Bye bye Aspergers?

4 Nov

The recent article in the New York Times concerning the possibility of the ‘vanishing’ of Aspergers Syndrome from the next version of the DSM (due in 2012) only asks two people (Temple Grandin and Ari Ne’eman) for their opinions. Nothing wrong with that as such but I’d like to hear what the AS community at large thinks.

Temple thinks that the AS community is too large and too vocal to simply disappear but I think she’s missing the point somewhat. The point is (in my opinion) neatly encapsulated by Ari. He points out that AS isn’t disappearing, its simply formally becoming ‘part’ of autism. Something the vast majority of the autism and autistic community have always known it is. To answer Temple directly, the AS community isn’t disappearing, its just finally taking its rightful place alongside the others in the autism community.

NB: this post first erroneously stated Temple Grandin had an AS diagnosis. This is now corrected.

91 Responses to “Bye bye Aspergers?”

  1. RAJ November 4, 2009 at 12:53 #

    Does Asperger Syndrome exist? Here’s one answer:

    http://www.ncbi.nlm.nih.gov/pubmed/11411788?

    Asperger Syndrome may be indistinguishable
    from Schizoid Personality Disorder as follows

    ICD-10 Definition of Schizoid Personality Disorder:

    Diagnostic criteria (ICD-10)
    According to the World Health Organization’s ICD-10, schizoid personality disorder is characterized by at least three of the following criteria:

    Emotional coldness, detachment or reduced affection.
    Limited capacity to express either positive or negative emotions towards others.
    Consistent preference for solitary activities.
    Very few, if any, close friends or relationships, and a lack of desire for such.
    Indifference to either praise or criticism.
    Taking pleasure in few, if any, activities.
    Indifference to social norms and conventions.
    Preoccupation with fantasy and introspection.
    Lack of desire for sexual experiences with another person.

    Asperger Syndrome is a more fashionable label than the negative label of ‘Schizoid Personality Disorder’. Narrowly defined autism, including ‘High functioning autism’ is a neurodevelopmental disorder while Asperger Syndrome and its previous definition ‘Schizoid Personality Disorder’ is better described as a personality disorder.

    • Kev November 4, 2009 at 14:00 #

      Yeah, that idea really caught fire eh RAJ?

  2. jypsy November 4, 2009 at 12:59 #

    Temple Grandin is not Asperger’s, she has an autism diagnosis.

    • Sullivan November 4, 2009 at 18:51 #

      Temple Grandin is not Asperger’s, she has an autism diagnosis.

      That is my understanding as well. The article was not really specific on Dr. Grandin, but I believe they are implying she is a person being “mild” autistic as a counterpoint to Ari Ne’eman as someone with an Aperger diagnosis.

  3. Laurentius Rex November 4, 2009 at 13:36 #

    I don’t regard and have never regarded Temple Grandin as an authority on autism, it isn’t her specialty and she blatantly and deliberately ignores the political aspects.

    All she is, is a personality who represents a succesful career trajectory with Autism, who has been given some celebrity in what was at that particular time a relative vacuum of personality’s.

    Unfortunately I can’t read the New York Article without signing up, which is something I will not do. However I think asking Temple something techical is the same as asking Jenny McCarthy something technical. Ari is closer to the truth, but projecting into the future, can we even be sure autism will stay?

    That depends on a lot else besides science.

    As for Gypsy’s comment, Temple Grandin cannot be asperger’s because it won’t exist to be asperger’s and to define people simply by the existing lexicon is never a good way to go because that is to give in to the vagaries of diagnostic fashion, don’t forget we were all psychotic once, because the manuals said so.

  4. jypsy November 4, 2009 at 14:08 #

    Larry, I’m with you re: Dr. Grandin. She’s very opinionated, paints with a very wide brush, and, on some things, is very wrong.

    What the NYT said was:
    “In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label. Temple Grandin, a Colorado State University animal scientist who is perhaps the best-known autistic American, said Asperger’s was too well established to be thrown overboard. “The Asperger community is a big vocal community,” Dr. Grandin said, “a reason in itself” to leave the diagnosis in place.

    “P.D.D.-N.O.S., I’d throw in the garbage can,” she added. “But I’d keep Asperger’s.” “

  5. Laurentius Rex November 4, 2009 at 14:30 #

    RAJ always gives the impression of knowing more than he does, because to every diagnosis there is a background and certainly some years ago there was debate mostly initiated by Sula Wolf regarding Schizoid personality disorder.

    However the state of knowlege weak though it still is in so many domeains, has moved on to understanding more of the mechanisms at work in autism which is what leads to the current conclusion.

    In fact if we had time to devote to it beyond our own fixation with this small section of the DSM that deals with autism we can expect many debates around other conditions and I know that the nosology of “personality disorders” is much disputed, particularly as they are behavioral stereotypes (I will not call them phenotypes, that is to dignify them too much) which do not at all indicate any commonality of causation, they are as wooly and wild as the fashion blows.

    It may well be the other way round and I rather suspect it is, from the various evidence of re-evaluating patients in mental hospitals for autistic traits, that these vague and less than useful personality diagnoses hide a great deal which is being easily dismissed and ignored.

