Not autistic under DSM 5!

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There was a study about this in the England some years ago.

http://archpsyc.ama-assn.org/cgi/conten ... t/68/5/459

That would include me. I haven't been diagnosed, but I think I have AS under the DSM IV criteria. I think I would also have it under these criteria, except that I don't have problems with non-verbal communication, at least not noticeably.



I'm wondering about the range of the deficits in this criterion. What does "Poorly integrated- verbal and nonverbal communication" mean?

The study in England was somewhat limited because it relied on self reports for adults in households, which excluded potential cases of autism among developmentally disabled adults. Also, the screening method was reviewed, per link below, and found to be a weak predictor of autism.

http://www.ncbi.nlm.nih.gov/pubmed/21798110

The 1 percent figure that was obtained was suggested as evidence by other sources that it was proof that the rates among the children where the same among those in the adult population, however the methodology used for measurement along with the functioning demographic was shown to be different.

It does provide some evidence though that milder cases of autism may be missed by the methodology currently used for children.

Interestingly England's official government statistics rely on a method similiar to the US, that is specific to children in the school system that are in classes for the developmentally disabled. Their statistics historically have been close to the prevalance figures in the US.

Last edited by aghogday on 08 Apr 2012, 12:10 am, edited 1 time in total.

The sad thing is, even if the dx is removed and people who previously qualified as having Asperger's and subsequently lose any kind of autism diagnosis, will likely be funneled into a different diagnostic category.

For example, suppose person A had Asperger's and "loses" that dx - s/he is no longer on the spectrum at all. Yet, person A still sees a psychiatrist or psychologist for longstanding social issues. That professional has to diagnose him/her with something.....so what would it be?

I see a scenario whereby misdiagnosis occurs. What are the leftover dxes that are not ASD?

Schizoid? Schizotypal? Schizophrenia? That person has to be lumped into some category so will we be experiencing a regression of sorts whereby people who escaped the misdiagnostic hell to reach an AS diagnosis get rediagnosed with some other mental health condition that only partially describes their symptoms? Or worse, they could get diagnosed with a personality disorder that only covers some of their "Aspie" traits.

I have no non-verbal problems except for one: I can't read between the lines with most people. If you have two people, one is fundamentally motivated to eat cake and the other is fundamentally motivated to give cake to squirrels, no amount of learning or native ability will bridge the basic communication gap. Those are examples because I don't really know my or anyone else's fundamental motivations (except to propagate DNA, so it must be higher level than that) but I can deduce the cause - a difference in motive - from the fact that between-the-lines is my only non-verbal problem. This seems like part of Aspergers to me.

Any time I've done well socially it's because I know how to create a reality for people to inhabit. I know that this needs to be done due to years of observing and modelling.

People who are already diagnosed will not lose their diagnosis when the new DSM comes out. We already have people diagnosed by different criteria and standards. People don't lose their diagnosis because of the fact that not everyone uses that standard.


My diagnosis does not just say "Asperger's Syndrome" it says "Asperger's Syndrome under the DSM-IV".

Essentially then we're back to "theory of mind " here. Some not qualifying for missing the nonverbal criteria, then it amounts to a different mind, a meeting of foreign minds -- the intention of 'another' is not naturally imagined ( e.g. the Sally Anne test).

I don't see any way around "Autism" as having 'a well intentioned understanding of another' and doing all or having enough of the other 299.80 criteria for a diagnoses.

Not unless it was by conscious choice to avoid people via having the restricted * nature/interests.* But this seems it would cross into the schizoid zone.

I don't think i have to worry about this, i mean its there anyway even if you change the name of a diagnose, its always been there if you ask me :o

In part it is dependent on where one lives, if re-evaluation is required, what diagnostic criteria is used, and whether or not one is still in contact with their initial diagnosing professional.

Kids in the US school system are diagnosed under the DSM criteria. Re-evaluation is commonly done as the children grow older, particularly those with a diagnosis of PDD NOS, requiring services from the school system. As these children currently diagnosed without RRB's are re-evaluated they will likely be moved into the Social Communication disorder, if they meet that criteria.

It's hard to say for sure how each diagnosing professional that uses the DSMV is going to handle this for those that are not required by a third party source to be re-evaluated.

If I was concerned about this I would ask my diagnosing professional, but it's not likely that he is going to make any changes that require paperwork unless I ask him to be rediagnosed and I pay him for it, in advance.

For all practical intents and purposes I don't exist until I visit him. I can't imagine a large pro-active effort by diagnosing professionals to re-evaluate patients unless there is a request as such from a patient and payment for the re-evaluation.

