Death of the Syndrome

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That assumes each adult's outcomes are similar. We know that's not the case.

Not necessarly - if the adult outcomes of individuals diagnosed with AS and AD vary much from individual from individual, but vary in the same range (in another words, if the range and probability of possible outcomes for individuals diagnosed with autism is similar to the ange and probability of possible outcomes for individuals diagnosed with AS), we can say that "there really isn't any tangible difference from one diagnosis to the next", even if there is big differences in individual outcomes.

Very good point. And as an adult who doesn't have children, I sometimes forget this.

For me, it's generally positive revealing myself and coming out of the closet. Hopefully, people can understand, oh, okay, that's why you're smart and verbal and also quirky and offbeat. And that's why you might get filled up with interaction and your energy tank drains to zero. (although sometimes when I tell people I'm on the autism spectrum, I sometimes get glassy eyes where I'm guessing the person is thinking I'm schizophrenic or bipolar because I am 'obviously' not autistic)

With kids, schools negatively track kids. They just do, straight up. Regardless of what they say they do. They put kids in special education and, instead of getting extra help, in a sense these kids get lower expectations and warehousing. And it certainly is not right. Parents need to be twice as involved as parents whose kids are not in special ed, without being overbearing and alienating school personnel, mainly the teachers but also including the secretaries. And I do not envy parents this task.

In a sense I am a mild Aspie (self-diagnosed) if employment and society at large were to cut me some slack. But employment and society at large does not cut me slack, so it's anything but mild.

For example, I am 50 years old and live in the United States. I have never made over the low twenties my entire life, and most years quite a bit less than that.

And yes, I do have things to contribute.

And I really like the potential political slogan . .

'We are all middle-functioning!'

(1) Well, it's kind of true. I mean, for most of us, there's some things we're good at and other things we're not so good at, right? And for those of us with sensory issues, some we can handle and put up with, and some it's a lot more difficult (and energy-taxing).

(2) It's a good response to officialdom. Helping professionals and educational authorities seem to need to define a person as either 'low'-functioning or 'high'-functioning. If a person is defined as middle-functioning, I can almost here them sputtering now, 'Well, well . . . What help would we give the person?!' Well, why don't we have a respectful dialogue with the person and a respectful working relationship and see what help the person needs. And over time, we will both get better at providing help and also asking for the help we need.

I made no such assumption. I'm referring to statistics, and statistically I have read there isn't really much difference as groups between "HFA" and "AS" in terms of adult outcomes. If you take any two adults then of course they will have different outcomes. If you look at them as populations this is not so much the case.

well the only part of it dont care for is that dr. hans asperger would no longer be directly acknowledged for his work in identifying the syndrome, but technically the disorder still exists, only under another nomenclature

Eh, Kanner hasn't been acknowledged for a long time, and for the most part, Lorna Wing deserves as much credit as Hans does regarding Asperger's.

the psychiatrists, psychologists, therapist and neuropsychologist i've discussed this matter with all agree that they'll always differentiate asperger's as a sub-diagnosis in the category of autism. it is not going away, as it is a valid diagnosis with its own presentation of symptoms and characteristics, although it fits in the general category of autism.

saying that asperger's will be no more is somewhat like saying that lung cancer will be no more because it's only going to be categorized as "cancer" from now on.

Do you typically employ ad hominem attacks and hyperbole in analyzing and making arguments? I ask this because I find this response a little shocking. He is disagreeing, not "denouncing." His argument is nuanced, not simplistic. He specifically cites the history of the evolution of the diagnoses through multiple DSMs. He is anything but a partisan zealot on this. You will find that he agrees with many, but not all of the arguments that you make in this thread and others.

Do you tend to see all paricipants in discussions of this kind as either allies or enemies? Black and white thinking is one of the traits of Autism. I hope you can see that it really is not always that simple.

This is a man who has been studying and working with adults and children at all points on the autistic spectrum for decades. This is a psychiatrist who immediately say. "there are no drugs for this." and has done the research (in a long list of peer reviewed publications) to speak with authority on the issue.

Some references to Dr Perry:

From the GRASP resources page: http://grasp.org/page/diagnostic-sources
I don't think this organization is sending people to a man with a questionable general level of expertise.

As is noted on that page, he was quoted as an established expert in the New York Times Magazine article, "The Little Professor Syndrome," back in 2000:
http://api.ning.com/files/Xl*BXDCLyD*cc ... V/prof.pdf

Perry is cited by Tony Attwood in the Complete Guide to Aspergers Syndrome, referencing two articles:
Perry, R. (1998) ‘Misdiagnosed ADD/ADHD; re-diagnosed PDD.’ Journal of the American Academy of Child and Adolescent Psychiatry 37, 113–114.
Perry, R. (2004) ‘Early diagnosis of Asperger’s disorder: lessons from a large clinical practice.’ Journal of the American Academy of Child and Adolescent Psychiatry 43, 1445–1449

You can find a bio for him on PBS's "This Emotional Life" microsite in the Autism Section:
http://www.pbs.org/thisemotionallife/node/274/bio/print

You can find a publication list for Dr Perry at the NYU Langone Center site:
http://www.med.nyu.edu/biosketch/perryr01

You will also find Dr Perry listed in Adam Feinstein's book, "A History of Autism: Conversations with the Pioneers" and quoted in a passage on early research distinguishing schizophrenia, specifically "Childhood Schizophrenia" from Autism--and concluding that drug therapy was not appropriate for Autism.

