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Why fold Asperger syndrome into autism spectrum disorder in the DSM-5?

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Francesca Happe
29 March 2011

Updated guidelines: Asperger syndrome, autism and pervasive developmental disorder not otherwise specified will be combined into one diagnosis — autism spectrum disorder — in the new DSM-5.

Draft criteria for the new edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due in 2013, have aroused high emotions, particularly in the case of Asperger syndrome.

In 1994, the association first introduced 'Asperger disorder' as a diagnostic category in the DSM-IV, the current edition of the manual, and distinguished it from 'autistic disorder' by a lack of significant delay in language and general cognition. The term Asperger syndrome has become popular, and there has been a great deal of research comparing those with this diagnosis to those with autism.

Why then do we in the DSM-5 Neurodevelopmental Disorders Workgroup suggest folding Asperger syndrome — along with pervasive developmental disorder — not otherwise specified (PDD-NOS) — into a new category of 'autism spectrum disorder?' Our aim is to acknowledge the widespread consensus that Asperger syndrome is part of the autism spectrum, to clean up a currently hard-to-implement and contradictory diagnostic schema, and to do away with distinctions that are made idiosyncratically and unreliably across different diagnostic centers and clinicians.

Range of autism:

First, we propose the term autism spectrum disorder because there is widespread agreement that autism is a spectrum that varies among different individuals and even within individuals during their lifetime. It is particularly variable among individuals with different intellectual levels or language abilities.

There have been many attempts to define subgroups within this heterogeneous spectrum. But a key question is whether there are meaningful differences between Asperger syndrome and high-functioning autism, loosely used to describe individuals with good current language and IQ in the average range despite earlier delays.

There has been no shortage of studies on this topic, along with some helpful recent reviews1. However, to date there is not a robust, replicated body of evidence to support the diagnostic distinction.

Individuals on the autism spectrum who meet expected language milestones in the first three years of life have the same outcome in adolescence and adulthood as those who are significantly delayed in early language — if one compares groups of the same developmental level or IQ2,3. There is also no evidence of different response to treatment or of a distinct cause in Asperger syndrome versus high-functioning autism.

Is the profile of abilities and difficulties on cognitive tests different in the two groups? To date, studies have both supported and refuted distinctions between Asperger syndrome and high-functioning autism on the basis of, for example, verbal-performance IQ pattern3,4, clumsiness5,6, theory of mind abilities3,7, or executive functions8,9.

What is well established is that an individual's current levels of intellectual ability and language have an enormous impact on his or her ability to function, and dictate the types of intervention that may be appropriate. Should Asperger syndrome be re-defined as "autism without accompanying intellectual or language deficits"? This is fine descriptively but makes no sense in terms of diagnosis; neither intellectual disability nor language impairment are part of the definition of autism, so people with autism can vary freely on these two dimensions.

Clinical confusion:

Second, the criteria for Asperger syndrome in the DSM-IV are flawed and hard to implement in practice, as highlighted by a number of researchers10,11,12. At least two problems exist: It is often difficult to establish whether single words were spoken before age 2 and phrases by age 3, as required for the Asperger diagnosis. Individuals receiving this diagnosis typically come into the clinic in middle childhood or later, and parental memory may be understandably vague. For the increasing number of people diagnosed in adulthood, the issue is even more problematic.

The other major problem with applying the current DSM Asperger criteria comes from the precedence rule: diagnose Asperger disorder only if the individual doesn't meet criteria for autistic disorder.

The Asperger diagnosis is distinguished from autism by a lack of language and cognitive delay. However, language and cognitive delay are not diagnostic criteria for autism. So, to fail to meet criteria for autism, a person with Asperger syndrome must not show the communication impairments specified for autism. Since these include "marked impairment in the ability to initiate or sustain a conversation," most — if not all — people with Asperger syndrome do meet diagnostic criteria for autism.

