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[quote=Anonymous]Regarding the article posted above I’ve never heard that before, nobody I knew had difficulty telling them apart if you looked at full case profiles. Sure if you just looked at them in a classroom in elementary school and beyond you might not know right off but they had very distinct diagnostic criteria.

https://www.autismsocietyofindiana.org/dsm-iv-diagnostic-classifications/

ASD diagnostic criteria was much more clear in DSM IV (6 total, 1 from this category, had to be present before age 3, etc). I still don’t understand their full reasoning for the change as they don’t link their study in the article. I’d like to know when it was done, if it was after the insurance mandate started in the late 00’s then I’d speculate it makes sense why people would be trying to push for ASD and not Asperger’s- I don’t recall Asperger’s being commonly covered by insurance, though I could be wrong (I also can’t recall how PDD NOS was viewed by those early insurance carriers, be interesting to see if there’s a connection).

I do think diagnostic changes along with insurance created a push/need for using the ADOS and other standardized testing, which used to be more secondary/less necessary than a combination of behavioral and developmental assessments (interestingly enough the person in your article from above that had a hand in changing the diagnostic criteria also helped create the ADOS).

I think getting rid of PDD-NOS was not useful either (though it could have been better expanded into it’s own criteria, separate from SCD-see below). It was very good for early diagnostics when you didn’t actually know what was going in. Often times children at say 18 months are not testable due to so many problem behaviors, lack of attending, etc so they’d get PDD-NOS until further intervention and development could take place. PDD NOS often times would be changed to ASD or something else or dropped all together. It was also a placeholder for older kids just like it was for younger kids. So if a child received that diagnosis at age 4/5 it indicated to me this child might have ASD/ADHD or something else but again the problem behaviors, attending, etc were  interfering so much it was  difficult to tease out the problem.

It’s interesting that the article compares social classes, I can see how that could play out. If you have more money you’d be more likely to have gotten an early PDD NOS diagnosis, intervention is applied, more assessments and information applied, you get a more clear diagnosis at a younger age. If you didn’t have the money you’d probably not be able to seek help until the child was flagged by the school, you’d get a PDD NOS diagnosis to satisfy the school and may or may not have the resources to get intervention, more testing, and eventually a clearer diagnosis.

While I can appreciate the class distinction, comparing PDD NOS as a whole diagnosis to Asperger’s diagnosis as a reason for elimination was detrimental imo. Of course if you have a thorough evaluation vs just a doctor writing a script you’ll get a more succinct diagnosis like Asperger’s vs PDD NOS. PDD NOS was never really meant to be a stand-alone diagnosis in the DSM IV, so that could have been expanded to meet the actual reasons doctors were using it.

I think their study made it clear (in theory, I haven’t read the study) that having increased access to early diagnostics/intervention is important for obtaining a clear diagnosis, but instead of just saying that they completely eliminated the very diagnosis that was commonly used to get access to those interventions. It just doesn’t make any sense. There has to be more to this that I’m not understanding…

Apparently they have since changed PDD NOS to SCD, which doesn’t actually make sense to me either (none of the changes do) because it aligns more to part 1 of DSM-IV Asperger’s.

Regardless I do like the SCD diagnostic criteria. It seems some combination of ADHD/ASD/Anxiety has taken the place of Asperger’s, when SCD actually fits quite well. I’m not sure why it’s not more utilized.

https://www.autismalert.org/uploads/PDF/INFO--DSM%205%20Diagnostic%20Criteria.pdf

Whatever the reasons for all these changes I certainly don’t think it did any children or caregivers any favors. We will get to a point where these diagnoses mean very little and you’ll need extensive testing to figure out what’s actually going on because the diagnosis alone will be almost useless.[/quote]

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