The consistencies made to describe the disorders in comparison to the individuals diagnosed with them as quoted below from the linked topic article seem to be in opposition to each other:
Quote:
There is no biological or genetic reason why Asperger’s should be separated on its own, said Dr. Evdokia Anagnostou, a child neurologist at Holland Bloorview Kids Rehabilitation Hospital.
“We assumed they were different but it looks like they are not,” she said. “Now we can call them all autism.”
Quote:
Child psychiatrist Dr. Peter Szatmari, a professor at McMaster University and a noted expert on autism, said the changes are a “good thing” as it will speed up the diagnostic progress.
But he cautioned that autism is “incredibly heterogeneous.”
“In 30 years, I don’t think I could say I have seen two cases the same,” he said, adding every child with autism needs his or her own individually tailored treatment path.
“You can’t treat a 2-year-old who is profoundly intellectually disabled and without language as the same as a 7-year-old who is very chatty about their stamp collection,” he said.
“We need a way to capture that diversity,” he said. “This is the part that I am still not clear about.”
The fact that the DSM removed factors associated with developmental delays associated with cognitive development and language development from what is understood to be a neurodevelopmental disorder, from the basic criteria in the revised definition, doesn't make the biological and genetically determined elements behind those delays that are different between some forms of the disorder magically go away too.
The factor of language development while hidden from the basic revised criteria is clearly addressed in the new severity levels provided by the DSM, where a complete lack of verbal communication is mentioned in level 3 and not mentioned in level 1 in the descriptions provided by the DSM in the severity levels.
There is no reason to call them different things, when one can describe them as the same thing in basic criteria and different things in effect per severity levels, otherwise known as smoke and mirrors. One can then even pretend that the neurological and biological factors associated with very different forms of the disorder are irrelevant as well as the overt characteristics that differentiate the different forms of the disorder, and then justify the change from the get go, in studying records of testing data, similar among individuals with more meticulously clinically assessed forms of Aspergers as compared to the records of those diagnosed with Autism Disorder and PDD NOS, rather than observation of behavior in the chaos of differences among real people across a wide range of clinical settings where the methodology of diagnosis varies widely. All of which has culminated in a reality of having no clear idea what the results of re-diagnosis are going to be in the real world, across the entire spectrum, other than a guess based on laboratory analysis of testing records.
So back to the question posed in the second quote in the article as to how one captures the diversity. It's seems straightforward one acknowledges, defines, and labels the differences, and targets those differences with different treatments as appropriate. They've moved the goal line from differently described disorders to one more narrowly described spectrum disorder, now acknowledging most of the same differences that were acknowledged before in the descriptions of the different disorders, through severity levels instead, separate from the new revised DSM5 basic criteria for Autism Spectrum Disorder.
Perhaps the most unusual statement is one provided by the co-author of the research, Catherine Lord, in attempting to justify the efficacy of the DSM5 revision, suggesting that the new criteria is intended and designed as broad principles whereby diagnosing professionals can observe behaviors in individuals to fit those broad principles provided in the new revised criteria, also stating she would be surprised if many people do not fit the new criteria, that most everyone, including her own actual research providing a suggestion of a 10% reduction of ASD diagnoses, agrees will result in overall fewer diagnoses of ASD's, as a result of a more narrowly defined criteria for the one disorder rather than 5 disorders. 10% of 2 million cases in the US is 200,000 people. If her own research were to prove out as an accurate indicator, that would definitely meet a standard definition of many people with a different diagnosis, if all were re-diagnosed.
The reality is that most diagnosing professionals will probably grandfather most into the new diagnostic classification, potentially justifying that action with reports like the one above from Catherine Lord. I'm not sure why the ones that care about their patients would want to take part in playing what is looking like a more unusual game of professional rhetoric as time goes one, if they don't have to. But it is the new patients that will more likely not receive a new diagnosis unless the clinical professionals continue to base their diagnoses on their same observations of the past, regardless of the changes in the DSM5. Eventually new professionals coming into the field, may be more strict, as they are more properly trained per the standards of the new criteria. By the time that happens there will likely be the attitude that "see the DSM5 didn't significantly impact anyone anyone".
It is notable that there has been no attention in studying the impact of the DSM5 revision on adults currently diagnosed on the spectrum, and I personally don't see that happening, as the diagnosis in adulthood is much rarer than diagnosis in childhood. The small field studies so far are based on new diagnoses of children, the results of which are coming in at less than a 10 percent reduction of total ASD's diagnosed.
In my opinion most people that already have a diagnosis, per what will happen in reality, have little need for concern that they will lose their current diagnosis. If computers start to diagnosis people instead of human beings, then there might be significant concern warranted.
03 Oct 2012, 9:42 am
