DSMIV/5 ASD vs. Gillberg Criteria

Post Reply New Topic

This is a very detailed analysis, but one can skip to the bolded and quoted sections for a quick overview.

Dr. Jon Brock, an Australian research scientist provides excellent analyses on Autism Research. In the second link, below, he provides an analysis of 2027 different diagnostic criteria combinations to reach an Autistic Disorder diagnosis per DSMIV-TR standards. That drops to 11 combinations in the last publicly provided DSM5 definition of ASD, although each mandatory and optional criterion element is described broadly.

Recently, a study led by Catherine Lord, a member of the DSM5 committee, that has been discussed quite a bit suggested that only 10% of people would not be diagnosed under DSM5 standards using the DSM5 diagnostic tool in the study among people already diagnosed, and cited how much better the DSM5 was in avoiding the potential of misdiagnosis.

However, what she did not highlight that Dr. Jon Brock does in the first link below is that the DSMIV diagnostic tool they used to measure PDDNOS in the control group of non-autistic individuals captured 90% of those non-autistic individuals in the control group meeting the diagnostic tool requirement for PDDNOS.

The DSM5 diagnostic tool was much more accurate in avoiding the misdiagnosis of any of the individuals in the general population sample. What this suggests is that the DSMIV standards for PDDNOS, are too broad, and that the minimal required criteria can potentially capture the majority of the general population. Diagnosing professionals in real life, in real time, with real patients consider clinical experience, so this does not likely happen anywhere close to 90% in the real clinical environment.

http://crackingtheenigma.blogspot.com/2 ... usion.html

http://crackingtheenigma.blogspot.com/2 ... o-get.html

Never the less the DSMIV-TR is all that is technically required for a professional to use for a diagnosis on the spectrum so that potential for misdiagnosis under DSMIV-TR standards is still substantial.

This is background information for why I personally believe that the behavioral impairments that are currently identified to meet the minimal requirements for a diagnosis on the spectrum, per DSMIV-TR standards is extremely broad and loosely defined and can potentially be met by influence of social-cultural environmental factors alone, without clearly defined neurodevelopmental factors.

The PDD NOS criteria under the DSMIV-TR, from the year 2000 are:

The severe impairment in social reciprocal social interaction is a mandatory requirement.

There is one optional criterion required out of the following three elements:

Impairment in verbal communication or
Impairment in non-verbal communication or
The presence of stereotyped behavior, interest and activities

The criteria for 1994 DSMIV PDD NOS, because of an editorial error, only required one of the four elements, so technically persons between 1994 and 2000 misdiagnosis occurred because of that error with only the observed presence of stereotyped behavior, interest and activities.

A person with a behavioral addiction could have been diagnosed with an autism spectrum disorder, during the course of those 6 years.

Even with the corrected PDD NOS criteria, in the year 2000 version of the DSMIV-TR, that potential still exists as a person with what might be described as a behavioral addiction that is all consuming could eventually lose interest in social interaction.

That could be an Autism Spectrum Disorder not necessarily because it is an ASD, per a neurodevelopmental disorder starting at birth, but because the DSMIV criteria is broadly and loosely described enough for a potential behavioral addiction to meet the criteria. PDDNOS, like Asperger's, currently has no minimum age requirements or childhood history required for a diagnosis.

http://crackingtheenigma.blogspot.com/2 ... d-nos.html

There appears to be the potential that someone might meet criteria in the DSMIV-TR definition of Autistic Disorder at the highest level of mandatory and optional diagnostic criteria, or a person might meet the lowest requirements that could potentially have a severe behavioral addiction, and associated loss of desire for social communication with the result of an Autism Spectrum diagnosis.

