Practical effects of proposed ASD diagnosis

I understand that the upcoming version of the diagnostic manual is expected to eliminated the Asperger's and PDD-NOS diagnoses in favor of a general ASD diagnosis. I also understand the scientific reasoning behind this change (i.e., it's a spectrum disorder with no objective demarcation between the current diagnoses). What is concerning me is that, absent a medical definition of the degree of impairment, schools are going to be free to set their own definitions in terms of who qualifies for services.

We're only now approaching the point where most districts recognize an Asperger's diagnosis (a "mild" form of autism) and use it as a qualification for access to autism services. Left to their own devices, I'm concerned that schools will set their own standards--perhaps based on something like GAD scores--to define the difference between children on the "severe" end of the spectrum, versus children on the "mild" end of the spectrum, and conveniently exclude a lot of "mild" (Asperger's) cases who are currently receiving services. I think we're likely to find ourselves back in the days before Asperger's was a widely recognized diagnosis, when children with less severe cases of autism didn't qualify for autism services.

The counter argument would probably be that that won't happen because all children with autism with have the same diagnosis.

However, in a situation where distinctions have to be made (i.e., children with classical autism require a different level of services than children with Asperger's), I am uncomfortable leaving the schools with such a big loophole. Currently the, admittedly rough, determination of severity (which winds up driving the level of educational services) is in medical hands. I fear that we're handing that determination over to the schools--who often have a vested financial interest in preventing access to services.

I think the desire to be more "scientific" about the diagnostic process--in the absence of medically defined degrees of impact, which are not yet available--is going to have undesirable practical implications.

Does anyone know if the people who are currently revising the diagnostic criteria are sensitive to this issue?

Sue

Hi Sue.

I think many parents, teachers, and others are concerned about this issue, and I suspect that a very proactive stance as the DSM-V takes effect and policies began to be made is going to be necessary.

I know one of the people in the group working on the autism section of the DSM-V, and he said "the available science doesn't support the existence of Asperger separate from high functioning autism," but that the team is aware of the concerns people are voicing about how various clinical or educational systems may interpret new guidelines. He encourages parents and others to offer their comments and concerns on the DSM-V website, here: http://www.dsm5.org/Pages/Default.aspx

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They are accepting comments through April 20, 2010.