Experts are phasing out the term Asperger’s Disorder. Traditionally, Asperger’s kids are socially awkward, highly verbal, clumsy, and of normal to high intelligence. However, experts starting putting kids with poor verbal skills, but high intelligence into that category, because the other categories didn’t deal with high intelligence and other unusual talents (such as hyperlexia and spacial or mathematical abilities). It’s very difficult to make categories of types of autism. Each kid is entirely different.
19 thoughts on “Autistic Categories”
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Apt. 11d 
This to me shows our society’s increased engagement with autism issues. Just like the Eskimos have a billion words for snow — autism is becoming more well understood and the terminology for it is progressing.
On the flip side I also sense a creeping narrowing of the definition of “normal” (whatever that is). Not a big fan of the narrowing thing.
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“Just like the Eskimos have a billion words for snow”
It’s not actually true that the Eskimos have a lot of words for snow. (If I’m remembering my Intro to Linguistics course correctly.)
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From the NYTimes article, I have no idea how this new definition scheme (a continuum, huge amount of variability) will be treated as an actual diagnosis. I agree with the idea in principle — that bright line descriptions of autism haven’t been very useful.
But, what will a ASD description give us? Will it become a meaningless word (as far as treatment is concerned) like cancer? If there’s a broad range of severity of symptoms, how will we decide which symptoms should be treated? for which will treatment be supported? paid for?
Seems like it’s going to be a morass.
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Agree, bj, we need to make distinctions between individuals who get an engineering degree and are terrible at parties from those who need institutional help. But the labels that exist right now are dumb: Asperger’s, PDD, PDD-NOS, High functioning autism. They don’t mean anything and everyone knows it. You can be autistic in a million different ways. Some are clumsy; others aren’t. Some are highly verbal; others aren’t. Some are wonderful artists; others never learn how to hold a pencil. Some have high levels of anxiety and want to be alone; others aren’t. I think there should be just three categories, low, medium, and high, to distinguish between the ability to function in mainstream society. Honestly, any other system would mean a hundred different categories.
The biggest problem is self-identity. A lot of people take pride in being an aspie. It’s much more socially acceptable than being autistic.
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I don’t know what the fallout would be for insurance and so on. Certainly classic autism versus Asperger’s is somewhat more descriptive than dividers like “high-functioning” and “low-functioning.” But it does seem like it’s more fluid than that.
My daughter was quite late with language and thus wouldn’t meet the DSM-IV standard for Asperger’s, but at 6 she certainly meets the Aspy stereotype of an anxious, chatty kid who is socially awkward and dying to tell you everything she knows about dinosaurs.
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Laura, I cross-posted but also in any one individual, high or low functioning seems extremely contextual. For example some highly intelligent autistics can do great work as long as they have all their sensory needs met and are insulated from social needs, but they are barely managing to keep themselves fed and their butts wiped in between writing great code, whereas autistics with much lower intelligence might be good at basic self-care, able to have productive social lives and work with others, but never produce any kind of high-value work to the capitalist market. And for some individuals their ability to function goes in phases, like it does for bipolar people. It’s really complicated.
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There would absolutely no impact on insurance, since insurance does not pay much for therapy anyway. Assholes. Most of it comes from the school district and from the pockets of the parents. The school districts don’t make any distinction between Asperger’s and PDD. They group all autism together and treat the particular deficit. If the kid needs physical therapy, the kid should get it. If the kid needs help with handwriting, there’s OT. If the kid has problem with behavior, there’s ABA therapy.
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The article actually says that Asperger’s diagnoses don’t get you services in CA & TX while an autism diagnosis might. I think this might be through another route (not directly through the schools), but I think that the definitions of disability interact variously with specific government programs (including public school). These interactions might be changed by the DSM IV or they might not be.
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bj,
I believe there has been a tendency to write the diagnosis that will produce the desired services.
You mean DSM-V, don’t you? The DSM-IV on Asperger’s is terrible (I gather that Tony Attwood thinks so, too).
