New DSM criteria on austic spectrum disorder pretty much cuts out Aspergers

[BusynMember]

http://www.huffingtonpost.com/2012/01/30/dsm-5-autism-spectrum-disorder-definition_n_1241495.html

My son would still qualify, but a lot of kids wouldn't. What do you think?

 

[Hound dog]

Connor and Alex still qualify, but then they're further down the spectrum too.

I think perhaps this might be an attempt to stop dxing those with just certain characteristics of autism spectrum with the actual disorder itself. Because the two are not the same thing. Nearly all of my grandsons so far at least have some of the characteristics, but only 2 show enough of those characteristics to actually say they have it. That is not to say that depending on which characteristics they have, that they can't have it affect their lives in a negative way as well. Know what I mean??

in my opinion docs are too quick to diagnosis autistic spectrum these days, just as they went through a major period where they were (and some still do) ADD/ADHD. You just can't fit every person into a nice neat tidy box no matter how hard you try to do so.

Just my take on it.

 

[TerryJ2]

I clicked on one of the highlighted links and this info is useful: http://www.cdc.gov/ncbddd/autism/signs.html

My son had issues with-not pointing out things until he was about 10, and with screaming until he was about 5. He knew language, he seemed to choose not to use it. He also had a lot of sensory issues with-urine and feces, and still likes to strip down to only his boxer shorts when he gets home. In addition, he still likes to "wear" something heavy, like a huge blanket, over himself while he reads, watches TV or does anything except take the bus.

I won't even get into the transistions and mood issues, especially the exaggerated responses!

 

[TeDo]

I am glad they added the sensory piece but the rest hoovers as far as I'm concerned. Under these new criteria, neither of my kids would qualify unless they are observed over a long period of time across ALL settings, in other words 24/7 observation for a week or two. Like that's ever going to happen. It would require a LOT of subjective input from everyone in their lives to sort it all out. Even then, it would be VERY subjective. Good thing they qualify now and won't lose what they have.

 

[lmf64]

I have a question about them changing the criteria. If someone has been dxd using the old criteria and receives services (SSI, medicaid, IEP, mental health services through the county, etc) but with the new criteria would likely not meet enough to be dxd (he is very high functioning, but has social deficits and other problems related to Autism Spectrum Disorders (ASD)) would they lose their diagnosis?

 

[TeDo]

The article MWM posted says that will not happen. The way they report it, it would be for future diagnosing. The only thing that "might" affect it would be if Social Security Administration requested a re-evaluation. If my understanding is correct, that needs to be done when he turns 18 anyway because he'd need to re-apply once he becomes an adult.

 

[lmf64]

We've already gone through the evaluation for adult SSI for him. So, I guess that means he'll be okay

 

[BusynMember]

My neuropsychologist warned us about this so rather than Pervasive Developmental Disorder (PDD)-not otherwise specified or Aspergers (I don't think he's an Aspie anyway), he put down Autism Spectrum Disorders (ASD) to make sure he'd still get services.

I think that even if you have "traits" but you can have friends, work productively, and are not too impaired you shouldn't get a full range of services. I agree with that. But now doctors won't be able to use that feel good "Aspergers" diagnosis for kids who really DO need interventions, like Sonic. They will have to swallow the Autism Spectrum Disorders (ASD) diagnosis. or get no services. That is, unless they somehow tweak it.

I know ADHD kids have trouble getting services. I hope those with Autism Spectrum Disorders (ASD) "traits" do get SOME help.

The new DSM is changing a lot of diagnosis. Those who understand borderline, take a look at THAT new criteria! And mood disorders!

 

[DammitJanet]

The following is the suggested wording for criteria for Personality Disorder:

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. (check)
b. Self-direction: Instability in goals, aspirations, values, or career plans. (check)

AND

2. Impairments in interpersonal functioning (a or b):
a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerability(check somewhat)
b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal. (check)
B. Pathological personality traits in the following domains:
1. Negative Affectivity, characterized by:
a. Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. ( check)
b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control. (check)
c. Separation insecurity: Fears of rejection by " and/or separation from " significant others, associated with fears of excessive dependency and complete loss of autonomy.(check)
d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior. (check)
2. Disinhibition, characterized by:
a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress. (check)
b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one's limitations and denial of the reality of personal danger. (not anymore)
3. Antagonism, characterized by:
a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults. (check)
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations. (check)
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment. (check)
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). (check)

In other words, I would still meet the criteria for all everything but one or two things and that would not change my diagnosis.

 

[BusynMember]

Or mine, although I never GOT the diagnosis. But I know I have Borderline (BPD), which is very much under control now (of course not 100%), but I haven't had any relationship problems that were loud or obnoxious for a very long time due to awareness and therapy. However there is interesting new stuff regarding mood disorders as well. I kind of enjoyed skimming through the changes of everything.

