What’s in a Name?: Autism Subtyping in DSM-5

Recently, there appeared an article in the Journal of Autism and Developmental Disorders on why autism should be taken apart. I have not read the article yet – going to do so after I’ve had a good night’s sleep -, but I have read Harold Doherty’s comments on it. They follow the usual autism awareness rhetoric: my child is not like autistic advocates and therefore autism must be taken apart. And oh by the way, the DSM-5 is bad for calling the entire spectrum by the same name.

Let’s focus on that last bit. I own a copy of the DSM-5, and in the criteria for autism spectrum disorder, there are specifiers for:

  • With/without accompanying intellectual impairment.

  • With/without accompanying language impairment.

  • Associated with a known medical or genetic condition.

  • Associated with another neurodevelopmental, behavioral or mental disorder.

Furthermore, most people in the autism community know this, but there are three severity levels with coding of severity on each of the two symptom domains: social communicative impairments and repetitive behaviors.

Let’s contrast this with the DM-IV, which people like for its distinciton between Asperger’s Syndrome and autistic disorder. Anyone who has a communicative impairment, which could be just being unable to hold a conversation, and meets the criteria for Asperge’rs, could be labeled with autistic disorder. In fact, many of the autistic advocates Doherty and others disagree with, have an autistic disorder diagnosis. In terms of severity, also, the DSM-IV is pretty rigid in its focus: you only get the GAF scale, which determines a patient’s global level of functioning. I have a GAF score of 40, which means severe impairment in severeal areas of functioning. It is not stated whether this severe impairment is due to my autism or my borderline personality disorder or even due to the many labels I have on axis III (general medical conditions) and IV (psychosocial functioning).

I am not against subtyping of autism. In fact, I completely see how intellectual disability, language impairmetn, associated medical conditons such as epilepsy, etc., make a huge difference in an autistic person’s functioning. What I am completely against is the dichotomous taking apart of autism that Doherty etc. so often advocaate, where you eithr have Asperger’s (ie. social ineptness) or you have low-fuctioning, severe, classic autism. This dichotomy means that people who have severe impairments in self-care skills but, say, an IQ above 70 and no language impairmetns, are denied services on the basis of being merely socially inept. I don’t need to go into the consequences of this.

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