As a result of these problems, the Asperger diagnosis is often given when, according to DSM-IV criteria, the diagnosis should be autism. A study that examined more than 300 pervasive developmental diagnoses from a survey of more than 400 clinicians shows that almost half the young people receiving Asperger or PDD-NOS labels in fact met DSM-IV criteria for autistic disorder13.

Because the current criteria are hard to apply, different places use the term Asperger disorder differently, and inconsistently. A forthcoming study shows that the best predictor of whether someone receives the diagnosis of Asperger syndrome, PDD-NOS or autism, is which clinic they go to — rather than any characteristics of the individuals themselves14.

Although Asperger syndrome, PDD-NOS and autism are not well distinguished in clinical practice, the same study suggests that the broader distinction between autism spectrum versus not is made with good agreement and reliability.

This is an important factor in the workgroup's proposal to subsume Asperger syndrome and PDD-NOS into the new category of autism spectrum disorder. The plan is to stop trying to 'carve meatloaf at the joints' and instead attempt to individualize diagnosis, while also recognizing the essential shared features of the autism spectrum.

Allowing for individuality:

Third, the intention of the DSM-5 is not to blur important boundaries among groups, but to ensure that individuals are described in terms of their specific pattern of needs, rather than fitting them into narrow categories that they do not really match.

The difficulty clinicians currently experience with trying to squeeze individuals on the autism spectrum into exact categories is perhaps reflected in the fact that the diagnosis of PDD-NOS is far more commonly given than autistic disorder15.

Instead, the DSM-5 plans to take a dimensional, as well as categorical, approach. So accompanying a diagnosis of autism spectrum disorder will be a complementary and comprehensive description of the individual's symptoms and strengths or impairments. For example, a doctor might describe a young person as showing social and communication difficulties requiring very substantial support, but restricted or repetitive behavior that requires much less support.

An individualized, dimensional approach should ensure that the individual's level of impairment — including accompanying intellectual or language difficulties, mood disorder or motor or sleep problems, and so on — is identified and well documented.

A major concern for the workgroup is that no individual currently diagnosed with Asperger syndrome or PDD-NOS who needs support should lose that support because of this change. We are striving to ensure that the new criteria for autism spectrum disorder — and the examples in the accompanying text — are thoughtful and thorough, taking into account the full range of manifestations across all ages and developmental or intellectual levels.

It is our intention that all individuals with clinical levels of social-communicative impairment and restricted, repetitive behaviour will meet criteria for autism spectrum disorder and their individual levels of intellectual and language functioning will be noted alongside this diagnosis.

We hope that the DSM-5 will be a clearer and simpler diagnostic system for those with autism spectrum disorders. The Asperger disorder category in the DSM-IV did a great service in raising awareness that some people on the autism spectrum have high IQ and good language. It is time to reintegrate Asperger syndrome with the rest of the spectrum, and to demand the same level of respect and lack of stigma for individuals across the full range of the spectrum.

Francesca Happé is professor of cognitive neuroscience at the MRC Social, Genetic and Developmental Psychiatry Centre, King's College London and a member of the American Psychiatric Association's Neurodevelopmental Disorders Work Group.

References:

