爱斯柏格症被DSM-V正式归入了自闭症谱系

binfeng2000

All:

What many of us have heard over the last two years now seems official, that in the DSM-V (due to be released around 2012-2013) Asperger’s Syndrome will no longer exist as a diagnosis. The condition will be merged into “Autism Spectrum Disorder.” Yesterday, the DSM-V committee publicly confirmed this.

As a result, there’s been a lot of press on the subject, and so we bring you a special blast of articles.

Below you’ll find:
•     A link to hear “Asperger’s Officially Placed Inside the Autism Spectrum” by Jon Hamilton of NPR (a story we were interviewed for)
•     “Revising Book on Disorders of the Mind” by Benedict Carey of the New York Times
•     An Op-Ed by Richard Roy Grinker; “Disorder Out of Chaos.”
•     and finally, the DSM-V’s proposed language and rationale (with an opportunity for you to send comments to the committee, which we’d love to see you use)

But first . . .

I won’t speak for GRASP, as I know some members (as well as Board members) have varying feelings about this change; but there’s a lot of pros, and a lot of cons that will come with this change.

The cons will all occur in the short term. Not only will many of our members struggle with a terminology that has regrettably carried with it different associations, but the social service world carries definite possibilities of chaos after the change is implemented. How many service agencies will deny benefits to our folks because the agency uses the old terminology, whilst the applicant uses the new? How many school districts will deny an appropriate education because they use the new terminology, whilst the family in need doesn’t have the money to get a new evaluation that adheres to the DSM-V? How much money will have to be spent by disproportionately poorer folks to get that new evaluation? And how bad will the inevitable resentment be towards those providing diagnostic services, as they reap untold amounts of dough from the world’s need to adapt to this new book? LOTS of internal as well as external disarray.

The pros, however, are for the long term. GRASP has always advocated that the spectrum’s complexity went against our very human need to compartmentalize. After all, it is really hard for the average Joe on the street to swallow the idea that people like Albert Einstein, Thomas Jefferson, and Emily Dickinson . . . could possibly have different variations of the same condition as someone who might never speak. But the fact is that every clinical attempt to draw a line in the sand where autism becomes Aspergers and vice versa has been proven false in practice, mostly because in varying proportion, everyone learns and adapts as life goes on. It simply IS that complicated. The stigma of the words “Asperger’s Syndrome” still has a long way to go, but the stigma of the word “autism” is unfortunately, still very dark. This change may push us (or force us) ALL towards digesting how complex this condition really is, so that we stop looking for a “picture” of Autism or Asperger’s that reflects what we see in the mirror.

Many of GRASP’s members diagnosed with AS refer to themselves as “autistic” or “having autism.” Others don’t. I personally have always used “AS” to describe myself because that’s what my two diagnoses called it (and I’m very careful not to assume that I’m a doctor :-) I also try to be cognizant of other’s resentment, whether I find their reasoning worthy of my respect or not.* But that doesn’t mean that I don’t cognitively agree with those diagnosed AS who call themselves autistic. It’s just that being right is not always what's important.

*There are parents of severely-challenged specrumites take great offense to those
  of us who, while presenting a better ability to mirror greater society, call themselves autistic.

So, I’m personally for this. We probably know very little about all this, when compared to what we some day are destined to know about the diagnosis; or how it relates to and blends in with the entire human condition. Just as the DSM-IV was a step, so too will be issue #5.

But I'm just one person. And anything having to do with identity will always be best left to the individual.

Maybe by the time the DSM #14 comes out, we’ll have it all figured out. Until then, we’ll have to be flexible. The terminology will probably change again and again. That’s how progress works. But everything is hard until you do it.

So I guess someday y’all should look for news from the Global and Regional “Autism Spectrum” Partnership :-)

Yours, y’all,

mjc


Asperger's Officially Placed Inside Autism Spectrum
by JON HAMILTON, National Public Radio

Liste to the story at: http://www.npr.org/templates/story/story.php?storyId=123527833


Revising Book on Disorders of the Mind
By BENEDICT CAREY - New York Times

Far fewer children would get a diagnosis of bipolar disorder. “Binge eating disorder” and “hypersexuality” might become part of the everyday language. And the way many mental disorders are diagnosed and treated would be sharply revised.