Chronic unrelenting stress in human or non-human animals can result in restrictive repetitive behavior as a defense mechanism. If the source of that unrelenting stress is social or emotional a decrease in desire or even ability to socially interact with others, or behavior like looking a person in the eye can potentially result, particularly if it is abuse that is physical/emotional/social in nature and/or social isolation is part of the equation of the chronic stress. Those observed behavioral impairments may not be the result of a neurodevelopmental disorder but they can happen in almost any person that does not have exceptional resilience to chronic unrelenting stress.

Those are just two examples of behavioral impairments that can mimic those identified in DSMIV-TR standards resulting in severe difficulties in social reciprocal interaction and RRBI's.

The same could technically result in a DSMIV Asperger's diagnosis as long as the RRBI’s and social reciprocal interaction behavioral impairments are identified along with substantial impairments in developing and maintaining peer appropriate friendships. That is almost a given in the two examples above, specific to PDDNOS, although the friendship impairment is not required as a third element to meet three mandatory criterion as it is in Asperger's syndrome along with the symptoms working together to impair a person in an important area of life functioning.

http://www.cdc.gov/ncbddd/autism/hcp-dsm.html

This likely does not happen when a battery of written and observed tests like the ADOS, and ADI-R are included in the diagnostic environment, but again technically only DSMIV-TR guidelines are required for diagnosis.

In summary, RRBI's and impairments in social reciprocal interaction are essentially all that is minimally required for a DSMIV-TR Autism Spectrum diagnosis. These impairments can potentially result from the influence of society/culture or the byproducts of society/culture alone, almost anywhere in the course of a lifetime when there is substantial exposure to a social/cultural environment one either cannot adapt to or adapts to in a way that result in those two observed behavioral impairments.

In one word the DSMIV Autism Spectrum criteria was broken, particularly with the 1994 editorial error in PDD NOS, but the DSMIV-TR is still vaguely written to actually capture a neurodevelopmental disorder consistently, even without the editorial error. The research from Catherine Lord seems to be enough evidence on its own to provide compelling evidence for that analysis.

With the last publicly provided revised DSM5 criteria the impairments in social communication are greater restricted as observed non-verbal behavioral impairments are a mandatory requirement along with the observed behavioral impairments of developing and maintaining peer appropriate friendships and observed behavioral impairments of social-emotional reciprocity.

https://sfari.org/news-and-opinion/news ... -disorders

Sue Swedo, the chair of the DSM5 committee has publicly announced in a video linked below from the APA website that the mandatory requirement for RRBI's can be met by history alone in DSM5 ASD criteria, so that technically leaves three criterion elements that are mandatory requirements for a diagnosis that must be observed during the diagnosis.

http://www.psychiatry.org/practice/dsm/ ... m-disorder

There is the potential of the non-verbal impairment in the inability to look the diagnosing professional in the eye, the difficulty with initiating or sustaining back and forth conversation, and behavioral impairments in developing or maintaining peer appropriate friendships resulting together in impairments and limits in everyday life functioning. There is still a potential recipe for diagnosis based on the social/cultural environment alone in the latest revised DSM5 criteria. Symptoms beginning in early childhood not fully manifesting until social demands surpass the capacity to adapt, makes it less likely.

A person who has been chronically socially/emotionally and/or physically/sexually could have a significant problem looking someone in the eye and potentially meet the mandatory non-verbal impairment requirement to meet the latest revised DSM5 criteria from the social/cultural environment alone, per at least that one example. I suppose a behavioral addiction could still potentially result in an observed non-verbal impairment, depending on the expertise of the diagnosing professional.

Behavioral addiction, through many peer reviewed studies has been identified by the American Society of Addiction Medicine as a real structurally changing organic brain addiction equivalent to that of substance abuse, but the DSM5 committee still hasn't caught up and come up with a definition they can agree upon. This kind of addiction is more than described "internet addiction". Behavioral addiction is a serious problem that can end up with some kind of diagnostic label, whether it is OCD, GAD, depression, ADHD, or an ASD.

http://www.asam.org/advocacy/find-a-pol ... -addiction

There are many sources of social abuse, that could lead to RRBI's, difficulties in social emotional reciprocity, developing and maintaining peer appropriate friendships, and even possibly difficulties in non-verbal communication, but one underlying inherent aspect of human development that may or may not be directly associated with brain development and autistic like traits, is androgyny.

