnosis altogether because they’re not severe enough for the autism label. That is what I am seeing among my autistic peers. That doesn’t sound like what’s really going on to me, though.</p>
<p>ETA: And, really, Asperger’s has ALWAYS been an autistic spectrum disorder. Nothing is really changing there. I think we’re just doing away with a distinction that was fuzzy and misleading in the first place. All of us on the spectrum are autistic, and not everyone with Asperger’s will be higher functioning than every “autistic” person.</p>
<p>As the parent of an autistic son, I always looked at the autism spectrum as a rainbow arc. Along its path were classic autism, PDD, PDD-NOS, Aspergers, maybe Retts. No two kids were identical, but many had common signs. So I don’t see the DSM-V as a huge change. </p>
<p>If anything, shouldn’t IEPs be easier diagnostically?</p>
<p>I think in general AS has been under the ASD umbrella for years, but others have argued about it being seperate. One does not need the distinction for services. In fact, it may be better for AS to be considered ASD so that students with AS get the services they need instead.
There has been ongoing questioning over the difference between AS and HFA- and whether they are different or not. Basically there can be a wide range in both categories- and it may be hard to tell. The label “ASD” gets services-then those services need to be individualized for any student regardless.
One difference that is agreed on is that people with AS have at least average intelligence and many have above average intelligence. The category of autism includes individuals who have below average IQ. I agree with the concern that people with AS might have their intelligence underestimated in the new label. Again, in the school setting, there will be test scores that show IQ. However, not all teachers are as vigilant about looking at IEP’s. Parents need to be vigilant here and stay in contact with teachers and the school.
Socially, I think there is a lot of confusion over AS, and ASD in the general public. Families and individual with AS may want to continue to use the term AS socially.
Ema- One difference between AS and HFA- to my knowlege- is the presence of language delay in Autism. With AS, there is no language delay in childhood. I do know of one very high functioning adult- who was diagnosed with HFA- but has chosen to use the term AS as it fits her better. I agree that it is better for her to use this socially now, but as a child, she needed speech therapy so it was important to use the best label to get her the services she needed then.</p>
<p>The definitions of disabilities used under IDEA, the federal law that applies to student 3 through 21 in public schools, have always been different and broader than those in the DSM. Asperger’s has never been recognized as a qualifying diagnosis for special education services, but the majority of students with Asperger’s meet criteria as students with Autism the way it’s defined in the law. There are also some students with Asperger’s who meet criteria for Emotional Disturbance, Learning Disabilities or Other Health Impairment, and some students who don’t meet eligibility criteria at all because their disability doesn’t impact their ability to learn and participate in a general education classroom.</p>
<p>In other words, this change shouldn’t have any impact on students served under IDEA at all.</p>
<p>I can’t speak to kids in higher education because I don’t have experience there.</p>
<p>I agree, and I don’t see any change in the future for students. I’ve always known Aspies were on the spectrum since I learned about it years ago.</p>
<p>There is a generation of young adults/older teens for whom Aspergers is an identity of which they are not ashamed…it describes who they are. Kind of like some in the deaf community who don’t want to be labeled as having a disability because they get by just fine thank you very much.</p>
<p>The consensus of the professionals on the DSM panel is that combining it uner the ASD rubric, which is really not that big of a change, witll increase availability of services, not decrease.</p>
<p>Yes, and they should keep it. I personally don’t agree with the DSM decision but I see where it is useful in medical coding, billing, getting services in school.