These are a few of the changes proposed on Tuesday by doctors charged with revising psychiatry’s encyclopedia of mental disorders, the guidebook that largely determines where society draws the line between normal and not normal, between eccentricity and illness, between self-indulgence and self-destruction — and, by extension, when and how patients should be treated.

The eagerly awaited revisions — to be published, if adopted, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013 — would be the first in a decade.

For months they have been the subject of intense speculation and lobbying by advocacy groups, and some proposed changes have already been widely discussed — including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.

But others, including a proposed alternative for bipolar disorder in many children, were unveiled on Tuesday. Experts said the recommendations, posted online at DSM5.orgfor public comment, could bring rapid change in several areas.

“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.

“The treatment of bipolar disorder is meds first, meds second and meds third,” said Dr. Jack McClellan, a psychiatrist at the University of Washington who is not working on the manual. “Whereas if these kids have a behavior disorder, then behavioral treatment should be considered the primary treatment.”

Some diagnoses of bipolar disorder have been in children as young as 2, and there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.

In a conference call on Tuesday, Dr. David Shaffer, a child psychiatrist at Columbia, said he and his colleagues on the panel working on the manual “wanted to come up with a diagnosis that captures the behavioral disturbance and mood upset, and hope the people contemplating a diagnosis of bipolar for these patients would think again.”

Experts gave the American Psychiatric Association, which publishes the manual, predictably mixed reviews. Some were relieved that the task force working on the manual — which includes neurologists and psychologists as well as psychiatrists — had revised the previous version rather than trying to rewrite it.

Others criticized the authors, saying many diagnoses in the manual would still lack a rigorous scientific basis.

The good news, said Edward Shorter, a historian of psychiatry who has been critical of the manual, is that most patients will be spared the confusion of a changed diagnosis. But “the bad news,” he added, “is that the scientific status of the main diseases in previous editions of the D.S.M. — the keystones of the vault of psychiatry — is fragile.”

To more completely characterize all patients, the authors propose using measures of severity, from mild to severe, and ratings of symptoms, like anxiety, that are found as often with personality disorders as with depression.

“In the current version of the manual, people either meet the threshold by having a certain number of symptoms, or they don’t,” said Dr. Darrel A. Regier, the psychiatric association’s research director and, with Dr. David J. Kupfer of the University of Pittsburgh, the co-chairman of the task force. “But often that doesn’t fit reality. Someone with schizophrenia might have symptoms of insomnia, of anxiety; these aren’t the diagnostic criteria for schizophrenia, but they affect the patient’s life, and we’d like to have a standard way of measuring them.”

In a conference call on Tuesday, Dr. Regier, Dr. Kupfer and several other members of the task force outlined their favored revisions. The task force favored making semantic changes that some psychiatrists have long argued for, trading the term “mental retardation” for “intellectual disability,” for instance, and “substance abuse” for “addiction.”

One of the most controversial proposals was to identify “risk syndromes,” that is, a risk of developing a disorder like schizophrenia or dementia. Studies of teenagers identified as at high risk of developing psychosis, for instance, find that 70 percent or more in fact do not come down with the disorder.

“I completely understand the idea of trying to catch something early,” Dr. First said, “but there’s a huge potential that many unusual, semi-deviant, creative kids could fall under this umbrella and carry this label for the rest of their lives.”

Dr. William T. Carpenter, a psychiatrist at the University of Maryland and part of the group proposing the idea, said it needed more testing. “Concerns about stigma and excessive treatment must be there,” he said. “But keep in mind that these are individuals seeking help, who have distress, and the question is, What’s wrong with them?”

The panel proposed adding several disorders with a high likelihood of entering the pop vernacular. One, a new description of sex addiction, is “hypersexuality,” which, in part, is when “a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.”

Another is “binge eating disorder,” defined as at least one binge a week for three months — eating platefuls of food, fast, and to the point of discomfort — accompanied by severe guilt and plunges in mood.

“This is not the normative overeating that we all do, by any means,” said Dr. B. Timothy Walsh, a psychiatrist at Columbia and the New York State Psychiatric Institute who is working on the manual. “It involves much more loss of control, more distress, deeper feelings of guilt and unhappiness.”



