Os antecessores da Greta: Pavlik Morozov, o menino de Estaline

Já agora, o argumento dos tipos da APA que retiraram a Sindrome de Asperger como diagnóstico distinto:

http://www.autismtruths.org/index.php?p=HowImplementationoftheDSMVwillImpactAutismDSMVTaskForceChairs

In making the recommendation to delete Asperger’s disorder, the following questions were considered:

Q.1. Have the DSM-IV diagnostic criteria for Asperger Disorder worked?
The ‘Asperger’ label has proved popular, ‘acceptable’, and has widened recognition of autism spectrum disorder (ASD) in combination with good language and intelligence. In addition, the introduction of this diagnostic entity has achieved the intended aim of prompting research into possible differences between this and other subgroups of PDD, with more than 500 published articles on Asperger syndrome.

1.1. Do the DSM-IV criteria work in clinical practice?

A number of published papers have argued that the DSM-IV Asperger disorder criteria do not work in the clinic (e.g., Mayes et al., 2001; Miller & Ozonoff, 2000; Leekam, Libby, Wing, Gould & Gillberg, 2000). Specifically, key problems exist in applying the current criteria (…)

As a result, ‘Asperger syndrome’ is used loosely with little agreement: e.g. Williams et al (2008) survey of 466 professionals reporting on 348 relevant cases, showed 44% of children given Asperger, PDD-NOS, atypical autism, or ‘other ASD’ label actually fulfilled criteria for Autistic Disorder (overall agreement between clinician’s label and DSM-IV criteria; Kappa 0.31).

1.2. Do the DSM-IV criteria delineate a meaningful subgroup for research or practice?
In part because of the difficulty in applying the criteria (as outlined in section 1.1.), different research groups often uses different criteria, and quality of early language milestone information is variable (Eisenmajer et al., 1996; Klin et al., 2005; Woodbury-Smith, Klin, & Volkmar, 2005). Different criteria lead to different samples being identified (see Klin et al, 2005 comparison of 3 diagnostic approaches; also Kopra et al., 2008; Woodbury-Smith et al., 2005). (…)

Q.2. Does the existing research literature allow us to suggest new criteria to diagnose Asperger Disorder, in contrast to Autistic Disorder/ASD?

The current clinical and research consensus appears to be that Asperger disorder is part of the autism spectrum, although with possible over-use of the term it is quite likely that other (non-ASD) types of individuals have received this label. (…)

2.1. What are the proposed differences? How strong is the evidence?

Several recent comprehensive reviews of the topic are available (Howlin, 2003; Macintosh & Dissanayake, 2004; Matson & Wilkins, 2008; Witwer & Lecavalier, 2008). Matson & Wilkins (2008) suggest current criteria could work if refined and supplemented. However, the research literature to date is not able to provide strong, replicated support for new or modified criteria likely to distinguish a meaningfully different group with Asperger disorder versus autism with good (current) language and IQ. Witwer and Lecavalier’s (2008) perhaps more comprehensive review concludes there is little evidence that Aspergers is distinct, and that current IQ is the main differentiating factor. Bennett et al’s (2008) follow-up study suggests that language impairment at 6-8years might have greater prognostic value than early language milestones, and Szatmari et al (2009) argue (on the basis of later developmental trajectory) for a distinction between ASD with (autism) versus without (Aspergers) structural language impairment at 6-8 years.
The draft criteria for ASD proposed by the Neurodevelopmental disorders workgroup would include dimensions of severity that include current language functioning and intellectual level/disability.

Q.3. If Asperger disorder does not appear in DSM-V as a separate diagnostic category, how will continuity and clarity be maintained for those with the diagnosis?
The aim of the draft criteria is that every person who has significant impairment in social-communication and RRBI should meet appropriate diagnostic criteria. Language impairment/delay is not a necessary criterion for diagnosis of ASD, and thus anyone who shows the Asperger type pattern of good language and IQ but significantly impaired social-communication and repetitive/restricted behavior and interests, who might previously have been given the Asperger disorder diagnosis, should now meet criteria for ASD, and be described dimensionally. The workgroup aims to provide detailed symptom examples suitable for all ages and language levels, so that ASD will not be missed by clinicians in adults of average or superior IQ who are experiencing clinical levels of difficulty.

There may be some individuals with subclinical features of Asperger/ASD who seek out a diagnosis of ‘Asperger Disorder’ in order to understand themselves better (perhaps following an autism diagnosis in a relative), rather than because of clinical-level impairment in everyday life. While such a use of the term may be close to Hans Asperger’s reference to a personality type, it is outside the scope of DSM, which explicitly concerns clinically-significant and impairing disorders. ‘Asperger-type’, like ‘Kanner-type’, may continue to be a useful shorthand for clinicians describing a constellation of features, or area of the multi-dimensional space defined by social/communication impairments, repetitive/restricted behaviour and interests, and IQ and language abilities.

[resumindo – as pessoas que foram diagnosticadas com Asperger, ou têm os mesmo sintomas que os autistas, ou não têm sintomas suficientes para serem diagnosticados com nada]

GostarGostar