Question re: DSM V and Aspergers diagnosis

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If I understand correctly the DSM V is scheduled to be published in 2012. There is apparently discussion of realigning the ASDs into a HFA, MFA, and LFA.

Assuming that the above is accurate what would this do to a person with an Aspergers Disorder diagnosis? *I know it is called Aspergers Syndrome on WP but the DSM says "disorder"*

In dealing with social services, and such would there remain a classification of Aspergers, or would the diagnosis transfer to HFA? Would it remain an Aspergers diagnosis but not be recognized and require a new evaluation by a psychologist/psichiatrist?

I have looked for this info online and failed to find an answer.

It would transfer to HFA, MFA, or LFA depending on which category that particular Aspie could be painfully squished into. Maybe some groups would automatically put all Aspies in HFA, but more correctly, seeing as some of us need pretty significant amounts of help, there would be a few in all three groups.

If it's true that they're using functioning labels now, that just makes me sad... I've been all three at various times and I think it's ridiculous to pigeonhole people like that. The only way I'd let 'em do it is if they kept the label flexible and categorized by GAF. At least GAF's a more concrete way of measuring functioning labels than "hey, she can talk but she can't hold down a job and it takes her ages to clean the kitchen, so let's stick her into the MFA box".

I would not m being HFA over AS, simply because it has a stronger impact on the people hearing the term.

I agree that some AS people would best not be considered HFA. In order to have a decision made about the functioing level of the individual they would need to be reavaluated right?

So if AS disappears and we all need to be reassigned for services, ADA, etc we would receive HFA unless rediagnosed lower or do you think we would have no diagnosis until rediagnosed?

It would suck to go through diagnosis again but I assume it would be much easier with old notes from the AS diagnosis and such. I wonder if it could serve as a "reset button" for people finding a diagnosis causing more trouble than it is worth...

I assume that the functioning level is being considered due to easier diagnosis.

They haven't even decided yet if they are keeping three realms of diagnosis or perhaps dropping repetative behavior. They may leave it the same. It is a big question mark to me that is why I posted this. I'm hoping someone who perseverates on PDDs will chime in.

I highly doubt you've been deemed as LFA before. Lorna Wing, the proponent of the spectrum, pegs Rain Man as HFA (albeit, in the aloof group, but still HFA).

LFA tend to be unresponsive (to an extent that they'd die if not fed by hand or prompted to eat), even as adults.

Anyway, nothing in the DSM-V is set in stone now; they're trying to see if there's enough difference between AS and HFA to keep AS separate. They haven't said at all that they'd include any of the various "functioning labels", rather, those who wish to remove AS want it as Autism and ASD-NOS (those with AS will be in Autism under this, unless they're of the mild AS make, and then they'll be in ASD-NOS).

Actually, autistics below the HFA threshold are considered LFA. That DOES allow for LFA people that are VERY lucid!

Yeah, but those who have a global IQ in the mentally ret*d range tend to be the most severe; they gain speech later, their self-help skills are far worst, their drive and executive functioning tend to be non-existent, etcetera.

There's many who're quite lucid and communicative when given the ability to communicate, but the majority aren't.

I don't know since I was never really autistic and really got my AS diagnosis thru the back door from NLD (the much more severe problem). I've got some bad habits, but other than that, not really isolated from the outside world. It's hard for the business community to "accept" AS and this would only make it harder. I've only had two obsessions in my entire life, once in weather at a much younger age being a prospective meteorologist and once as a licensed broker. Some people with AS are great at sales or at sports; this would confuse everything. High Functioning Autism is where the nonverbal are stronger than the verbal whereas in NLD and in AS, the verbal is stronger than the nonverbal.

Last edited by smartguy47 on 15 Feb 2009, 8:47 pm, edited 1 time in total.

For what it's worth:

My son is rated by the educational system as "severe" translating roughly to LFA. His "official" diagnosis is currently Classic autism without a LFA or HFA attached. Depending if it is a good or bad day he is either just over or just below the HFA cusp.

It would simplify things (for us) to have a MFA rating.

He tested with an IQ of just over 100. The psychologist said that is unusually high for LFA though not unheard of. He was nonverbal at the time of testing but now does lots of echolalia with some original speech. He can also feed himself (just don't expect him to use a spoon).

I don't think it affected the dx but he has some pretty severe sensory issues. He also frequently withdraws into his own world.

He is three now but was dxed over the period surrounding his second birthday.

"Low functioning", but not technically "low functioning autistic", because at that point I hadn't been diagnosed yet. Basically, I was doing a lot of self-injury and had been hospitalized because I was suicidal and not taking care of myself. So yeah, GAF in the twenties or so. The autism by itself has never been more than moderate; but combine it with depression, and suddenly the ability to cope with anything at all is about as bad as for somebody who's born with really strong autism. Give me a physical illness, and you get similar reduction in functioning level. Same thing in some environments. You can't really pick apart a person and say, "well, this part is autism, and this part is depression, and this part is executive dysfunction, and this part is epilepsy, and this part is PTSD"... it's all one person.

I disagree with the Rain Man as HFA thing. Some people will say "high functioning" if you can speak and interact somewhat; but consider this--the guy needs full-time care, at least according to the movie. If you assume Rain Man is high-functioning, then so is about 99% of the Spectrum, and that makes the labels pretty meaningless.

Maybe Lorna Wing meant "autistic with a high IQ"? Often times they will categorize autistics by their IQ regardless of their impairment level, so that somebody like, say, Sue Rubin ("Autism is a World", measured IQ in the 130s, nonverbal, needs full-time care), would be categorized as "high-functioning" right along with your basic barely-detectable Aspie. (Still kind of funny, because the guy Rain Man was based on actually has a low IQ... but then again, he doesn't have autism, either.) Or else they'll say that anybody who doesn't fit the stereotype of non-verbal, totally isolated, constant tantrums, diapers, nonstop stimming, etc. is "high functioning"... it's almost applied as sort of a compliment. Like, "well, you're autistic, but you're not as bad as THOSE people".