Sexual orientation is undisclosed to avoid potential social abuse but androgyny can be present from early childhood and difficult to hide. This potential abuse can be the result of a patriarchal point of view, when a boy is mistaken as a girl or a girl is mistaken as a boy as a child, or the androgynous girls and boys in middle school, as targets of particularly cruel social-emotional abuse when the instinctual primate competition starts for subsistence and mates.

http://keithsneuroblog.blogspot.com/201 ... l?spref=fb

Excessive prenatal testosterone can increase the potential for language development problems in males and additional prenatal testosterone enhances the protection of verbal language development in females. An interesting finding there for females on the spectrum diagnosed with Asperger's syndrome displaying the androgynous trait associated with 2d/4d digit ratio associated with exposure to prenatal testosterone, and other resulting androgynous traits, along with intelligence and verbosity, while not necessarily emotional verbosity.

http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract

Given the DSM related information, I think there is a good argument there are potential social/cultural environmental factors resulting in a substantial number of the behavioral impairments in DSMIV, and DSMIV-TR minimal criterion requirements for a diagnosis in PDDNOS and Asperger's syndrome. It does not appear that the minimal criteria always result in a neurodevelopmental disorder.

However, through the process of neuroplasticity the neurodevelopmental process continues through adulthood that can potentially result in a form of negative neuroplasticity through social/emotional/physical abuse and/or behavioral addiction.

I think regressive autism is an interesting ASD subgroup example as males with this condition with a dramatic loss of the use of spoken language almost exclusively have been identified with abnormal brain growth, not usually found in any other subgroup on the spectrum. It is probably one of the clearest examples of some type of actual neurological origin of ASD past the association with fragile X syndrome, and the perhaps the best evidence to end the vaccine causes all cases of autism myth. Regressive autism is the subgroup of ASD that inspires the most concern in the general population.

http://www.ucdmc.ucdavis.edu/publish/news/newsroom/5983

Linked and quoted below is the Gillberg diagnostic criteria for Asperger’s Disorder that requires the direct observance of evidence of behavior for a neurodevelopmental disorder/condition, as minimal required criteria for diagnosis that Christopher Gillberg developed in 1992, before the DSMIV criteria was developed in 1994.

This criteria is based on Lorna Wing and Uta Frith's description and translation of what Hans Asperger specifically identified in his case studies, for what he described as "Autistic Psychopathy" as opposed to the regressive autism and loss of spoken language described in at least one of Kanner's case studies, that Kanner overall described as "Autistic disturbances of affective contact"

It is apparent though that Kanner still captured many of the other traits that Hans Asperger captured in his case studies.

http://mail.neurodiversity.com/library_kanner_1943.pdf

The mandatory required elements in Criteria 4 and 6 below in the Gillberg criteria do not result from social-cultural environment alone. There can be no question that a person diagnosed by Gillberg criteria does not have a neurodevelopmental disorder. However, the potential is still left open in the Gillberg criteria that some individuals diagnosed may function satisfactorily in day-to-day life, even though they have severe impairments as listed below in the criteria.

Simon Baron Cohen and Tony Atwood both studied directly under Uta Frith who provided the authoritative English translation of Hans Asperger's work. Cohen and Atwood have both reported that it is possible for an individual who has the Gillberg type Asperger's criteria to live life without substantial disability or disorder, if they find an environmental niche that supports them, but never the less these professionals still live in areas that use International Classification for Disease ICD or DSM criteria for ASD diagnoses. It will be interesting to see the ICD version 11 definition and criteria of what is reported will replace Asperger's Syndrome in that manual as Social-Emotional Reciprocity Disorder.

