A few of us have posted many times how we believe how the DSM-IV transitioned AS into ASD with the DSM-V was heavily influenced through the development of the Affordable Care Act. A political and fiscal decision- not a medical decision.
Where politicians and insurers set out to blur neurodiversity to the point where it is more difficult to seek both help and/or government entitlements to primarily reduce costs.
Now that the ACA appears to be on the verge of being repealed in whole or in part, I can't help but wonder if there will eventually be yet another revision of what presently constitutes ASD. Of course if this happens, the question becomes whether this process will get even worse, or better. I can't say I'm optimistic about this myself.
Are you saying they have made the 'symptoms' more severe (e.g., so that less people qualify for them? i.e., Aspergers don't stand a change of getting help but autistic people do? Below I have set out possible reasons for the change in the DSM (collapsing Asperger Syndrome into autism in 2013).
Possible clinical reasons for subsuming AS into autism
1. The belief that ‘quantitative’ diagnosis is more accurate than ‘qualitative’?
Trying to capture different levels (quantities) of severity of the condition, at the expense of capturing different qualities, is disingenuous. The reason is that experts and clinicians, no less than lay people, diagnose mental conditions using labels, stereotypes and images in their minds rather than theories and lists of necessary-and-sufficient conditions (‘quantitative factors’). Perhaps the DSM wants to move towards biological evidence for psychopathologies and autism conforms to this ‘medicalising’ model to a greater extent than does Asperger Syndrome?
2. To ensure that Asperger individuals obtain support?
Asperger Syndrome may have been collapsed into the diagnostic category ‘autism’ to provide support for Asperger individuals who otherwise would not have the same support as a classic autistic but still need it. But then this raises the question of why AS wasn’t simply left in the DSM as it was before: ‘Asperger disorder’.
Just as society was starting to understand that ‘being on the autistic spectrum’ is not necessarily correlated with ‘low IQ’, we are back to associating Asperger’s with autism and pervasive learning difficulties. Removing Asperger’s from the DSM has arguably set us back decades in terms of autism accuracy – especially when ever more accounts are coming out, giving us an increasingly accurate, nuanced understanding of all the manifestations of Aspergers. Could there be political, rather than clinical, processes at work in the changes to the DSM-5 regarding ASD?
Possible political reasons for subsuming AS into autism
1. To drum up custom? (Were too few being diagnosed?)
The cynic might wonder whether DSM clinicians ‘converted’ the less-severe ‘Asperger disorder’ label into the ‘more severe’ autism because Asperger Syndrome was not severe enough for their clinical attention. Seeing Asperger’s becoming ‘de-pathologised’, they may have sought to expand their client base by calling everyone with social eccentricities ‘disordered’ (autistic). Unless the condition is medicalised (that is, appears in the DSM of mental disorders), psychiatrists in the US cannot charge fees . Thus, medicalising Asperger’s by calling it autism may have a financial incentive in that it could ensure ongoing work and professional advancement for psychiatrists. Again, this raises the question of why it couldn’t just remain medicalised as ‘Asperger disorder’ in the DSM.
2. To save money? (Were too many being diagnosed?)
A contrary possible political motivation for excising Asperger Syndrome from the DSM is to save money. Those with an average or high IQ cannot be diagnosed as autistic; they are therefore not eligible for support as an adult, such as financial subsidisation to pay for a community college course. Due to limited resources, only severe cases can obtain support, and organisations prefer to focus on individuals who have the most difficulty in dealing with life. Equating ASD with ‘low IQ’ could be a convenient way out of paying for those who are Asperger’s.
It is possible that ‘too many’ people were being diagnosed with Asperger Syndrome, particularly in the mid to late 2000s. By making the only available label ‘autism’, many may think twice about getting a diagnosis because of the social stigma it entails, which may exclude them from certain kinds of work. Since fewer people will now get an autism diagnosis, resources will be conserved.
3. To simplify things administratively?
The change in the DSM may also have been implemented to bypass the complexity of spectrum conditions. That is, to pander to society’s appetite for unequivocal, unnuanced, black-and-white messages that can compete against the cacophony of media culture. Thus, it is simpler to educate ‘the masses’ about ‘autism’ than about all the nuances in the characteristics comprising Asperger Syndrome. The label ‘autism’ is an easy catch-all phrase sanctioning medical solutions for ‘problem people’.
A more accurate stance would be to hold two contradictory ideas in mind at once: (1) that Aspergers can be ignorant about basic matters yet brilliant at complex tasks for which the majority lacks skills; (2) that Aspergers are not disabled yet they may be more suited to part-time work than full-time work. On the other hand, Aspergers may have no trouble with full-time work if they are self-employed. It is the social exposure and politics that makes full-time employment outside of the home taxing for Aspergers. Hopefully high-achieving Aspergers can help to change the stereotype of associating ‘autistic spectrum’ with ‘low IQ’ so that those who are marginalised in society are not automatically assumed to be intellectually deficient, and are not deemed unworthy of support simply because they have average-to-high IQs.
