A Question About a Diagnosis

Re “The Short Life of a Diagnosis” (Op-Ed, Nov. 10):

I’m writing in support of Simon Baron-Cohen’s argument for maintaining the diagnosis of Asperger’s syndrome in the Diagnostic and Statistical Manual of Mental Disorders.

My son and I have Asperger’s syndrome. I’ve written, produced and directed 10 DVDs about Asperger’s syndrome and autism. I’ve just finished a DVD about people with the condition who have beaten long odds and found steady employment. A common link among these employees is that they all disclosed the condition to their employers, got some reasonable accommodations and worked hard to modify challenging behaviors.

Changing the diagnosis to “autism spectrum disorder” will make job applicants less likely to disclose — and employers less likely to understand and accept — their capabilities and challenges.

In the real world, continuing to use the diagnosis of Asperger’s syndrome as a condition on the autism spectrum does no harm and will help talented, deserving people find and keep employment.

Dan Coulter
Winston-Salem, N.C., Nov. 10, 2009

•
To the Editor:

As a physician who has been involved in the development of diagnostic criteria for pain medicine and psychiatry, I take issue with Simon Baron-Cohen’s discussion of classification of disorders in psychiatry.

Mr. Baron-Cohen states, “Psychiatry is not at the stage of other branches of medicine, where a diagnostic category depends on a known biological mechanism.” If he knows the biological mechanism that causes fibromyalgia or most cases of low back pain or innumerable disorders in all fields of medicine the etiologies of which are still unknown, I wish he would enlighten the rest of us.

He also argues that changes in the number and types of disorders included in the various editions of the Diagnostic and Statistical Manual of Mental Disorders indicate a lack of science unique to psychiatry. If one were to compare the list of disorders in any medical specialty from 1952, when the first edition of the psychiatric classification system, DSM-I, was published, to today, one would find many changes, including a great increase in the number of diagnoses reflecting increased knowledge and changes in medical practice.

Steven A. King
New York, Nov. 10, 2009

•
To the Editor:

Thanks to Simon Baron-Cohen for discussing some of the issues surrounding the potential loss of Asperger’s syndrome as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

I have a background in psychology and am the mother of a 5-year-old who received a diagnosis in January, and the more time we spend with other children on the autism spectrum, the more I sense that there is a true difference, if mainly qualitative.

It is not something that can easily be described in bullet-form criteria, as the D.S.M. features, and the current criteria are questionable in and of themselves.

I would encourage anyone who wants a better understanding of the qualitative feel of the condition to go back and read the writings of Hans Asperger himself. Full of genuine affection and real-life examples of behavior, Asperger writes convincingly and authoritatively of children he recognized as both part of the autistic family and a distinct subgroup.

Amanda J. Hammond
Guelph, Ontario, Nov. 10, 2009

•
To the Editor:

Simon Baron-Cohen should make a distinction between language and speech. Many people with autism have difficulty speaking or have no speech at all. But language can exist independent of speech.

As we learn that the autistic can have “hidden” language, we will have a much better idea of how to define these syndromes.

Meanwhile, chopping and changing diagnoses can leave people with Asperger’s without a guaranteed right to an education.

Mary L. Flanagan
Port Washington, N.Y., Nov. 11, 2009

•
To the Editor:

Removing Asperger’s syndrome from the Diagnostic and Statistical Manual of Mental Disorders would be a mistake. Just look at current autism statistics, which lump classic autism and Asperger’s syndrome into one group.

Autism affects 1 in 91 children, according to Autism Speaks, a science and advocacy organization. Though my son who has severe autism is counted in that number, he is part of a subset of individuals who look completely different from those with Asperger’s syndrome.

My son is nonverbal and requires round-the-clock supervision, while a person with Asperger’s syndrome often leads a “normal” life.

The autism statistic of 1 in 91, however, does nothing to highlight these important distinctions. One term for all would be to homogenize a category that is disturbingly broad.

Annie Lubliner Lehmann
West Bloomfield, Mich., Nov. 11, 2009

The writer is the author of “The Accidental Teacher: Life Lessons From My Silent Son.”