Asperger's Syndrome continues in the Gilberg criteria, as there is no suggestion it will retire in countries currently used in. That makes things even more confusing globally, but I think it is better criteria than what was designed in the DSMIV and ICD9 criteria from the beginning for what was labeled as Asperger's Syndrome, in what Hans Asperger actually described in his case studies.

Short summary of Hans Asperger's 1944 paper in English here at this link:

http://www.paulcooijmans.com/asperger/a ... rized.html

http://www.bbbautism.com/asp_gillberg.htm



http://www.youtube.com/watch?feature=en ... e-iik&NR=1

My take on myself with the following criteria.

"GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER

1.Severe impairment in reciprocal social interaction (at least two of the following)
(a) inability to interact with peers - no
(b) lack of desire to interact with peers - yes
(c) lack of appreciation of social cues - yes
(d) socially and emotionally inappropriate behavior - no

2.All-absorbing narrow interest (at least one of the following)
(a) exclusion of other activities - yes
(b) repetitive adherence - no
(c) more rote than meaning - no

3.Imposition of routines and interests (at least one of the following)
(a) on self, in aspects of life - yes
(b) on others - no

4.Speech and language problems (at least three of the following)
(a) delayed development - no
(b) superficially perfect expressive language - no
(c) formal, pedantic language - used to
(d) odd prosody, peculiar voice characteristics - yes
(e) impairment of comprehension including misinterpretations of literal/implied meanings - sometimes

5.Non-verbal communication problems (at least one of the following)
(a) limited use of gestures - no
(b) clumsy/gauche body language - no
(c) limited facial expression - no
(d) inappropriate expression - maybe
(e) peculiar, stiff gaze - no

6.Motor clumsiness: poor performance on neurodevelopmental examination - no

(All six criteria must be met for confirmation of diagnosis.)

By this definition I would not be considered having Asperger's Syndrome.

This is my take on me regarding the upcoming DSM-V criteria.

“This is the proposed definition of ASD. For a person to be diagnosed, they must meet criteria A, B, C, and D.

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, - yes

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated-verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. yes

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people - yes

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases); - no

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes); - yes, but not with the intensity of someone like, say, Sheldon Cooper.

3. Highly restricted, fixated interests that are abnormal in intensity or focus (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests); - no

4. ** Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment(such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects); (emphasis mine) - yes

**This is new

C. Symptoms must be present in early childhood(but may not become fully manifest until social demands exceed limited capacities) - maybe

D. Symptoms together limit and impair everyday functioning.” - yes

By DSM-V's reasoning I am probably autistic but probably at the lightest level.

What I'd like to see addressed in both criteria, and what really identifies a lot of us, are our particular quirks. To wit:

1. Nail biting, legs or body rocking, hair twirling, pencil tapping, hands flapping or squealing and unusual sounds.
2. Wearing a hat in or out the house all day long.
3. Wearing a jacket or overcoat in or out the house all day long.
4. Walking up and down the stairs always on the same side.
5. Total disregard for what is normally eaten at breakfast, lunch or dinner.
6. Total disregard for the normal times of eating breakfast lunch or dinner.
7. Total disregard for breakfast, lunch and/or dinner.
8. Total disregard for what is trendy and having no fashion sense.
9. Listening to music or watch movies uncommon for one's age group.
10. Always having to sit facing the same way.
11. When writing on the internet, has a fondness for unusual fonts, words or phrases.
12. Will only eat or drink out of a particular utensil.
13. Must wear mismatched socks or one-colour shirts or long sleeve sweaters every day.
14. Refuses to shake anyone's hand for whatever reason.
15. When they are forced to socialize they always make up a reason to disappear.
16. Walking down the street while eating a meal with utensils.
17. Constant need to construct long lists.

What difference does it make? We're getting DSM 5, like it or not.

