Monday, December 17, 2012

Aspergers Losing it's place in the DSM V

There is quite a bit of talk that the Connecticut shooter, Adam Lanza had a form of Autism called Aspergers.  Aspergers deals with the sometime inability to socially interact with others in acceptable manners. Communication issues, disruptive behavior and repetitive behaviors are just some of the characteristics of Aspergers.  Children with Aspergers are typically bright but because of behavior issues may at times suffer in getting good grades. 

Aspergers does qualify children for IEP's. But the parents have to push for it and work with the school.  In cases where the child gets an IEP, they are then entitled to obtain certain services to encourage positive learning and behavior  But according to the article below.  The Diagnostic and Statistical Manual of Psychiatry published by the American Psychiatric Association is going to drop Aspergers from its newest edition DSM-V which will be published in 2013.  Aspergers will then be categorized under the "Autism spectrum disorder" instead of having its own special diagnosis and Axis. This is certainly not a good thing when parents are trying to work with schools and other service oriented therapies to help their child make it through the difficult times.
Having Aspergers alone would not cause Adam Lanza to commit horrible acts of violence according to forensic psychiatrists, usually the child or in Adam's case teen will have another disorder along with Aspergers.  Sometimes children with Autism and or Aspergers suffer from bullying or isolation from their peers because they are different.  These behavior can cause depression, mood disorders and other personality disorders.  Or there could be issues of schizophrenia, delusional disorder, paranoia or oppositional defiant disorder.  We can't really categorize Adam until we have all the facts.  But I will say that taking Aspergers out of its own category of the DSM is just anotoher way to take focus away from a very important life altering neurological disorder. 

 Here is part of the article from Fox
According to the Mayo Clinic, the core issues for children with autism include problems with social interaction, language and behavior.

Ablow said the DSM is basically a “bible” of conditions psychiatrists use to diagnose their patients and, to a great extent, determine what treatments would benefit them. The DSM also has extremely important implications for what kinds of psychiatric problems insurers will cover, and even which ones schools and employers will consider disabilities.
The APA said in a statement earlier this month that the decision to remove Asperger’s from the DSM-V, is to “help more accurately and consistently diagnose children with autism.”
There are other changes to the new DSM as well, including adding entries for new disorders, like hoarding and disruptive mood dysregulation disorder (which refers to frequent temper tantrums). Dyslexia, a learning disorder that affects a person’s ability to read, will also be removed.
Ablow, as well as other distinguished psychiatrists, has disagreed with the APA’s decision from the very beginning.
“This contradicts previous studies that have found 45 percent or more of the patients now considered autistic would no longer be diagnosed as such,” Ablow wrote in a previous article.
Ablow continued to say that psychiatric researchers “apparently differ by more than 400 percent in their estimates of how many patients will no longer be considered autistic,” and so for the millions of Asperger’s patients who have already been diagnosed, may be taken away from them.
“Medical specialties—psychiatry included—should not be in the habit of shifting their diagnoses every time a new diagnostic manual is published by its trade guild,” Ablow told “Rather than the pace of discovery, it could be argued that what is shifting is the way organized psychiatry eyes third-party reimbursement or keys its diagnoses to match up with available medications.”
Dr. Manny Alvarez, senior managing health editor of, said one of the main differences between Asperger’s and autism is there is no speech delay in Asperger’s, but individuals with the condition may not be able to pick up on subtleties like humor or sarcasm.
The Autism Society states that while children with autism may seem uninterested in social interaction, those with Asperger's typically want to fit in and interact with others - but are incapable of knowing how to do so.
Individuals with Asperger’s usually have above-average intelligence, Alvarez added.
Alvarez noted that the removal of Asperger’s from the DSM-V could diminish early intervention for these people, which “is key to mainstream treatment.”
In a recent blog, Dr. Allen Frances, professor emeritus at Duke University, and the chairman of the DSM-IV task force, said clinical trials that supposedly determine whether the new DSM-V is a good and accurate guide “have been pure disaster from start to finish.”
Frances accused the APA of having “lost its competence and credibility,” saying the trials were a “fiasco.”

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