The Battle of Diagnosing Asperger’s Disorder

The goal posts for diagnosing Asperger’s disorder have been moved. Asperger’s disorder has been placed under the Autism Spectrum Disorder (ASD) umbrella and Psychiatrists and Clinical Psychologists have to review and redo their diagnoses. Is this for the better?

The Diagnostic Statistical Manual (DSM) is your Psychopathology 101 guide book. Really. The idea of the DSM was to give Psychiatrists and Clinical Psychologists a standard guide of psychological disorders across the western world. Four versions later and the guide is much thicker, more detailed and more relevant as it’s predecessors. But as my mum (and a retired Psychotherapist) once said,

“The DSM should be seen as guidelines. You learn it cover-to-cover for your exams and then never look at it again.”

This is because learning how to treat psychological disorders is like learning to drive a car. You learn the rules and the manoeuvres then once you pass your test you really start learning how to drive. So the DSM is a necessity and has been used by therapists and researchers alike. But since the latest version of the DSM came out, DSM-5, there has been a HUGE amount of scrutiny and backlash, and with regards to the new Autistic disorder or ASD diagnosis you can see why.

The DSM-IV (the previous version complete with Roman numerals) made a distinction between autism and Asperger’s disorder, which is communication skills. Children aged 1-3 years with autism can have problems with their language skills, i.e. they delay or don’t speak to others, but instead gesture or mime. They also don’t play make-believe or play using their imaginations compared to non-autistic children. As they get older they’ll find they’re unable to initiate or sustain conversations with others, and tend to repeat certain stereotypical phrases (N.B. this is just a summary of what’s in my mum’s DSM-IV).

This is a pretty big distinction between the two disorders. So much so that one might think that they’d keep the two as separate disorders… This is exactly Allen Frances’s argument, one of the most prominent members of the DSM task force (yep they even had a task force). The DSM-5 also mentions, as a footnote, that those who are already familiar with the DSM-IV diagnosis of Autistic disorder and Asperger’s disorder should diagnose their patients as having ASD. In other words, please bring your patients back and diagnose them again. Francis also argued that the new DSM-5 is imprecise, open to interpretation and unreliable.

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So why did they change the diagnosis? Why is Asperger’s disorder now under the ASD umbrella?

The simple answer is money. I’m being totally serious. It’s not to sell more DSM-5 books mind you; it’s to get more funding. Research funding is being slowly cut at the throat. But the new DSM-5 task force team, which oddly consisted of mostly researchers this time around, have possibly found a way to keep getting their research funded (and get their pet projects published). Autism research will likely continue to get funded because of the sky rocketing number of people that are being diagnosed with autism. Notice how a said diagnosed and not suffer from? But Asperger’s disorder is more difficult to diagnose and can often get misdiagnosed. It also has a much smaller population compared to the autism population, which can also cut research funding.

Now here’s the conundrum: Is it right to lump people with two previous separate disorders into the same disorder category? Will these people still get the proper treatment? Could this have repercussions that have not been considered? Or will it do the opposite? Will it increase research funding? Will more research increase our understanding of this disorder? And if so, won’t that benefit everyone in the long run?

Only time will tell. But I will finish with this – I’m siding with Allan Francis on this one.

Written by Alison Holland

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.