"Asperger's syndrome" is dropped as a separate diagnosis in the first major rewrite in almost two decades of the American Psychiatric Association's Diagnostic and Statistical Manual.
Previously, Asperger’s was defined as a separate disorder from autism in the psychiatric tome. As a result of the changes, the Asperger’s diagnosis will be placed under “autism spectrum disorder.”
Autism spectrum disorder was not in the manual until this revision. The single category will include autistic disorder, Asperger’s syndrome, childhood disintegrative disorder, and pervasive development disorder not otherwise specified.
Revisions were approved this month by the psychiatric association’s board of trustees in Washington, D.C. The changes are crucial to defining developmental disorders.
“The new diagnostic criteria attempts to rate severity in core deficits: communication, social relations and repetitive movements/restricted interests,” said Jocelyn Carter, assistant professor of clinical psychology at DePaul University.
Once the revisions are complete, individuals with Asperger’s will be diagnosed with “autism spectrum disorder, likely of a mild severity,” said Peter Thaxter, a doctoral student in clinical child psychology at DePaul University. The spectrum will span mild, moderate and severe forms of autism.
Asperger’s syndrome was added to the manual 1994. While both autistic disorder and Asperger’s now fall under the autism spectrum disorder category, the two differ in symptoms.
According to the National Institutes of Health, Asperger’s syndrome is defined as a complex developmental disorder characterized by social impairment, communication difficulties and restrictive/repetitive stereotyped behavior patterns.
Autistic children develop speech later in life, whereas children with Asperger’s have no lack of speech but may experience socialization and communication problems.
“People with Asperger’s can have high IQs but minimal or decreased social skills, making it difficult for them to navigate in the community, school or at a job,” said Mary Kay Betz, executive director at the Autism Society of Illinois.
The revisions are intended to offer increased precision in the diagnostic process.
Emily Dobson, a member of a now defunct autism support group in Decatur said she has been conflicted about Asperger’s since she learned about the disorder.
“After Asperger’s became a diagnosis, I’ve seen many children and adults struggle under its weight,” she said.
For some, the manual revisions will not change what they call their diagnosis.
“A lot of individuals with Asperger’s still will use that [term] to describe themselves,” said Betz, who has two children, one diagnosed with autism, the other with Asperger’s syndrome. “They’ll still treat Asperger’s the same.”
Some worry the revision could affect those applying for programs such as social skills training, previously covered by insurance.
“My concern is that individuals will not get the correct diagnosis and that will lead to the wrong or no service,” said Betz. “We still do not know how the services will be delivered or if patients will qualify for some school and state services, insurance policies or even Social Security [disability].”
The completely revised manual will not be published until May 2013. Once it is in effect, Carter said, “mental-health professionals will need to review these new criteria carefully and seek consultation regarding their assessment and diagnostic processes.”