The of autism (Autism Society, 2015). Asperger’s

The Diagnostic Statistical Manual of
Mental disorders published by the American Psychiatric Association was created
to help physician’s diagnosis symptoms of mental health disorders. From the
creation of the first edition in 1952, there have been four revised editions created
to encompass new research in the field (American Psychiatric Association, n.d).
However updated versions of the DSM have been shown to cause apprehension
amongst physicians and patients due to the instability of diagnostic criteria.
Asperger’s spectrum disorder is one example of a mental disorder of which has
undergone diagnostic changes amongst the DSM-IV and DSM-V. The removal of
Asperger’s Syndrome as a distinct disorder from the DSM-V has caused controversial
uproar amongst physicians and patients alike (Mayes et al., 2001). The
controversial issues will be explored and addressed in this paper.

 

Asperger’s syndrome was first outlined by
pediatrician, Hans Asperger during the 1940s through an experiment involving
the observation of boys with normal cognitive aptitude. He formed the
conclusion that the behaviors and social communication skills of the young boys
were in accordance with that of autism (Autism Society, 2015). Asperger’s
syndrome is a developmental disorder characterized by social impairments and
intensive limited interests and activities without significant impairment and
cognitive deficit (Kaland, 2011). At the same time individuals with Asperger’s
are shown to have average or above average IQ, a wide vocabulary and good
grammar but possess a tendency to us speech in non-social ways (Kite, Gullifer
& Graham, 2013). Though many viewed Asperger’s disorders as a higher
functioning level of autism, its was added to the DSM in 1994 as a distinct
condition (Autism Society, 2015).

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The
diagnostic characteristics of Asperger’s Syndrome vary between the DSM-IV and
the DSM-V. The DSM-IV
contained a more explicit and expanded diagnostic criteria for identifying
symptoms and deficits of multiple disorders. Asperger’s disorder was included
in the DSM-IV as a result of numerous studies in which physicians viewed the
diagnosis of Asperger’s differed from autism and pervasive developmental
disorder in important ways (Volkmar et al., 1994). In particular, the
DSM-IV outlines the defining features of Asperger’s disorder as a qualitative
impairment of social communication, interactions and the development of
restricted repetitive patterns of behavior, interests and activity (Autism Society,
2015). The impairment must show significant negative effect in social,
occupational and other forms of functioning. However, it is not associated with delays in language or
cognitive development as well as adaptive behavior and general curiosity (Autism
Society, 2015). The age of
onset was determined to be before 3 years (Kite,
Gullifer and Granham, 2013). The DSM-IV requires the
possession of six or more symptoms for the diagnosis of Asperger’s disorder and
a diagnosis can only be made dependent on present
conditions as it determine the patient’s needs. In order to be diagnosed with Asperger’s
disorder, established criteria cannot overlap that of Pervasive Developmental
Disorder or Schizophrenia.

In contrast there have been many
modifications made between the DSM-IV and the DSM-V. The DSM-V removed the
categorization of individual disorders and implements an integrated approach.
In specific, it allocates Asperger’s syndrome as well as autistic disorder and
pervasive developmental disorder under the broad category of autism spectrum
disorder (Beighley et al., 2013). Autism spectrum disorder is a new
condition and is characterized by reduced social communication, social
interaction and restricted and repetitive behaviors, interests and activities (Beighley et al., 2013).
The previous DSM-IV contained a three symptom classification while the new DSM-V
has merged social communication and social interaction into one symptom
category with associated deficits. The second category consisted of restricted
repetitive behaviors (Young & Rodi, 2013). To differentiate the multiple
disorders that underlie autism spectrum disorder, it is qualified across three
severity levels. They range from slight impairment requiring support to severe
impairment requiring very substantial support (Beighley
et al., 2013).  Another alterations in diagnosis of
Asperger’s amongst the DSM-V is the classification that symptoms must exist
during early development stages as opposed to a specific age (American Psychiatric
Association, n.d).  In accordance, this
was accompanied by age requirements for the diagnosis of autism spectrum
disorder. Alterations of the criteria in the all the DSM over time have
coincided with an increase in prevalence of the diagnosis autism spectrum
disorder (Newsome, 2016). All things considered, alterations to the DSM are due
to the constant development of knowledge concerning the disorder, which
contributes to a more accurate diagnostic criteria (Newsome, 2016).

 

Since Asperger’s syndrome was induced
into the DSM-IV, there has been a growing debate on whether it is a separate
condition or simply a high functioning form of autism. Many studies have failed
to show a distinction between Asperger’s syndrome and autism (Macintosh and Dissanyake 2004). In agreement, evidence put forward that
Asperger’s consists of the same underlying etiology thus providing reason to
classify it as one disorder with a basis if severity rather than type (Young
& Rodi, 2014). Moreover, the higher than expected familial occurrence of
Asperger’s disorder and autism points to the possibility of genetic similarity (Bishop et al. 2004).