    I would warrant that almost anyone at some stage in there life would merit a personality disorder diagnosis simply by virtue of having sought professional clinical advice, because this is the way the mindset works, when you look through clinical spectacles at the normal, but fail to engage your own “pathology” as it were.

    I wish there were some gift out there that could be given to collectors of pubmed citations and listers of disorders of a faculty of understanding them all critically in aggregate and full historical context.

    Again what ICD10 and DSM are, are not statements of fact, they are not the cutting edge of research opinion, they are coding systems whose validity has more to do with meeting there own set of subjectice criteria than any reflection of the real world. They are in effect a rather poor model which everyso often needs revising to reflect how far out of step it is with the current state of knowlege, this is what this current process is about, it is not about defining the conditions, that is always a work in progress, it is about labling and cataloguing them.

    Hey Pluto ceased to be a planet recently, does that mean that Pluto has changed it’s orbit, it’s size or shape, and does that mean it is no longer a heavenly body at all. Of course not, it just means that it has been recategorised to suit more current observations.

  6. Arthur Golden November 4, 2009 at 14:36 #

    Kev,

    1. Concerning Temple Grandin, the article now states (already quoted in comment with time of 14:08, so I won’t repeat).

    2. The article now has a note that “Correction: An earlier version of this article incorrectly said Temple Grandin was a professor at the University of Colorado.”

    3. The article was somewhat ambiguous when it started with “In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label.” In the next sentence when it then mentions Temple Grandin it states “who is perhaps the best-known autistic American” and does not state she is AS. I think you should correct your blog entry that states “two people with the AS diagnosis (Temple Grandin and Ari Ne’eman).” However, the article is still misleading when it uses the term “mild autism” in the sentence before mentioning Temple Grandin. Of course, the focus of the article is Asperger’s Syndrome and not severity of autism, but I would avoid the use of the term “mild autism” in referring to Temple Grandin.

    Arthur Golden

  7. farmwifetwo November 4, 2009 at 14:56 #

    I have high hopes it gets rid of those that are self-dx’d aspies and think that Asperger’s is some cutsie club that makes them look like they are genius’. I would part with my eldest’s dx of NLD if it protected the little one and his dx of Autistic disorder.

    I have NO issues of anyone with a current Asperger’s dx getting services.

    A diagnosis IMO is SOLELY for getting necessary services, programming and funding for ALL those that require it.

    Maybe it’ll shorten the actual diagnostic list if you now actually have to prove that an actual disability exists. Plus, no longer having that “Aspergers = genius” catagory, those that are joining the “club” for those reasons may finally leave and those that need the diagnosis b/c of true disability will remain. One can only hope.

  8. farmwifetwo November 4, 2009 at 15:01 #

    Re: Temple Grandin.

    If you have never heard her speak, I recommend you do. She does have full autistic disorder, it’s very obvious in her mannerisms and speach patterns but she has taught herself proper social/behavioural coping mechanisms and that too shows. She’s not a young woman, I am going to guess she has to be around 60yrs old since she grew up in the 50’s.

    She also admits to having opinions. She admits her opinions may not be the same as yours. She also wonders if some of them have to do with growing up in the 50’s when parent’s taught the word “no” and therapies didn’t exist. She doesn’t appologize for her opinions either.

    One thing that is obvious, is that she cares. She cares about those from one end of the spectrum to the other. She may not totally understand the politics, the therapies, the camps, but she tries to, tries to listen atleast.

    I like her. She calls it as she sees it… you have to respect that.

    • Sullivan November 4, 2009 at 17:30 #

      She cares about those from one end of the spectrum to the other

      I have high hopes it gets rid of those that are self-dx’d aspies and think that Asperger’s is some cutsie club that makes them look like they are genius’.

      Do you even see the contradictions in your comments? My guess is that you do because you don’t usually use “self-diagnosed” when using the disrespectful and uncaring “cutesie club” statements you often use.

  9. Joseph November 4, 2009 at 15:09 #

    RAJ’s link is not working for me right now, but I’m willing to bet that’s not a case-control study, right? You’d have to compare an Apserger’s and a Schizoid personality disorder group, matched for IQ, and see if there aren’t any differences of note.

    If there aren’t any differences, that would argue for discarding Schizoid personality disorder, which is a not a label in common use. That is, Schizoid personality disorder should get merged into ASD along with Asperger’s.

  10. Joseph November 4, 2009 at 15:26 #

    A diagnosis IMO is SOLELY for getting necessary services, programming and funding for ALL those that require it.

    @FW2: So in your view, Temple Grandin should not have a diagnosis, is that right? I’m not sure she requires services. She takes medication for anxiety, but I don’t believe an ASD diagnosis would be necessary for that.

  11. Laurentius Rex November 4, 2009 at 15:28 #

    I have met Temple Grandin, and I have heard her speak, and she has met me and heard me speak, (We even had a photograph taken together and published if you want the proof) indeed she has seen one of my videos which I was showing on that occasion.

    I base my opinion on her lack of politics on having discussed it with her.

    Her speciality is animal science and you can’t dispute that, mine is currently in autism and I don’t think you can dispute that either. She is close enough to me in age for there to be resonances in background there even though we grew up in different cultures the mores of the times were similar.

