In Part Six of our blog series…Dissecting the DSM-5…What it Means for Kids and Families we’ll look at the decision to exclude the diagnosis of Asperger’s Disorder from the most recent update of the diagnostic criteria.
Every once in a while, my esteemed and learned colleagues in academia are prone to overlook realities that are patently obvious to those of us who are mere mortals. That appears to have been the case when the committee responsible for neurodevelopmental disorders revised the diagnostic criteria for autism spectrum disorders.
From Sesame Street…
One of These Things (Is Not Like The Others)
One Of These Things (Is Not Like The Others)
One of these things is not like the others,
One of these things just doesn’t belong,
Can you tell which thing is not like the others
By the time I finish my song?
Did you guess which thing was not like the others?
Did you guess which thing just doesn’t belong?
If you guessed this one is not like the others,
Then you’re absolutely…right!
From a clinician’s standpoint, kids with Asperger’s are VERY different from kids with “classic” autism. Kids with Asperger’s have the intelligence and language skills to very effectively communicate their thoughts and perceptions. They also have a far greater capacity for self-awareness of their social deficits…and are far more amenable to treatment interventions to ameliorate their weaknesses in social situations. Most can be effectively served in mainstream or gifted classrooms. They’re so different that the vast preponderance of kids with traditional autism in our community receiving medical intervention are seen by developmental pediatricians and pediatric neurologists, not child psychiatrists.
Kids with Asperger’s and kids with autism do have a common trait…restricted, repetitive patterns of behavior, interests and activities. They also have in common a diminished capacity for social communication…although there are generally orders of magnitude difference in the capacity for social communication of a child with Asperger’s when compared to a child with more traditional autism.
I could make an argument that the kids I treat with Asperger’s Disorder have more in common with my patients with OCD than they do with kids with classic autism.
Last year, I wrote about the purpose for a system of diagnosis when the controversy about revisions to the criteria for autism began to bubble to the surface. As a reminder, these are the three primary reasons why a diagnostic classification system is necessary…
- Common criteria help ensure that our diagnoses are both accurate and consistent.
- Common criteria that are consistent and reliable are essential for meaningful research.
- The process of establishing a clinical diagnosis and case formulation helps us to organize our thoughts about how to best treat our patients.
In Asperger’s Disorder, we have a condition that was well-defined with widely known and accepted diagnostic criteria, as well as a relatively homogeneous group for research within the autism spectrum. Most importantly, the Asperger’s paradigm leads to very different treatment approaches than those employed with children with classic autism.
It’s interesting that the APA went to great lengths, establishing new diagnostic criteria for Disruptive Mood Dysregulation Disorder to prevent kids with irritability as their predominant mood state, but made a controversial decision to lump all kids together with restricted, repetitive behavior into a single category.
The clinical presentation and treatment of persons with Asperger’s Disorder is clearly different than other autism spectrum disorders…in the context of our flawed diagnostic classification system, Asperger’s Disorder should have been retained.
Author’s note…The purpose of the Sesame Street illustration was to dramatize the differences between persons with Asperger’s Disorder and persons with other autism spectrum disorders-and illustrate why the designation of Asperger’s Disorder should have been retained in DSM-5.
Most recently updated January 25, 2014
Key Ministry has assembled a helpful resource on the topic of Asperger’s Disorder and Spiritual Development. This page includes the blog series Dr. Grcevich and Mike Woods developed for Key Ministry, links to lots of helpful resources from other like-minded organizations, and Dr. Grcevich’s presentation on the topic from the 2012 Children’s Ministry Web Summit. Click here to access the page!