Disorder Out of Chaos
By ROY RICHARD GRINKER Washington

IF you ask my daughter, Isabel, what autism means to her, she won’t say that it is a condition marked by impaired social communication and repetitive behaviors. She will say that her autism makes her a good artist, helps her to relate to animals and gives her perfect pitch.

The stigma of autism is fading fast. One reason is that we now understand that autism is a spectrum with an enormous range. Some people with autism are nonverbal with profound cognitive disabilities, while others are accomplished professionals.

Many people with milder symptoms of autism have, for the past 20 years or so, received a diagnosis of Asperger’s disorder. Some autistic adults call themselves “Aspies” to celebrate their talents and differences. And many parents have embraced the label because they have found it less stigmatizing, and so it has eased their sense of loss.

This may soon change, however. The American Psychiatric Association, with its release this week of proposed revisions to its authoritative Diagnostic and Statistical Manual of Mental Disorders, is recommending that Asperger’s be dropped. If this revision is adopted, the condition will be folded into the category of “autism spectrum disorder,” which will no longer contain any categories for distinct subtypes of autism like Asperger’s and “pervasive developmental disorder not otherwise specified” (a category for children with some traits of autism but not enough to warrant a diagnosis).

The change is welcome, because careful study of people with Asperger’s has demonstrated that the diagnosis is misleading and invalid, and there are clear benefits to understanding autism as one condition that runs along a spectrum.

When the American Psychiatric Association first recognized Asperger’s disorder in 1994, it was thought to be a subtype of autism. As the diagnosis became more common, it broadened the public understanding of autism as a spectrum. It helped previously undiagnosed adults to understand their years of feeling unconnected to others, but without bestowing what was considered the stigma of autism. And it helped educators justify providing services for children who, in the past, might have been unappreciated or even bullied because of their differences, but received no help from teachers.

It’s no longer a secret that people with autism can have careers and meaningful social relationships. Witness the spate of recent movies, from HBO’s “Temple Grandin,” about a woman with autism who became an animal scientist famed for her designs of humane slaughterhouses, to “Mary and Max,” an animated feature about a friendship between a 44-year-old man with Asperger’s and an 8-year-old girl.

But a culturally meaningful distinction isn’t always a scientifically valid one. Almost everyone with Asperger’s also fits the profile of the more classic autistic disorder. Indeed, in the current diagnostic manual, a child who has good language acquisition and intelligence qualifies as autistic if, in addition to having restricted interests and problems with social interactions, he has just one of the following symptoms, which are common among children with Asperger’s: difficulty conversing, an inability to engage in make-believe play or repetitive or unusual use of language. Even the best available diagnostic instruments cannot clearly distinguish between Asperger’s and autistic disorder.

People who now have a diagnosis of Asperger’s can be just as socially impaired as those with autism. So Asperger’s should not be a synonym for “high functioning.” Likewise, people with autism who are described as “low functioning,” including those without language, can have the kinds of intelligence and hidden abilities that are associated with Asperger’s — in art, music and engineering, for example — and can communicate if given assistance.

Moreover, large epidemiological studies have demonstrated that mild symptoms of autism are common in the general population. In particular, scientists have found that family members of a child with autism often exhibit isolated autistic traits. With autism, as with many medical diagnoses — like hypertension and obesity — the boundary lines are drawn as much by culture as by nature. Dividing up the workings of the mind is not as neat and orderly as categorizing species.

The proposed new diagnostic criteria, by describing severity and functioning along a single continuum, would also capture the often unpredictable changes among children with autism. When Isabel was 3, she had all the symptoms of autistic disorder, but if she walked into a doctor’s office today as a new patient — a chatty, quirky high school senior — she would more likely be given a diagnosis of Asperger’s disorder. Narrow diagnostic categories do not help us understand the way a person will develop over time.

We no longer need Asperger’s disorder to reduce stigma. And my daughter does not need the term Asperger’s to bolster her self-esteem. Just last week, she introduced herself to a new teacher in her high school health class. “My name is Isabel,” she said, “and my strength is that I have autism.”

Roy Richard Grinker, a professor of anthropology at George Washington University, is the author of “Unstrange Minds: Remapping the World of Autism.”