  12. Tom November 4, 2009 at 15:52 #

    Old RAJ playing the bait and switch again. The article he links evaluated 157 children with autism or Aspergers. All had “impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both),which are DSM-IV criteria for autism.” No where in this paper is schizoid personality disorder mentioned. As a metter of fact, the article is making the claim that Aspergers is really just autism.

    I strenuously object to this dishonesty. It’s an insult no different than Bensmyson’s agenda of insulting those on the higher end of the spectrum.

  13. NightStorm November 4, 2009 at 16:15 #

    I kinda hope they get rid AS, I am sick of it being use to separate from the other autistic community, being used as divider. I want to say, “I am autistic” no if ands or buts.

  14. Leila November 4, 2009 at 16:17 #

    I think Asperger’s Syndrome is distinct from autism mainly in the criteria of “no language delay in childhood”. You may find HFA adults that are indistinguishable from their Asperger’s peers, but this is not the majority of cases. If a study proves it otherwise, then go ahead and eliminate the label, but I doubt it will happen. I think Asperger’s should remain as a distinct diagnosis, within the autism spectrum, just as it is today.

    PDD-NOS is trickier to diagnose, but it’s valid when the child doesn’t meet all DSM criteria for autism but still presents some autistic traits. I see PDD-NOS kids and compare them to my kid (diagnosed ASD) and the difference is obvious. They are more verbal and more social.

  15. daedalus2u November 4, 2009 at 16:33 #

    I agree with Tom. Comparing Asperger’s/autism with Schizophrenia is disingenuous/dishonest. The physical symptoms are very different (pretty much opposite).

    Click to access 115-Crespi&Badcock2008.pdf

    The only similarity that I see is that some NTs think that both are “weird” and should be considered pathological. I see this as an attempt to justify the feelings that some NTs have toward both by blaming the individuals that NTs have feelings about rather than forcing NTs to examine themselves and understand why they have those specific feelings about other people.

    The feelings that NTs have (or that anyone has) are about the person having the feelings. To project those feelings onto someone else is pathology, the pathology of borderline personality disorder and the other psychotic spectrum disorders. A pathology that is rare to non-existent in people with autism.

  16. Joseph November 4, 2009 at 16:38 #

    If a study proves it otherwise, then go ahead and eliminate the label, but I doubt it will happen.

    It pretty much has already happened. Briefly, when they compare groups of people diagnosed with autistic disorder vs. people diagnosed with Asperger’s, matched for IQ, they typically find few differences of note. There are some studies that say otherwise, however.

    Additionally, there are several studies where they strictly re-diagnose ASD children based on DSM-IV criteria. They find that the proper diagnosis for all or nearly all Asperger children is actually autistic disorder. Basically what this means is that DSM-IV Asperger’s is poorly defined.

  17. Kate November 4, 2009 at 16:55 #

    I am torn on this. My son was dx’d with Asperger’s (late dx in middle school) due to the fact that he had no language delay in childhood. When we first started to search out what was going on with him, autism never entered our minds since we were only familiar with the “Kanners” autism. I am now, much more familiar with the wide spectrum that can occurr with an autism dx but I worry that other parents may miss a dx or get mis-diagnosed, as we did. So due to the fact that those “cute aspies” (sarcasm) are so vocal, we found the answers to our questions.
    My son (16) has stopped using Aspergers when the odd question comes up about him. He has been teased about Ass Burgers enough and now just uses autism. And if using autism instead of Asperger’s stops farmwife from slandering my guy (and others), I would be okay with that.
    Kate

  18. Anne November 4, 2009 at 16:56 #

    The study that RAJ links to is one of the studies that suppports the proposal of the DSM-V’s Neurodevelopmental to fold Autistic Disorder, Asperger’s, and PDD-NOS into one classification. The study found that subjects with an Asperger’s diagnosis also fit the diagnostic criteria for Autistic Disorder.

    The fact that some parents of kids with AS diagnoses are reportedly objecting to this proposal suggests to me that autism is considered a more stigmatizing diagnosis.

  19. Joseph November 4, 2009 at 17:08 #

    Yep, I can access the link now, and Tom is absolutely correct. RAJ’s behavior is unbelievable. The bait is the title of paper: “Does DSM-IV Asperger’s disorder exist?” It has nothing to do with Schizoid personality disorder. The paper is also not about what RAJ would like it to be about. It’s exactly about what I said above:

    Additionally, there are several studies where they strictly re-diagnose ASD children based on DSM-IV criteria. They find that the proper diagnosis for all or nearly all Asperger children is actually autistic disorder. Basically what this means is that DSM-IV Asperger’s is poorly defined.

  20. Kate November 4, 2009 at 17:49 #

    One more thing and this is direct to fw2. Getting a dx of Asperger’s can be detrimental as in some areas it actually EXCLUDES services. Sadly the meme, that it is milder or self diagnosed or whatever, that you farmwife are determined to spread far and wide, undermines the ability of accessing those services.

    I am sure that if a lot people just up and decided that NLD was due to a bunch a people getting together to form a “cutsie club” and it was time to get rid of them, you would be okay with that? Right?