I think that the DSM-5 is best for diagnosing autistic people with autism and not diagnosing non-autistic people with autism.

The DSM-IV criteria are too broad and loose, eggspecially for PDD-NOS.

The Gillberg criteria are too specific to what eggsacly Hans Asperger described.

Agreed, and I find it hilarious you use egg for replacement of few choice words...

1.Severe impairment in reciprocal social interaction (at least two of the following)
(a) inability to interact with peers Partly
(b) lack of desire to interact with peers Yes
(c) lack of appreciation of social cues Yes
(d) socially and emotionally inappropriate behavior Partly

2.All-absorbing narrow interest (at least one of the following)
(a) exclusion of other activities Yes and no, depends what kind of activities... so vague
(b) repetitive adherence Yes, gaming & programming
(c) more rote than meaning Yes, especially with programming

3.Imposition of routines and interests (at least one of the following)
(a) on self, in aspects of life Yes
(b) on others No

4.Speech and language problems (at least three of the following)
(a) delayed development I don't know
(b) superficially perfect expressive language I don't know
(c) formal, pedantic language No
(d) odd prosody, peculiar voice characteristics I don't know
(e) impairment of comprehension including misinterpretations of literal/implied meanings Yes

5.Non-verbal communication problems (at least one of the following)
(a) limited use of gestures Yes
(b) clumsy/gauche body language Yes
(c) limited facial expression No
(d) inappropriate expression No
(e) peculiar, stiff gaze No

6.Motor clumsiness: poor performance on neurodevelopmental examination

1. Nail biting, legs or body rocking, hair twirling, pencil tapping, hands flapping or squealing and unusual sounds. Nail biting
2. Wearing a hat in or out the house all day long. No
3. Wearing a jacket or overcoat in or out the house all day long. Sometimes
4. Walking up and down the stairs always on the same side. Sometimes
5. Total disregard for what is normally eaten at breakfast, lunch or dinner. No
6. Total disregard for the normal times of eating breakfast lunch or dinner. Yes
7. Total disregard for breakfast, lunch and/or dinner. Sometimes
8. Total disregard for what is trendy and having no fashion sense. Yes
9. Listening to music or watch movies uncommon for one's age group. Yes, does watching movies/cartoons for kids or listening to game music count?
10. Always having to sit facing the same way. No
11. When writing on the internet, has a fondness for unusual fonts, words or phrases. Sometimes
12. Will only eat or drink out of a particular utensil. No
13. Must wear mismatched socks or one-colour shirts or long sleeve sweaters every day. No
14. Refuses to shake anyone's hand for whatever reason. No
15. When they are forced to socialize they always make up a reason to disappear. Yes
16. Walking down the street while eating a meal with utensils. No
17. Constant need to construct long lists. No

While not specifically identified, 1, 2, 3, 4, 10, 12, 13, and 17 could all potentially fit as behaviors falling under the elements of the RRBI Criterion in the DSM5. 14 possibly, and 15 definitely could fall under the elements of social-communication impairments. However, some of the behaviors listed including 14 could also fall under behaviors associated with OCD. And most of the ones I identified would also likely fit under the descriptions of elements of criteria under the Gillberg Criteria. Some of the others might too, in both criteria, depending on clinical judgement.

The criterion elements while more restrictive in number in the DSM5 are broadly described where many behaviors can fall under those broad descriptions, depending on clinical judgement.

The Gillberg Criterion have always been more restrictive in mandatory elements required under the criteria, but they are also described in a way where many of these behaviors could fit the general descriptions of the elements.

True that is inevitable and according to Sue Swedo some people will not retain their diagnoses if they don't meet the Social Communication Impairments through the course of a lifetime, if re-assessed. However RRBI's can be met by history. That part makes a big difference per general information, because there was confusion before in what Catherine Lord had meant in an article in the New York Times, where she suggested "essentially everyone" would get in, not clarifying exactly who would not get in, if re-assessed, by history specific to RRBI's and not by Social Communication impairments.