Copyright 2010 The New York Times Company

binfeng2000

From the Official DSM-V development page: (http://www.dsm5.org/Pages/Default.aspx)

(p.s. you can log on to comment at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97)


1. Proposed Revision

The work group is proposing that this disorder be subsumed into an existing disorder:  Autistic Disorder (Autism Spectrum Disorder).


2. Rationale

In making the recommendation to delete Asperger’s disorder, the following questions were considered:

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).

1.2. Do the DSM-IV criteria delineate a meaningful subgroup for research or practice?
In part because of the difficulty in applying the criteria (as outlined in section 1.1.), different research groups often uses different criteria,  and quality of early language milestone information is variable (Eisenmajer et al., 1996; Klin et al., 2005; Woodbury-Smith, Klin, & Volkmar, 2005).  Different criteria lead to different samples being identified (see Klin et al, 2005 comparison of 3 diagnostic approaches; also Kopra et al., 2008; Woodbury-Smith et al., 2005).

Research suggests early language criteria do not demarcate a distinct subgroup with different:
                        Course/outcome: Children with autism who develop fluent language have very similar trajectories and later outcomes to children with Asperger disorder (Bennett et al., 2008; Howlin, 2003; Szatmari et al., 2000) and the two conditions are indistinguishable by school-age (Macintosh & Dissanayake, 2004), adolescence (Eisenmajer, Prior, Leekam, Wing, Ong, Gould & Welham 1998; Ozonoff, South and Miller 2000) and adulthood (Howlin, 2003).
                        Cause/aetiology: Autism and Asperger syndrome co-occur in the same families (Bolton et al., 1994; Chakrabarti & Fombonne, 2001; Lauritsen et al., 2005; Ghaziuddin, 2005; Volkmar et al., 1998). No clear evidence to date of distinct aetiology.
                        Neuro-Cognitive profile: mixed evidence, for example some authors have reported worse motor functioning in Asperger than HFA (Klin et al., 1995; Rinehart et al, 2006), while others have not found significant group differences (Jansiewicz et al., 2006; Manjiviona & Prior, 1995; Miller & Ozonoff, 2000; Thede & Coolidge, 2007). Evidence is similarly mixed for differentiation of Asperger group by lower performance than verbal IQ profile (for, Klin et al, 1995; against, Barnhill et al., 2000; Gilchrist et al., 2001; Ozonoff, South & Miller, 2000; Spek et al., 2008), better theory of mind (for, Ozonoff et al, 2000 ; against, Dahlgren & Trillingsgaard, 1996;            Spek et al, in press JADD; Barbaro & Dissanayake 2007) or executive function (for, Rinehart et al, 2006; reviewed by Klin, McPartland & Volkmar, 2005 ; against, Miller & Ozonoff, 2000; Thede & Coolidge, 2007; Verte et al., 2006) .  Note the risk of circularity for group differences relating to verbal ability, since early language development (grouping criterion) is generally predictive of later language abilities (Paul & Cohen, 1984; Rutter, Greenfield & Lockyer, 1967; Rutter, Mawhood & Howlin, 1992).
                        Treatment needs/response: no empirical studies demonstrating the need for different treatments or different responses to the same treatment, and in clinical practice the same interventions are typically offered.

Q.2. Does the existing research literature allow us to suggest new criteria to diagnose Asperger Disorder, in contrast to Autistic Disorder/ASD?
The current clinical and research consensus appears to be that Asperger disorder is part of the autism spectrum, although with possible over-use of the term it is quite likely that other (non-ASD) types of individuals have received this label.
Research field currently reflects two views:
                        That Asperger disorder is not substantially different from other forms of ‘high functioning’ autism (HFA); i.e. Asperger’s is the part of the autism spectrum with good formal language skills and good (at least Verbal) IQ. Note that ‘HFA’ is itself a vague term, with underspecification of the area of ‘high functioning’ (performance IQ, verbal IQ, adaptation, or symptom severity).
                        That Asperger disorder is distinct from other subgroups within the autism spectrum (see Matson & Wilkins, 2008, review): e.g. Klin, et al. (2005) suggest the lack of differentiating findings reflects the need for a more stringent approach, with a more nuanced view of onset patterns and early language (e.g. one-sided verbosity, unusual circumscribed interests).

