Should the Diagnoses "Asperger Syndrome" and "PDD-NOS" Be Removed from the Diagnostic Manual?

PDD-NOS accounts for roughly half of all children on the autism spectrum. If you eliminate it and Asperger’s from the DSM-V, the prevalence of ASDs will fall from 1:100 to 1:220. The news and entertainment media will puzzle over the decrease in autism, and anti-vaccine groups will credit the elimination of thimerosal from scheduled pediatric vaccines.

You read it here first. ; -)

wouldn’t that be nice! lol

problem is, so far as I understand it, they’d just fold people with Aspergers and PDD into the general “autism spectrum” umbrella. as a result, again so far as I understand it, we’d be even less able to parse out distinct syndromes, causes, treatments, cures.

bleh.

Lisa

“Asperger’s syndrome and another mild form of autism, pervasive developmental disorder not otherwise specified (P.D.D.-N.O.S. for short), will be folded into a single broad diagnosis, autism spectrum disorder.” My personal preference would be for my grandson’s condition to be as narrowly described as possible, such as ASD Type 351, which designates certain traits specific to him in order to focus his treatment better. I understand what they’re saying, that Asperger’s in one state might be autism in another. It doesn’t sound as though the incidence rate would change.

My choice isn’t on the poll. I’d get rid of PDD-NOS since what that really means is a child sort of maybe might fit here, but maybe not. Asperger’s should stay.
I disagree that autism isn’t distinct, and a person can have sensory disorder or physical without having autism. Those that only have sensory issues would not be autism or PDD-NOS. I think what is confusing is any child who has a meltdown, delayed and doesn’t speak ends up PDD-NOS because they don’t fit all the criteria of any of the other diagnosis and doctors don’t look further to what else it could be. PDD-NOS is the least distinct of them all. Prior to a diagnosis, very few do medical testing to rule out other causes which could account for some of those PDD-NOS’s.

We need the distinctions, since the causes of various autistic symptoms differ, the optimal therapies differ.
Research on prevention has to distinguish between genetic causes and fetal trauma causes.
For instance, there is no point sending someone with Down’s syndrome to a genetic study on autism.

autismnewsbeat

With respect I don’t think you understand the proposed changes correctly.

The proposal discussed in the NYT would consider removing PDD NOS and Aspergers as labels but renaming them as autism disorders. Renaming the “autism spectrum ” disorders would not necessarily result in new autism prevalence figures.

The autism disorders on the new “autism spectrum” would be distinguished by severity and by presence or absence of what are now called co-morbid conditions. Thus someone with Aspergers Disorder might subsequently receive a new diagnosis of Autistic Disorder 5 …. or whatever naming method they are using to distinguish between severity levels of diagnosis.

heh. I’m not sure. If it is as Harold Doherty says, I’m a bit more supportive, but Aspergers, according to what is in the current DSM, is a distinct autism spectrum disorder.

I’m not a huge fan of PDD-NOS, because that is one that is not only used incorrectly, quite frequently, but it’s also one that Insurance Companies frequently don’t cover therapies for… at least from what I’ve read.

PDD-NOS is, in essence saying, Autism Spectrum Disorder, but doesn’t fit into our 3 or 4 other categories. So people frequently assume it is a ‘moderate’ form of autism. It’s not. My son has been labeled PDD-NOS by some, because he successfully expresses emotion and interacts with adults and is extremely affectionate, so they don’t think he qualifies as classicly autistic (others will tell you he does; it depends on who you talk to). He is, however, severely autistic and his disorder is profoundly disabling in many ways (though part of me thinks the sensory integration dysfunction is as much or if not more disabling than the autism itself).

Is Dr. Catherine Lord being taken out of context? seriously, I’m surprised that quote comes from her. If it’s accurate, it makes be glad I didn’t take my son to Ann Arbor. But then it was UofM’s autism center that decided he couldn’t participate in a study because they couldn’t get an accurate evaluation on him within a few hours, because of his autistic symptoms. facepalm. So maybe I shouldn’t doubt the quote.

