Baron-Cohen Asperger Article in NYT

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No, actually, they're saying it IS autism. They want to simply call it Autism instead of Asperger's now.

I'm new to this and I seem to have discovered my Autism in the middle of this food fight (I mean food fight in the wider world, not here on WP)

If what you say is correct, what is the big deal?

Would people with HFA also get downgraded/upgraded (depending on your perspective) to Autism too?

Sorry if this has already been answered in the thread but I really couldn't get into the essay posts

Certainly, although the change in the DSM does not actually effect this. If researchers find it useful to do so, they will continue to note in their work, the features of Kanner and Asperger types. Further, whether or not researchers begin with any distinction, if there is some underlying genetic significance to any individual or clustered groups of traits or to severity, or other clinically significant features, these will not be less readily identifiable because of the removal of a DSM distinction.
I think I understand why you would say this, but I doubt that this risk applies at the all important “wedge” end of the proceedings. That is at the clinical/research end of things where knowledge is formed and disseminated from, and where authority to define knowledge (as applies to ASDs) is more strongly vested and entrenched. In respect of the wider public, they will probably be confused about any issue of any complexity, or that is characterized by any degree of obscurity, or that entails counter intuitive elements.

What we have now is an instruction to look for one or more of two traits that are not known to have any wider meaning. Much like if I redefined books so that books were exactly what they are now, except that if a book has red writing or the letter K in the title on the front cover, then it is not actually a book, but is a similar object on the book spectrum. Redefining book like this would not actually be less confusing than just calling books books. In fact it’s arguably more confusing as it implies there might be some significance to the particular traits or to what they imply. If such a distinction were regularly applied, people would both expect there to be a real distinction and would begin to “characterize” each set of objects accordingly.

This is why Kanner type is “low functioning/severe” etc and Asperger type ranges from “mild childhood condition that is mostly grown out of by adulthood”, to less than stellar social charm/manipulation skills (within the norm) but occassionally a cause of mild discomfort or needing a little extra effort to fit in with others, and entailing multiple beneficial traits included enhanced cognition/intelligence, precision, organization, etc. Temple Grandin is more successful in her occupational domain than many people with AS or without Autism, and many with Asperger Syndrome have little prospect of ever achieving even normal levels of success in occupationally. So we can see that the characterizations encouraged by the division are misleading and confusing rather than clarifying. They are also unhelpful to those they ill describe (causing some to be written off or underestimated and others to face unreaslistic expectations while being denied necessary support or accommodations). The distinction invites attributing different characteristics to each group, but since the distinguishing traits do not consistently correlate to any other distinct trait, these characterizations are always misrepresentative of at least some members of each group.


Making this a distinguishing feature between conditions though does not aid this. There are other traits that would also be influential and they should be attended to as well. Everyone with Autism probably has some anomaly or deficit in verbal communication that is relevant in this way, so the assumption that some language anomally of significance to learning is likely to be present should be applied to the whole group. Dividing on this basis does not encourage that. Further it does not encourge further investigation while failing to give enough information.

If there is no “delay in language acquisition” criteria being used for sorting into categories, but everyone is assumed to be likely to have some kind of anomally in this area (and that the anomaly is likely to be significant for learning), then the best course of action is to identify the particular anomalies that apply to a particular individual and only to categorize the individual with others whose share one or more anomalies in some practical sense (such as anomalies that all respond to a particular intervention being categorized together). Groupings based on qualitative language anomalies (that share some independently significant feature) are not encouraged by the current division, and would be more useful both for research and clinical application.

In your instance, such an approach would have entailed identifying specific anomalies in your language use, determining the impacts of these anomalies in various domains of functioning (such as learning), identifying and applying interventions that might improve the underlying language competencies, as well as identifying strategies to apply to limit the impact of language anomalies on other areas of functioning.

Currently, if language acquisition is delayed then it’s a Kanner anomaly and if not then Asperger. Some vague varied “trends” within the groups are identified and described in terms of “being common” or “many are effected by” or “often manifests” or the even more vague “while both AS/Kanner, AS is_more likely than Kanner to...”....


Comments to this effects always leave me a bit curious as to what the person making them understands them to mean.

Asperger Syndrome is conclusively Autism. Autism is any condition conforming to particular characteristics, and Asperger Syndrome is a condition that conforms to those characteristics, so Asperger Syndrome cannot not be Autism.

I am not sure why the definition of the Autism and the definition of Asperger Syndrome do not meet that standard.

Are you certain? I know that differences between the groups have been found, but differences between individuals would be big news. I can cross one of the list, as research has persistently found that a large number of those with Asperger Syndrome do not appear to be impacted by clinically significant levels of motor coordination dysfunction.
Also, on what basis are you concluding that any correlation to delays or absences of delays in language acquisition of self help skills, can be excluded? For instance, are you aware of research proving there is no link between proficiency in language and weaknesses in motor coordination or between particular typical developmental stages/tasks entailed in language acquisition and the development of motor coordination skills.?

