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Thursday, December 30, 2010

Asperger and the DSM

From National Public Radio:

In a small condo on the beach in San Diego lives Allen Frances, who blames himself for what he calls the "Epidemic of Asperger's." Frances edited the last edition of the DSM, and he's also the new DSM's most prominent critic.

Frances is the one who put the word Asperger's in the DSM in the first place, thereby making it an official mental disorder.

In the editions before Frances was editor, there was an entry for autism, but it was defined by severe symptoms. Frances says doctors felt the diagnosis for autism didn't cover a more mild disorder they were actually encountering.

"Pediatricians and child psychiatrists would see kids who could talk but who had social discomfort — severe social discomfort — and awkwardness and a very restricted and impairing level of interests and activities, and they wanted a diagnosis for this," Frances says.

A study was done to figure out how common Asperger's was, and the results were clear: It was vanishingly rare. Then Frances put it in the DSM, and the number of kids diagnosed with the disorder exploded. Frances remembers sitting in his condo reading articles about this new epidemic of Asperger's that was sweeping the nation.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, is the official list of all the mental disorders doctors can use to diagnose mental illness.

"At that point I did an 'oops,' " he says. "This is a complete misunderstanding. It was distressing. Quite distressing."

Kristina Chew responds:

While I do think Dr. Frances has a point about how the DSM criteria can be linked to changes in the rates at which a diagnosis is given, I really think it is inaccurate and, if I may say so, more than a bit insensitive to suggest that anyone seeks a diagnosis of Asperger's for a child with the sole desire to get a child 'into a special program.' As my own son Charlie is on the severer end of the autism spectrum, his diagnosis and the extent of his needs have rarely been in question. But too many of my friends who have a child with Asperger's or with PDD-NOS or 'mild' autism have had to struggle mightily and persistently to get their child the education and services he or she needs simply to get through a school day in one piece.