That said, from what I understand of the Asperger’s Diagnosis, it is a very specific form of autism. I’m all for not calling labeling all those with high functioning or mild autism as Aspergers, because Aspergers is not high functioning or mild autism. I could see saying that Aspergers falls under a specific subset of the autism spectrum though. That makes sense to me. I’m all for distinguishing further between the different kinds of autism, as it will help with research into which treatments are beneficial for who.

My son’s initial Dx was PDD-NOS, which I thought was somehow “better” to have than autism. It took me *months* to parse all the data and try to come to grips that it was still somehow autism.

Then at his follow-up at age 4, they changed his Dx to autism. It was confusing to me, since I thought he had improved so much. How could it be autism?

My point is, PDD-NOS is sort of a gray area Dx that only serves to obscure the bottom line. Losing the Dx “PDD-NOS” will be helpful to everyone, I think.

I can understand that Asperger’s is distinct in only one way: no speech delay. I think it is OK to keep it separate, because this is a significant difference, and does describe a very different life experience.

Venessa – I had a very similar experience, but no change of dx (never asked for one, which may be why lol!). Our son is verbal and engaged, so I had assumed PDD-NOS meant either “delays but not very serious ones” or the same thing as “high functioning autism.”

Was amazed to learn it meant “everything but the kitchen sink.” Very frustrating!!

Lisa

I had a speech delay and I have a diagnosis of Asperger’s (received long after I had begun to talk and was talking on the same level as other kids). If I told people that I have autism, instead of saying I have Asperger’s, they wouldn’t even believe me. Do you really think I should have a diagnosis of classic autism just because of my speech delay?

I think this is a really good example of just how messy and inaccurate the AD/AS/PDD categories are. It really would be better to just diagnose everyone with ASD because the idea that everyone fits into one of these three categories really doesn’t take into account uneven skills, changing skills, etc.

Hey! Keep on trying in every way, and remember to see beauty on even your hardest day. Take a breath every once and a while and take time to forget about all the politics and policies behind autism, just for a moment here and there. One day at a time, one child at a time. Just always be there in any way you can. You are your child’s hero, even if you bother to take a rest here and there. I know it is okay to do all of this every once in a while because I walked in most of your shoes and fight the same battle, and into year sixteen things are looking pretty good.

Maybe one day they will drop it all and call it “heavy metal poisoning” or “vaccine induced inflammation”..maybe the word autism will go altogether?
interesting story..
http://www.reuters.com/article/pressRelease/idUS117937+05-Nov-2009+PRN20091105

As a mother with a child diagnosed with PDD-NOS, I feel its not fair to cut those children from the Autism classification. My son IS autistic & has every right to receive services based upon his disability. I don’t believe “simpler” forms should be eliminated.

Actually, Cassidi, your child’s PDD-NOS diagnosis would almost certainly be changed to an “autism” or “autism spectrum” diagnosis, because the category PDD-NOS would go away while your son’s symptoms would not.

Does that make sense?

Lisa

Did you read that chelation study? The only heavy metal mentioned was lead which of course would also look like autism. Another interesting thing about this study, those who were chosen for the study had high urinary excretion of toxic metals, which kind of relates to that blood test being no good.

Maybe one day they should call it “heavy metal poisoning” or “vaccine induced inflammation”. That way we’d know who truly has autism and who does not.

Remember, the basis for removing the Asperger Syndrome (AS) diagnosis is the overwhelming research and evidence for many years proves there is no significant difference between AS and high-functioning autistic disorder. By removing the AS diagnosis and calling it “autism” it will give access to untold numbers of children through adults to neede services previously denied to them. Per Patricia Howlin in Autism and Asperger Syndrome: Preparing for Adulthood, 2nd edition, 2004: “Asperger Syndrome is often referred to as a ‘mild form of autism’. Nothing could be further from the truth…A recent follow-up study by Gillberg and his colleagues, for example (Billstedt 2003), has indicated that quality of life ratings for more able adults with autism are actually lower than for those with moderate to severe intellectual abilities.”

THE SPECTRUM is NOT AUTISM. AUTISM is ON The Spectrum. The Spectrum is: Pervasive Developmental Disorder. Think of it as a ruler. PDD is the name of the ruler (across the top). Autism, Rhet’s Syndrome, Asperger’s, Pdd-NOS, Childhood Disintegrative Disorder, etc are like the inches on the ruler.