Symptoms do change over time, so it wouldn't be professional to re-diagnosis someone under a new criteria, unless there was an actual face to face re-evaluation.

In addition, there are many people that do not remain in contact with the initial diagnosing professional.

If a third party source requires a current certification of diagnosis, a new diagnosing professional could be required in some cases for those diagnosed under the DSMIV. A third party source is not likely going to accept a diagnosis of PDD NOS or Aspergers, diagnosed under the DSMIV, once the DSMV comes out.

If one is no longer seeing their initial diagnosing professional and has no need for proof of a re-diagnosis from a third party source, this may be a non-issue until proof of diagnosis is required by a third party source.

There does need to be an "atypical" category to soak up the cases that don't quite fit the new criteria.

New criteria, in brief:
I. All of:
A. Speech/language/verbal communication problems.
B. Nonverbal communication problems.
C. Difficulty with relationships.
II. Two of:
A. Stimming
B. Routine dependence
C. Special interests
D. Sensory integration problems
III. Early childhood onset
IV. Significant impariment.

I'm trying to trace through the reasoning here and it seems to make sense, in general, to exclude people from the autism spectrum if they don't fit these, because if they don't, they probably fit more precisely into another category.

If you had nonverbal communication problems but totally normal language, then it's likely that your problems come from difficulty analyzing visual-spatial information: for example, prosopagnosia, dyspraxia. Also can come from social anxiety problems.

If you had speech/language problems but not problems with relationships, you probably have a specific speech disorder rather than autism.

Stimming alone is stereotypic movement disorder.
Special interests alone are eccentric-but-not-disordered behavior.
Sensory integration problems alone are better diagnosed as sensory integration disorder.
Routine dependence in the absence of other autistic traits is likely to be OCD.

So you could have somebody with problems with non-verbal communication and routine dependence, and it's likely that they have an anxiety disorder that has led to routine-dependence and social withdrawal, for example...

I think that they are trying to stop autism from being the catch-all category for atypical development of any sort, to put some of those borderline cases in other categories.

The significant-impairment criterion, by the way, says that all symptoms taken together have to create significant impairment; it doesn't say that any specific trait alone has to do so. That is, if you have a trait but it causes no impairment, it still counts for the purposes of diagnosis as long as that impairment exists as a result of all the traits together. You could have atypical communication that didn't create any problems for you in daily life, a restricted social life that didn't cause distress, stimming that didn't get in the way, and sensory integration problems that caused problems with overload, and you'd be diagnosable just because all of that stuff together causes problems--even though your only actual problem is with your sensory overload.

"Theory of mind" is actually not in the diagnostic criteria, and it is unclear that methods used to test theory of mind actually test theory of mind instead of testing, for example, language comprehension. Deaf children have similar difficulties getting the Sally Anne question right to autistic children's difficulties, if I recall correctly.

That issue about friends; I have friends (had them at the time of my diagnosis too) but I still meet this criterion of the DSM-V because it's essence is the same as that of the ICD-10:







Yes, I think that is an issue that a revision of the criteria hopefully addresses.

Children with delayed social development due to "side-effects" from other conditions such as "developmental delay", selective mutism, ADHD (combined-type and ADHD-PI), complex motor delay, speech impairment, language impairment due to an identified cause (such as early hearing loss) also frequently get considered to have "autistic features", sub-clinical AS (sometimes referred to as English "BAP" in medial records) or AS. (ICD-10 here)

When compared to autistic children (who were very definitely autistic since infancy by current diagnostic standards) all those children (except for one kid who has such a complex medical history he could as well have PDD-NOS alongside with ADHD and FAS) that I happened to come in contact with personally grew out of their social delays when their social development was focussed upon after the diagnosis of autistic features, broader autism phenotype or AS. It was interesting to see how they caught up after 2 to 3 years (though with some the time they missed out was noticeable and they seemed to be clueless about experiences their peers made during that time without the constant guidance by adults which leads to awkward moments).

Interesting enough, none of these kids show(ed) the full manifestation of AS as those other kids with AS and classical autism do who do not start developing typically after receiving ASD therapy for some time.

Those other kids definitely had/have social delays and primarily those with motor skill impairments and/or ADHD apparently also were reported to have shown sensory oddities at some point during their early childhood or still showed a sensory impairment that primarily led/leads to confusion and exhaustion when being in an environments with intense stimuli.

I really think such kids are different (and likely not autistic in the same way as other autistic people) because of the course of their development when compared to children and adults who had autistic symptoms since infancy and who retain their autistic impairments in an obvious or subtle way throughout years.

