Autism redefined for clearer diagnoses

Absorbing Asperger’s syndrome will mean faster access to more treatment options

Early next year, a new definition of autism will be used by scientists in order to more precisely diagnose kids with the brain disorder.

The diagnosis of Asperger’s syndrome, considered a “higher functioning” form of autism, will disappear once the new criteria for identifying the disorder come out in May 2013, according to Dr. Catherine Lord, director of the Center for Autism and the Developing Brain. The latter is a collaborative program between New York-Presbyterian Hospital, Weill Cornell Medical College and Columbia University, in partnership with the New York Center for Autism.

The proposed changes on how doctors define and diagnose autism were the subject of a research study conducted by Lord.

“You can’t treat a 2-year-old who is profoundly intellectually disabled and without language the same as a 7-year-old who is chatty about their stamp collection.” DR. PETER SZATMARI CHILD PSYCHIATRIST WHO SPECIALIZES IN AUTISM

The study was published in the latest issue of the American Journal of Psychiatry.

“As a scientific medical diagnosis, Asperger’s is merged into autism spectrum disorder,” Lord said. “Our committee felt there just wasn’t any way to justify its continuance.”

Lord is part of the American Psychiatric Association’s working group responsible for updating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a guide used by physicians around the world. Improved diagnosis leads to better treatment.

“There was so much confusion of who had Asperger’s and who didn’t. We were also concerned that there were kids being denied services because Asperger’s sounds like a better diagnosis,” she said.

Autism rates are staggering in North America. A debate is raging among physicians as to whether the rates are actually increasing or if experts have just recognized that many syndromes are linked.

One in 88 children is believed to have the neurological disorder. Symptoms range from repetitive or aggressive behaviour to a complete lack of social skills and an inability to speak or make eye contact.

Clinicians are scrambling to better define autism in an effort to quickly identify children and get them into interactive, behavioural treatment. There is no cure for autism and the burden on families can be immense as many autistic people cannot live on their own.

Nearly 70 years ago, Austrian pediatrician Hans Asperger was the first to notice intellectual children with social problems who were somewhat obsessed with specific topics. These children often avoided eye contact and were clumsy. But it wasn’t until the 1990s that Asperger’s syndrome was added to a list of mental disorders.

Famous people thought to have Asperger’s include physicist Sir Isaac Newton, Microsoft founder Bill Gates and British author Jane Austen.

Reaction to the changing scope of autism has been positive.

There is no biological or genetic reason why Asperger’s should be separated on its own, said Dr. Evdokia Anagnostou, a child neurologist at Holland Bloorview Kids Rehabilitation Hospital. “We assumed they were different but it looks like they are not,” she said. “Now we can call them all autism.”

Also being swallowed into the autism spectrum is Pervasive Developmental Disorder, a term used to classify some developmental issues, including an inability to socialize.

Child psychiatrist Dr. Peter Szatmari, a professor at McMaster University and a noted expert on autism, said the changes are a “good thing” as they will speed up the diagnostic progress. But he cautioned that autism is “incredibly heterogeneous.”

“In 30 years, I don’t think I could say I have seen two cases the same,” he said. “You can’t treat a 2-year-old who is profoundly intellectually disabled and without language as the same as a 7-year-old who is very chatty about their stamp collection.”

“We need a way to capture that diversity,” he said.

People previously diagnosed with Asperger’s should be able to keep that label or name, noted Alycia Halladay, director of environmental research at the U.S.-based Autism Speaks advocacy group.

“The intent is to ensure that people with Asperger’s receive the same needed interventions and services as those with an autism diagnosis,” she said.