I’ve been asking myself this question since the American Psychiatric Association (APA) published the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition) in 2013, which dropped the Asperger’s diagnosis.
But it took me a while to get my hands on a copy of the DSM-5. This week I examined the section on the new diagnosis of Autism Spectrum Disorder (ASD), and I see that it clearly excludes Asperger’s.
For anyone who was diagnosed with Asperger’s, this is unlikely to mean that they could find themselves out in the street without a diagnosis of some kind. The section includes this note:
Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
The APA obviously wanted to do away with Asperger’s, placing AS people on an ASD spectrum. That makes sense to me, though many Asperger’s people don’t welcome this.
As for the revised definition of autism – it seems to me to just be a rearranging of ideas, not anything new.
But what about this other diagnosis – “social (pragmatic) communication disorder?”
Why is that there? Well, on the website autismspeaks.com (April 3, 2015), speech-language pathologists Dr Diane Paul and Dr Donna Murray comment on the confusion caused by this addition to the DSM-5:
Social (Pragmatic) communication disorder (SCD) is indeed a new addition to the ….. DSM-5. ….. SCD encompasses problems with social interaction, social understanding, and pragmatics. Pragmatics refers to using language in a proper context. For example, it’s important for a child to learn to use language differently when playing with, say, a younger child versus a teacher.
They say field tests have shown that some children who were diagnosed with autism under the DSM-IV would now be diagnosed with SCD, and they add,
But while SCD is new to the DSM manual, it is not new to speech-language pathologists. We have the training and experience to help.
So it looks like speech-language pathologists have manged to get their expertise recognized in the DSM.
Does this mean that former Asperger people might now become SCD people? That seems a bit odd. It has been said of Asperger’s that it was autism without the language impairment.
But, as I’ve said in my book The Shyness Guide, and as I’ve shown in my novel The Birdcatcher, you can have language skills at a high level that are still a problem because they don’t match up with those of your peers.
Two people may both speak English as their native language, but that is no guarantee they will understand each other. I can read and write as well as anyone (well, almost), but I had frequent miscommunication problems with people throughout school and all through my working life.
But Asperger’s is still a diagnosis in the ICD-10, the diagnostic manual (International Statistical Classification of Diseases and Related Health Problems) of the World Health Organization. It was published in 1990 and though it has had revisions, it remains in effect today. The ICD-10 is recognized even in North America, since it covers all diseases, not just those of the mind.
There is discussion from time to time about getting the ICD and the DSM to be more consistent with each other. Why? Why shouldn’t there be disagreement in a field (psychology) that has been in flux for over a century? If we create a system that has only one version of reality, aren’t we just setting up dogma?
Anyway, I suspect Asperger’s will survive as a diagnosis in the UK, and maybe elsewhere, at least for the time being..
What about the public, especially those in the public who were diagnosed with Asperger’s? Are they going to abandon the diagnosis just like that? I just checked the forums on the Wrong Planet website (www.wrongplanet.net), a popular site that was started by a couple of Asperger people, and I see that the term Asperger’s is still used there, though ‘autism’ may be increasing its presence.
Asperger’s isn’t gone yet, but where it is going remains to be seen.