 

[SearchingForRainbows]

I agree with Hound dog's comments. difficult child 1 would no longer qualify under the new guidelines. He was definitely diagnosed during the period where docs were too quick to jump to conclusions. While difficult child 1 has many of the characteristics of Autism Spectrum Disorders (ASD), they are less noticeable as he matures. As a young adult, I doubt anyone would think of him as having Autism Spectrum Disorders (ASD), maybe a bit "quirky," but then again, much of his "quirkiness" stems from his obsessiveness, fascination with computers. He has managed to turn his obsessiveness into a job he loves. He not only thrives at work, but also thrives socially, as all of his friends share similar interests, and many work for the same employer. He is totally self-sufficient and does not receive disability benefits.

on the other hand, difficult child 2 will still qualify under the new guidelines. He is much more impaired than difficult child 1. It is questionable as to whether or not he'll ever be able to live without supports in place. Of course he doesn't think he needs them any longer! He really has no concept of how much help he truly needs/receives to be able to live in his studio apartment by himself. However, he is more than happy to receive his monthly SSI benefits and would be very angry if the checks stopped coming!

 

[BusynMember]

In one article I read, it said that parents of very impaired kids wanted their kids to get the services rather than having the "marginal" kids have them by the way. If somebody can work, ace school, has friends, etc...but are a bit quirky, in my opinion they aren't disabled.

They are not going to take the label away from anyone who already has it. These are for the newly diagnosed. If they have "traits" it seems they will be labeled with "communication disorder" or just plain old ADHD. I've seen some very imparied kids labeed Aspergers and always felt it was a "feel good" diagnosis. for some kids who really need the supports. Now, like Sonic, they will have to accept the Autism Spectrum Disorders (ASD) label in order to get supports and, later, community supports.

 

[SearchingForRainbows]

MWM,

I agree that kids who are capable of working and providing for themselves shouldn't receive services. difficult child 1 appears very different now than he did when he was a child. difficult child 1 was given dual diagnoses of Asperger's and bipolar. The bipolar diagnosis is accurate but if he were being diagnosed under the new guidelines, I highly doubt he would fit the criteria for Autism Spectrum Disorders (ASD).

However, as a young child, he was much more impaired than just being sort of "quirky." His obsession with computers interfered with every aspect of his life. He had no friends, didn't seem to care about anyone or anything except for his computer. Some of his teachers thought he had ADHD. He has cousins ranging from 10 to 15 years older than he is who were diagnosed either with ADD or with ADHD. Interesting...

I could go on and on and on, but, got to get going. Lots to do today!

 

[SuZir]

In one article I read, it said that parents of very impaired kids wanted their kids to get the services rather than having the "marginal" kids have them by the way. If somebody can work, ace school, has friends, etc...but are a bit quirky, in my opinion they aren't disabled.

We don't use DSM and my difficult child doesn't qualify into the old or new in DSM and neither with ICD. But I have to disagree with you. It is very, very short-sighted to take away services (and if I have understood correctly you tend to need diagnosis to get services, not like in our system, there need for services and Dxs are considered mostly independently) from marginal kids. Without those services many of them don't turn out to be adults who are able to work, have friends etc. More likely they will turn out to be labelled with other diagnoses (like severe social anxiety disorder) that will make them disabled adults. And that is awful waste of money and human resources, not mentioning the unnecessary suffering for those individuals and their families.

 

[InsaneCdn]

No pervasive diagnosis = NO HELP. At least, that's the general rule around here, with a couple of exceptions... diagnosed LDs get help, IF your needs fit in with the help available. And "medical" dxes get help (hearing, even Auditory Processing Disorders (APD), vision, etc.). Anything else? it's either a pervasive diagnosis (Autism Spectrum Disorders (ASD), Downs, etc.) or... it doesn't count.

Result? The kid with multiple challenges but no pervasive diagnosis gets NOTHING. Worse than that, it's assumed that all their problems are either bad attitude or bad parenting. Until the kid gets driven to the edge of insanity and either ends up with a pervasive diagnosis (here, at least, severe MH issues qualify!), or ends up dead or in jail.

So... did the kid who, in grade 2, had problems with writing, with motor skills, with social interactions, and with "listening" (i.e. should have had Auditory Processing Disorders (APD) diagnosis) really not need services? Sorry. I heard once too often, "His problems aren't bad enough for us to divert services from higher-needs kids."

We need to change the focus away from DXes and onto NEEDS.

 

[witzend]

I think this is motivated by money. IEP's for every child on the spectrum including the Asperger's spectrum is more than they can handle when they are cutting school funding.