  1. Witwer A.N. and L. Lecavalier J. Autism Dev. Disord. 38, 1611–1624 (2008) PubMed

  2. Howlin P. J. Autism Dev. Disord. 33, 3–13 (2003) PubMed

  3. Ozonoff S. et al. Autism 4, 29–46 (2000) Abstract

  4. Klin A. et al. J. Child Psychol. Psychiatry 36, 1127–1140 (1995) PubMed

  5. Rinehart N.J. et al. Autism 10, 70–85 (2006a) PubMed

  6. Thede L.L. and F.L. Coolidge J. Autism Dev. Disord. 37, 847-54 (2007) PubMed

  7. Barbaro J. and C. Dissanayake J. Autism Dev. Disord. 37, 1235-46 (2007) PubMed

  8. Rinehart N.J. et al. Eur. Child Adolesc. Psychiatry 15, 256–64 (2006b) PubMed

  9. Verte S. et al. J. Autism Dev. Disord. 36, 351–372 (2006) PubMed

  10. Mayes S.D. et al. J. Abnorm. Child Psychol. 29, 263–271 (2001) PubMed

  11. Miller, J. N. and S. Ozonoff J. Abnorm. Psychol. 109, 227–238 (2000) PubMed

  12. Leekam, S. et al. Autism 4, 11–28 (2000) Abstract

  13. Williams, K. et al. J. Paediatr. Child Health 44, 108-113 (2008) PubMed

  14. Lord, C. et al. Submitted (2011)

  15. Chakrabarti, S. and E. Fombonne Am. J. Psychiatry 285, 3093–9 (2001) PubMed

Comments

Name: Michelle Dawson
30 March 2011 - 4:51AM

I agree that the political arguments over removing Asperger's arise only because of how negatively, and wrongly, autistics have been portrayed.

But in my view things are more interesting at a research level.

On one hand, there's the rush towards ever earlier autism detection and intervention, on the assumption that early development is critical and should be as typical--as un-delayed--as possible.

Now on the other hand, there's the DSM-5, which says that for autistics, a lot of early development doesn't really matter. You start speaking at 12 months or at 5yrs, this in itself doesn't matter for outcomes or anything else. You do or don't have delays in basic abilities? Doesn't matter.

Name: Henry Dunn
30 March 2011 - 7:19AM

I coordinate the Autistic Spectrum Conditions Network for the Association for Professional Music Therapists. I feel, along with Ros Blackburn, that high functioning autism and Aspergers are very different. People with the former often have the stereotypical movements associated with autism, whereas people with Asperger's usually don't. Also people with Aspergers, in my experience, are keen to form relationships but don't understand the "rules of engagement". This can cause immense frustration for them. People with high functioning autism on the other hand appear less motivated to form relationships. Obviously this is a generalisation and there are exceptions, but it is the case often enough to suggest significant differences. A lot of people with Aspergers are very attached to that label, as it gives them a sense of community and a way of understanding themselves. As Simon Baron-Cohen recently warned, take away the diagnosis and you take away people's identity.

Name: RAJensen
30 March 2011 - 8:21AM

Dr Happe conducts studies of twins recruited from the Teds Early Development Study one of the largest twin registries in the world. Dr. Happe has written that among general population twins 'Around 10% of all children showed only social impairment, only communicative dificulties or only rigid and repetitive interests and behavior, and these problems appear to be at a level of severity comparable to that found in children with diagnosed ASD in our sample'.

Is Dr. Happe overdiagnosing autism? In the early 1960's Leo Kanner joined Van Krevelan in vigirously objecting to the 'abuse of the diagnosis of autism' that 'threatens to become a fashion':

“While the majority of the Europeans were satisfied with a sharp delineation of infantile autism as an illness sui generis, there was a tendency in this country to view it as a developmental anomaly ascribed exclusively to maternal emotional determinants. Moreover, it became a habit to dilute the original concept of infantile autism by diagnosing it in many disparate conditions which show one or another isolated symptom found as a part feature of the overall syndrome. Almost overnight, the country seemed to be populated by a multitude of autistic children, and somehow this trend became noticeable overseas as well. Mentally defective children who displayed bizarre behavior were promptly labeled autistic” ( Kanner 1965).

In the same paper Kanner also wrote:

'To complicate things further, Crewel, in the hope of avoiding confusion between true autism and other conditions with autistic-like features, suggested the term pseudo-autism for the latter. Even this term came to be employed haphazardly, and conditions variously described as hospitalism, anaclitic depression, and separation anxiety were put under the heading of pseudo-autism'.

In 2007 Rutter et al in describing children who suffered severe insitutional deprivation in Romanian orphanges who met diagnostic criteria for an ASD using ADI-R and ADOS coined another term 'Quasi-autism' reminiscent of Crewel's use of the lable 'Pseudo Autism'.