  21. Leila November 4, 2009 at 17:58 #

    Joseph, please clarify – were they comparing AS and HFA adults with similar IQ’s? In that case, it won’t show the difference between an Asperger’s adult and an autistic adult with lower IQs.

  22. Tom November 4, 2009 at 18:09 #

    Farmwifetwo,

    Are you aware that AS and NLD share many very common features? Some think they are identical entities. Could it be that your child is part of this “cutsie club” you so despise? Maybe you shouldn’t be throwing stones. You might hit your son.

  23. Joseph November 4, 2009 at 18:25 #

    Joseph, please clarify – were they comparing AS and HFA adults with similar IQ’s? In that case, it won’t show the difference between an Asperger’s adult and an autistic adult with lower IQs.

    Well, yes, but that’s the point. If there are no differences of note between an HFA adult and an AS adult with the same IQ, why should the HFA adult be called HFA and not AS, and vice versa?

    You could argue that every ASD person with an IQ above X should be called AS and everyone below X should be called autistic. However, there’s already a research classification for this cognitive dimension: HFA vs. LFA. No need for Asperger’s.

    Also, what would you do with an untestable child? You’re not going to call the child “possible Asperger’s,” right?

    The DSM-V spectrum won’t be divided along cognitive lines, btw. The “severity” dimension there will be based on something else, I understand.

  24. David N. Brown November 4, 2009 at 18:50 #

    Classifying AS relative to autism is an important technical question, but I have never considered it necessary or particularly useful for services. In presenting, I have introduces the issue with a joke I came up with about paleontology: “We don’t know what it is, but we can name it!”

  25. Socrates (Dead) November 4, 2009 at 18:53 #

    RAJ – Finally I get the proof I’ve been looking for, for years – You are a capital-see-you-en-tea.

  26. jypsy November 4, 2009 at 18:56 #

    Sullivan,
    That is what I was saying (or trying to). It was Kev who said she’s Aspergers.

  27. Laurentius Rex November 4, 2009 at 19:14 #

    Socrates there is a worse four letter word than the one you spell out, it is Tee Arr Oh Ell Ell, whoops five letters, I’ll get me coat.

    To serious matters, (as if trolling were not a heinous abuse of netiquette)

    Semiotics tells us that a name, or a lable exists for a reason, that is it has some use as a signifier, however if the thing that it signifies turns out to be less “significant” to the culture then that sign either adapts and points to something else or drops out of use.

    The reasons that Lorna Wing siezed upon eponymity to posit an expanded version of what was then just autism is because the epidemiology indicated it, indeed the whole concept of an epidemic is predicated upon the statistics in the USA catching up with those early estimates, to honour Dr Aspergers largely overlooked contribution, and because alas for those un PC times it was considered to be more acceptable to folk with a regular IQ.

    It was not really intended as a clinical diagnosis at all, just a research position, however as I said before, Klin and Volkmar, amongst others took the ball and ran. The early years were chaotic ones with conflicting sets of criteria Szatmari(sp) Gillberg and what ended up in DSM with more than a nod toward ICD 9 I think it was.

    Those are the facts, if you don’t believe me ask Lorna Wing. When I was writing “Whichever way” I ran it past Lorna Wing first and she did not find anything to disagree over other than that I had been a bit cheeky toward Christopher Gillberg.

  28. Arthur Golden November 4, 2009 at 19:21 #

    Although I am generally familiar with the biography of Temple Grandin, it seems some posters here are not and did not try to Google for factual information, so I took the following from Wikipedia, hoping future posts will be based on actual facts:

    Temple Grandin was born August 29, 1947 in Boston, Massachusetts. She was diagnosed as autistic in 1950. Having been labeled and diagnosed with brain damage at age two, she was placed in a structured nursery school with what she considers to have been good teachers. Grandin’s mother spoke to a doctor who suggested speech therapy, and she hired a nanny who spent hours playing turn-based games with Grandin and her sister. At age four, Grandin began talking, and she began making progress.

    She considers herself lucky to have had supportive mentors from primary school onwards. However, Grandin has said that middle school and high school were the worst parts of her life. She was the “nerdy kid,” the one whom everyone teased and picked on. She would be walking down the street and people would say “tape recorder,” because she would repeat things over and over again. Grandin states that “I could laugh about it now, but back then it really hurt.”

    After graduating from Hampshire Country School, a boarding school for gifted children in Rindge, New Hampshire in the 1960s, Grandin went on to college. She received her bachelor’s degree in psychology from Franklin Pierce College (also located in Rindge) in 1970, her master’s degree in animal science from Arizona State University in 1975, and her Ph.D. in animal science from the University of Illinois at Urbana-Champaign in 1989.

    Based on personal experience, Grandin advocates early intervention to address autism, and supportive teachers who can direct fixations of the autistic child in fruitful directions. She has described her hypersensitivity to noise and other sensory stimuli. She claims she is a primarily visual thinker and has said that language is her second language.

  29. Leila November 4, 2009 at 19:22 #

    I’m still not convinced that High Functioning Autism is so similar to Asperger’s Syndrome. The cognitive aspect is critical in my opinion. HFA people can still have limited speech or conversational skills and a lot of trouble following a basic academic curriculum – savant abilities not withstanding.