I think his general level of expertise is quite high and his analysis is worth more than a quick brush-off. Is it possible that this is reasoned, informed argument by an experienced person that comes to different conclusions than you have reached? Perhaps you are both right in different ways?

I think it was a joke on Richard Perry, who wrote (about the clinicians who are in favour of the fusion) "The clinicians included in the survey included child psychiatrists, pediatricians, psychologists, speech and language therapists and "clinicians representing multidisciplinary teams". At the risk of offending any of them, I question their general level of expertise given their lack of perspective on how the two diagnoses evolved."

It seems to make sense to me. I wonder if we are reading it the same way?


Perry is noting that Happé says most people with Aspergers do not meet the diagnostic criteria for autisitc disorder and mentions evidence supporting this view.


Perry expresses his understanding that a distinction was made between the DSM III4 diagnosis of Infantile Autism, the DSM III R4 diagnosis of Autistic Disorder and the DSM IV diagnosis of Autistic Disorder on the one hand and the DSM IV diagnosis of Aspergers Disorder on the other and the distinction had to do with degrees of impairment.


Continuing the previous thought that there was historically a distinction between Aspergers Disorder and Autistic Disorder, Perry notes that the DSM III R gave "Kanner Autism" as another name for Autistic Disorder. You have to bring the external knowledge that people had long used "Kanner type" and "Asperger type" as modifiers to "Autism" to indicate two clusters of observed characteristics. Historically, clinicians saw a difference and the way the disorders were defined, they should be mutually exclusive.

[quoteI guess it is the way they interpret the DSM-IV criteria for the two disorders which is, in part, identical for the two disorders. [/quote]
Perry points out that the probably cause of some clinicians diagnosing people with mutually exclusive disorders is the fact that some of the criteria for each are identical. Perry is acknowledging the central problem with the DSM IV definitions.

Some people conclude that the solution to this problem is to say there is no distinction between the two. Perry is arguing that there was an observed distinction historically and that it is still useful.

Does that make sense?

In any case, time will tell. I don't see any value in denigrating reasonable arguments on either side or pretending they don't exist. If the situation were simple and the solution obvious, there would be no difference of views.

Happe is saying that most people diagnosed with Asperger's do meet the criteria for Autistic Disorder.

Her comment about "poor agreement between label given and criteria met" refers to the fact that people who should be diagnosed with Autistic Disorder are being diagnosed with Asperger's or PDD-NOS-- despite the fact that they do meet criteria for Autistic Disorder.

If you'd like to confirm this for yourself, here's a link to the original article by Francesca Happe:
http://sfari.org/news-and-opinion/viewpoint/2011/why-fold-asperger-syndrome-into-autism-spectrum-disorder-in-the-dsm-5

The first statement in my response is very nearly a word for word quotation of something he wrote in the letter you linked:



I used the word "denounce" specifically because of that sentence. Since that specific language seems to have bothered you, I wonder why it was okay coming from Dr. Perry?



No, I don't see all participants as either allies or enemies. I see Dr. Perry made an ad hominem attack on the competence of the people involved in the study(ies) in question.



^^^ That.

See animalcrackers.



By "historically", you mean since 1994?

The argument "Austic Disorder is synonimous of Kanner Autism and Infantile Autism, then Asperger Syndrome is different form Autistic Disorder" seems a "non sequitur"; or better, these argument only could make logical sense if we start from the assumption that Kanner Autism/Infantile Autism is different form Asperger Syndrome, but it is exactly that assumption that it is being put in question.

I see it, sorry Verdandi.

But Perry actually makes an argument, albeit with that sharp language. Is that historical, contextual argument not worth responding to or invalidated because of his use of that language? I think it may just be OK for Perry to use that irritating phrase because he gives a pretty strong reason for it,

Sorry I screwed up the interpretation above--Perry still makes sense, though--even if I flubbed parsing that passage.

He raises objections to three elements in the Happé piece

1. the bit out using the redefined diagnoses to somehow equalize stigma and respect across the full range of manifestation of ASD

2. the bit about "most people with Asperger disorder do meet criteria for autistic disorder."

3. the bit about consensus among clinicians about who is and is not on the spectrum and related language and related language from the APA about reliable ad valid diagnosis.

He offers countering points about all three. You may not agree with them, but they are not ad hominem attacks, they are argument. I really like the Temple Grandin piece arguing that we move beyond these broad diagnostic categories to look at individual symptoms. I don't think the need for some distinction among those symptoms is going away though.

Over in the Parents forum, there is someone asking a question for parents of "LFA" children. I don't know exactly what that means, but I have some idea, and that's a useful distinction. I have been told that the difference between HFA and Aspergers is the spelling of the words, but also that people with Aspergers have different childhood experiences than people with HFA--there seems to be a meaningful distinction there. Maybe not. Time will tell.