The trend among genetic epidemiologists such as Dr. Happe is to stretch the boundaries of 'autism' defintion almost to the point of meaninglessness.

If you thow out too wide a net you catch all the wrong kinds of fish. The further broadening of 'autism spectrum disorders' may lead to another spike in the so-called 'autism epidemic'.

REFERENCES
Kanner L. Infantile autism and the schizophrenias. Behav Sci. 1965 Oct;10(4):412-20.

http://neurodiversity.com/library_kanner_1965.html

Rutter M, Kreppner J, Croft C, Murin M, Colvert E et al. Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III Quasi-autism. J Child Psychol Psychiatry. 2007 Dec;48(12):1200-7.

http://www.ncbi.nlm.nih.gov/pubmed/18093025

Ronald A, Happe F, Bolton P, Butcher LM, Price TS et al. Time to give up on a single explanation for autism. J Am Acad Child Adolesc Psychiatry. 2006 Jun;45(6):691-9

http://www.psyc.bbk.ac.uk/research/DNL/personalpages/HappeRonaldPlomin.pdf

Name: Penelope Main
31 March 2011 - 8:01PM

My concern is that using the proposed DSMV criteria many women with high functioning forms of autism will be misdiagnosed as having borderline personality disorder

Name: Hannah J Capps
9 February 2012 - 2:10AM

I second this, women are as it is misdiagnosed or the bulls eye isn't hit... ...I would like to thank David Kupfer, M.D. for responding to the two emails I've sent along to your office, it did help bring some semblance of peace of mind...For my own sake as well as other females on the spectrum who have been or will be diagnosed with Aspergers Syndrome or the like don't get lost in the shuffle as I did...Something no female should have to go through, the co-morbid diagnosed problems were being addressed before the Aspergers ever was...

Name: Pacific Surfliner
25 September 2011 - 4:26AM

It is a good idea to fold autism into autism in the DSM V.

Name: Alicia K
9 February 2012 - 2:35AM

Aspergers' persons most certainly have language deficits. They have huge deficits in the area of pragmatics. There are also deficits in expressive language. Body language and eye contact are understood in all languages but not for those who are diagnosed with Aspergers. I am wondering if any speech therapists or linguists were consulted.

Name: Stephanie H
9 February 2012 - 4:20AM

I am very concerned about the change in the Asperger Syndrome diagnosis. I know the article mentioned that people currently diagnosed with Asperger's should not lose services, but I am afraid then you do not know how the school system works. Their job it seems is to offer the least amount of services as possible. For those of us with children with Asperger's the way we get services for our children is because it falls under the autism spectrum. Other wise their peculiarities, anxiety, obsessions, difficulty focusing, language pragmatics are not really concerns of the school system or for employers for that matter. Calling is a communication disorder is far from expressing what it is like to have a child or teen with Asperger's. I understand their are differences in lower spectrum end autism and Asperger's- but that is why it is a spectrum. It is extremely difficult to get services for students who just have "anxiety" or communication issues. The school says "that is not an educational concern it is a social concern." It was not until my daughter got the diagnosis of Asperger's that they got her an IEP and she turned around. They just kept saying she was mentally ill, she had Intermidant Explosive Disorder or Mood issues. You fail to see the significance of simply removing the term Asperger's. It is like the term anti-social doesn't really describe what a sociopath is. Oh he is anti-social to most people means he doesn't like to engage in conversation not he is capable of homicidal rage. Changing Asperger's to a "communication disorder" takes away its strength to help kids get what they need in school. Other Health Impaired is difficult to get services under. I agree with Alicia K, OT and PT and Speech Language Specialists should be consulted. You are not getting the full picture of what Asperger's entails. What about other diagnostics for Asperger's like in the ICD-10? I am sorry but I believe this is a way to lower the number of autism cases to make it look like the problem has gone down- to lower ASD numbers. This smacks of a political move and not as scientific as we are being led to believe. I am a licensed counselor, have been a school guidance counselor, and proud mom of an Asperger's child. I wish you would reconsider ASD criteria and keep Asperger's and PDDNOS on the spectrum.