Pdd-NOS is NOT a catch-all for those who don’t fit other pieces of the PDD Spectrum. Pdd-NOS is for those who fit the dx BUT also exhibit other problems NOT associated with a different (non ASD related) condition.

These disorders are not, technically, Autism. They are on the same spectrum as Autism. It’s like saying Rheumatoid Arthritis and Arthritis are the same thing. They are not. Arthritis isn’t fatal if left untreated. Miserable, yes, but not fatal. RA, however, is fatal if left untreated.

After thinking about it-go ahead and lump Pdd-NOS into “Autism”. Perhaps then, my 11 year old son would FINALLY get some therapy. As it stands, he doesn’t qualify because his dx is so “vague”. Go figure.

Michele
Louisville, KY
Mom to an 11 yr old with Pdd-NOS, a 15 yr old who PROBABLY has some aspie tendency but is not on the spectrum, and ONE healthy-NT child. Genetics much? Environment much?

I submitted a long msg and it disappeared… Starting over, maybe shorten it will help.

1) THE SPECTRUM is not an Autism Spectrum. It’s called: Pervasive Developmental Disorder. AUTISM, Childhood Disintegrative Disorder, Aspergers, Pdd-NOS, Rhet’s, etc fall UNDER PDD. It’s a PDD spectrum, but much simpler for the general public to hear “autism” than one of the other disorders our children have.

2) My 11 yr old son is Labeled Pdd-NOS. I knew it was a junk all dx, but then, ya gotta start somewhere, right? Pdd-NOS is REAL tho, just different from the others.

3) Whichever parent said they thought Pdd-NOS was the “easier” of the dx’s…. talk to an Aspie and then talk to a child with Pdd-NOS and you tell me which one you’d rather be dealing with-I guarantee you, I know the answer ! Pdd-NOS seems to have much stronger tantrums and aggression than the other disorders. Seems to be dx’d later as opposed to the time frames the other dx’s are performed and gets the least amount of therapy (if any)

4) While I am opposed (I think) to lumping all the disorders into one category, the more I contemplate it, I don’t see a problem with it. They’re labels. But if the label is absorbed into the other dx’s, will my child no longer be classified as being on the spectrum or will he then just be considered Autistic? If that’s the case, then…BRING IT ON! AUTISM gets more research, more therapy than any of the other dx’s. Pdd-NOS, we have to FIGHT for our children’s therapy every single day…. oh the joy of not fighting. Yeah, I’m rethinking it….

PDD-NOS is a diagnosis by exclusion. If a child presents with some symptoms from (1), (2), and/or (3) from the DMS, and their pattern of symptoms is not better described by one of the other PDD diagnoses (Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, or Childhood Disintegrative disorder) PDD-NOS is given.

It’s been controversial for years and doctors have been wanting to get rid of PDD-NOS for years. PDD-NOS is a vague diagnosis and they cant really lump it into to autism if the child doesn’t display all the criteria for autism. With in that article:

“A child can look like they have P.D.D.-N.O.S., then Asperger’s, then back to autism,” Dr. Lord said. The inconsistent use of these labels has been a problem for researchers recruiting subjects for studies of autism spectrum disorder.”

And the use and how labels are given is confusing to everyone. The thing is, diagnosis shouldn’t be altered in order to get services. The places providing the services need to change and adapt to include all the diagnosis.

Sandy – completely agree with you. The problem though, is that by lumping EVERY person with “autism-like” symptoms together under one diagnostic term, you wind up with the muddiest waters ever!

What’s the use of a diagnosis that could mean absolutely anything, including any constellation of symptoms at any level?! I know PDD-NOS is, in many ways, that diagnosis – but at least there are other options now, if the criteria are met.

IMHO, we should have a whole series of diagnoses that take into account not only the severity of the symptoms but also the “co-morbid” symptoms. That would include not only the physical (GI, epilepsy, etc.) but also the mental (depression, anxiety, etc.).

With careful parsing, we might actually be able to provide some direction for treatment, education and prognosis!