People have debated whether AS is part of the spectrum or not. It’s a difficult debate to decide. It’s also difficult to diagnose an adult backwards because a detailed developmental history is important. Again, a main distinction is language/speech delay- present in autism and not in AS. Kids with AS are often highly verbal but share many behaviors as kids with autism. The other confusion is that the developmental picture can (or can not) change over time. In the case of the young adult I mentioned, the childhood speech delay is not really apparent in social situations now.</p>
<p>I personally think the distinction between a child with language-speech delay and one who does not have it is important- but regardless- all kids on the spectrum should have a speech/language evaluation and the results will be addressed in the IEP. </p>
<p>There is a wide range of how an adult functions in the world, and my own personal feelings are than people with AS can choose to keep their label socially if it suits them- or not use a label at all if they don’t want to.</p>
<p>Our son was diagnosed with autism, period. The people who did the testing and diagnosis years ago told us that they didn’t consider Asperger’s a meaningful diagnostic term – which is where the DSM is now. Our son started out with language delays but now is very high functioning. The term Asperger’s fits him quite well, even though it is technically not his diagnosis. Sometimes we use the word autism and sometimes Asperger’s, depending on the situation. He prefers Asperger’s but will use autism as well.</p>
<p>Because he is so high functioning, some people who don’t know him well don’t see him as autistic but seem to “get” that he has Asperger’s. More and more we hear the term “on the spectrum” and have started using it ourselves.</p>
<p>Another thing to consider, is that the DSM is revised every few years. Look back at the changes in Attention Deficit Disorder over the years. In the DSM, it’s been ADD, ADHD, ADD-I, ADD combined, ADD-H.</p>
<p>In conversation however, people tend to say “ADD” or ADHD" . I think that AS will remain a conversational term if people choose it. It may even return someday in a future DSM.</p>
<p>It’s also because these conditions are for the most part diagnosed clinically- by how the child appears to the people evaluating him/her. There is no test like an X ray that can be done, so the DSM has to be written in the most useful and specific way possible. The DSM is also a reflection of the current culture.</p>
<p>People with AS have existed for ages, long before the DSM. One can also see that there are conditions that were once a “disorder” in the DSM that are no longer considered disorders now. In many ways, people with AS are not necessarily much different from the general population. In this case, they are free to drop the label if it no longer serves them, or use ASD if they need services. </p>
<p>I personally feel that all children on the spectrum should get the intervention and services they need in school. Even for a high functioning child who is fully mainstreamed, the label is important to avoid excessive punishment from teachers for certain behaviors and possibly protection from bullying. By adolescence, high functioning individuals can choose to keep their privacy if they want. None of us walk around with our 4th grade report card on display.</p>
Pennylane- Have you been around long enough to remember when it was called minimal brain dysfunction and then hyperkinesis?</p>
<p>BTW, Dyslexia will also be gone frm the DSM V, subsumed under reading disorder. While I disagree with the removal of the diagnosis of Dyslexia, I agree that it is not a mental health disorder and doesnt belong in the mental health section of the diagnostic manuals, but rather that it belongs in the neurology section of the ICD.</p>
<p>Jym, yes, I do recall that era.
I also don’t think of ASD and AS as mental disorders either. I think they are in the area of child development/neurology like dyslexia. However, children on the spectrum are also seen by psychologists/psychiatrists, so it has a place on the DSM.</p>
<p>I’ve used the term " on the spectrum" ever since my daughter was a baby & didn’t want to be touched. She has sensory processing disorder, and dyslexia but because she didn’t have certain qualifying factors for autism/aspergers/pdd-nos, she didnt receive help for anything, but " specific learning disability" once she was in public school.</p>
<p>( which consisted of sitting in a room doing homework from other classes while the teacher helped the kids who were working on basic grammar/ sitting in a chair with four legs on the floor.)</p>
<p>I sought to get her therapy, but medical insurance deemed it " educational" without an autism diagnosis. ( They would pay for medication though)
We couldn’t afford OT, the most I could do was read about it as much as I could and try and piece together help where I could. She was in several studies, that could have provided more help, for a sliding scale, but she was reluctant to participate, and the grad students didn’t have the skill or experience to get her to cooperate. Her symptoms also varied enough that in some circumstances she could “pass” for neurotypical.</p>
<p>When I asked the medical profs about her pulling skin off her feet until they bled ( she was four), about her anxiety, refusal to wear clothes, her anger, they were confused by my use of the term “spectrum”, and replied that since she looked at the person who was speaking, she wasn’t “autistic”. That was all they said.
And these were Drs who were overseeing a study of high risk children.
:rolleyes:
No wonder her pediatrician had even less idea of what I was talking about.
I hope the new criteria will get more people help who need it, but I am not sure what the impact will be.</p>