Name: serge deuvletian
9 February 2012 - 4:48PM

when it comes to asperger syndrome (my condition) and high functioning autism i like to quote Yogi Berra: 'Our similarities are different'.

Name: Jan Ball
9 February 2012 - 7:45PM

Is it me? Maybe I misread the article, but it sounds to me like they ARE going to include Aspergers and PDD-NOS in the Autism category of diagnosis? If that's the case, then surely we will be able to receive either the same or more services than we currently do, right? I am a 46 y.o. female, recently diagnosed with Aspergers Syndrome via the Psychiatrist with our Dept. of Labor's Vocational Rehab program. I have had problems my whole life. Sensory issues galore. I am "high functioning" in a sense, but I also cannot be around lots of people, I rock back and forth and am a bit on the twitchy side with my hands. I have been to local support groups for other Aspies and it seems that we are all VERY different. I didn't notice others with my rocking or twitchy habits, but I think that's why it's supposed to be a "spectrum" disorder - right? We're kind of all over the map?

The article sounds like they are trying to put us all into the autism category so that we CAN get the help we need. Or - like I said - am I just totally reading it incorrectly? I am SO confused (and worried!) I live on food stamps, have applied for disability because I cannot get nor keep a job, and am currently living with my 84 year old father (who was recently diagnosed with lymphoma.) I am scared to death. If anything happens to him, I will be pretty much homeless. Is there no hope for people with developmental issues? I sure hope I read that article right because it sounded to me like it WOULD be helpful.

Jan Ball - Ringgold, GA (www.whomeautistic.com)

Name: Jessica Wright
9 February 2012 - 8:11PM

Jan,

Thank you for your comment.

You are correct that the goal of merging the disorders is not to exclude anyone who is currently receiving support, but to tailor treatments more specifically to the individual, rather than based on what seems to be an arbitrary label.

Individuals who currently have an Asperger's or PDD-NOS diagnosis should remain on the spectrum — they will receive a diagnosis of 'Autism Spectrum Disorder' along with those who have a diagnosis of 'classic autism'.

There is some concern that despite this, people at the very high-functioning edge of the spectrum might no longer be included, however.

https://sfari.org/news-and-opinion/news/2011/new-diagnostic-criteria-for-autism-fuel-debate

However, the goal does seem to be to still offer support to all those who need it, under a new diagnosis of 'Autism Spectrum Disorder' that includes the entire spectrum.

Name: Ben
9 February 2012 - 11:19PM

I didn't say much in my early childhood, but by the time I had reached 8 years old my language skills were very advanced, surprising my parents! I currently have a diagnosis of Asperger's Syndrome, but my concern is that people assessed as having Level 1 skills won't get as much support as those with level 3 skills, when they may need support in certain areas of life to function properly!

Name: Melissa Higgins
18 February 2012 - 5:17PM

Please do not 1) NARROW the criteria for ASD and 2) Remove sub-types altogether like Asperger's and PDD. Sign the petition asking the task for not to do the above: https://www.change.org/petitions/do-not-remove-aspergers-syndrome-and-other-autism-sub-types-from-dsm

Name: Melissa
18 February 2012 - 5:25PM

The task force is communicating a problem with assessment of ASD and related disorders. Perhaps the real issue here is training and education so that the clinics and assessors know how to properly identify where individuals fall on the spectrum so the best interventions and therapies may be applied. You can make any changes to the DSM you want, but if the professionals out there lack the understanding of how to apply these in practice it won't make any difference and will ultimately hurt far more people than it will help. How about trying to educate people FIRST. It sounds like you all need to improve the existing criteria without removing the sub-groups and without narrowing the field in such a way that people are at a risk of losing services or not being eligible. Integrating Asperger's further into the ASD diagnosis in such a way that it no longer exists individually is not going to help existing professionals understand the spectrum any better. If anything, it is going to make the issue seem more vague, abstract, and confusing. The solution you are proposing is not the answer. There are too many people's lives at risk here to make a decision like this without taking into account the parents, families, and people who actually HAVE ASD. This includes myself and people you've heard from above. Thank you.

