As we noted yesterday, the final revision was approved for publication. The DSM-5 is how clinicians and researchers diagnose mental disorders in the United States. A common language is especially important when conducting research, to ensure treatments are actually working for the symptoms people have.

One of the changes getting a lot of attention is the “doing away” of Asperger’s Syndrome. But to be clear — Asperger’s isn’t being dropped from the DSM-5. It’s simply being merged and renamed, to better reflect a consensus of our scientific knowledge on the disorder as one form of the new “autism spectrum disorder” diagnosis.

So while the term, “Asperger’s” is going away, the actual diagnosis — you know, the thing that actually matters — is not.

But you wouldn’t know it reading some of the mainstream media’s reporting on this concern.

The board of trustees of the American Psychiatric Association, who released the approved changes on Saturday, said the reason they were renaming Asperger’s was “to help more accurately and consistently diagnose children with autism.” Which I agree with, because it’s important for clinicians and researchers to have a common, logical language.¹

I wish the media could differentiate between a label or word, and the actual diagnosis though. Because from the news coverage on this change, you’d believe the actual diagnosis was going away unless you read more carefully.

CBS News screams, Asperger’s syndrome dropped from American Psychiatric Association manual:

Asperger’s syndrome will be dropped from the latest edition of the psychiatrist’s “bible,” the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

It’s not until the third paragraph of this article do you realize the American Psychiatric Association, the publisher of the DSM-5, just decided to rename Asperger’s. (And why do so many media keep referring to a psychiatric diagnostic manual — a scientific instrument — as a “bible?” That is the strangest disconnect I keep reading time and time again. I’m not even sure any reporter who writes those words could tell you the reasoning behind calling it that.)

Fox News announced that “Asperger’s dropped from revised diagnosis manual,” but then quickly notes that it’s just the term that’s being dropped — not the actual diagnosis.

The UK’s Guardian does a little better, mentioning the renaming in its subtitle, “DSM-5, latest revision of Diagnostic and Statistical Manual, merges Asperger’s with autism and widens dyslexia category.”

So yes, the label of “Asperger’s syndrome” is leaving the diagnostic nomenclature, as our understanding of this disorder has increased substantially in the nearly 20 years since the DSM-IV was published. But the diagnosis itself remains, with a new label — as a mild form of autism spectrum disorder.

People who are currently receiving treatment and care for this disorder will continue to do so, and insurance companies, Medicaid and others will continue to cover the costs of treating it.

1. This is a good argument to do away with the terms “dysthmia” and “cyclothymia” as well, and just call them what they are — chronic depression and chronic bipolar disorder.

It is not uncommon to see a young child with ASD (autism spectrum disorder) who does not understand the “give me” gesture of an open hand or the meaning of a point. Your child may not understand the significance of an angry or sad face on another person.

Sometimes people interpret the child’s lack of interest or response to others’ expressions as a lack of cooperation, but children with ASD just don’t understand. How can you teach your child to pay attention to people and recognize what their body language means?

Here are three easy steps:

• Step 1: Exaggerate your gestures.
• Step 2: Add predictable steps.
• Step 3: Provide needed help.

And here are five simple exercises you and your young child can do today to help with paying attention to people and better understanding body language.

1. When dressing, show and label each piece of clothing before you put it on.

When you involve your child in helping or giving, use big gestures like holding out your hand for your child to give.

2. When diapering, show the diaper and name it before giving it to your child to hold.

When you ask for it back, use a big gesture to get it, and give a big “thank you” afterward.

3. At mealtimes, give your child a few bites of food on the high chair try, and then point out one for him to eat.

Help your child follow your point to get it. If he doesn’t, then next time, just give one and point to that one before your child gets it. That way, your child has to be following your point.

4. At bath time, ask for a hand or foot to wash by pointing, asking, and holding your hand out.

Ask for the bath toys at the end, and point to them to be put away one at a time.

5. When playing, exaggerate the gestures for chase, tickle, swing, and spin.

Sing “Itsy Bitsy Spider.” Get down on eye level, face your child, make a big, excited smile, position your hands dramatically, and then start the game with big energy. Help your child anticipate what is going to happen from your face and body posture.