The topic question is just a "special interest" of mine, as I find the history of the diagnostic classifications interesting and divergent from what Hans Asperger described as "autistic psychopathy" as a neurodevelopmental disorder much later named "Asperger's syndrome" by Lorna Wing.

Gillberg determined he was going to describe the syndrome Asperger described, and the ICD and DSM determined they were going to describe "Autism Lite", by removing the communication criterion and exclusion for some of the developmental delays, along with a reduction of the number of optional elements required in the exact same social interaction criterion and RRBI criterion.

And PDDNOS was "Autism extremely lighter" in 1994 in the DSMIV as a result of an editorial error, and corrected to "Autism lighter" in 2000 in the DSMIV-TR.

That was a tidy way of including the similarities associated with the Kanner and Asperger's syndromes that were described, but not an effective way of describing two different syndromes on a large spectrum. It is one of the main reasons that the Asperger's diagnosis is going away, per DSM5 standards. It was never fully described with mandatory or optional criterion, in the DSM or ICD classifications, as a different syndrome.

It remains to be seen what the ICD11 comes up with for social-reciprocity disorder to replace the label of Asperger's Syndrome, but Asperger's syndrome, per what Asperger described, never really fully existed, anyway, in what the ICD or DSM determined as the "Autism Lite" version of it.

Asperger's syndrome as described by Asperger continues on as an Autism Spectrum disorder in those countries that use the Gillberg criteria, as it has since 1992, in the only places it was actually identified by Hans Asperger standards effectively as a different syndrome with different required mandatory criteria for a diagnosis.

this is all great, but to put it bluntly: should i get diagnosed now or after the dsm v?

my psychologist has nearly finished his assessment.

http://apps.who.int/classifications/icd ... cd%23F84.5

To date here is the draft revsion of Social Reciprocity Disorder in the DSM11 beta version. It is much different than the DSM5 definition of Social Communication Disorder except that RRBI's are also not included in the definition. And they are still calling it Asperger's syndrome by synonym.

I have heard some people suggest that this is the equivalent of social communication disorder but it is much different as suggested in the quotes below to date.

http://crackingtheenigma.blogspot.com/2 ... r-new.html



Even if one were to add the definition of Social Reciprocity Disorder to the definition of Social Communication Disorder it would not come close to fully describing what Hans Asperger described in "autistic psychopathy", as some of the RRBI's were an inherent part of it.

My suggestion would be if you've already paid for it and there is no refund, not to interrupt your current diagnosis. In looking at the DSM5 requirements, the psychologist should be able to provide information to you, if your current assessment meets the mandatory criteria in the DSM5 that is similar the optional criteria in the DSMIV, except for the RRBI hypo/hyper sensory impairment. And also if you would likely be considered impaired and limited in everyday functioning as a result of the symptoms.

But the bottom line is that whenever re-assessment is done with a different clinician there is a potential for a different analysis. If you are not going to be receiving some type of government assistance with periodic mandatory re-assessment of medical condition to continue assistance, that is not likely going to be a requirement in the future. But even if you could be assessed with DSM5 criteria now, it still could be a requirement in the future to be re-assessed if government assistance is ever something that is needed, and there still could be the potential for a different clinical analysis if a different professional is used, but not likely.

PDD-NOS as it was written was a mess. It was and is used though, to capture children and adults with severe social impairments who don't fit prototypical AS or AD. Would most of these people have an ASD? Probably, as I think the other disorders listed under PDDs would cloud the view of the diagnosticians, and they'd be looking for people who're "like" this or that, but aren't exactly this or that, so enter PDD-NOS.

Gillberg's fits AS better due to the two main areas blatantly needed (which define AS for the most part), the interest and the social deficits. Whilst the DSM-IV-TR is worded in the expanded text to point to those two being the main points of AS, the criteria themselves don't -- I think a lot of confusion came and comes from people looking solely at the criteria. Not that the expanded text should be the key qualifier, though it should be half of it, with the criteria being the other half.

