The proposed changes to the diagnosis of autisitc disorders include the elimination of subgroups of Pervasive Developmental Disorders (PDD). There will be one set of criteria for Autistic Spectrum Disorder (ASD). The term PDD will be eliminated which is not very significant as it was hitherto synonymous with ASD. The new criteria, in my opinion, is appropriate for capturing those diagnosed with an autistic disorder whatever their level of functioning. In other words, the criteria could apply to those currently diagnosed with Autistic Disorder as well as Asperger’s Disorder (AD). However, I do have problems with the elimination of AD as a distinct group with ASD.
Those members of the American Psychiatric Association (APA) who advanced the proposal wrote in the rationale for the changes: “Differentiation of autism spectrum from typical development and from nonspectrum disorders is done reliably and with validity, while distinctions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder”. When the APA first published the proposals, one could reply on line to them and I wrote that I wondered on what basis one could say that one can differentiate reliably and with validity spectrum from nonspectrum disorders. In my experience in diagnosing AD there are many borderline cases as there are many relatively clear, close to textbook, cases. For the unclear cases it is left up to the diagnostician to decide whether one meets the threshold of AD and there is no tool that one can depend on to determine with absolute certainty that one has AD. If AD is eliminated, what will happen to the ongoing research of subjects diagnosed with AD that seeks more objective psychological and biological signs that differentiate autistic spectrum from typical development and from nonspectrum disorders? I also argue that in my opinion one can not say that there are no characteristic features that differentiates one that clearly meets criteria for AD from others within the autistic spectrum.
The American Academy of Child and Adolescent Psychiatry (AACAP) has commented about the changes concerning AD. Noted by the AACAP is that when reassigned as an ASD one previously diagnosed with AD may “suffer stigmatization”. This is a valid point. I have always counseled those diagnosed with AD to be aware of what is meant by Autistic Disorder under the DSM-IV and how the word autism is sometimes used to denote the whole spectrum or those diagnosed with Autistic Disorder whom under the DSM-IV were more impaired. In other words, when one diagnosed with AD says I am autistic, the listener may assume inaccurately that the individual with AD is more impaired that he or she is.
I did not note in reading from the APA nor AACAP websites that it was clearly stated that AD would not appear in any way in the DSM-V. It was noted by the APA that Asperger-type like Kanner-type (i.e. more like the more impaired cases described by Dr.Leo Kanner in 1943) “may continue to be a useful shorthand for clinicians” in describing features of their cases. Nor did those organizations comment on the culture that has grown up around AD (like the cultures that have formed around many other disorders), the multitude of support groups, the books and scholarly articles that have addressed AD and those who have received any AD related entitlements or accommodations since 1994. Will many diagnosed with AD have to now be re‑diagnosed? These are issues and questions that should be addressed by the APA.