New Autism Spectrum Disorder in DSM, Fifth Edition

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New Autism Spectrum Disorder in DSM-5

According to the story published at the link just above, the basic idea is that because 4 out of 5 people with autism have been found to have a co-morbid intellectual disability, autism with intellectual disability is the new default description of autism in general; autism without intellectual disability has to be specified as such [I sound like a computer geek with my references to default value and specifying otherwise--Douglas_MacNeill]. Persons with an Autism Spectrum Disorder will be assumed to have a co-morbid intellectual disability/mental retardation unless they are specifically stated to have Autism without Intellectual Disability.

Fortunately for us Aspies, we are likely to be included in this new category in the DSM-5. With this, at least, we will remain in some position to fight for our own cause without the assumption that we cannot speak for ourselves (no mental retardation yields no loss in capacity to advocate for ourselves). Take this, Autism Speaks!

Before anybody makes assumptions, I'm going to point out that the article you linked to is not an official publication of the APA; it's the opinion of someone who is looking at the proposal for the new ASD definition that was published months ago.

But, yes; being defined as part of the autism spectrum proper instead of something peripheral will help us demand rights for everyone, not just the "high-functioning" Asperger's and non-developmentally delayed Kanner's autistics. We have always been on the spectrum; but there have been a great many people who tell us we are "not really autistic" and that this means our ideas don't count. (Handily, they often define as "not autistic enough" anyone who can communicate their own ideas; which means that no autistic person can have a voice at all and they get to make all the decisions for us.)

Of course, there will always be those who use the Not Like My Child excuse; but it should become a little easier for people formerly diagnosed Asperger's to advocate for the autism spectrum as a whole.

Now if we can just get them to stop making the assumption that we're trying to "speak for" other autistic people, rather than simply demanding basic human rights for them, we'll have made some headway...

I think you misread it, the article seems to criticize the new DSM for NOT taking intellectual disabilities into account, but rather leaving it out. It then goes on proposing that autism criteria should include intellectual disability as it will be easier to connect it to vaccines (go figure).

Except the fact that 4 out of 5 people with autism spectrum disorders DO NOT have intellectual disabilities. It is one of the most debated things out there, as most people who use this are using figures for infinitile (ie classic) autism, not ALL autism spectrum disorders. The people with intellectual disabilities represents .5 in 1000, where the overall autism spectrum disorder numbers is 1 in 150. Guess what, most of the people with autism spectrum disorders do not have intellectual disabilities. This four out of five number is one of the most gross misrepresentations out there. The thing is this may be the case with "classic" autism, or infinitile autism, but classic autism only represents .5 in 1000 people in the general population. AS is 1 in 1000, and the PDD-NOS makes up the overwhelming majority of the 1 in 150. This is why the ASD thing may be confusing. Some people see autism only through the lens of classic autism, and think ASD is the same as classic autism, its not. It is really meant as an umbrella diagnosis.

With that being said LEARNING DISABILITIES are very common.

One of the biggest problems is those who have multiple disabilities also getting pegged with autism. PDD-NOS is the most common diagnosis for Autism spectrum disorders, it is usually medium to mild variant. Not the severe variant where intellectual disabilities are present.

One of the reasons why to move things away from the intellectual disability is to provide more clarity. One of the issues is that those with multiple disabilities may have more problems related to thier primary disability (intellectual or otherwise) than autism. They are behaving autistic maybe because of x,y, and z, but they are not primarily autistic. While you can pin down the person with a normal IQ, who has difficulty with verbal and nonverbal communication, but can communicate via writing, as autistic (which is the case for some people here) and nothing but. The point being is they are focusing autism as a purely communication disability, which in reality is what it is, and moving away from any linking to intellectual disabilities from the classic autistic disorder. This is a wise move. While she is right in classic autistic disorder 4 out of 5 did have intellectual disabilities, that is not the case with autism spectrum disorders, which with PDD-NOS and AS which make up a majority of the cases of autism spectrum disorders, intellectual disabilities are NOT present. If anything they are clarifying what autism is, and I do not think with intellectual disabilities is a needed addition. If anything it is a step in the right direction, and one that has come with better understanding of spectrum, which has in fact come from scientific research.