Gillberg's isn't going anywhere, no matter the latest ICD or DSM.

The expanded text was woefully inadequate in 1994, but it did appear to acknowledge, in 2000, in the DSMIV-TR that not nearly enough information was provided in the 1994 DSMIV basic criteria to accurately diagnosis people. I have been interested in getting access to the expanded text for PDDNOS but have only been able to find it for Autistic Disorder and Asperger's syndrome at these links:

https://sites.google.com/site/gavinboll ... for-autism

https://sites.google.com/site/gavinboll ... -aspergers

I still think it is unfortunate that none of the language impairments that Hans Asperger described were even mentioned in the expanded text for Asperger's syndrome in the DSMIV or DSMIV-TR, not even in the associated features section. But, are fully described in Autistic Disorder.

This is one part of Asperger's in the classic Hans Asperger sense that is difficult for anyone to hide per the fact that some cannot be pin-pointed to any regional dialect even if they lived there their entire life.

It is interesting to me that the focus of SCD, alternatively, has become pragmatic language impairments as the source of difficulty in social communication, that if identified along with the rest of the criteria of Asperger's from the start in the DSMIV and ICD10 might have been a better capture of what Hans Asperger described.

I don't see it necessary that motor skills difficulties should be a mandatory criterion, but it definitely leaves no doubt that there is some type of underlying neuro-developmental disorder associated just as the language impairments provide evidence for.

It is also interesting that the DSMIV-TR expanded text identifies the deficits in visual-spatial skills often associated with non-verbal learning disorder along with the ADHD symptoms that Asperger did identify in his paper that are also associated with hyperlexia, pragmatic learning impairment, non-verbal learning disorder, and ASD. In addition, the DSMIV-TR expanded text does describe motor skills difficulties as an associated feature that is usually very mild.

I think the DSMIV-TR definition of Asperger's has best captured non-verbal learning disorder symptoms and the ADHD symptoms that are often co-morbid in that condition.

http://en.wikipedia.org/wiki/Nonverbal_ ... g_disorder

In reading the definition of Pragmatic Language Impairments, PLI, it seems to me that the DSMIV-TR might not have mentioned it in Asperger's because language delays are often part of PLI, as is the case for Hyperlexia.

But, there are so many clinical features that are reported elsewhere associated with Asperger's syndrome included in the linked definition below of PLI, the association seems as strong as non-verbal learning disorder, but I wonder if the language delay detail is what kept many out of Asperger's Syndrome and in HFA Autistic Disorder or PDDNOS, along with the fact that pragmatic language impairments are not at all described in the diagnostic test for Asperger's syndrome in the DSMIV-TR.

It seems like the DSM5's decision was to leave verbal language impairments completely out of the basic criteria set, but I'm sure they will remain in the expanded diagnostic test in the final revision of the DSM5.

http://en.wikipedia.org/wiki/Pragmatic_ ... _to_autism

Overall, the common criteria of Social Communication, the ability to meet RRBI's by history, and what likely will be a long list and description of expanded text of diagnostic features and associated features, is a much better solution in the DSM5 than what the DSMIV-TR provided for autism spectrum disorders as a whole.

A little bit like the new Anti-Social Personality Disorder criteria in the DSM5 that has been expanded to capture the non-criminal and criminal spectrum of "sociopathy and psychopathy". It now fits almost any politician well other than the caveat that the behavior must be outside of the social norm..

That's all the DSM-IV-TR has on PDD-NOS.

Some clinicians have come up with quasi-official subtypes like the above "atypical autism", such as:

Atypical Asperger's
Residual Autism/Asperger's
Mixed Autism and Asperger's
Broader Autism Phenotype (yep, some include this under PDD-NOS; "subthreshold symptomatology" would be why they do, really)