2.1. What are the proposed differences? How strong is the evidence?
Several recent comprehensive reviews of the topic are available (Howlin, 2003; Macintosh & Dissanayake, 2004; Matson & Wilkins, 2008; Witwer & Lecavalier, 2008). Matson & Wilkins (2008) suggest current criteria could work if refined and supplemented. However, the research literature to date is not able to provide strong, replicated support for new or modified criteria likely to distinguish a meaningfully different group with Asperger disorder versus autism with good (current) language and IQ. Witwer and Lecavalier’s (2008) perhaps more comprehensive review concludes there is little evidence that Aspergers is distinct, and that current IQ is the main differentiating factor. Bennett et al’s (2008) follow-up study suggests that language impairment at 6-8years might have greater prognostic value than early language milestones, and Szatmari et al (2009) argue (on the basis of later developmental trajectory) for a distinction between ASD with (autism) versus without (Aspergers) structural language impairment at 6-8 years.
The draft criteria for ASD proposed by the Neurodevelopmental disorders workgroup would include dimensions of severity that include current language functioning and intellectual level/disability.

Q.3.  If Asperger disorder does not appear in DSM-V as a separate diagnostic category, how will  continuity and clarity be maintained for those with the diagnosis?
The aim of the draft criteria is that every person who has significant impairment in social-communication and RRBI should meet appropriate diagnostic criteria.  Language impairment/delay is not a necessary criterion for diagnosis of ASD, and thus anyone who shows the Asperger type pattern of good language and IQ but significantly impaired social-communication and repetitive/restricted behavior and interests, who might previously have been given the Asperger disorder diagnosis, should now meet criteria for ASD, and be described dimensionally. The workgroup aims to provide detailed symptom examples suitable for all ages and language levels, so that ASD will not be missed by clinicians in adults of average or superior IQ who are experiencing clinical levels of difficulty.
There may be some individuals with subclinical features of Asperger/ASD who seek out a diagnosis of ‘Asperger Disorder’ in order to understand themselves better (perhaps following an autism diagnosis in a relative), rather than because of clinical-level impairment in everyday life. While such a use of the term may be close to Hans Asperger’s reference to a personality type, it is outside the scope of DSM, which explicitly concerns clinically-significant and impairing disorders.  ‘Asperger-type’, like ‘Kanner-type’, may continue to be a useful shorthand for clinicians describing a constellation of features, or area of the multi-dimensional space defined by social/communication impairments, repetitive/restricted behaviour and interests, and IQ and language abilities.


3. New Proposed Diagnostic Criteria

Asperger’s Disorder
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1)  marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2)  failure to develop peer relationships appropriate to developmental level
(3)  a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4)  lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1)  encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2)  apparently inflexible adherence to specific, nonfunctional routines or rituals
(3)  stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4)  persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
F.    Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

GRASP
The Global and Regional Asperger Syndrome Partnership, Inc.
666 Broadway, Suite 830
New York, NY 10012
p + f = 1.888.474.7277
www.grasp.org

BMW

应该还是草案吧，好像要到2013年才定。

我看到很多成年AS对此很不爽，觉得一下子变成自闭，自我评价降了不少。

燕原

上面的 New Proposed Diagnostic Criteria 部分还是DSM-IV 中关于AS的诊断标准。
新的DSM-V的草案，提出完全去掉针对 PDD-NOS 和 AS 的单独诊断，一起都放在新的孤独症谱系诊断标准之下。

Here are the proposed criteria:
    Autism Spectrum Disorder
    Must meet criteria 1, 2, and 3:

    1.  Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following:
    a.  Marked deficits in nonverbal and verbal communication used for social interaction:
    b.  Lack of social reciprocity;
    c.  Failure to develop and maintain peer relationships appropriate to developmental level

    2.  Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following:
    a.  Stereotyped motor or verbal behaviors, or unusual sensory behaviors
    b.  Excessive adherence to routines and ritualized patterns of behavior
    c.  Restricted, fixated interests

    3.  Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

有评论员认为，按照这个新的孤独症谱系诊断标准草案，被诊断的儿童数目可能会越来越多。

DD妈

真的改了啊 .我个人还是认为AS单独分出来的好.就我的理解AS的生理跟症状的表现跟其它的ASD还是有很大不同的. AS这个标签还是有参考价值的.但是可能对很多父母来说会很好.因为很多州不给AS提供服务,这样一归入,就能得到应得的帮助了.

