Asperger's was eliminated as a diagnosis because differentiating it from autism was hard to do. Two different evaluations could land a kid as either autistic or asperger's depending on the day and the evaluator.
And, importantly, Asperger's qualified for less therapies and treatment than autism did. That meant that even though your kid likely needed more treatment, they'd be denied it because they had a good day when being evaluated.
The crossover for treatment was largely the same with autism qualifying for more.
Even if it was the "Nazi link" they'd simply have changed the name to something more acceptable.
TFA is suggesting that there are probably multiple conditions which cluster around similar symptoms which makes it hard to identify the exact cause of autism.
The diagnostic reliability criteria even back then painted a picture of the details of the condition space being more nuanced than what were currently being captured, not less nuanced, so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. However, that decision remains defensible and supported by the social justice / equity / de-hierarchicalization / eponym erasure motivational drives. These, besides the eponym erasure specifically, also explain many of the other changes in the DSM-5, like the elimination of many other more-detailed diagnoses, like PDD-NOS.
This isn't to assert that the clinical reasoning offered didn't have merit, just that institutional consensus-forming behavior isn't immune to the macro backdrop of the sociopolitical winds of the day.
Committee member A thinks: "These diagnostic categories aren't reliable" (true, clinical concern)
Committee member B thinks: "Honoring Asperger is ethically uncomfortable" (true, historical concern)
Committee member C thinks: "Hierarchical categories are problematic" (true, equity concern)
Committee member D thinks: "Spectrum model reflects current research better" (true, scientific concern)
No single person needs a "primary political motivation." No conspiracy needed. No explicit coordination required. Yet the outcome eliminating Asperger's and collapsing categories - emerges from a system where:
- Progressive ideology shapes what problems become salient
- Shared epistemic frameworks determine what solutions seem natural
- Professional incentives reward what can be publicly justified
- Social proof operates through "everyone reasonable agrees"
"The clinical rationale was legitimate" doesn't contradict "political ideology shaped the outcome."
> so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint.
Again, it does not because the treatments as a result of diagnosis remain the same. The primary role of diagnosis is to inform treatment.
If patients are seeing worse outcomes because of arbitrary "nuance", that indicates that the nuance carved out wasn't what needed to be carved out.
> isn't immune to the macro backdrop of the sociopolitical winds of the day.
This is conspiracy thinking.
You don't have any evidence that it was "progressive ideology" that eliminated the diagnosis, you just surmise it based on some people not liking their diagnosis being named after a nazi.
Slamming in reactionary politics in where it doesn't fit and a reasonable explanation does fit is just silly.
Sure, nobody is immune from politics. But I'm going to need more than "feels, vibes, and makes sense to me" before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
Diagnoses for mental disorders, by their nature, are almost always going to have a level of arbitrary lines that could be drawn. That's why we have 5 versions of the DSM and will likely have a 6th in the future.
>before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
If empirical reliability of outcomes were based on social standing of the committee, you'd have a great point, but alas, there's a trending new paper on Nature explaining the precise mechanisms of how and why DSM-5's category elimination between Asperger's and ASD is a measurably less accurate approach than the DSM-4's categorical differentiation of the two conditions. TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
Regardless of your opinion on influence of the politics involved, the hard fact of the matter is that DSM-5 made moves in the exact opposite direction for increasing understanding of autism-family disorders relative to DSM-4, and some of the newest, most comprehensive empirical science ever done on the subject is trending on Nature right now stating exactly that: we need more categories, more nuance, more differentiation, not to paint everyone under one broad brush of "it's all a spectrum of the exact same underlying pathology".
It seems abundantly clear to me, and to I think anyone else who's had any amount of meaningful exposure to or working with both groups: nonverbal autism looks much more like profound, pervasive developmental disabilities - think down's syndrome - than Asperger's does. The latter has a bunch of people that can generously be called eclectic, but writ large, are generally capable of supporting themselves and leading independent lives: emotionally, financially, socially, mentally, physically, maybe with some therapy, some counseling, some CBT, and maybe reasonable workplace or school accommodations, like being allowed to wear noise-cancelling headphones during solitary work. The former, categorically, tend to not be capable of that level of independence. It seems facetious and absurd to allege on any level that these two groups are substantially or meaningfully similar, especially if such similarity is being used to justify a treatment approach that is as identical as you purport it to be. These are, very obviously, so obviously even a child could grasp it, at least two dramatically different groups, with at least two dramatically different sets of needs and courses of treatment.