The best definitions, I think, use GAFs... something like LFA 0-33, MFA 34-66, HFA 67-100... around that. I don't like the idea that you stay in a fixed functioning-level category because in many cases, either the non-fixed nature of some particular case of autism, or else the non-fixed nature of peoples' circumstances and co-morbids, really stops them from staying categorically in any one group.

About 1/6 of the spectrum are the classic low-functioning depiction; people who require full-time care.

Wing's comment on Rain Man is from the book, "High-functioning Individuals with Autism". She uses him as an example of someone with HFA who so happens to have the aloof social presentation (I see him as HFA due to him not needing full-time care, and he doesn't. He can get around by himself if everything is provided for him. He only runs into problems when his routine is broken). Someone with HFA or AS who is of the odd and eccentric manifestation would be Mr Bean. He can drive, approach others for social contact (his girlfriend), live by himself (in other words, he can provide for himself, whereas Rain Man can't). They're both "high-functioning" compared to the individual with LFA who doesn't do anything at all.

It depends on what someone defines as "high-functioning". No one with a diagnosable ASD will function at a normal level; AS and HFA are seen as high-functioning compared to individuals with LFA, but that's not saying much.

Rain Man didn't seem very high functioning to me. His general ability seemed closer to a 4 or 5 year old than to an adult. SURE, he could react, BUT....

1. He was VERY guilable. Even in ways that I doubt most here would be.

An HFA person shouldn't have been so free about revealing the counting of cards, or the desire to use the roulette wheel

2. He insisted that things be his way to the point that it was almost unbearable.

An HFA person should have been better able to voice his concerns, and a bit more flexible.

3. He had great math abilities, but had no ability to apply them to things like money.

An HFA person should have been able to apply them to money.

4. He could memorize things well, but applied the information sporadically.

An HFA person should have been able to apply the facts better. Crashes are EXPECTED! Look at all the flights that DIDN'T crash though. A car crash is more likely, and one in a convertible has a greater chance of being fatal. He didn't realize THAT though.

BTW rainman wanted to have everything taken care of. SURE he could accept an environment and attendant change, but that seemed to be about it.

I would rather be labeled as HFA than AS, so I hope they do do away with the AS label. I would rather people assume I am lower functioning than having some disorder nobody knows of. At least if people assume I am low functioning I won't be expected to do thing I can't, and I can correct them about what it is I can do. I think having it all labeld as autism would be a good thing.

EDIT: Reason it would be a good thing, few people associate AS with autism, which it clearly is if you understand both, so by calling it autism, you are having people better understand it for what it is.

I have no idea how you can make those statements about HFA individuals functional capabilities. It seems as if you have not met many people who are dignosed as being autistic and considered to be HFA. There are huge differences in functional capacities within this catagory and several dozens of different presentations.

Gullibility and naivety doesn't denote functioning as far as I'm aware, as it's common amongst all people with an ASD to a somewhat severe amount. I doubt he'd walk off a mountain if you told him to (I'm betting that some people with LFA would do just that). In the same text where Lorna Wing says Rain Man has HFA, she mentions a young [undiagnosed] man with HFA who ended up in jail due to someone making him do something illegal at work (he was doing what someone said to without understanding his actions). When they found out that he had HFA, he was released. Some people can censor themselves, whereas others just blurt everything out at the first sign; this doesn't really point to any specific level of functioning.

Routine tends to be a seemingly matter of life and death for individuals with HFA; it's only really found in individuals with such too, as those with a younger mental age (LFA) don't have the mental faculties to create routines to circumvent executive dysfunction. When the routine is broken, the person with HFA usually loses his or her ability to function. Someone with AS usually gets upset and feels discomfort when a routine is broken, but oftentimes they can continue.

He probably has problems with receptive language, which is possible in HFA; he probably didn't understand what the doctor said when he gave the sum in a different way than a pure sum. This is within the realm of HFA. He is also called a savant in the movie, which means he most likely really sucks at receptive speech, and expressive too (note how he says "yeah" a lot, no matter what it's applied to, that's a common thing for someone with a verbal impairment to do). He was also sheltered from monetary concerns.

He remembered things that were important to him, and he used them for his social approaches due to lacking social reciprocity; this can be in AS and HFA both. I doubt he would have flown if he could have flown on Qantas, he was just using the statistics to point out a reason for why he didn't want to fly; there very well could have been many other reasons (i.e., he didn't plan for it). He also was afraid to drive on the freeway due to the possibility of lethal car accidents. On this note, there is one thing that is out of place with the depiction of HFA, and that's when he steered the car into the incoming traffic as his brother was driving; this is more in line with someone who has a young mental age (LFA) rather than not.

Many people with HFA and AS require financial support, cleaners, cooks, drivers, etcetera (this usually falls on the family nowadays), so how he lives is in the realm of HFA and AS. LFA tend to need people to actually put food in front of them, and then require prompting to eat, people to help them shower, to clean their teeth for them (actually do it), etcetera. Rain Man was ok with all of this, even though he spent most of his life in an institution.

But it is a matter of degree. HECK, he basically FLAUNTED it.



Again, DEGREE!



Your theory about him merely discouraging flying is good. I didn't think about that. If I didn't care about the time, effort, and safety, I would do the SAME. I HATE planes! Alas, they ARE faster/safer. 8-( You have a point.



You're right about that, but I still think it was TOO much.