Interesting new study in the upcoming issue of Journal of Autism and Developmental Disorders which examines the historical emergence of the classification of autism alongside the emergence of the classification of Aspergers. Abstract is:
The histories of autism and Asperger’s Disorder (AD), based on original contributions by Kanner and Asperger, are reviewed in relation to DSM-IV diagnostic criteria. Their original articles appear to have influenced the distinction between AD and autism made in the DSM-IV. Based on up-to-date empirical research, however, it appears that AD and autism are not qualitatively distinct disorders, but are different quantitative manifestations of the same disorder. The differences between AD and autism may be a function of individual variability in these areas, not the manifestation of qualitatively distinct disorders. The DSM-IV criteria for AD and autism need to be considered with their historical developments, and based on empirical evidence, the DSM-IV diagnostic criteria may be subject to critical review.
The whole paper is a fascinating and accessible read but its overall conclusion is difficult to resist. Despite certain peoples beliefs that autism (by which I mean classic/severe/whatever) and aspergers (and the artificial construct of HFA) are very different, there is, in reality, very little difference between the two and, as the author argues, are simply slightly differing manifestations of the same ‘thing’.
Sanders (the author) makes the excellent point that the fact that these are seen as two different things is almost certainly due to the fact that Aspergers paper was only introduced into the USA in 1981, one year after the introduction of DSM III. It was further not fully translated into English until 1991. Amazing.
There is apparently talk of separating autism and aspergers in the new revisiion of the DSM. Based on the contents of this paper I’d say that is very premature.
Left Brain Right Brain 
Not anymore. A Black Helicopter landed on their heads, changing their minds. The astonishingly fit Prof. Happé, escaped with her gorgeousnesses unscathed, with no more than a slight wrinkle in her Laura Ashley Wrap-Around:
Report of the DSM-V Neurodevelopmental Disorders Work Group:
1) The Workgroup is considering a change in DSM-V that would replace the Pervasive Developmental Disorder (PDD) category with the title “Autism Spectrum Disorders” (ASD). The change would utilize a single diagnosis for the disorders currently entitled: Autism, PDD-NOS and Asperger disorder. Several factors support making this change:
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A single spectrum better reflects the pathology and symptoms.
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Separation of ASD from typical development is reliable and valid, while separation of disorders within the spectrum is variable and inconsistent.
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Individuals with autism, PDD-NOS or Asperger disorder often are diagnosed by severity, rather than unique, separate criteria defining the three diagnoses.
The difference between my AS son and kids I know with “classic autism” is language ability. That’s about it. In fact, his official diagnosis is “mild autism/high-functioning autism/Asperger’s Syndrome,” which essentially means he is a verbal autistic.
I am interested in seeing the difference between ADHD and Asperger’s clarified in the DSM. Many of the kids I know with so-called “mild Asperger’s” are kids who started out with an ADHD diagnosis. My son would never have been mistaken for anything but autistic.
I so agree with this we are all under the bigger autism umbrella, all autistic individuals and I feel maybe more neurological differences should also be under the bigger umbrella, with clearer links…
I feel part of the problem, many of our labels are for the professiona’s trying to put us into boxes we simply do not fit into!
We are not labels and all quite varied and different on the autism spectrum, we simply view, sense the world differently, a difference which I feel about time was recognized and allowed…
It seems the more associated conditions we have the more complex some of us are…. or as I see it interesting, intriguingly different, I will always have a autism core what ever labels I am given… http://asplanet.info/index.php?option=com_content&task=view&id=79&Itemid=125
I have HFA/AS and I have a cousin who is profoundly autistic. Comparing us is like comparing apples and air conditioners. Of course, the argument can be made that he is also retarded and if his MR were removed his “autism” would still be intact and he would be like every other HFA/AS.
But, of course, maybe he is not retarded and is simply profoundly autistic and cannot communicate and so it only appears that way.