Lisa

The DSM is mental health, not sure how mental health can work along side of a GI doc or the doc who would treat epilepsy. I’m not sure that some one with lets say bi-polar along with GI issues would find one doctor to care for all symptom’s and I’m not sure I’d be comfortable with that idea. Not sure why combining it would even make a difference to any diagnosis towards autism. You’re crossing over different medical expertise into one. If one was to combine co-morbids, you’re going to end up with everything under the sun. You’ll end up with a kid who has GI issues or epilepsy and the parent will worry endlessly about autism when that wouldn’t be connected to either. Those things occur within people who don’t have an ASD.

Good point, Sandy.

But it seems to me that there are quite a few disorders that do combine physical with mental issues… there’s a lot of crossover. Depression/sleep issues, for example, or anxiety/anorexia.

I don’t know enough about the medical or psychiatric systems to know how these related issues are treated, but I imagine there must be a team approach.

We’re often exhorted to put together a team for our kids with autism; can’t see why that team couldn’t include experts in physical and mental health issues. IMHO, that’s one reason that the DAN protocol exists: a crossover expert is needed, and they’re the ones who are available!

Lisa

The only two available DAN doctors where I live last I looked, were chiropractors. DAN doctors do not mean they are experts or have any medical training let’s say in GI issues or epilepsy. The DAN protocol doesn’t exists as a crossover either. Many are not experts in internal medicine or mental health.

As for depression/sleep issues, anxiety/anorexia; you’re talking about manifestations of anorexia and depression plus there are different types of anxieties, and sleep disorder’s. But what you’re talking about is separate mental health disorder’s and the manifestations are not medical issues like GI or epilepsy. My child’s sleep disorder may or may not be related to autism, and where he needed to go for a team was a children’s sleep clinic, not a DAN doctor.

Also, that team that we have to put together, you’re suggesting a set team with a set protocol and that of course isn’t going to work for all since all kids are different, all wont benefit or react to the same interventions.

My point was that there does seem to be a group of kids with autism who present with both physical and mental issues – and that parents are looking for a way to treat both. DAN practitioners do treat both, and some parents go that route because they see the two as connected.

You’re right: there may be no connection between, say, autism and GI symptoms (still up for grabs) – but there are most certainly connections between autism and epilepsy, autism and sleep issues, autism and mood disorders.

In theory – and at this point – a parent basically has to build a team that includes separate treatment, say, of developmental delays; epilepsy; mood disorders; and behavioral issues. In other words, you need to find and coordinate a developmental pediatrician, a neurologist, a psychiatrist, a behaviorist, a speech therapist… etc. It’s a huge challenge, and as a result it’s often poorly handled.

Lisa

I suppose where you live it might be a huge challenge but it is not impossible. I live way out in the boonies of MN and I got it done. Where I live we don’t even have one stop light or a 3 story building. The interesting thing for me is the only 2 DAN docs are located way on the farthest end of the Twin Cities and that ‘team’ I formulated for my child were all closer than the DAN doc was and some of that team was an hour away. I’d have had to go further for that DAN doc. If you’re telling me a DAN protocol includes developmental pediatrician, a neurologist, a psychiatrist, a behaviorist, a speech therapist… etc all wrapped up into one, I’m going to say right out the majority do not. Besides that, none of that has anything to do with this diagnosing business, either. Even if they included all you suggest into that diagnosing criteria, you’re not going to locate one doctor to cover it all therapy/ intervention-wise. You treat each issue with separate treatment. Plus you’re forgetting those long waiting lists and out of pocket expenses that does along with a DAN doc. I would not want a chiropractor giving my child RX’s for his sleep disorder or treat his GI issues, do blood tests, genetic testing (fragile X) do an MRI or EEG or perform the GI scopes. Would you? There are connections between autism and epilepsy, autism and sleep issues, autism and mood disorders, but no one really knows those actual statistic. In my school district when my son went to EI, he was the only child at that time they ever had with a sleep disorder. The school he goes to now consists of families from 7 surrounding towns and still my child is the only one with sleep issues. Of all the people I have personally met, the only ones I know who shares my sons same sleep disorder is those I met on-line. He doesn’t have epilepsy or mood disorders, does your child?
Including that into the criteria makes no sense since those can occur with out autism and it’s not only seen in those with autism. Pretty soon we’ll end up with out getting a diagnosis because the child doesn’t also display medical issues. If a person had a heart attack or a stroke, one doctor wouldn’t offer the therapies. You’d have to still locate and create that ‘team’ to provide O.T and speech and anything else required for that person including prevention for another heart attack or stroke.

