Mild Form Of Autism

Is the diagnosis of Asperger’s Syndrome — a mild form of autism mostly diagnosed in boys — heading the way of the dodo bird? A new article in the New York Times suggests that the new revision of the diagnostic manual — the DSM-V — is likely to do away with the diagnosis.

How can you just delete an entire diagnosis and do away with a diagnostic label that hundreds of thousands of clinicians use everyday and millions identify with? If you’re the American Psychiatric Association, the folks behind the latest DSM revision, you can pretty much do anything you want.

Before I get to Asperger’s, I have to note what’s really cringe-worthy in this article — how it completely misrepresents how mental disorders are diagnosed in practice today. Take this explanation, for instance:

Another broad change is to better recognize that psychiatric patients often have many health problems affecting mind and body and that clinicians need to evaluate and treat the whole patient.

Historically, [Dr. Darrel A. Regier, research director at the American Psychiatric Association] said, the diagnostic manual was used to sort hospital patients based on what was judged to be their most serious problem. A patient with a primary diagnosis of major depression would not be evaluated for anxiety, for example, even though the two disorders often go hand in hand.

Similarly, a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism. Thus, they might go untreated, or the treatment would not be covered by insurance.

I’m not sure if this is a bad translation of what Dr. Regier was trying to say or what, but the suggestion that a person is only diagnosed with a single diagnostic label (and can only be treated for a single disorder at a time) is simply untrue (and a ridiculous assertion). People are diagnosed — and treated — every day with more than one disorder. Indeed, there are thousands of children who carry both an ADHD diagnosis and an autism diagnosis — the two are not mutually exclusive (nor have they ever been). So while maybe back in the 1970s the DSM was used in the manner Dr. Regier describes, it hasn’t been used in that manner in modern practice for decades.

But getting back to the core reason why Asperger’s Syndrome, as a diagnosis, may be going away is because the new DSM is apparently going more toward a continuum approach for disorders. It actually already has this capability in the current edition, but it’s not a part of every diagnosis (for instance, you’ll find it for major depressive disorder, but not for things like ADHD). I believe the new DSM will ensure that every disorder is treated equally in this way — you can have mild ADHD, moderate ADHD, or severe ADHD.

In the same manner, you can have a mild form of autism and it’ll just be called “mild autism” — not Asperger’s.

I think the effort to make the diagnostic manual of mental disorders more internally consistent is a needed change. But doing away with well-used labels like “Asperger’s” is perhaps prematurely unnecessary; why couldn’t we use both labels to describe this form of mild autism? Certainly exceptions to the consistency can be made (and will have to be made anyway, since not every disorder will fit nicely into any classification system one could design).

While not ideal, allowances should be made during the transitional edition of this mainstay of mental disorder diagnoses to ensure that everybody embraces it — both patients and professionals alike. It could be as simple as including the phrase, “(also known as Asperger’s Syndrome)” next to the “mild autism” diagnostic criteria.

Read the full article: A Vanishing Diagnosis for Asperger’s Syndrome