We’re in a spot of wondering how far the spectrum swings. I have a child with “classic” autism who now is verbal, but he’s not nearly as verbal as any child I have met diagnosed as Asperger’s. His sensory needs are far less intense as well- in fact, he seems to function in a group better than a lot of the AS kids, even though he can’t speak well. My other child has clear (though mild) sensory processing disorder, and I think we’re heading towards an ADHD (or at least an HD) diagnosis. Is he autistic? I don’t think so, but I have the strongest contrast with my older child. How would I know if he is actually mildly on the spectrum, too far to one side to be diagnosed (or disabled) by his neurology, but still in the same family/spectrum of issues? When do we draw lines?
“I so agree with this we are all under the bigger autism umbrella, all autistic individuals and I feel maybe more neurological differences should also be under the bigger umbrella, with clearer links”
THis is alrady underway. Cognitive psychologists have in the path few months linked Gender Identity Disorder with ASD.
http://imfar.confex.com/imfar/2009/webprogram/Paper4222.html
Anorexia has also been recently linked to ASD with some psychiatrists suggesting anorexia should be a sub category of autism:
http://www.ncbi.nlm.nih.gov/pubmed/18208640?
This ever widening net continues to catch all the wrong kinds of fish:
http://www.ncbi.nlm.nih.gov/pubmed/17615427?
and:
http://www.autismwebsite.com/crimetimes/05c/w05cp13.htm
Michael Fitzgerald has made a comfortable living diagnosing the dead and the neurodiversity crowd embraces his ‘retrospective’ diagnosis of famous historical and currently admired figures such as Isaac Newton, Albert Einstein and Bill Gates as having Asperger Syndrome. On the other hand Fitzgerald has also retrospectively diagnosed Adolph Hilter with Asperger Syndrome.
The expanding universe of the definition of autism cannot does not permit the neurodiversity crowd to claim Isaac Newton and Albert Einstein as being ‘one of us’ and reject Jeffery Dahmer and Adolph Hitler as being ‘one of us’.
@sri “When do we draw lines?”,
it’s an almost impossible question to answer – it’ll vary between families, cultures, doctors…
“in fact, he seems to function in a group better than a lot of the AS kids, even though he can’t speak well”
thanks for mentioning this. It’s difficult to express how difficult life can be for us, that many think deserve booting off of the spectrum.
It seems that clinically there is mild, moderate and severe “autism” and psychiatrists have to develop a defintion of each type perhaps related to how many of the potentially possible 100+ symptoms of “autism” affect the patient, or the prominence of one particularly common symptom. The checklist may include
1.Clinical hyper/hyposensitivity to extreme negative and less frequently extreme positive thoughts and feelings.
2.Increased or decreased connectivity with external environment.
3.Clinical hyper/hyposensitivity to higher sensory modalities
Vision. Hearing. Taste. Smell.
4.Clinical hyper/hyposensitivity to peripheral sensory modalities.
Touch. Proprioception. Vibration. Pain. Temperature.
5.Obsessive-compulsive behaviour.
6.Gross/fine motor and speech delay or hyperactivity.
7.Clinical hyper/hyposensitivity of the autonomic nervous system.
8.Gastro-intestinal symptoms.
9.Sleep symptoms.
Asperger`s disease may eventually be categorised as mild “autism”.
Many other medical conditions are being divided into mild, moderate and severe types but using additional physiological measurements.Perhaps eventually “autism” will also require functional MRI scans and CSF cytokine measurements for categorisation in the future in addition to clinical assessment.
Neuroscience and neuro-immunology are increasingly making current psychiatric nosology outdated.
I don’t see what severity has to do with diagnostic category. It’s not whether you’re high functioning or low functioning (whatever that is) that matters in determining diagnostic category, but autistic versus bipolar versus ADHD versus whatever. If there are no clear differences between two labels, then why have two labels? All that does is add confusion.
I would like clear diagnostic criteria distinguishing between autism and “comorbids” like eccentricity or giftedness, though (speaking of Fitzgerald).
And kudos to the unflappable Happé.
