DSM-V: Automatic transfer of AS to a particular Level (1)?

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This question came up tangentially on another thread yesterday, But I wanted to address it specifically so people knowledgeable about it would be morel likely to see it.

Obviously a lot of people are already diagnosed with Aspergers. The new ASD designation in the DSM-V it's proposed will have 3 levels: 1 mild (requiring support), 2 moderate (requiring substantial support) and 3 severe (requiring very substantial support).

Maybe I'm wrong but I would think of this as generally translating colloquially as Level 1 --> High functioning; Level 3 --> Low functioning; and Level 2 as Medium (?) functioning. With Asperger's seen as consistent with "high functioning autism" I would imagine that, by default, Aspergers cases would be considered Level 1 unless additional diagnosis revealed something unusual (for an AS person).

Is it essentially a given that people with basic AS will be designated as level 1? I'm talking about the systematic way they intend to handle these existing diagnoses--not particular special cases or unusual circumstances. Surely there has to be some plan in place that specifically fits the former AS designation into the new system (it's not really reasonable that all these people would need to be "re-diagnosed")

I just want to get clarification on this, preferably by someone who's something of an "insider" or who is participating in this revision process and has clarity into how this is scheduled to be handled. I'd like to avoid idle speculation, but if you have some particular relevant information on this please post!

Thanks in advance.

This is just idle speculation (sorry) but I believe some with AS or mild PDD-NOS might get recatagorized with the new Social Communication Disorder.

Thanks. It's kind of unbelievable to me that they would would have everyone presently diagnosed have to submit to a new diagnostic process. If the reforms make sense that's great. The idea that they wouldn't have in mind a place for existing people to be positioned by default seems really odd to me. The DSM-V info talks aboput Aspergers being "subsumed" into ASD.... so the idea that it would just cut people off from this altogether seems really problematic to me.

Is there a reason you assume that there's an automatic transfer rather than people having the same diagnosis they had unless they are reassessed?

Yes. The reason I'm guessing there might be some automatic transfer is because the diagnosis of Aspergers is being eliminated. Consequently people are not going to be given this diagnosid anymore, and it won't be contained within the DSM. Since this same diagnosis will not be available, I'm giving them the benefit of the doubt by assuming they have taken into account what they're going to be doing with all these already-diagnosed people, in terms of fitting them into the re-written standards.

Maybe I'm not understanding your question, but I don't see how they can say "Aspergers doesn't exist it's a part of ASD" and still "treat" or work with people with an Aspergers diagnosis--without somehow shifting it to the new guidelines.

A comment by Tony Attwood on DSM-V & AS
http://www.youtube.com/watch?v=icaWFay-rtE

This is not the first time they're merging diagnoses or that they're changing diagnoses like this - what was done in the past?

There is no reason that they can't keep treating people with old diagnoses while using the new diagnostic methods for new diagnoses. When people are diagnosed, its not just a label they're given, its a label and what diagnostic criteria it was under. "Asperger's under the DSM-IV" for example, or "Asperger's using the the Gillberg criteria". The DSM isn't the only criteria anyways.

The people who were diagnosed under the DSM-IV still had been diagnosed under that. It's just outdated diagnoses once the DSM-5 comes out and people won't be using the DSM-IV to make diagnoses anymore.

I don't know how the insurance billing part of stuff works, but I know there are at least a few years of leeway for that. It's not an automatic everything needs to change in May 2013.

I see absolutely no reason to think what you're thinking will happen. I don't know for sure what's going on. I'm not part of the process. I have no strong support either way. But I don't understand why that would happen, because I see no support for it - it makes assumptions about people that aren't necessarily true, doesn't take into account that there is more than one set of diagnostic criteria anyways, and doesn't take into account the fact that people are treated the same way with different diagnoses from different diagnostic criteria and different countries anyways. People don't need to get re-diagnosed when they move between countries that use different diagnostic manuals. Why would their diagnostic label have to change for this?

The assumptions it makes about people are huge too. The differences between the severity classes and the differences between classic autism and Asperger's are very different.

Well, what is a diagnosis? Basically there are no Asperger people and no ASD people at all. There are only individuals looking for help with their individual problems. ASD is only a word invented by doctors to categorize those people. Grouping people with similar treats makes it easier, or possible at all, to help and study them.