    There are many different presentations of autism, and even though they have to be under the same umbrella, it doesn’t help to eliminate the “subcategories” if you want a better understanding of this condition.

  30. Laurentius Rex November 4, 2009 at 19:43 #

    Speculation about Temple Grandins diagnosis is a bit moot, I don’t know whether she has had a seperate adult dx or not, and in any case a diagnosis ought to be date stamped as the diagnosis of autism in the 50’s and 60’s is not the same as the current diagnosis in DSM IV Tr, which gives rise to a lot of confusion and really confounds a lot of the studies.

    There are many people who had autism diagnoses in childhood(of varying rigour given that Autism itself did not hit the DSM until 1980, who either lost them or mislaid them and subsequently gained an Asperger’s dx in adulthood.

    There is also another big problem an elephant in the room as it were in that not all speech delay is autism, language and speech being frequently confused. Autism and Asperger’s both essentially contains a language disorder whether that manifests as significantly late speech or in other ways. It is an absolute myth even to associate speech delay with Kanners original variety of autism, a number of his patients were by contrast hyperlexic with early speech.

    To use the date of the onset of speech as a marker to seperate two conditions is really not practical, it doesn’t work other than at a simplistic level (for example who has blue eyes and who brown) it says nothing of what is really going on.

    The markers for the “true” autistic seem to fluctuate not just over time but according to who is speaking, for instant the mercury militia would probably include lack of toilet training as the marker, or something equally arbitrary, being that Temple Grandin is almost always in because she makes no waves, but Donna Williams is out because she is a “fruit salad” – that was too tempting an analogy not to make, sorry Donna your analogy not mine 🙂

  31. Laurentius Rex November 4, 2009 at 19:56 #

    Indeed Arthur, the point is that her middle and high school experiences were mainstream and not unlike mine at all, or many other people I am familiar with.

    It was very extraordinary to get an Autism diagnosis in 1950, that meant one had to be in contact with one of the few people that believed enough in it, to grant a diagnosis other than some unspecified brain disorder, or childhood psychosis. Back in the 50’s and 60’s even Mike Rutter was going with Childhood psychosis.

    Although Asperger gave us the term in German of Psychopathy, he meant something very different and was putting it more in the domain of personality ‘disorders’ in his opinion. Pyscophathy not having aquired the popular connotations of cold blooded axe murderer it has today.

    When I was born in 1955 which puts me not that far apart generationally from Temple in the immediate post war era, there was a lot of cultural difference between the US and UK approaches to psychiatry and pediatrics, each side of the atlantic having there own terms and sticking to them. However terms such as “minimal brain damage” “clumsy child syndrome” and “hyperkinesia” were in vogue to describe children who just did not fit the pattern, I aquired the lable of hyperkinesia because I was very volatile, hardly slept, was a climber and a runner but for most of my early childhood and right up through my teens I was considered to be the psychodynamic product of a difficult marriage relationship of my parents, thus it goes. Temple was damn lucky, I was just working class.

  32. Tera November 4, 2009 at 20:01 #

    farmwifetwo said:

    I would part with my eldest’s dx of NLD if it protected the little one and his dx of Autistic disorder.

    You’re arguing apples and oranges here. While Asperger’s is on the autistic spectrum, NLD is not, in any official way.

    Lorna Wing has said she thinks NLD is on the autistic spectrum, and although in the 1980s, Dr. Byron Rourke tried to fit “early infantile autism” under what he called the “NLD umbrella.” He no longer says that anymore, and hasn’t for years. But it is merely a learning style that some autistic people have (people with diagnoses of HFA and AS) and some non-autistic people have.

    The committee trying to sort this stuff out for the upcoming DSM-V (so far) refer to NLD as a “co-morbidity”–as much as I hate that phrase–of autistic spectrum conditions, along with AD(H)D and intellectual disability.

  33. laurentius rex November 4, 2009 at 20:04 #

    Leila, it helps to have the right subcategories under the umbrella, Asperger’s was never the right one, it was abused and did not in the end work at all, which is why it is likely going.

    Given that the spectrum is multi dimensional, cognitive impairments if you will, in more than one domain, the permutations are vast, even if you cluster, just look at the mathematical picture if you can. That is why individual assesment is necessary not judgement en masse by diagnosis alone.

    I actually have some quite severe cognitive impairments, that is a matter of record, that it does not show is a matter of adaptation. My immediate diagnosis prior to Aspergers (and I am not going into earlier ones tentative or otherwise) was specific learning and cognitive difficulties.

    Aspergers was always too clumsy and ill specified a diagnosis, often a diagnosis of default for an adult.

  34. RAJ November 4, 2009 at 21:41 #

    Joseph wrote:
    “Yep, I can access the link now, and Tom is absolutely correct. RAJ’s behavior is unbelievable. The bait is the title of paper: “Does DSM-IV Asperger’s disorder exist?” It has nothing to do with Schizoid personality disorder. The paper is also not about what RAJ would like it to be about. It’s exactly about what I said above”

    Sorry Joseph, but on your own website you claim to be ‘on the spectrum’ yourself. Were you diagnosed as a child with autistic disorder?