Sandy, I never said “families successfully build multi-disciplinary medical teams by going through DAN practitioners.” My point is that DAN practitioners think about both mental and physical factors, and that is helpful to parents – especially when traditional practioners rarely do. Whether they do a good job of TREATING those factors is another issue.

As to building the team, you may not know it but you are most unusual. It is very impressive to have done what you have – and I’m not sure I could do it myself. Even when I lived in Philadelphia, the process of locating, meeting with, and managing the involvement of multiple therapists and docs was beyond me.

Sure, I could find an OT, a developmental ped, etc. But I couldn’t SEE the developmental ped more than once or twice a year, and she wouldn’t communicate with me in between. The OT was from the school, and followed school guidelines, while the speech therapist was private and had no access to school personnel. And so it went.

Basically, there was no coordination among therapists or docs. In the long run, I’ve given up on therapists, docs and teachers in an official sense altogether. Tom has a pediatrician, a speech therapist, and a number of hand-picked teachers/tutors who have no autism background whatever.

Works for us!

Lisa

Aside from where I live and that many here have insurance that covers private and they’ve also obtained what I have, I have quite a few on line pals, and the team I had isn’t unusual but if people are kept believing it is unusual, they’ll feel it can never happen. Much of this depends on insurance coverage as well and not everyone get’s denials for services. The idea many parents have is the school district services is enough, and that needs to change. I once seen a family on TV, I think from IL who had triplets all on the spectrum. The dad said something very interesting, which was something to the effect of take your time needed to be sad, but then you get busy. And when you assemble all these services, your diagnosis means nothing, other than that is the cause. These therapists all reassess per their service; O.T, S.T and so on. Yes, it involves many phone calls, many appointments, much travel time but that’s what you do when you have a child with a disability which I did that when my child was sleeping 2 hours of 24, 24/7. I am not exceptional or unusual, however I am not sure how I got connected with an in home therapist, because I was so tired maybe that drove me harder. I don’t know about you I was no expert on autism, I couldn’t have done any of this with out that team nor would my child be where he is today. All of those therapists played a part in his progress.

Did the private O.T ever talk to the ST or to the school? Not often but that’s not what the team is, to all work together. As I said before each team member is to have has a particular functional job with that child and family, not with the rest of that team. The ST’s input wouldn’t have much value to the psych doc or neurological doc, either. We already knew he was non verbal, hardly need everyone in the same room to figure that out or figure out what to do about it. They don’t need to talk to each other, all they need to do is serve a functional service for my child.

“DAN practitioners think about both mental and physical factors,” Again, would the only DAN in my state which are chiropractors be qualified for mental and physical factors?? My son’s Peds doc isn’t qualified for autism, yet she ‘thought’ about it and suggested to me that’s what this was. Thinking is one thing, being qualified is another.

My daughter was diagnosed as classically autistic when she was 2 1/2. I had started her in early intervention @ 15 months old due to a regression with her speech, and she was receiving services during those oh so important first 3 years. At 5 yrs. old, she was still “on the spectrum” at 7 her doctor said she now fit the diagnosis of PDD-NOS. I asked the Dr, just what that meant, and she said “she is still on the spectrum”. So darn confusing! I agree with John who said that he wishes it could be classified with subtypes, like ASD 351. The main goal for me is to make sure my daughter continues to receive the services she currently has in place. As she grows, she sometimes seems like a typically developing tween, other days, she is so obviously on the spectrum. She is constantly changing and so are her challenges. I just wish that the medical community could come to some sort of agreement on the whole PDD-NOS/Aspergers diagnosis and then just figure out how to proceed with treatment and services.

I could not answer the poll because I do not think the possible answers covered my opinion on the matter. I don’t think most of those cases labeled as Aspergers should be considered as a disability or disorder at all.

