TL:DR Warning....
(For the record, I'm not in the psychological profession but that doesn't necessarily disqualify me from making some observations)
Although, I can appreciate some of the social justice elements of this piece, the medical linking of two diagnoses into a spectrum theory doesn’t always promote better outcomes.
Current research is showing there have been some negative effects as a result which should be taken into long-term consideration.
For example, a five year follow up study showed a 20.8% decrease in ASD diagnosis overall. In comparing original subtypes, they found AD had a 10.1% reduction and Asperger’s had a 23.3% reduction relative to the new classification. Said study also questioned the creation of the catch-all diagnosis of social communication disorder (SCD). They showed “less than one-third… of individuals who did not retain their ASD diagnosis under DSM-5 criteria would qualify for an SCD diagnosis.” To make matters worse, the same study noted from another study “that nearly 30% of US children with ASD are not receiving behavioral or medication treatment.”
A 2021 study in Australia involving women showed the discriminatory treatment of those at one end of the spectrum.
As one woman is quoted saying in the study, “I had a hell of a time getting diagnosed for the ASC cause I had any number of clinicians go, ‘oh, look, you’re a parent, and you got married, and you have a job’; hey! Let’s not even go down that path cause that’s just bullshit; therefore, you can’t be autistic, and I’m just like, are you fucking kidding me? I’m like, can you see how long I can keep a job for? (Piper)”
This small case study shows the inherent flaws with the spectrum idea. Using the analogy of visible light as a stand in for the behavior/communicative deficits caused by autism, let’s assume all white light represents the whole of that concept. Within that white light is broken down individual colors, ROYGBIV. Let’s assume V is normative behavior; and B and I represent what used to be known as Asperger’s; and with the reclassification everything below V is Autism. If V looks down towards R, B and I look like V. So, they must be the same. Maybe more jerky or antisocial. But everything past B is different, and therefore not V.
This could explain the Piper’s quote as a perception bias referenced by the individual looking down the spectrum. This doesn’t dismiss the diagnosis because blue and indigo are separate colors from violet, but it shows that those who are violet may not see the difference.
I cannot help but wonder if some of all these changes might have been for something deeper than combining two communities for social justice. This might have something to do with “off-label prescribing” of antipsychotic drugs. In a 2019 study they found “comorbid autism the prevalence of (antipsychotic) AP use was significantly higher compared to the non-autism ID group.” If it’s true that the first study I mentioned found a decrease in medication treatment for ASD, could this mean a reduction in off-label prescribing? Maybe. And with the combination of comorbidities in the DSM-V, this allows for easier prescription and development of more common drugs overall. It’s far easier to prescribe or develop a drug for depression than one for Asperger’s or Autism. This also supports earlier research into Asperger’s showing brain structural differences. Drugs in general can’t change physical anomalies, but they can alter brain chemistry.
Cites in Order of Study Presentation
Kulage, K.M., Goldberg, J., Usseglio, J. et al. How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis. J Autism Dev Disord 50, 2102–2127 (2020). https://doi.org/10.1007/s10803-019-03967-5
1. Seers K, Hogg RC. ‘You don’t look autistic’: A qualitative exploration of women’s experiences of being the ‘autistic other.’ Autism. March 2021. doi:10.1177/1362361321993722
van der Plaat, A. J. S., van Dooren, D. D. D., Kuiper, I. E., van der Bijl, J., Oppewal, A., & Mergler, S. (2019). Antipsychotic drug use in people with intellectual disability and comorbid autism. autism, 8(9), 27-31.
Belmonte, M. K., & Carper, R. A. (2006). Monozygotic twins with Asperger syndrome: Differences in behaviour reflect variations in brain structure and function. Brain and Cognition, 61(1), 110-121.