I say that as someone who grew up with more or less all of the hallmarks of (and was indeed diagnosed with) what we used to call Asperger's Syndrome, but also as someone who volunteered at events like the local Special Olympics chapter, and I'm firmly in agreement with in_cahoots's chief concern: 'Today most of the money and advocacy is for high-performing or moderately-performing people with autism.'
There are a lot of people who need a lot more support than people like me, and those with that greater need are getting less of it than they need, because people with well-managed conditions like mine are being lumped in alongside people like in_cahoot's cousin who genuinely need much more support. These two groups are a difference of kind, not a difference in degree.
> TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
TFA explicitly says the opposite
> “The term ‘autism’ likely describes multiple conditions,” said Dr Varun Warrier, from Cambridge’s department of psychiatry, senior author of the research. “For the first time, we have found that earlier and later diagnosed autism have different underlying biological and developmental profiles.”
> The scientists are *not* advocating for a move towards two diagnostic categories, saying that this could be unhelpful for the many who fall somewhere in the middle.
> “It is a gradient,” said Warrier. “There are also many other factors that contribute to age of diagnosis, so the moment you go from averages to anything that is applicable to an individual, it’s false equivalency.”
The Nature article and the guardian article are both just saying that these are likely multiple genetic disorders with similar symptoms and treatments. Classifying and understanding them is useful valid research to do, nobody doing this research is suggesting that actually DSM 4 had it right.
These will split into different diagnoses if it's found that significant differences in treatments can yield better results. Otherwise, they are just going to call it autism. Much like, for example, we call uncontrolled tumor growth cancer even though it's really 1000 different diseases that all manifest the same way.
The study "speaks to the need to be a bit more fine-grained in our approaches to diagnosis" with subtypes rather than a single condition, as one of the authors put it, there. Additional context: https://www.scientificamerican.com/article/four-new-autism-s...
Nobody's making the argument that the DSM-4 had it right: the argument being made is that the DSM-5's direction of fewer categories and more generalization was the wrong direction, and going instead towards more categories and less generalization was and is the right direction for increasing understanding, treatment attempt outcomes, and greater efficiency in diagnosing and serving those with greater needs.
Do blind people and nearsighted people have the same treatment? Saying people with profound autism need the same treatment as people with autism commenting on Hacker News is patently absurd. Go ahead and try offering therapy and workplace accommodations to nonverbal people living in a residential home. You're proving my point for me, we've lost sight of these people.
Even with cancer- the diagnosis and treatment vary tremendously depending on what type of cancer you have, how far along it is, and more recently how your particular genome responds to that version of cancer and each version of treatment. We don't just say, "whoops you have cancer" and start chemotherapy on the targeted area. Your argument doesn't make any sense.
> Do blind people and nearsighted people have the same treatment?
Yes, they both need to see optometrists on a regular basis. They get the same therapy even though a blind person won't get glasses.
It's the same for autism. Someone with profound autism will still see occupational, behavior, and speech therapists. The therapy will be different from what someone with mild autism gets, but the specialists involved will largely be the same. The OT for someone with profound autism can be identical to mild autism because there are many different aspects. Profound autism simply means several aspects have severe problems.
That's my point.
Very similar to how with an oncologist you might have a specialist for your cancer but ultimately you deal with a team that often treat different cancers. For example, people to draw your blood and run labs.
That's why hospitals have an oncology department and not a lung cancer department.
They see the same people but definitely don't get the same treatment. The insurance codes are different and the body of research is different. Putting $1 of research into genetic blindness does nothing for preventing astigmatism, even though patients may go to the same doctor.
Saying that everyone who goes to a therapist, or an oncologist gets the same treatment and therefore should be lumped together is absurd. Most other specialties are moving toward taxonomic differentiation, not away from it.
Asperger's was eliminated as a diagnosis because differentiating it from autism was hard to do. Two different evaluations could land a kid as either autistic or asperger's depending on the day and the evaluator.
And, importantly, Asperger's qualified for less therapies and treatment than autism did. That meant that even though your kid likely needed more treatment, they'd be denied it because they had a good day when being evaluated.
The crossover for treatment was largely the same with autism qualifying for more.
Even if it was the "Nazi link" they'd simply have changed the name to something more acceptable.
TFA is suggesting that there are probably multiple conditions which cluster around similar symptoms which makes it hard to identify the exact cause of autism.