I am confused how since the distinction was never clarifying to begin with.
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For example, somebody who has moderately severe AS and somebody else who has moderately severe autistic disorder have different problems, different strengths and weaknesses.
Not on any widespread scale. On the contrary it is very rare to find research that does not differentiate between the groups (within the PDD range) when more than one is represented in the sample group. Differentiating between these groups among research samples is actually the norm, not the exception.

hi, just thought i'd say, while i pretty much agree with you all the way, and i do think AS is autism. it is not true that AS is conclusively autism as far as i know.

Asperger's = Autism

Heart Burn = Heart Attack

Parking ticket = Career Criminal

Non verbal, takes 24 hour care, wears a diaper,

Because some Psychobabble Witchdoctor says so?

Whore = Will do anything for money

Autism = non functioning ret*d person

I was referring to the fact that, from a neuroscientific perspective, it has NOT been concluded yet that Asperger's is a form of autism. Show me conclusive proof that Asperger's Syndrome has the same neurobiological abnormalities as autism, and I will gladly say that I am an autistic. And once again, I am a neuroscientist. I obviously know that the current classification in the DSM-IV is that Asperger's is a form of autism.

And if you look through the literature, you will find many, many studies that have an "autism" group that is composed of both individuals with autistic disorder and Asperger's diagnoses. As for studies finding a correlation between clumsiness/poor motor coordination and language abilities, no, I do not know of any studies that have looked at this relationship. But that fact in and of itself supports my point: The Asperger's diagnosis has not been properly looked at from a research perspective. Currently, studies are only looking for differences between those on the autism spectrum and controls. Looking at differences between autistic disorder and Asperger's is pretty much moot. And this needs to be considered before Asperger's is taken off of the diagnostic list.
-OddDuckNash99-

I'm just happy someone else finally pointed out how much the DSM is basically a book of behaviors. He did refer to it as "the Bible" and too many shrinks really do see it as set in stone. Now if he could have taken it one step further and looked beyond autism and pointed out how we already do treat a diagnosis that is solely based on behavior with medication (harsh ones at that).... like depression and ADHD....

I agree with you about how the DSM is poorly written and is just a bunch of ambiguous behaviors. However, medication is prescribed for neuropsychiatric disorders because the neuroscience behind the disorders gives strong evidence that there are biochemical abnormalities present. Everything we do is driven by brain chemicals, and behaviors fall into this category, as well. I do agree that disorders are overdiagnosed, and that medication is often over-prescribed as a "cure-all" nowadays, though. People seem to think that a pill is a "cure," when, in reality, it is only a treatment used to properly manage symptoms. I take medications to manage my OCD, panic attacks, and AS mood swings, but I know that the problem still exists if I would stop the medications.
-OddDuckNash99-

What particularly interests me is, Simon Baron-Cohen claims there may be genetic differences between autism and Asperger's, and I recently read a study that found brain anatomical differences. However, the current DSM-IV criteria are so vague that we cannot be sure why these different groups were distinguished. IOW, why are subjects A, B and C, who have genetic profile or brain anatomy X, diagnosed with Asperger's and subjects D, E and F, who have brain antomy or genetic profile Y, diagnosed with HFA, when the mandatory differences are so small (you don't even have to have a speech delay for HFA, for example, just one criterion from the communication list). I for one do believ ein possible autism subtypes, but research (clinical/behavioral and medical/biological) is not yet far enough to reliably distinguish them. That's why I believe we need just one name for now, until research has sorted out the different autism subtypes.

I agree that some of those medications do help people, especially when suicide is a factor; however, we are still working on a concept of "strong evidence." To me, that's not enough to be prescribing little kids amphetamine cocktails because they don't sit all day at school. Placing the burden of diagnosis on opinion and observation of behaviors as opposed to actual biological testing (such as blood work or something visible in an MRI) has opened a door to abuse, and our medical industry (at least here in the States) can't handle such responsibility. As a result, if you can't afford cocaine, you can always purchase some Ritalin off your neighborhood high school students. What's worse? Too many people do take it to be gold and many schools require some of these students to be "treated" in such a manner if the student wants to continue attendance.

Behavior is something that's defined by our body chemistry, but also our environment. Until we have a means to find out what exactly is causing someone's undesired behavior on a case by case basis (whether it be a bio-chemical abnormality in the brain or some environmental factor), we really should not be assuming all the behavior is associated to the one option and ignore the other possibilities when it comes to treatment. We only do because people don't just want a "cure all" but they want the easy way out. A pill is much less work and effort than therapy. Culturally, we are in an age where we are always looking to add convenience to our lives. Considering the known (as well as unknown) side effects of many of these medications (since we're not just talking some Tylenol here, and many are taken daily), is the benefit really outweighing the cost?