Excerpted with permission from An Early Start for Your Child with Autism by Sally Rogers, PhD, Geraldine Dawson, PhD, and Laurie Vismara, PhD.

Navigating social situations can be difficult for anyone, but for people on the autism spectrum, it’s not just difficult — it’s a minefield.

People with autism or Asperger’s don’t pick up on social clues that seem obvious to most people. There are unwritten social rules that they can’t fathom. Things blow up on them when they have no idea what they’ve done wrong.

To put it mildly, that’s stressful.

High anxiety is often the silent partner of people with autism, even those who are high-functioning. That anxiety can be paralyzing in social situations. Not just deer-in-the-headlights frozen, but full-on engulfed in fear. For people with autism, it compounds their already difficult challenges.

Emotions drive our physiology, including our brain function. Stressful emotions drive our brains into chaos, making it difficult to focus, remember things, perceive what’s in front of us, and think of what to say. But there’s a flip side — positive emotions drive our brains into coherence, improving attention, memory, perception, and communication. This is true for all of us, whether we’re on the autism spectrum or not.

It is encouraging to learn that when researchers at the Yale School of Medicine gave young people with autism the hormone oxytocin (called “the love hormone” because of its role in maternal bonding), there were measurable increases in brain function in areas associated with processing social information.

This opens new possibilities for treatment of autism. However, we can produce beneficial hormone levels and improve brain function naturally through the power of positive emotions.

3 Tips to Help Someone with Autism

In my stress coaching for people with Aspergers and ADHD, I use simple and powerful ways to put the biochemistry of love to work.

1. Start small, go slow, think big.

Autism is a developmental delay, not a life sentence. Expect that they can go beyond their limitations, but never push them there. Don’t fight small battles; let them be where they are, and just take time to look for small victories. Each one is a big deal.

2. Fill your own positive, emotional gas tank.

Stress is also a huge problem for parents of autistic children. Put this power to work for you first. Practice self-care. Give yourself lots of empathy. Then let love fill you and radiate to your child. It will be the power their emotional muscles will grow into.

3. Teach them that positive emotions are our greatest source of power.

Our real power comes from the heart. That’s where we become the person we can be and learn how to connect with other people. Reflect their feelings to help them learn to do the same. If your child has a special interest, help them distinguish the positive feelings it gives them. They can learn to self-generate those feelings and use that power to overcome challenges.

Nothing will fill your heart with joy like when your autistic child, teen, or young adult lovingly expresses what is in their heart to others. Help them past their anxiety, and they’ll find the way.

That’s because you and your partner think and feel very differently, she says. And that leaves a lot of room for misunderstanding and miscommunication.

In her book, Ariel provides wise advice and practical exercises to help you improve your relationship and overcome common obstacles. (She suggests keeping a journal to record your responses.) Here are five ideas you might find helpful.

1. Don’t put the blame solely on your partner.

Your partner isn’t solely to blame for your relationship problems. As Ariel writes, “The true problems lie in the blending of two different modes of being. It is not your partner’s fault that he doesn’t understand certain social expectations, just as it is not your fault that you don’t understand how the pipes in your house work.”

2. Learn as much as you can about AS.

If you don’t know much about AS, it’s easy to misinterpret your partner’s actions and think they don’t care about you. Educating yourself on how AS functions can be a huge help in better understanding your partner and feeling compassion toward them.

Individuals with AS don’t process information the same way everyone else does. According to Ariel, research using brain scans have shown differences between the brain structure and shape of people with AS vs. people without AS.

People with AS have a tough time picking up on nonverbal cues in interactions and understanding people’s emotions. They may misinterpret a loved one’s needs. They may fixate on their own interests and appear like they’re self-absorbed and just don’t care about others. Essentially, people with AS see and experience the world differently. But they absolutely do care and experience emotions — again, just differently.

Learn more in our article on myths and facts about Asperger Syndrome.