    As far as the relationship between and the overlap of Asperger Syndrome with schizoid personality disorder you might want to read Schopler’s commentary on the relationship:

    http://books.google.com/books?id=jz_xbeWgG9AC&pg=PA131&lpg=PA131&dq=asperger+schizoid+personality&source=web&ots=OspedsIwWX&sig=puBzdgzIf_8EXFjs8HuBsjeOoiM&hl=en#v=onepage&q=asperger%20schizoid%20personality&f=false

    Schizoid Personality Disorder does carry a negative impression in the ND group but how would you seperate these two overlapping conditions?

  35. Patrick November 4, 2009 at 22:35 #

    The diagnosis mess can be confusing. Not sure if I really care about the disappearance of Asperger’s as long as the needs of the diagnosis holder(s) are getting addressed.

    I used to hold a personality disorder diagnosis, in fact it was given in 1995, and then Major Depression and an Asperger’s diagnosis in about 2005. The trail goes all the way back to teenage years, but problems were manifest well before then, and unrecognized by the medical/education community of the day.

    Yes, there are overlaps, but what the Personality Disorder folks aren’t bringing to the table are MRI scans of grey vs white matters to characterize the clients brain development. (Or perhaps they have and I am underinformed.) There are likely socio-environmental factors that play into some PD diagnoses, like strict or abusive parenting, or being in a neighborhood filled with criminal activity. But their have been researchers looking into the organic basis for some of these too.

    There are researchers that claim to be able to differentiate between certain Autism Spectrum disorders based on the distribution of grey matter, but again, the people who need help indeed need help, and at least some probably don’t care what the label placed on them is.

    I wouldn’t mind being MRI scanned for one of these studies to see where I fall, but my impression at this time is that they will call me functional even if my executive function doesn’t exist, for all practical purposes.

  36. Socrates (deceased) November 4, 2009 at 22:42 #

    Chaps, I don’t feel given RAJ’s entrée, that any further engagement of him would serve any useful purpose.

    While wallowing in this ocean of corruption, let us at least try and keep our eyes on the horizon, in the expectation of a brighter dawn.

  37. Anne November 4, 2009 at 22:44 #

    RAJ, Schopler distinguishes AS from SPD in finding that AS is like autism, but SPD is not. In fact, in the book you linked to, Schopler says that the AS/Autism distinction is not meaningful, which is the same thing that the Neurodevelopmental Workgroup for the DSM-V is saying. On page 23 of the book you linked to, Schopler says that, in his opinion, AS and HFA are not distinct conditions, and that the most useful method of grouping is to use one classification of ASD, and then subgroup according to “quality of social interaction and level of ability in verbal and nonverbal skills.”

    I understand that you’re just trolling, but your link to this 1998 book by Schopler, Mesibov and Kunce does show that there have been advocates for abolishing the AS/Autism distinction for quite some time, and it appears that this view is going to win the day.

  38. Mike Stanton November 4, 2009 at 23:32 #

    Raj

    The reference you cite in your opening comment does not support your contention that Asperger syndrome is a personality disorder equivalent to Schizoid Personality Disorder and distinct from neurodevelopmental disorders like autism. It does in fact support Joseph’s point that many if not all Asperger children meet the criteria for DSM IV autistic disorder. I fail to see how Joseph’s diagnostic status has any bearing on this.

    You also wrongly describe the chapter that you link to as a commentary by Eric Schopler

    As far as the relationship between and the overlap of Asperger Syndrome with schizoid personality disorder you might want to read Schopler’s commentary on the relationship:
    http://books.google.com/books?…..38;f=false
    Schizoid Personality Disorder does carry a negative impression in the ND group but how would you seperate these two overlapping conditions?

    It is in fact a chapter by Sula Wollf in which she explores the differences and the similarities between Asperger Syndrome and Schizoid Personality Disorder. Her observation that she found an excess of schizoid personality traits in the parents of autistic children suggests to me that the distinction between personlity disorders and developmental disorders is not as clear cut as you suggest. Wolff is quite clear that for Schizoid children their difficulties arise from inherent features of their personality. It is part of who they are and not the result of life experiences.

    I am not convinced that Schizoid Personality Disorder is viewed negatively by those of us who favour neurodiversity. There is a case to be made for including it in the autistic spectrum. At the very least the relationship is more complex than the either/or scenario you suggest.

  39. Corina Becker November 4, 2009 at 23:35 #

    I support merging Asperger’s with the rest of the ASD, as it simplifies classification and eliminates confusion and potential discrimination.

    One of the concerns that has been brought to my attention about this issue is that if Asperger Syndrome is no longer in the DSM, that all the hard work of raising awareness will be wasted, and that people with the diagnosis of Asperger’s will fall through the cracks again.

    However, I think because of the awareness that has been made about Asperger Syndrome can be shifted to be about ASD. Also, the wider range of diagnostic criteria means that people previously diagnosed as Asperger Syndrome will be recognized as being ASD, and thus will not fall into the cracks as before. Of course, this is under the impression that appropriate services for all ranges of the spectrum and all ages, from childhood to adult, are available. If those services aren’t available and implemented properly, then yes, people will fall through the cracks.