I personally suffer Chronic Fatigue, and with 2 kids and one on the way, after I have this 3rd child, I really don't think I'm going to make it through some days trying to live up to the expectations of being a mom without the assistance of something a helluva lot stronger than caffeine. I will admit that I will probably be taking advantage of the pharmacotherapeutical options, so I'm the farthest thing from some liberal health conscious hippy even though I'm lecturing like I'm one.

I totally agree. ADHD is extremely overdiagnosed, and Ritalin and other stimulants are overly prescribed. Granted, there are kids out there who genuinely have ADHD and genuinely need medication to be able to function, but I do think that the first thing doctors do is head for the prescription pad. I'm a different story, though. I didn't start taking psychiatric medication until I was 15 1/2, even though I needed it as a child. It's just that my mental health issues did not start being noticed until I was a teenager. But sadly, I lost many years of childhood and happiness from OCD, because I did not know what it was. I hope you are able to manage your chronic fatigue; good luck with your new baby.
-OddDuckNash99-

To make matters more complicated our brain chemistry is also affected by our behavior and environment, which means causality is very complex in this issue.

As far as I know neither autism nor ADHD can be positively identified by MRI's or blood tests (with some exceptions), so behavior is really the only clue. I've also come to understand that since the DSM 3 came into action, all diagnoses have been made on observed behavior, since there is too little consensus on the causes of conditions and diagnosing based on this would make the system even more random.

edited for spelling

Progress is being made in some related areas. Differences (from control / "normal" subjects) in the right cerebellum and right lentiform nucleus are the "best biomarker of dyslexia" in 100% of those in a recent study viewable here. It seems that researchers are looking at brain regions traditionally not thought to be centers of behavior or cognitive processes, such as the cerebellum that has long been thought to regulate physical movement. It turns out that the cerebellum appears to regulate much more, and autism researchers are also looking to the cerebellum such as in the study found here.

With all of the research underway, it is only a matter of time until autism spectrum diagnosis will rely on much more than just observed behavior.

Z

Actually I think that removing Asperger is good. It's too much stereotypic.

hi.
Autism is defined to be any developmental condition entailing particular ranges of impairment in three particular domains of functioning. Asperger Syndrome is defined as a developmental condition entailing such a range of impairment in those three particular domains of functioning, ergo Asperger Syndrome is categorically an Autism.


Autism is not a neuroscientific word or concept. It is a psychological/psychiatric concept/word. It does not refer to causes or suggest a common cause. It refers to observable traits that are construed as the outcome of some cause or causes. That conditions that are Autisms share anything (such as neurological features) beyond the traits by which Autism is defined, is not part of the concept.
Then it’s surprising you seem to think that Autism is referring to some common set of neurological anomalies rather than a common set of observable behaviors. There is no evidence that incidences of Kanner type Autism share a common cause or neurological anomaly, and there is no evidence that those with Asperger type Autism share a common cause or neurological anomaly amongst them either. Such a standard currently has nothing to do with how either category is defined, it has nothing to do with how Autism is defined, and so it’s completely irrelevant to how these conditions are organized.

Which substantiates my assertion that the mess you wish to attribute to this distinction not being made cannot be so attributed as this distinction is clearly being made. Otherwise we would not know that a sample included both Kanner and Asperger diagnosed subjects.

No it does not. Unless we can know that the criteria that is used to differentiate Asperger from Kanner types is not a variable influencing other differences we cannot conclude whether some other difference that clusters within the groups is not caused by or causal to the difference used to assort the groups, so we cannot use such differences to claim that the original sorting had any wider significance. It’s surprising a neuro scientist would not know this general principal.

This is complete nonsense. Research that includes mixed diagnostic groups, in nearly every instance distinguishes between the diagnostic groups. I personally have never encountered any credible research that uses mixed groups and fails to track and provide results for these groups distinct from results for the Autistic group as a whole.

Thank you. Half my problem is that I don't know what fatigue is stress induced/chronic fatigue related and what fatigue is sleep deprivation related, but fortunately, I think most medication helps the symptoms instead of cause so I'm hoping for the best. This is all given I actually make time to talk to a doctor about it rather than procrastinating it and settling for OTC energy/weight loss products that have not been FDA approved. Of course I don't take anything like that while pregnant...as crazy as I go is maybe a McCafe once in a while, and even then, it makes me more nauseous than providing a boost.


I'm glad your medication has helped you...obviously since you succeeded at completing a crap ton of college. On the plus side... I try to find medical doctors who have OCD (or are just incredibly particular about how things are done) because I think they are better doctors...especially when it comes to managing the staff. My OBGYN is very OCD and germ phob, and he looks like the guy from Ghostbusters...Egon or something... anyway, I remember when I gave birth to my last baby, they had already given me the epidural and were trying to move my legs, so my husband grabs my leg and moves it. The OBGYN freaked screaming how my leg was contaminated, and my husband was like if you think the germs from my hands are contaminating, you don't want to know how I helped make that baby...lol. Seriously though, people with OCD tend to be very accurate and thorough, and that's almost a necessity in the medical and scientific fields.