Opinions on the new diagnostic criteria in the DSM-V?

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I'm very supportive of the Autism Spectrum Disorder diagnosis instead of the separate diagnoses, and think its just better for the autism spectrum, but think that it would have also been far better for NVLD and SPD to have gotten diagnoses added to the DSM.

NVLD should have been added to the DSM-5. The deciders farked up by not adding it at the same time that they removed AS. I agree that there are at least two big subgroups within the AS supergroup, people who have NVLD and people who have autism. These two groups of people are verry merry berry different from each other, I think. I think that the stereotype of AS is more NVLD-like than autism-like. I don't identify at all with the stereotype of AS, and I don't identify much with people in the NVLD-like subgroup of AS. I identify with adults and children who have classic autism and autism-like AS.

The proposed criteria of the new ASD diagnosis in DSM-V has been altered so that it's more inclusive now, AFAIK. It released some fear of losing their diagnoses on the side of very high functioning people. I agree with the notion that there are at least two subgroups of people with an AS diagnosis (one NVLD-ish and one autism-like). However, I'm not sure putting an NVLD diagnosis into the new DSM would be any better than the current separation of ASD diagnoses.

I'm diagnosed with PDD-NOS and I definitely identify with the "super-HFA" description the most, meaning I have autism-like symptoms at a fairly mild level, mostly less severe than that of a typical person with a HFA diagnosis. I'm almost certain I would be diagnosable under the new DSM with ASD (1).

My personal opinion is that the Asperger's diagnosis is already used as an inclusive diagnostic label for those who are high functioning enough, at least I get this impression looking at the practice in the USA, mostly based on my observations at Wrong Planet, presumably to separate spectrumites into two neat and widely known category, autism and Asperger's. PDD-NOS is just not specific enough to get public attention. Even early PDD-NOS diagnoses are often changed later to either autism or Asperger's, if not dropped completely in adulthood.

I'm mostly glad about it. I'm diagnosed PDD NOS, but saying that tells you nothing about me that you wouldn't know from me saying I'm autistic. (And I meet the autism criteria. I'd be level 1 in social, and probably about a .5 in RRB - it's rare that it actually causes problems rather than just being a preference.) I'd have liked if they added Newson Syndrome, but it does have very little research behind it, so I understand why they didn't.

However, one thing that bugs me is that there are ways they could split up the autism spectrum that would be substantiated by research, and they didn't do it. Two particular divisions have been studied and found useful:

Social subtypes - Aloof (usually rejects social initiation and rarely initiates themselves), Passive (accepts interaction and enjoys it but rarely initiates) and Active but odd (initiates interaction readily in an atypical way)

Aloof and Active but odd have been found to have a high degree of reliability and validity, while Passive is lower but still somewhat reliable. Aloof is more common in lower functioning individuals, and Active but odd in higher functioning, but all types are found at any functioning level. Active but odd individuals have a higher rate of executive dysfunction and more overlap with ADHD. Passive subtype is more common among autistics who later develop catatonic features. The different subtypes also show differences in brain activity.

IQ profile - PIQ>VIQ, VIQ>PIQ and VIQ=PIQ

The three profiles are about equally common. The PIQ>VIQ subtype is most likely to have language delay and tends to have more severe social difficulties, while the VIQ>PIQ subtype has the characteristics typical of NVLD as well as autism (meaning specific learning difficulties in math and spatial skills, motor coordination problems, and so forth). The PIQ>VIQ group are more likely to have unusually large heads as well, suggesting a different underlying cause. The PIQ>VIQ group also shows evidence of visual thinking, such as lack of inner speech use in tasks where most people use inner speech. Meanwhile, the NVLD profile is associated with white matter abnormalities in the right hemisphere.

So, yeah, I wish they'd added specifiers for social and IQ profile subtypes, instead of just the severity ratings.

I think that it is a good idear to include the information about social subtype and IQ profile in addition to severity level. But they probably can't do this, because once this specification process starts, it doesn't end.

Also, severity level, social subtype, and IQ profile are all subject to change as a child grows up, and there are further subtleties beyond the straightforward classifications that can be made at different ages.

For eggsample, I had a big PIQ > VIQ difference when I was a child, due to abnormally low verbal cognitive functioning and abnormally high non-verbal cognitive functioning. I was both eggstremely bad at language and eggstremely good at non-verbal eberrything. As I grew up, I gained moar moar moar language skills, gained speech, gained verbal comprehension, gained verbal thinking abilities, so I am now in the PIQ = VIQ category. However, that is only based on my performance on the tests that I know that I am taking, not my eberryday thinking in my eberryday life, which still follows a PIQ > VIQ, non-verbal >>> verbal pattern. I can use my good verbal skills to do well on verbal tests, but by default, when I am not taking a test, my cognition is still in the non-verbal >>> verbal category, the natural normal thing for me. So even though my scores have evened out, I think that I still think quite different from someone who always had the PIQ = VIQ pattern from childhood.

The same pattern is true for social subtype. I used to be aloof, but now I am passive, because I no longer ignore people when they talk to me. I used to ignore them completely, because I did not know what was the meaning of them talking to me, or that there was any need for me to give any sign that I had heard them. After I learned these things, I became moar like the passive subtype. So now I am passive when I turn it up to interact with people, but in terms of social desires and need for companionship and enjoyment of social interaction and social cognition abilities, I am still my natural normal aloof self, so I am probably still different from someone who was always passive from childhood.

I think that I changed moar moar moar than most from childhood to adulthood, but only in some behaviors that are like icing put onto the cake, that I turn it up to engage. Inside my mind, I feel about the same.

Not to mention, for many autistics, including myself, the large split is within PIQ (PRI or POI vs. PSI).

I have an uneducated hunch that brains that exhibit "extremes" are going to have "issues" in the social arena.

I like how you put that, XFilesGeek.

Anyway, probably to no one's surprise, I'm in nearly complete agreement with Tuttle and Callista. I say nearly complete because I can't be positive that we agree on every particular.

I also agree a lot with what Ettina says. And with btbnnyr.

I also agree that NVLD and sensory processing disorder should have been in the DSM-5.

I don't have much to add right now as many of the things I would have posted have already been posted by the above posters. So mostly I just want to acknowledge that.

I have a question (and I hope my question doesn't get lost in the shuffle-it often does) and I apologize if this question has already been answered somewhere in this thread, but; I'd like to know if I would fit a diagnosis if my social issue criteria are fully met and have gone over my lifetime from severe in childhood to moderate in adulthood after meds, but my behavioral criteria are present but mild and not particularly disabling. In short, do you have to show significant impairment in all categories to fit a diagnosis?

You do, but what you think significant impairment means may not be what it actually is intended to mean. You may actually have significant impairment in terms of the DSM-5.

[youtube]http://www.youtube.com/watch?v=PAQp2aNm2T4[/youtube]

Thanks, aspi-rant, I'll watch it when I have a chance.