    Also, I recently discussed this issue with my mother. She’s a high school teacher, and while she understands my concerns and agrees that Asperger is Autism, she has explained that as a teacher, the label has been a useful tool for her to figure out what can and can’t a student do, and what accommodations to make in the classroom. I suggested to her that perhaps then more descriptive IEPs may be in order, so that the knowledge behind the label will not be lost in the (highly likely, yet unconfirmed) merge.

  40. Laurentius Rex November 4, 2009 at 23:58 #

    Mike you are altogether too soft on the opposition and your suggestion regarding schizoid is a non runner.

    To begin with Sula Wolf is another of these mavericks like Elizabeth Newsome who can write the odd popular book or two based on clinical experiences for sure (as can Digby Tantum) but have an odd agenda to create new classes of nosology. Sula is really out in the wilderness.

    The problem is with personality disorders themselves, they just do not work, they are probably one of the biggest messes in the DSM altogether because they do not seperate out into clearly distinct patterns or entities at all, they overlap and interweave and indeed can contain within the diagnostic descriptors several classes of quite unlike behavioral symptomologies.

    It’s an area best left well alone unless you are a new broom determined to sweep clean.

    It just gets beyond my understanding how someone in order to advance a position they want to believe will pull old literature out of context, without the history, and without the revisions since, it is like trying to diagnose a problem in your fuel injected ecu controlled car using a pre war model T ford manual, some of it is the same for sure, but a lot has changed, including our understanding of what goes on in the combustion chamber itself.

  41. Mike Stanton November 5, 2009 at 00:30 #

    hi Larry

    you may well be right about personality disorders. I have not read widely inthis area but I do find Wolff’s work intriguing. I am not fully persuaded by her argument that there is a distinct difference between Aspergers and Schizoid personality disorder. My suggestion was that rather than taking Aspergers out of the spectrum we should consider whether the schizoid children she described belong on the spectrum instead.

    I agree completely about taking sources out of context. Bending the facts to suit your agenda is never a good idea.

  42. Laurentius Rex November 5, 2009 at 00:32 #

    What we do not see with RAJ is a serious attempt to examine personality disorders alongside autism and I have no intention of putting further fuel on his fire by giving him a few more to chew on that have confused the issue with autism before, other than to say that he is playing a mean trick in order to associate a whole class of people he does not like, namely rebellious young ‘aspies’ who he feels are poisoning his clear cut notions of a pure autism that never was.

    Schizoid is by far not the worst PD you want to be labled with and fairly neutral if you consider that being a loner is not such a bad thing at all.

    Schizoid only sounds bad because of that slight onomatopea with Schizophrenia, which also gets a worse press than it deserves.

    I could go on about that in detail as well concerning the way research is lumping that with bipolar on a spectrum, perhaps those lables will be going too, eventually and not before time.

    Anyway to get back to the chase, some autism researchers are onto the PD thing, here is one example, Blair, R J (2007)Fine Cuts of Empathy and the Amygdala: Neurocognitive Approaches to Developmental Disorders: A Festschrift for Uta Frith: A Special Issue of the Quarterly Journal of Experimental Psychology, Psychology Press. Very interesting I was there to here the lecture.

    Does RAJ ever bother read the somewhat squiffy citations he gives? Or does he just conjure a word cloud out of google?

  43. Laurentius Rex November 5, 2009 at 00:48 #

    Mike I think you are misunderstanding the whole process, nobody is suggesting that Aspergers is going, simply that it is being absorbed within the class that currently contains classes as being of no practical use.

    I personally am not worried by carrying a lable that is no longer valid because that does not mean my autism will have changed or gone away, any more than I was changed when I first recieved the lable. In terms of the work that the NAS is doing that’s not going to make any difference, in the UK at least where things are already going this way, it will make it clearer, it is only in the US with the private insurance system and the bizarre way in which departments of developmental disorders work that it might mean something if a corresponding code of severity comes out, which is the other suggestion.

    I am dyslexic in this country, widely recognised, but in the US, in DSM it does not exist so this really is to some extent a semantic argument not a real one, dyslexia was lost to the US lexicon a long time ago in favour of learning disability which in the UK and I believe Australia carries an entirely different connotation as you are aware. DSM is crazy, it seperates developmental reading disorder from developmental writing disorder and a whole bunch of other stuff which educationally in the UK (because none of this belongs in the medical and psychiatric domains) is lumped under specific learning disability and often uses dyslexia as a fallback “nom du guerre”

    As I keep on saying there is a lot of sociology behind all this, none of it can be understood from the perspective of psychiatry alone.

    I believe squarely that autism belongs in the educational domain, and needs no medical professional for diagnosis. (any more than a broken bone or head cold really does)

    The only fall out from this is Dr Asperger’s memory, he was a remarkable man by all accounts and a very humane one who believed in the inherent ability of disabled children, that is to say all disabled children, as I learned from a former patient of his how he intervened to get him into a mainstream school and a proper education.

  44. Mike Stanton November 5, 2009 at 01:03 #

    Larry,
    I take your point entirely that Aspergers is not being removed. It is being relocated. I was making the point that RAJ’s citations actually pointed in the opposite direction to the one he was arguing for vis a vis Aspergers.