Not shocking one of the vaccine folks wrote this.

Last edited by starygrrl on 09 Apr 2010, 11:15 am, edited 1 time in total.

Seems to me the difficulty hinges on the fact that the theoretical concept of "autism spectrum" has never been scientifically/medically proven.

Apparently around 50% of schoolchildren in the UK have some "special need". This does not mean they all have the *same* special need. Although it possibly does mean that the psychiatrists haven't figured out what disorder to tag onto the remaining 50%....yet.

Last edited by ManErg on 09 Apr 2010, 11:07 am, edited 1 time in total.

Hmm... I'm not sure how I would be classified if something like this was done. I'm gifted and learning disabled.

It hasn't been fully defined. Neither have ADHD, dyslexia and other learning disabilities, schizophrenia, chronic fatigue syndrome, some kinds of cancer, migraines, some kinds of epilepsy, most kinds of mental retardation, bipolar disorder, the many variants of depression, the personality disorders, many autoimmune disorders, essential hypertension, anything with "idiopathic" in the name, and most of the rest of the diagnostic labels in medicine and psychology. That we haven't fully defined diagnostic boundaries for those labels doesn't mean they are not real.

Autism is currently defined as a set of behavioral traits which we share, expressed at different strengths from person to person. That's the best definition we have; and it is the same state of affairs as the vast majority of the diagnoses listed in the DSM. If we gave things names only once we had fully defined their origins, symptoms, and courses, we would probably be able to hand out the DSM in three-page pamphlet form.

I wonder where classical autism would fall within this category.

http://www.iancommunity.org/cs/glossary ... 7&letter=M

Source: American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV-TR (4th ed., text revision)

It's good to know that we're going to be included.

"Much lower" than 80-90% is a rather broad range--I continue to maintain that we don't have very good data because all the different studies had such different criteria and executions.

I wonder whether we'd be able to get anything if we tried gathering up all the decent studies on autistic cognition done over the past few years, and analyzing them to try to put together the different bits and pieces. It would be a huge undertaking; everyone has a different approach; but maybe some of the differences would average out... at the cost of a large margin of error. (Has anybody done this? I can't imagine they wouldn't at least have tried.)

Some of the trouble with most professionally done research on autism, though, is the selection criteria. They want to study autism; so they pick people who are obviously autistic, and haven't got anything else (or much else) complicating their cases. That leaves out people with atypical presentations, like one of my mom's special ed kids who's non-verbal and stims all the time but gets body language like a pro; and it leaves out the borderline cases, where you've got a slight speech delay or none at all and a nerdy kid who doesn't need that much help; and it leaves out all the people who've got autism-plus-whatever, when "whatever" is something significant (and autism-plus-whatever tends to be a significant part of the spectrum).

I get that they want to study autism, unambigious cases and not too much else complicating them; but that doesn't give them the whole picture if they're going to be making statements about the spectrum as a whole. And maybe that's also part of why we haven't gotten a lot of agreement on just how autistic people do think--not just that we are so different from each other, but that the researchers are starting to realize it and are too timid of being blasted by their colleagues for drawing wide generalizations from their carefully-picked samples.

Generalizations about spectrum-wide traits and expected outcomes, if anybody's making them, probably need to be done by selecting all the kids with an autism diagnosis from a few randomly scattered school systems (and trying to dragnet out the home-schoolers and private-schoolers if you can), rather than picking them for how well they fit the diagnosis.

Callista: I think one major reason why they choose clear-cut cases for the studies is because some professional diagnoses aren't what they ought to be. It would be a huge undertaking to re-diagnose your test subjects and I think we can agree that if people who have autism are not being diagnosed because of ignorance then some people may also be diagnosed although they suffer from something else.

I could imagine a different solution to the problem though - having an autism evaluator in the research group who goes through the documentation on each subject to ensure that the diagnosis is correct.

OT perhaps, but I have a keen interest in research methodology. Therein lies the key to the closest approximation of the truth that we can hope for.