If somebody did therapy because of some Asperger proplems, he'll need (and maybe get) the same therapy with DSM-V. Because he/she is the same individual, no matter what's the name of the official category. I guess, a re-diagnosis will only be necessary for your insurance. But that's paper stuff. A nice doctor will write down a ASD-level that justifies the same therapy (or other kind of help) as before. An evil insurance might try to kick people out of the spectrum by re-diagnosis to get rid of an expense factor. But as long as somebody does not need help on a regular basis, the diagnosis does not matter at all. Who cares for the official word, when there's no need to explain yourself?

I get what you're saying, and on one level that makes sense. But on another, their goal isn't to "eliminate" anything but to shift their diagnostic understanding of where these things fit in.... So they're not saying "people with Aspergers no longer have Aspergers" but they're saying--going forward at very least--these people will be examined in a different light--and hence guided, addressed, treated, etc in a different light. The date of diagnosis is a random thing. Somebody with whatever traits they have is going to have those traits whether diagnosed before or ofter publication date, 2013. So I would think for purposes of professional integrity they would HAVE to try to fit existing people into the new way that these issues are being looked at. I don't see how anything else would make more sense.

For a crude example, just for purposes of describing what I'm saying above, they used to call a disease "Black Death" and think it was related to religious impiety. At some point someone discovered that it was actually caused by fleas on rodents and they called it "Bubonic Plague". The people who were handled clinically immediately before the precise time this "switch" in understanding was made would not still be ethically treated as if they were religiously impious still once the shift in understanding had been made. Rather it would go without saying: "Our understanding has changed--these people do not now have two different conditions but rather a single one--we need to treat them all according to our new view of things." Similarly they're not saying Aspergers traits no longer exist, they're saying "we're understand these traits as something else". They can't ethically just on the arbitrary basis of diagnosis date treat one group of people with *EXACTLY THE SAME THING* different from another. And treating them requires establishing some equivalency.

So I'm not sure that there would not be some schedule to "shift" people to a new diagnosis. Sure the old one would still be valid--if you have it, you have it, they can't really take that away... But for purposes of services, fitting into the system, etc, it would be ridiculous if some sort of allowances like this were not made to fit existing people into the new understanding. This is what I'm trying to get at. Thanks.

Is it me or do people that are independent and have AS would require no support and therefor never meet the DSM-V criteria? And how does support/severity level get assessed? It seems like a pretty ambiguous system to me.

For instance, I cannot live on my own but don't burn the house down making dinner (that's if I have been able to decide what to make, can afford the groceries to make dinner and have a plan). Another point, where is all the money coming from for these new "supports"? There are already almost zero supports for adults with AS... will they suddenly become autistics requiring support, more support and even more support? And what is this support? Help tying my shoe laces or finding a job? Who and what decides?

I cannot get past the viewpoint that psychiatry is just a sock puppet for the pharmaceutical industry and if anything, these revisions would drastically limit resources for less severe cases. *(haven't we had many talks about severity and how it's judged? society has standards, meet them, you're not disabled.... but what it takes for some of us to meet those standards... and fail, and then not get the help we need AND deserve...)

?/soapbox

It sounds like that to me. It's one of the reasons I feel there is no point in my getting diagnosed since, although I have suffered a lot of misery and heartache, I don't require professional support to live my life. If anything, I am more likely to help others with their problems than need their help with mine. Of course, there are always times when all of us need a little help but I don't consider myself to be abnormal in this area. Maybe it's just part of the blessings I have due to how I am. I can sort and repair darn near anything and people usually need my help and so I exchange my help to them for their help in the future. About the only time I really get overwhelmed is when I let the mess go too far and I can't get motivated to start working on it. In those cases, my mom and dad usually come over and help me with things like dishes or bathroom cleaning. Now my depressions and anxiety issues are another thing entirely, but I usually can muddle through them alone. Then again, I have the ability to tolerate far more emotional pain that normal since I have learned to shut down to my emotions and just act out of duty.

I seem to meet Level 2 from what I remember.

Daniel the Debased:

Class: Level 2 Autistic; Level 5 Wizard
Special Properties (if any): can innately cast spells without words (Silent Spell)
Items: Pouch of Plenty containing +1 lead marbles that doesn't contain any +1 lead marbles; Staff of Stupidity Detection (can cast Detect Stupid five times a day); Robes of the Asocial (can cast Invisible to Socializing a million times a day)
Stats: Average across the board, barring -2 in Charisma and 16 Intelligence (2nd Edition)

Goodness, is it strange I know exactly the game you're referencing....

Anywho, any thoughts on severity assessment?

(play World of Warcraft by chance? I do... mage and warlock main, go figure)

From DSM IV:

(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

That's always been there, if your level of impairment doesn't warrant intervention, then you should not be diagnosed.

Jason.