Name: John
26 February 2012 - 10:58AM

I do believe this is another soft analysis of DSM-5 changes. Look deeply into this please. If you don’t have time to look deeper and obsess over every detail and go after info regarding this DSM-5 change to autism diagnosis, may I suggest you go to a website with a mom of autistic son who already did quite a bit of research on this and tells us more than we may care to know. It can be found at http://www.autismseizureselfinjuriousbehavior.com/2012/01/has-american-psychiatric-association.html
or type in a search engine the title, “Autistics with Severe Behaviors Exist”. It exposes a very possible reason why Dr. Catherine Lord and others are trying to create a caste system in the autism diagnosis. They seem to want to eliminate the most high functioning among spectrum, along with the most severely afflicted autistics. It’s all about money. Big pharma. They want autistics with moderate to high (but not too high) to be in the research now. It’s so much easier. And fits some big money agenda, which is discussed in this moms blog.

Name: Bruce
23 March 2012 - 5:57AM

The APA is about to alienate a large number of people who otherwise need their care. Regardless of your "intentions", that will be the outcome. Those diagnosed with Aspergers - including myself - are a self identifying group of (often) intelligent people with issues that are different to, but not necessarily less severe, than those with autism.

Perhaps it's because psychologists have led the research into Aspergers, but I have found that most psychiatrists are next to useless in diagnosing it and treating the co-morbidities such as anxiety and depression. The last "highly recommended" psychiatrist I went to could not comprehend that many of the deficits and patterns of behaviour present in an Aspergers child could be managed by an intelligent adult to the extent they were no longer obvious in a one-to-one interview. (My mother had previously assisted my diagnosis by answering a detailed questionnaire - she had always wondered what was "wrong" with me. Tony Attwood's book was her most helpful guide to understanding me.)

What annoys me for the proposed DSM V and old DSM IV is that it is never made clear that many with Aspergers can learn the rules of social behaviour so that the deficits and patterns are no longer obvious on presentation. But these are always learned, and often come clumsily, but never naturally.

As to the lumping issue, it seems to be that much the same could be done with many fields of psychiatry. The differential diagnoses of various clinics often depend on the prerogatives (i.e. prejudices) of the physicians. I can't remember how many forms of depression and anxiety I've been diagnosed with. (Can you be sure you've not had a hypomanic episode?) It's a dog's breakfast. Shouldn't they all be lumped? I'm a medical statistician so I know something about diagnosis, and the whole field of psychiatry should hang it's head in shame.

Psychiatry is in it's infancy. Differential diagnosis is fraught with problems. But it is absolutely clear that autism and aspergers, though related, are different and require different approaches to diagnosis and treatment; just as it is clear that there are differences withing depressive disorders, anxiety disorders, and just about every other class in the DSM. A little bit of humility and listening to your patients is in order!

Name: RAJensen
24 March 2012 - 10:56AM

DSM is the North American manual, but the more widely used diagnostic manual is the World Health Organizations (WHO) ICD manual (International Classification of Diseases). Major revisions of both manuals coincide with their publication dates to insure that both manuals would be consistent with respect to diagnostic criteria for autism. In 1994 the working groups for DSM-IV (1994) and ICD-10 (1994) worked closely together to establish the same diagnostic criteria for both widely accepted manuals. Not only are there problems with the DSM5 working groups approach, but there is also some dispute also between the DSM5 and ICD-11 working groups for autism that suggest that those differences may not be resolved between the groups before the 2013 deadline for publishing both diagnostic manuals.

