DSM 5
The Recently Updated Manual of Mental Disorders

The DSM 5 is the recently revised Diagnostic and Statistical Manual of Mental Disorders, which the American Psychiatric Association publish in May 2013.

I don't care what the DSM 5 says. Aspergers is Awe-tism!

You probably have heard all the controversy about the proposed changes, but just in case you haven't, here's what is happening.

The American Psychiatric Association has proposed the elimination of Aspergers Syndrome as a diagnosis that is distinct from Autism. If the DSM 5 goes forward as currently proposed, Aspergers will not be a diagnosis any longer. Basically, they are saying that Aspergers is Autism, phasing out the term "Aspergers" (at least in the United States) altogether.

Aspergers Syndrome has always been a form of Autism. It's hard to find someone who disagrees. The problem with the change to the diagnostic criteria is threefold.

  1. Many adults with Aspergers strongly identify with their diagnosis and don't want their diagnosis changed to Autism Spectrum Disorder.

  2. Parents of children who have more Aspergers characteristics than Autism characteristics need to be able to find information about Aspergers easily rather than have to sort through all the Autism information to find what they need to know because parenting a child with Aspergers is similar but still different than parenting a child with Autism.

    A teen recorded a video about his own Aspergers characteristics and posted it on YouTube. In the video titled "In My Mind," Alex Olinkiewicz says that with Aspergers, he is half Autistic and half NT. I love his description! I agree with him completely because while parenting a child with Aspergers, I sometimes forget that my child is not NT. But when I work with children who have Autism, their Autism is much more apparent all day long.

  3. Although the DSM 5 committee says that it's trying to align its diagnoses with the World Health Organization's (WHO) International Statistical Classification of Diseases and Related Health Problems, the proposed ICD 11 does include Aspergers. So it seems that if you want to have an Aspergers Syndrome diagnosis, then you need to not live in the United States.

You can read how the Autism Speaks organization has addressed the elimination of Aspergers in its letter to the DSM work group.

Good Change

One of the changes that the Association has made is a good one. That's the removal of "clinically significant delays in language" from the definition of Autism.

The delay in language has been one of the significant differences cited between Aspergers and Autism according to the current DSM 4. Aspergers supposedly has no delay but Autism does. However, current research does not support that distinction. A delay in language may or may not happen with Aspergers.

One draft of the DSM 5 moved this diagnostic criteria into a new diagnosis of Late Language Emergence with a recommendation for early and continuing intervention. I loved it!

However, the Neurodevelopmental Disorders work group has since removed the Late Language Emergence diagnosis. Now the child would probably get a diagnosis of Speech Disorder or possibly of Language Disorder. You can read the entire outline of the DSM 5 Neurodevelopmental Disorders for yourself.

Bad Change

What is not so good is the tighter criteria for social communication, which is half of the definition of Autism. This is the change that parents complain about and that you read about in the news.

Although my Trio Man is not effected by this change, I do sympathize and agree with the families who would be. I don't think it's right to put more families in a situation where they need services but can't get them because the criteria for the diagnosis has changed. There's no other diagnosis in the proposal to help these kids get the services that they need.

However, the first studies of the proposed DSM 5 show that children will not lose their diagnosis. Of course there are those who say that there are flaws in these studies and more studies are needed. Time will tell.

For a side-by-side comparison of social communication in the current and proposed DSMs, go to the Tighter Criteria for Social Communication page.

You may also be affected by the second half of the definition of Autism, for which the criteria has changed. The proposed DSM lists four behaviors that demonstrate such patterns. The four behaviors match up to the DSM 4 and then adds one more. The DSM 5 requires two of these behaviors, so the DSM 5 is not necessarily more restrictive. I guess it depends on what behaviors your child is showing. You can read more on the Autism Behaviors page.

Summary of Changes

If you're like me, then reading the outline will help you understand how the Association has changed the diagnoses. You can read the new outline for Neurodevelopmental Disorders and compare it to the retired outline of the DSM 4's Disorders Usually First Diagnosed in Infancy, Childhood, and Adolescence.

Notice where ADHD is in comparison to Autism and that Aspergers and PDD-NOS are no longer listed.

You may also want to read my side-by-side comparison of Autism and Aspergers in the DSM 4 and DSM 5. If you have a diagnosis of PDD-NOS or High-Functioning Autism, then you may want to read a bit about them as well. It's also interesting to read how the World Health Organization (WHO) names and organizes its list of Disorders of Psychological Development in the ICD 10.

The new DSM lists severity levels of Autism. Perhaps Aspergers is supposed to be severity level 1. Read more on the List of Severity Levels page.

And if you want my opinion on what to tell your family, see the Do I say "Aspergers"? page.

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