  45. Laurentius Rex November 5, 2009 at 02:45 #

    Whoops just posted this to the wrong slot, it was meant for here

    That is the problem isn’t it Mike, that whilst the internet has undoubtedly democratised access to a lot of material and allowed the lay person to trawl databases for citations, it has also allowed for a lot of sloppy practice and outright cheating.

    Whilst it is legitimate to search by key words it still means you ought to read the abstract itself and then if you have decided it is of relevance to attempt the whole paper itself. That is where most people fall down, they will post a list of citations supposedly in support of the argument, having failed to consider counter citations (which any good rhetorician needs to look at as well in order to prepare ones own counter arguments as to why they are not felt to support the data one is defending.

    One of the things you are taught as a post grad is how to read papers properly and to consider that abstracts are not the be all and end all, as there are good abstracts and bad abstracts, and mostly they tell you nothing about the methodology or not enough to be able to mount a proper critique.

    Of course we all get sloppy, opinionated and biased, to the extent that we will prejudge that if a paper is coming from such and such a name, who has little reputation preceding of well argued papers then we are more likely to pass it over, especially when it is coming from the bad science brigade.

    The new flim flammery though is to make it appear that those more respected authors who we trust are saying the opposite of what we expect them too, witness the way the Geiers jumped on the semi-legitimate science of the double barrelled one to support there unsustainable quackery.

    Well this is what RAJ and those other Trolls who cut there teeth on the ASA newsgroup do, because all they have to do is misdirect and fool enough people to look authoratative in whatever they are saying, it’s trickery worthy of Derren Brown the charlatans charlatan isn’t it? Absolutely classic.

    You will notice I am doing it myself by my own magisterial pronouncement seen in the phrase “semi-legitimate science of the double barreled one” therein lies my own bias, but I have to say that not in a long time have I found him convincing in the least, and won’t until he takes off those monotropic spectacles of his and starts being objective again.

    At least I can take the piss out of myself eh, this pot is shining himself with brillo 🙂

  46. Joseph November 5, 2009 at 04:44 #

    Were you diagnosed as a child with autistic disorder?

    I’ll let you figure that one out. Let’s see. The diagnosis of ‘autistic disorder’ first appeared in the DSM-III-R, in 1987. At the time I had already graduated high school, so what do you think?

    What is the point of this diversion, anyway? Another random attempt at trying to offend and discredit people?

  47. David N. Brown November 5, 2009 at 05:53 #

    I have posted an article of the overlap between ASD and schizophrenia at the page below:
    http://evilpossum.weebly.com/info.html
    It includes a theoretical proposal for the psychiatric classification of “delusional aspie” distinct from classic schizophrenia.
    Also, taking a second look, RAJ’s description of “Schizoid Personality Disorder” is very different from schizophrenia.
    I’ve commented on this issue before. It seems to me that, in my own discussions and even more on this thread, the people bringing this up don’t seem that interested in discussing the core characteristics of classic schizophrenia. Unfortunate, as this is a complex, subtle and potentially very important issue.

  48. dr treg November 5, 2009 at 09:54 #

    As usual psychiatric nosology is causing problems again i.e. creating a box and trying to fit people into the box who do not fit thus labelling them incorrectly and often for life.
    It is best to keep psychiatric symptoms descriptive and simple i.e.
    1. What are the main symptoms in simple terms i.e. excessive fear, self-pity, resentment, dishonesty?
    2. Is there altered sensitivity i.e. hypo/hypersensitivity to these thoughts/feelings?
    3. Is there reduced connectivity?
    4. Is there obsession-compulsion?
    to get a feel for how inflamed the patient`s brain is and where most of the inflammation is likely to be.
    i.e. auditory hallucinations suggest schizophrenia and may be associated with inflammation causing reduced density of dendritic spines in the auditory cortex.
    http://www.ncbi.nlm.nih.gov/pubmed/18463626
    There seem to be increasing numbers of people who are in a state of deficiency in understanding, processing, or describing emotions (alexithymia) who have recognisable abnormalities of the immune system. Many of them are probably being labelled personality disorders/ borderline psychiatric disease when all they need is some insight.
    http://www.associatedcontent.com/article/1685950/feelings_pg2_pg2.html?cat=5
    What does it matter if someone is borderline Aspie or borderline schizo-affective personality disorder? It probably only matters because the labels stigmatise the patient in society making their situation even worse.

  49. Laurentius Rex November 5, 2009 at 11:39 #

    To be honest I see delusion as more of a mainstream thing, a product of the very adaptation the human brain has to seeing pattern, in that it is very easily in the case of insufficient evidence to hypothosise to far into delusion.

    I see an awful lot of it in the blogosphere amongst those stubborn types who will not see the evidence even when it is pointed out to them.

    Possibly that is something lacking in there education, statistics is not the easiest subject to appreciate if you are weak in maths (as I admit to being) possibly there is something sub-pathological, in that there are alternate “survival” drives urging one towards conclusions that support the world view that makes them comfortable, or good old fashioned cognitive dissonance.

    The thing that will not work is back room amateur psychiatry cobbling together new disorders or combinations out of the existing descriptions, because the descriptions are only the surface phenomenon, the ripples on the pond as it were.

    You really have to understand where the descriptions are coming from to make sense of it, and that requires a little more understanding and study alas, it doesn’t come overnight. I only wish it did.

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