Sir Michael Rutter is in charge of the ICD-11 working group on autism and has had this to say about the different approaches between the working groups which are supposed to be in agreement with new diagnostic criteria:

'At the moment there are important differences between proposals for DSM-5 and ICD-11. For the most part, there is broad agreement on the overall concepts but there are difficulties with respect to the details. That arises most especially because the DSM-5 starts with dealing with research criteria before considering the concepts and WHO does it the opposite way round. That is to say, the starting point with WHO is the clinical conceptualization and the clinical criteria. At a later point, of course, research criteria have to be developed but that comes secondarily. In my view, that is the most appropriate way round'.

http://www.itasd.org/index.php?option=com_content&view=article&id=38%3Amichaelrutterinterview&catid=8&Itemid=7&lang=en

Dr. Allen Francis, the editor of DSM-IV (1994) has stated that the field trials of DSM-IV (1994) failed to predict the false epidemics of autism, attentional disorders and bi-polar disorders. He most recently joined the growing number of people objecting to the DSM5 working groups’ removal of the ambiguously defined DSM-IV (1994) categories of PDD/NOS and Asperger Syndrome from DSM5 proposed criteria. In analyzing the Yale Universality still unpublished data he found that 75% of Asperger Syndrome cases and 80% of those diagnosed with PDD/NOS will lose their diagnostic category. Under the DSM5 diagnostic scheme autism prevalence rates would plummet by at least half.

http://www.huffingtonpost.com/allen-frances/dsm-5-will-lower-autism-r_b_1240016.html

Those who would lose their diagnosis would most likely fall into a new DSM5 diagnostic category ‘Social-Communication Disorder’. Perhaps one solution would be to rename the new DSM5 proposed ‘Social Communication Disorder’ category Asperger Syndrome.

Name: Elizabeth B Torres
24 March 2012 - 4:30PM

I run a sensory-motor integration lab at Rutgers University. In 2009 The NSF awarded our lab a grant, the first of its kind at the NSF

http://www.nsf.gov/awardsearch/showAward.do?AwardNumber=0941587

to derive the first set of objective metrics to quantify autism severity and to provide therapies tailored to the individual's capabilities and best predispositions.
Today in March 2012 we have proof of concept of such metrics. We can sub-type people in the broad spectrum of cognitive-perceptual-motor abilities, rather than based on their disabilities (which are obvious and lead nowhere). We provide in our novel approach to this problem a gateway into the sensory-motor capabilities of the individual and into their predispositions to learn. We are testing therapies at this point and moving into a large scale study involving the underlying genetics. Our OBJECTIVE metrics can certainly distinguish Asperger's from High-Functioning ASD, from Mathematically gifted people.

We do not have a voice out there. We have tried to publish our results and cannot even make it through the Editorial Board of any Journal. Yet our results are sound and our studies as rigorous and as formal as they can be. We delivered our promise to the NSF.

My laboratory at Rutgers University is committed to the dissemination of our novel conceptual framework and the operational definitions that we have created as objective tools free of deductive inference to diagnose and to treat people regardless of their mental / verbal capabilities.

I have taken the first steps to bypass our impossibility to have a voice out there in the conventional world of autism
http://www.frontiersin.org/Integrative%20Neuroscience/researchtopics/Autism_The_Movement_Perspectiv/801
Stay tuned and come to see what researchers from all over the globe have to say about this in the Journal of Frontiers. For we have found a way to break this barrier and move forward in the open access format of science. It is just a matter of time.

Name: Leanne Strong
10 January 2014 - 1:18AM

I'm 20, and have an Asperger Syndrome diagnosis. I was first diagnosed at age 2 1/2 with PDD-NOS (I don't know if maybe this was because it was too early on to tell where I was on the spectrum). But my parents thought I met more of the criteria for Asperger's (I was an early talker, and never lost the ability to communicate verbally). When I was 15 (almost 16), I went in for another evaluation, and the doctor who did the evaluation also thought I was more Asperger's than PDD-NOS. But I usually use the term, "Asperger Syndrome," to describe my condition.

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