I think it's likely that we will indeed find that a lot of the people who "lose" their diagnosis at five to nine years of age will be in the groups who are no longer diagnosed with autism... That seems like a good thing, to me, just as long as they have a diagnosis to be put into, to get the help that lets them deal with their delays. You don't need a life-long diagnosis for a temporary problem.

Well, whatever the effect is, I think it's very important that we don't lose touch with the other atypical-development groups, whether or not they are called "autistic" in the future. I'm very aware of the way people with various disabilities, if we don't look out, tend to group into their little sub-groups. You see it on here, even: WP aspies vs. WP auties... or people living independently versus people who don't... And then there's autistic versus ADHD, and mental versus physical, and visible versus invisible disabilities.

I'm lucky in that I've been going to school since I was about fourteen with lots of other people who also have disabilities, and that includes college because the school I'm at is pretty good at accommodating disabilities and as a consequence has lots of disabled students. What I think is very important to remember is that we have a LOT in common with people who are disabled in other ways than autism--physical disabilities as well as other mental/neurological ones. There's even a large social component to it, even when your disability is purely physical. Relating to other people when you are in a minority group with different life experiences gets difficult even if you aren't autistic. And then there's the issue of how much you can safely do without burning out--the "spoon theory" problem--as well as how to handle stress and how to deal with the expectations of people around you, which have carried with them all the stereotypes about disabilities. All of that is common to pretty much everybody with a disability.

If we get isolated into our little subgroups, then we start to lose touch with all of that. And that's a bad thing. We need to stay connected. If it does end up that there are people who are being labeled different things--say, social communication disorder, or social anxiety, or schizoid personality--we need to be sure that we stay connected with those groups, as well as maintaining our connections to the rest of the disability community. If we don't do that, we're missing out on a lot, and we're going to get a lot less done because there's an awful lot of strength in numbers and disabled people are the biggest minority almost anywhere.

Did your diagnosing professional specify that you did meet that specific criteria, in the ICD10, or is it your analysis that you meet the criteria?

The reason I ask, is that the relationship impairment criteria is not a mandatory requirement for a diagnosis in either the DSMIV, the ICD10, or the Gilberg Criteria. Unless your diagnosing professional gave you that detail, there would be no way to know for sure what his professional analysis was on that specific criteria.

At this point it is only a mandatory requirement in the DSMV revision.

While the two diagnostic criteria are similiar, in that they address the development of appropriate peer relationships, they are also quite different in the fact that the ICD10 addresses the shared emotional component, activity component and interest component of relationships; whereas the DSMV addresses adjustments of behavior in social context, sharing imaginative play (childhood criteria specific), difficulties in making friends, and an abscence of interest in people.

So a person could have quite a few friends and face difficulties in sharing emotions, activities, and interests, in maintaining friendships and potentially meet the ICD10 criteria, whereas a person with these same issues with quite a few friends per the DSMV could potentially have all these issues that the DSMV does not address, have no major problems in adjusting behavior in social context in maintaining friendships, that the ICD10 does not address, but the DSMV does, and potentially not meet the DSMV criteria.

Of course that's under the analysis of a diagnosing professional.

I'm not suggesting that you as individual don't meet the DSMV criteria, however in general, a diagnosis under the ICD10, without specific information from the diagnosing professional that one meets this specific non-mandatory criteria, is no guarantee that they do, and even if they do meet that specific criteria there is no guarantee they will under the DSMV, because the details of the two generally similiar criteria are quite different.

It is in my diagnostic report (edit: I know because surprisingly, it already said that I meet all three criteria despite the relatively few and far more difficult communication from back then compared to now) and has been a major topic of discussion with ASD therapists in the past years since my diagnosis and the therapeutic reports (edit: that do a much better job at going in depth), I also agree that I still meet this from their point of view.

Judging from my case, the similarities of the criteria would be that I fail to adjust correctly (to different levels) how I speak, the content of what I say (which is also dependant on my understanding of what is discussed and my level of interest in it), my body language and tone of voice to the other person/to my social position to the other person. That is caused partly by the non-verbal deficits, language deficits, abnormal reciprocity and my "deficits" in how I fail to emotionally participate in the relationship with the other person typically (also what I say to them, which activities I (want to) do with them and how I participate in those activities and my understanding and interest in the different aspects of the relationship I have with that person).

Not from the diagnosis but from therapy: that different way to interacting with them in turn causes more differences (or deficits) in those very areas, also leading to difficulties developing (peer) relationships, both starting them myself and keeping to develop them.

I kind of have this fear that those such as me who are trying to save money to get tested will instead be thrown on to the mild Austim instead of calling it aspergers. I also fear that it will make ever one and there mother have ADD/ADHD.

At the age of 31 I just don't really want to deal with a lot of that.