As the DSM establishes these disorders as “severe early childhood disorders” I do not see how many of the Aspergers, PDD-NOS, or HFA cases I have seen could possibly fit anywhere. There are in my experience, which is vast and I will not take time to relate since this is only my opinion posted on a BLOG, a great many cases diagnosed in this category that are not severe disorders at all. At best these are individual differences, at worst mild social fluidity disorders and not “Pervasive” disorders at all.

I also have seen cases where the person diagnosed with Aspergers or PDD-NOS have much more sensory processing disorders, social impairment, and unreliable daily living skills than many moderate autism cases.

I agree that there needs to be many more subtypes of autism diagnoses, not a more thorough blending of existing categories. Perhaps then, some could be classified as severe childhood disorders, and pervasive while others are not severe or pervasive, but still disorders of a type.

I guess, it is difficult to take seeing a severe case of low functioning autism being classified and served in the same group as someone who is fully verbal, exceedingly intelligent, yet mildly delayed in social understanding – which I know will affect their personal life and job skills, etc., but will not mean total care for the lifespan.

Dave.

My sons were dx’ed 10yrs ago. One Aspie and one PDD. I have always believed that AS should be it’s own dx for many reasons. The primary distinctions, the academic ability and the use of language. I have always had an issue with the way the DSM details the criterion for language in an AS dx. Language delay is subjective and not at all relevant when held against ‘how’ an Aspie uses language. I think those two elements was what Hans was focusing on when he named the dx. It’s there in the cog processing, logic, self awareness as well as the expressive language that Aspies use. Very distinct from HFA in that an Aspie has a true and deliberate command of language. It’s not a splinter skill, it’s a very specific criteria which the DSM has ineffectively identified. Gilberg’s is almost there but not quite. The DSM, using verbage ‘not clinically significant delay’ is the stupidest criteria for a symptom ever. Many clinicians, and many parents, are also not adapt at seeing the difference in a pervasive interest vs OCD vs an interest or subject that evolves as an Aspie ages and matures. Whereas in HFA that repetitive interest may, sometimes, stay in the same ‘frame’ in which it was originated. Clinicians have to be careful here in considering co-morbid issues that may make one clinician call it AS and another HFA. I also believe PDD should be apart from ASD. My PDD son has responded greatly to intense intervention. I can truthfully and objectively say that he no longer meets the criteria for Autism as he once did He has simple delays, perhaps even severe LD. He makes and keeps friends easily, does not prevaricate. Sometimes it is really is just a delay. Only careful monitoring and r-evals can move a PDD into ASD. The DSM V is only going to further fracture this divided community. Some clinicians are making it worse by adding all these labels. I met a child the other day with EIGHT dx’es and this child’s mother happily told me how she was going after number nine, she was sure her kid had this dx b/c of a one time incident. No good can come of this way of thinking or this over dx’ing of every little thing.

PDD-NOS is one of those “conditions” that is so broad and subjective in scope that it used as a justification for psychiatric medications. Because this is so lucrative for those in the medical and educational professions, there’s an economic incentive to give children this diagnosis. This may seem like an extreme point of view, but as far as I’m concerned, to dismiss the economic aspect of the ever expanding population of ASD children is just as extreme. Follow the money trail.

I don’t think they should be removed but the names for them should be different:

PDD (Pervasive Development Disorder):
should be the term for all different childhood developmental delays, e.g. Autism spectrum disorder (ASD), Rett’s syndrome, Down syndrome, Tic disorders (including Tourette’s syndrome), ADHD (which should be renamed to Impulsive hyperactivity disorder (IHD)) etc. PDD-NOS should not have anything to do with ASD; instead it should be the term where the child is diagnosed with an unknown developmental delay that can’t be diagnosed by professionals.

And throw Childhood disintegrative disorder (CDD) in the garbage; if professionals keep it, they may as well have an “infantile disintegrative disorder” and “born with it disintegrative disorder”. They’re called “Autism” or “Infantile Autism”, so CDD should just be “Childhood autism”, and not be included as an actual diagnose.