If the patient has isolated variable hypersensitivity to extreme positive and negative feelings then “bipolar disease” is more likely.
If the patient has isolated increased motor activity and impatience then “ADHD” is more likely.
However these are probably variants of frontal lobe/ motor area inflammation and hopefully neuroscience will be able to localise where the inflamed areas are in the future as resolution of fMRI scans is improving.The areas of inflammation on fMRI scan will correlate with the clinical symptoms – rather similar to MRI scan of the back and lower limb symptoms.
Perhaps the numbers of areas of the brain affected by inflammation will correlate with the severity of “autism”, and more limited involvement will result in diagnoses such as “bipolar” and “ADHD”.
Not to raise anyone’s ire about the DSM-V idea, but here in Florida, Gov. Crist has issued an Executive Order that defines autism as a neurological condition as a matter of law. That would seem to mean the entire DMS-V idea could be enjoined for use in Florida for all autism diagnosing and classification.
But, what do I know ? Except that I have definite vestiges remaining in my adult brain of my childhood autism bi-lateral temporal parietal hypoperfusion, a neurological condition.
Dear Parents,
My name is Parth Desai, a Florida resident at St. Pete High. Florida families are grossly underrepresented in the studies and birth registries that track childhood outcomes of prenatal exposure to medication and folate. For example, Florida families have low representation in the National Children’s Study; the National Pregnancy Registry for Atypical Antipsychotics; The North American Antiepileptic Drug Pregnancy Registry, and no representation in the CHARGE Study of environmental exposures; the prospective NEAD Study (Neurodevelopmental Effects of Antiepileptic Drugs); or the national EARLI Study (Early Autism Risk Longitudinal Investigation).
This summer, I am working on this issue as an intern for the national FEND-Folate Study sponsored by Georgetown University Medical Center (IRB # 2009-162). “FEND” stands for Fetal Exposure to Neuroactive Drugs. Please help us expand awareness and accelerate understanding of fetal exposure to neuroactive medications and folate by participating in this 5-minute, anonymous and encrypted survey. The FEND Study would like you to be our collaborator and help us disseminate this online, national risk assessment survey: http://www.surveymonkey.com/s.aspx?sm=qY4du_2bdtYao2HumBxcYjRA_3d_3d.
Would you please read the following information and forward the survey to parents within your organization? Thank you for your cooperation! Please call the principal investigator Dr. McVearry (202-687-4966 or fendstudy@georgetown.edu) if you have any questions.
Knowledge Gap: Human Studies of Prenatal Exposure to Neuroactive Medications and Folate
As a medication class, anticonvulsant drugs rank fifth among the most prescribed drugs in the United States, with over 56 million prescriptions written in 2004 (IMS Health). Additionally, 48 million women of childbearing age took antiepileptic drugs in survey year 2000, according to U.S. Census Bureau statistics reported by Epilepsy Society of America. While several human studies explicitly link autism and prenatal exposure to anticonvulsant medications, this literature has three crucial limitations. First, human studies are primarily limited to valproate exposures. Second, human studies are predominately based on case report and retrospective enrollment methods, not prospective methods. Finally, epidemiological data based on prenatal exposure are not currently available for this medication class, and the population attributable risk (PAR) for autism has not been investigated.
The Big Picture
Advances in autism diagnosis, treatment and FDA policy will be made more rapidly if we understand autism not as an incurable disorder, but as a set of treatable – and, in cases of chemical exposure, preventable – illnesses that have genetic and environmental contributors. Understanding both genetic and environmental causes of autism will help prevent autism from occurring in high-risk children and offer treatments that target both the different symptoms and different causes of autism spectrum and pervasive developmental disorders. Our goal is both basic and ambitious: to have every Florida parent who has a child with a diagnosed, or suspected, autism spectrum or pervasive developmental disorder take this 5-minute, anonymous online survey. http://www.surveymonkey.com/s.aspx?sm=qY4du_2bdtYao2HumBxcYjRA_3d_3d.