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The DSM-IV is quite a bit better than the DSM-III. Axis IV is no longer ‘evil spirits’.
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I’m actually in favour of official diagnoses all being ASD if they’re truly all on a spectrum. My daughter’s officially diagnosed as moderately autistic. Before that, she was diagnosed provisionally as PDD-NOS. Most people label her as Asperger’s because she’s very verbal and perseverates on topics of interest.
Neither of the latter two diagnoses would get her the services that she qualifies for right now, so that’s pretty silly given that they’re all part of this spectrum. If you’re having problems enough with enunciation, gross motor skills and the like, the services should be provided. You can call yourself whatever you want, but it makes sense to acknowledge that these are all related issues on the spectrum and make all such people eligible for relevant services.
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Beyond the question of the relationship between different points on the autistic spectrum, there’s also the question of the relationship between autism, AD/HD, Tourette’s and OCD. As I recall, over half of Asperger’s kids are also AD/HD, which is a pretty striking overlap.
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Yes, the new DSM will be V; the current is IV. As far as I can tell, the difference between Aspergers and Autism in the DSM IV relies almost solely on early language development: set of symptoms + language delay = autism v set of symptoms, no language delay = aspergers. I thing what’s happen now is that they’ve realized that children that present with an early language delay can end up having “high functioning autism” which was thought to be roughly synonymous w/ aspergers. They used to think that early language delay would be a predictor of future outcomes, and have decided that it doesn’t seem to be (or at least, isn’t strong enough) that differentiating on the basis of that developmental tidbit isn’t meaningful.
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Sometimes I think that we should throw out all the definitions and just look at each individual child and his/her needs. I’m struck at how many differences there are simply among the 3 AS kids I know of whose parents post here.
One of my students did her TED Talks project on Rebecca Saxe and the RPTJ (a section of the brain). In her talk, she basically explains a “Theory of Mind” experiment she does with kids, then talks about the brain physiology behind it. I don’t know if brain scanning and neurophysiology is going to be the way of the DSM future, but it’s fascinating to me how many of these things are due to simple brain development issues.
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“They used to think that early language delay would be a predictor of future outcomes, and have decided that it doesn’t seem to be (or at least, isn’t strong enough) that differentiating on the basis of that developmental tidbit isn’t meaningful.” True.
The key variables for predicting future outcomes are intelligence and relationship w/mother.
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Sometimes I think that we should throw out all the definitions and just look at each individual child and his/her needs.
That would make research and evaluation impossible (until SAS develops ‘proc explaineverything’).
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Health care is already notorious for providing bad data in terms of inappropriately grouping things together, at least on the outpatient side. It’s one of the reasons quality indicators are so hard to develop. Don’t even get me started on what this means for health care reform.
IMHO it’s more damaging to give the impression of having clean, comparable data than to provide no detailed data at all. (Although the SAS feature would be welcome.)
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But measuring intelligence in small children is fraught with difficulties. Small autistic children even more so.
(Anecdote: my kid was assessed at age 4 by a teaching hospital, refused to complete various tests, was labelled with a suspected IQ of 70. We were warned she might be too stupid to learn daily routines. At 6 she’s reading at grade level and has a huge vocabulary. No one who’s ever worked with her daily thinks she isn’t smart. But there’s that number sitting in a file somewhere.)
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Someone around here refused to do his IQ test at 4 also. Ran around the room and turned the lights on and off. Got an IQ of 70. But he read with perfect comprehension at a third grade level. Right now, he’s on grade level for academics and does Lego projects that are aimed at kids two years older. Informal assessments of his IQ would put him in the gifted range.
The indicators for future success are just for academics. They aren’t important for health care provision and could needlessly worry parents. Particular deficits should get treatment. The only reason to use the umbrella term autism, which is itself a bit useless, is that it opens the doors to the provision of services. It’s excellent leverage against a recalcitrant school district.
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