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The Effects of Removing Asperger Syndrome from the DSM

Asperger syndrome has been popularized recently by notable, and uniquely lovable, television characters like The Big Bang Theory’s Sheldon Cooper and Community’s Abed Nadir, who many viewers have diagnosed with the condition from their living rooms.

But the American Psychiatric Association recently removed Asperger from its manual for diagnosing and treating the condition.

Asperger syndrome is now grouped with Autism Spectrum Disorder (ASD) in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was published in 2013. The DSM, often called “the Bible of psychiatry”, is significant because it determines the level of treatment that insurance companies will cover.

"It shapes who will receive what treatment," said Dr. Mark Olfson, a Columbia University psychiatry professor told CBS News. "Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

People who have difficulty carrying a normal conversation, noticing nonverbal communication and display repetitive behavioral habits can be diagnosed with Autism Spectrum Disorder (ASD) under the new system. The DSM lays out three levels of ASD within the spectrum based on the severity of impairment.

Asperger is now considered a high-functioning level of ASD

It is most typically characterized by limited social interactions, a tendency to have one-sided conversations and a lack of eye contact, according to Autism Speaks, an advocacy group for Autism. These symptoms often come with intellectual gifts like an exceptional memory and academic skills.

Some people with Asperger oppose the new criteria because of how will affect the public’s perception of their disorder.

“The label of Asperger at least gives observers the impression of intelligence and ability. But, when most people think of “autism,” they think of someone who should be institutionalized and cannot live independently,” said Hanna Fjeldsted, a young adult with Asperger in a 2010 article about the change. “Therefore, if people with Asperger are merged under the autistic group, brilliantly gifted and capable individuals could be unfairly stereotyped as incapable and unprofitable.”

The change may hurt some people with Asperger, but the psychiatrists who create the DSM believe it will lead to more accurate diagnoses.

Despite multiple studies on the matter, there is no consensus about whether the new DSM criteria will lead to an increase or decrease in Autism diagnoses. A 2012 study in the American Journal of Psychiatry found that most children who received diagnoses under the old DSM will still be eligible under the new standards. A separate study in the Journal of the American Academy of Child & Adolescent Psychiatry found that 75 percent of people with Asperger would no longer qualify under the new standards.

Some experts think that the real issue is that schools will use the new diagnosis as a loophole to avoid individualized education programs, which are mandated by federal law. People with Asperger could miss out on useful treatment programs if bureaucrats decide to redistribute funding based on the new DSM.

More time and research is needed to determine if the new DSM classification is beneficial for people with ASD. The shift could lead to more objective and accurate diagnoses for people who can benefit from treatment. Or it could leave a significant number of people with Asperger untreated.  If the change turns out to be harmful, it could have long-term consequences. The DSM had not been updated in almost 20 years before the newest edition.

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