I've made this point several times here, and since it gained some traction, I thought I would quote some references. I don't have the actual studies linked, but I did locate other references that discussed the same issue, which is part of the reason that AS is being merged with ASD.
The short version is that a lot of people (apparently mostly children, but there are reasons adults get this too) who have been diagnosed with AS should - per the DSM-IV criteria - have been diagnosed with autism instead:
Quote:
The issue of precedence has been examined by several research studies (Dickerson Mayes, Calhoun and Crites 2001; Eisenmajer et al. 1996; Ghaziuddin, Tsai and Ghaziuddin 1992; Manjiviona and Prior 1995; Miller and Ozonoff 1997; Szatmari et
al. 1995). The general conclusion of these studies is that a diagnosis of Asperger’s syndrome is almost impossible using current DSM-IV criteria.
Many clinicians, including myself, have rejected the hierarchical rule. The general consensus among clinicians at present is that if the current profile of abilities of the child is consistent with the descriptions of Asperger’s syndrome, then the diagnosis of Asperger’s syndrome takes precedence over a diagnosis of autism. Thus, contrary to the DSM-IV, if a child meets criteria for both autism and Asperger’s syndrome, the child is usually given a diagnosis of Asperger’s syndrome by clinicians (Mahoney et al. 1998). It is important to recognize that the diagnostic criteria are still a work in progressA hierarchical approach The DSM-IV guidelines are that if the criteria for autism are confirmed in a diagnostic assessment, then despite the child’s cognitive, social, linguistic,motor and sensory abilities and interests being consistent with the descriptions of a child with Asperger’s syndrome, a diagnosis of autism should take precedence over a diagnosis of Asperger’s syndrome.
And this pdf online:
http://www.muhlenberg.edu/depts/psychol ... t_2004.pdfQuote:
One common criticism of the current criteria for AsD is that the distinguishing characteristics listed in the DSM-IV have not been empirically supported. For instance, the DSM-IV operationally defines significant language delay in terms of developmental milestones. However, research has failed to support the discriminant validity of this language delay criterion (Mayes & Calhoun, 2001). Substantive concerns have also been raised over the DSM-IV criteria pertaining to the nature of differences between AsD and AuD in cognitive development, stereotyped or restricted patterns of behavior, and social interaction.
Moreover, the DSM-IV criteria neglect the interactive nature of the core symptom areas of AsD and AuD (Kugler, 1998). Consequently, if clinicians adhere strictly to the DSM-IV criteria, it is virtually impossible to make a diagnosis of AsD (Mayes & Calhoun, 2001). Several studies have documented that most children who receive a diagnosis of AsD should or could have been diagnosed with AuD, suggesting that clinicians must be basing their diagnosis on criteria other than those specified in the DSM-IV (Eisenmajer et al., 1996; Mayes, Calhoun, & Crites, 2001). For instance, Sciutto and Cantwell (2003) found that a higher IQ and a desire to engage others in social interaction when combined with an absence of a language delay significantly increased the likelihood of an Asperger’s diagnosis. In their study, the presence of a delay in language milestones decreased the likelihood but did not rule out an Asperger’s diagnosis. In fact, many clinicians (55%) recommended a diagnosis of Asperger’s Disorder even when there was clear evidence of a language delay, which suggests that other factors may lead clinicians to move beyond the DSM criteria.
And from the DSM5 rationale:
Link here to cache, as the DSM-V site is unresponsive for meQuote:
Q.1. Have the DSM-IV diagnostic criteria for Asperger Disorder worked?
The ‘Asperger’ label has proved popular, ‘acceptable’, and has widened recognition of autism spectrum disorder (ASD) in combination with good language and intelligence. In addition, the introduction of this diagnostic entity has achieved the intended aim of prompting research into possible differences between this and other subgroups of PDD, with more than 500 published articles on Asperger syndrome.
1.1. Do the DSM-IV criteria work in clinical practice?
A number of published papers have argued that the DSM-IV Asperger disorder criteria do not work in the clinic (e.g., Mayes et al., 2001; Miller & Ozonoff, 2000; Leekam, Libby, Wing, Gould & Gillberg, 2000). Specifically, key problems exist in applying the current criteria:
· Early language details are hard to establish in retrospect, especially for older children and adults; average age of first diagnosis is late (7 years according to Mandell et al. 2005; 11yrs, Howlin & Asgharian, 1999).
· The trumping rule means most/all Asperger cases should strictly be diagnosed as having ‘Autistic disorder’ (Miller & Ozonoff, 2000; Bennett et al, 2008; Williams et al, 2008), although clinicians prefer to give the more specific term (Mahoney, et al.,1998)
o Specifically, since language delay is not a necessary criterion for Autistic disorder, to meet criteria for Asperger disorder (without being trumped by Autistic disorder), a person would need to fail to meet Communication criteria for Autistic disorder. In practice, the Communication criterion (B.2.) of “marked impairment in the ability to initiate or sustain a conversation with others” is typically met by even very able individuals fitting the Asperger picture.
As a result, ‘Asperger syndrome’ is used loosely with little agreement: e.g. Williams et al (2008) survey of 466 professionals reporting on 348 relevant cases, showed 44% of children given Asperger, PDD-NOS, atypical autism, or ‘other ASD’ label actually fulfilled criteria for Autistic Disorder (overall agreement between clinician’s label and DSM-IV criteria; Kappa 0.31).
I have found that with a diagnosis of Asperger's Syndrome I keep running up against expectations that my condition and symptoms should be mild, which they are not. I said something to SuperTrouper to this effect when she was discussing whether AS is the correct diagnosis for her.
However, a lot of people really identify with the AS label (and as Aspies), and they feel this diagnosis fits them best - so I'm not going to particularly argue that anyone needs a specific label over any other label.
I don't think anything in these quotes should be used to minimize differences in severity - as many people find things problematic that others find difficult to identify with.
09 Jul 2011, 5:18 pm