 

Asperger’s syndrome draws parallel to autism
disorder in that they are both characterized by similar behaviors and social
communication deficits. Conversely, they are separated by functioning ability
in which Asperger’s patients score higher (Autism Society, 2015). In specific,
the DSM-IV differentiates Asperger’s syndrome from autism through three
criteria. Firstly, the communication portion lacks diagnostic criteria.
Secondly, the age of onset for the disorder is not required to be 3 years.
Thirdly, additional supporting criteria involve harmful dysfunction, lack and
deficit of cognitive development and language delay (Mcparthland, 2012).  In contrast, the DSM-V syndicates Asperger’s
syndrome and autism as one disorder and separates them by degree of severity.

 

The removal of Asperger’s syndrome as a
separate disorder from the DMS-V was a controversial issue. There is some
support for the revision, indicating that it will lead to more clear and
reliable standards of Asperger’s Syndrome (Lai et al., 2013). Though, the ­­­­­­­­experts
behind the change to the DSM have defended their alteration, there is still a
debate as to whether it is a beneficial change (Newsome, 2016). A study
analyzing the perspectives of healthcare professionals and teachers on the
disparity between Asperger’s Syndrome and Autism found that 97% of the
participants believed that they were distinct (Kite, Gullifer & Graham,
2013). This highlights the notion that there should be two individual diagnoses
for each disorder to prevent the misdiagnosis of an individual under a larger
umbrella disorder that might not fully characterize them (Wing et al., 2011).

 

Considering the DSM-V was recently
published in 2013, a complete evaluation on the benefits and ramifications of
the alteration has yet to be concluded (Newsome, 2016). It has been proposed
that diagnosed populations could change, as well as the symptom description (Dobson,
2014). Studies that have been conducted have found the amendment to leave
individuals that are already diagnosed with the disorder vulnerable to
exclusion (Beighley et al., 2013). This could result in the devastating denial
of services for which they are dependent on. 
In a grand scheme, the projective rates of Autism diagnosis under the
new criteria of the DSM-V could be positive or negative dependent on whether
the individuals are acknowledged by the criteria. These individuals include the
significant amount of higher functioning Asperger’s patients (Lai et al.,
2013). The inability to meet the criteria requirements could result in an
increased stigma for previously diagnosed Asperger’s individuals. These
individuals will be seen in a more positive light than Autistic individuals as
well as an increased diagnostic label for individuals with Asperger’s who were
previously under diagnosed (Kite, Gullifer & Graham, 2013). McPartland,
Reichow, and Volkmar (2012) estimated that 39.4% of previously diagnosed
Asperger’s patients would not qualify under the new criteria mostly due to the
failure to satisfy the three criteria for social communication domain.  A
study conducted by Young and Rodi (2014) revealed the three social communication
criteria were not satisfied because the individuals had intact nonverbal
behaviors, reduced impairments in developing and maintenance of relationships.
Likewise, 56% of the individuals assessed only satisfied two of the four
repetitive and ritualistic patterns of interests, behaviors or activities
(Young & Rodi, 2014).

 

            One
of the most at risk populations are children, who are at risk of be excluded in
the new criterion ­due to the less distinctive approach to communication and
social-emotional symptoms (Grant and Nozyce, 2013). This would result in the
termination of any treatment they were previously receiving resulting in
ambiguity regarding their health. 
Interestingly, Mayes, Calhoun and Crites (2001) conducted a study before
the revision of the DSM-IV and recommended a better differentiation between
Asperger’s Syndrome and Autism for better diagnosis and treatment.  It was surprise when it was removed as a
definite disorder.

 

Many believe the DSM-V should maintain
the previous subgroups that place an individual along the autism spectrum. In
support, the addition of diagnostic criteria for Asperger’s disorder would be
more effective (Wing et al., 2011).  This
view is supported by Dr. Volkmar; the primary contributor to the Pervasive
Developmental Disorder section of the DSM-IV viewed the removal of Asperger’s
extreme action that would affect individuals who have pre-existing
identification with the disorder (Dobson, 2014). These individuals could
experience an increase incidence of depression, a comorbidity of Asperger’s
Syndrome, due to the loss of diagnosis. Predictions of the possible effects of
the DSM-IV cannot be confirmed until it is fully implemented and sufficient
research is conducted (Buxbaum & Baron-Cohen, 2013).

 

As the body of research on Asperger’s syndrome
grows, so do our understanding and the possibility of ongoing updates and
refinements to the diagnostic system. Though the changes made to the DSM-V
have not been widely accepted and are subject to many controversial issues, the
goal was to create a more reliable method of diagnosing individuals who would
benefit from autism spectrum disorder treatment. The authors believe the DSM
should not cause individuals to loser their current diagnosis and treatment. All in all, the publications regarding this controversy agree on
the importance of accurately identifying individuals with
Asperger’s syndrome is of great importance especially considering the
increasing prevalence, familial and societal effects, and importance of early
prognosis.