overgame

本人举双手表示同意合并同类项，西医就是太过细分了（我没有宣传中医贬低西医的意思，先声明），有时会视树木而不见森林。以后这样发展下去弄不好会统称SOCIAL DISORDER替代AUTISTIC（牛津英英字典就是难以和人交朋友的思维故障的疾患）

binfeng2000

Proposed Autism Diagnosis Changes Anger "Aspies"

Story Updated: Feb 13, 2010 at 12:45 PM CST

CHICAGO (AP) -- In the autism world, "Aspies" are sometimes seen as the elites, the ones who are socially awkward, yet academically gifted and who embrace their quirkiness.

Now, many Aspies, a nickname for people with Asperger's syndrome, are upset over a proposal they see as an attack on their identity. Under proposed changes to the most widely used diagnostic manual of mental illness, Asperger's syndrome would no longer be a separate diagnosis.

Instead, Asperger's and other forms of autism would be lumped together in a single "autism spectrum disorders" category. Some parents say they'd welcome the change, thinking it would eliminate confusion over autism's variations and perhaps lead to better educational services for affected kids.

But opponents - mostly older teens and adults with Asperger's - disagree.

Liane Holliday Willey, a Michigan author and self-described Aspie whose daughter also has Asperger's, fears Asperger's kids will be stigmatized by the autism label - or will go undiagnosed and get no services at all.

Grouping Aspies with people "who have language delays, need more self-care and have lower IQs, how in the world are we going to rise to what we can do?" Willey said.

Rebecca Rubinstein, 23, a graduate student from Massapequa, N.Y., says she "vehemently" opposes the proposal and will think of herself as someone with Asperger's no matter what.

Autism and Asperger's "mean such different things," she said.

Yes and no.

Both are classified as neurodevelopmental disorders. Autism has long been considered a disorder that can range from mild to severe. Asperger's symptoms can vary, but the condition is generally thought of as a mild form and since 1994 has had a separate category in psychiatrists' diagnostic manual. Both autism and Asperger's involve poor social skills, repetitive behavior or interests, and problems communicating. But unlike classic autism, Asperger's does not typically involve delays in mental development or speech.

The American Psychiatric Association's proposed revisions, announced Wednesday, involve autism and several other conditions. The suggested autism changes are based on research advances since 1994 showing little difference between mild autism and Asperger's. Evidence also suggests that doctors use the term loosely and disagree on what it means, according to psychiatrists urging the revisions.

A new autism spectrum category recognizes that "the symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders," said Dr. Edwin Cook, a University of Illinois at Chicago autism researcher and member of the APA work group proposing the changes.

The proposed revisions are posted online at http://www.DSM5.org for public comment, which will influence whether they are adopted. Publication of the updated manual is planned for May 2013.

Dr. Mina Dulcan, child and adolescent psychiatry chief at Chicago's Children's Memorial Hospital, said Aspies' opposition "is not really a medical question, it's an identity question."

"It would be just like if you were a student at MIT. You might not want to be lumped with somebody in the community college," said Dulcan who supports the diagnostic change.

"One of the characteristics of people with Asperger's is that they're very resistant to change," Dulcan added. The change "makes scientific sense. I'm sorry if it hurts people's feelings," she said.

Harold Doherty, a New Brunswick lawyer whose 13-year-old son has severe autism, opposes the proposed change for a different reason. He says the public perception of autism is skewed by success stories - the high-functioning "brainiac" kids who thrive despite their disability.

Doherty says people don't want to think about children like his son, Conor, who will never be able to function on his own. The revision would only skew the perception further, leading doctors and researchers to focus more on mild forms, he said.

It's not clear whether the change would affect autistic kids' access to special services.

But Kelli Gibson of Battle Creek, Mich., whose four sons have different forms of autism, thinks it would. She says the revision could make services now designated just for kids with an "autism" diagnosis available to less severely affected kids - including those with Asperger's and a variation called pervasive developmental disorder-not otherwise specified.

Also, Gibson said, she'd no longer have to use four different terms to describe her boys.

"Hallelujah! Let's just put them all in the same category and be done with it," Gibson said.

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