Then, ASD (Autism spectrum disorder), should consist of the following:

Autistic disorder (Severe “Classic”, moderate)
High-functioning autism (HFA) (Mild autism)
ASD-NOS (Autistic spectrum disorder-not otherwise specified)
Asperger’s syndrome (Milder autism spectrum disorder)

Explanation:
. ASD-NOS is a diagnose when they’re the autism spectrum and have some, but not all the symptoms. The “ASD-NOS” label should be diagnosed when the child has some but not all the symptoms. If mild, they generally, they love to socialize, even too much, which distinguishes from HFA and Aspies (who don’t normally socialize unless, sometimes, if they’re in the right environment or learn the skills over time), although all may be “socially inappropriate”. In between moderate-to-severe (including atypical autism) is more like “autistic” symptoms like language, no eye contact, echolalia, etc. but still like “expressing” socialization, although inappropriate as well and don’t have all the symptoms.

. HFA, which is debated if its real are not, which I believe is real because:
HFA (like Asperger’s) are socially avoident and inappropriate. Although, only sometimes, and at times maybe display stereotypic movements, and other times may not.

. Asperger’s is mild too, but are “almost” always don’t enjoy socializing and may read a book instead of socializing. Aspies can only also be socially inappropriate.

==Also==
ADD should not stay ADHD-PI (Predumptly inattentive) but should remain ADD underneath the category “Learning disability”.

When you have a parent determined to discover why their child is unruly, PDDNOS is the perfect diagnosis, as is ADHD. It is so broad in definition that virtually any child with any type of behavior problem can qualify. I have talked to most of the parents of the kids in my 2nd grader’s class, and have found that up to a quarter of them have gotten their child a diagnosis of ASD and/or ADHD, and are giving them medications for treatment. This is outrageous! It’s as if it’s fashoinable to have a child on “the spectrum”, and there seems to be very little concern with risks associated with all of the pills they’re giving their kids. And, these parents seem eager to share their kids’ medical disagnosis, but are angry to hear that they may be putting their child at risk unnecessarily. I regret that my child will grow up in a culture where pill popping is so accepted, and I fear that this growing population of children will be so desensitized and casual about drugs that it will not seem so dangerous and destructive to begin experimenting with street drugs that aren’t all that different than the pills they’ve been taking since pre-school. The truth is we can’t possibly know the long term effects of starting a pre-schooler on psychiatric drugs and keeping them on them throughout their entire childhood because this practice is relatively new in our culture. When we discover that the pills produced by the drug companies actually cause long term damage, the only news outlets that will report it will be the news outlets that don’t run advertisements by the drug companies. Since every other TV ad is promoting the latest pill, it is doubtful that they will run a story (although it may be true) that is critical of their best customers. By combining all “ASD” diagnoses into a single condition will further fuel the growth of this population of children with “disorders”, and in turn, will further grow the customer base for the drug companies. When will our society wake up???

I’ve changed my mine, High-Functioning Autism (HFA) should be the nick name for a mild case of autism, and should fall into the category of just Autism (Severe “Classic”, Moderate, Mild “High-Functioning”) and I still agree that it remains separate from Asperger’s syndrome and PDD-NOS (which should be renamed to ASD-NOS), with PDD-NOS meaning something completely different as stated above.

One problem with combining the types is that it will make it more difficult to design research with very precisely defined study groups. To better treat the variety of forms of disorder that fall on the spectrum, we need research that addresses specific sub-types. If there are no specific criteria for defining the sub-types, then research gets muddled because each individual researcher has to define their own study groups, and the lack of consistency will hinder progress. I am glad I’m able to look up studies that specifically addresses the issues my son faces. If everything was simple called “autistic spectrum,” then I would have to wade through a lot more irrelevant information than I already do. Although the definitions are unfortunately imprecise, eliminating them has the potential to confuse things even more. So I’d prefer to see more distinctions among the groups, not less, with the understanding that they all fall on a continuum, and there will inevitably be some overlap… The clinical classification of the disorders should be geared toward supporting more appropriate treatment and research. The availability of services for pdd-nos and AS are political issues that should be addressed by demanding services for all children with developmental disabilities, not by eliminating destinations among very different forms of the disorder. I’m ok with changing the name to something ethat’s more inclusive of the spectrum, but I think it’s valuable to keep, and better define, distinctions among subgroups. If I were to change a label, I would move ADHD-inattentive type to the autistic spectrum, as it seems to have far more in common with autism than other forms of ADHD.