3. Reframe your partner’s behavior.

You might think that your partner knows precisely what you need but purposely ignores it or intentionally does something to hurt you. And when you think your partner is cold and mean, you not only get upset and angry, but you also might view all of their actions and intentions negatively, Ariel says.

Reframing your partner’s behaviors helps you refocus on your relationship and work to improve it (vs. stewing in the negativity). It also might help you come up with creative solutions.

You still might disagree with their actions and feel hurt. But you may better understand your partner and work to move forward.

To help you reframe your partner’s actions, Ariel recommends creating three columns in your journal: Behavior or Situation; How it Makes Me Feel; and Another Perspective.

In the first column, describe a behavior or situation that upsets you. In the second column, record your feelings and why you think your partner acts this way. In the third column, try to think of a different explanation for their behavior.

Say you were upset recently about how your spouse handled you being sick. According to Ariel, here’s how your columns might look:

1st column: “When I was sick in bed for three days, she came in only at dinnertime. She left food without asking how I felt.”

2nd column: “This proves how self-centered she is. She didn’t care that I felt lonely and sad because of our lack of connection.”

3rd column: “She likes to be alone when she feels sick. She thinks asking people how they feel when they’re sick is dumb.”

It helps if both of you do this exercise and can discuss it.

4. Be specific about your needs.

Many of us expect our partners to automatically know what we want. Or to know what we want after the many hints we drop.

In reality, that’s rarely the case. And it’s especially not the case with AS partners. Rather than expecting your partner to naturally know what you want or hinting at it, communicate your needs as specifically and directly as possible.

This can be tricky because you might think that you’re already being very obvious. Here’s a simple example: According to Ariel, you might say, “I’m going out for a few hours. Can you please do the yard work?” To you this obviously means bagging the leaves because it’s fall and they’re everywhere. To your partner, this might mean weeding.

Instead, it’s more helpful to say: “Can you please rake the leaves and put them in the leaf bags by the curb for Friday’s pickup?”

5. Talk about how you’d like to connect with each other.

Because you and your partner experience emotions differently, having an emotional connection also can be challenging. Remember that people with AS have a difficult time understanding and identifying emotions, and they may show very little emotion or express inappropriate emotions. You also might miss displays of deep connection from your partner because you express emotions so differently.

Ariel includes the below exercise to help you and your partner articulate how you can improve your emotional connection.

• Using index cards or slips of paper, write down what you do to help you feel more connected to your partner.
• Next write down at least five things you’d like your partner to do.
• Have your partner do the same and list what they do to help you feel connected and what they’d like you to do.
• Read each other’s cards and talk about how you’d like to connect in the future.
• Put the cards in boxes: one box for what you’d like your partner to do; another box for what they’d like you to do.
• Try to do a few of these behaviors each week, and regularly review your lists.

Even though being in a relationship with someone with AS may add additional challenges, together, you can absolutely learn to better understand each other and improve your relationship.

You can learn more about Cindy Ariel at her website.

Who made this diagnosis? His mom.

His mom was so convinced that her then 17-year-old teenage son had this disorder, she put in him in an educational video about Asperger’s. Asperger’s is usually diagnosed in childhood or as a young teenager, and is characterized by a severe degree of social impairment, isolation, and what others might see as eccentric behavior.

While I commend Mr. Nugent for sharing his story with the world, I have to really question his understanding of how mental disorders are diagnosed by mental health clinicians.

Here’s his story…

Benjamin Nugent appeared in an educational video about Asperger’s, created by his mom, apparently an expert in Asperger’s:

The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality. [...]

Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

First of all, it’s highly unethical to go around diagnosing your family members — much less your children. Any first-year graduate student knows this.

Nugent was apparently only “diagnosed” by these two academicians — his mom and his mom’s colleague working alongside her in her own department.

I don’t care if your mom was the equivalent of Einstein in Asperger’s research — it’s just not ethical for a mental health clinician to diagnose someone they know (at least not in any official capacity). It’s also not very ethical for researchers or academicians to make clinical judgments about people they know.

That’s what licensed clinical psychologists do. I wonder if Nugent ever saw one of those?

You also can self-diagnose according to the DSM criteria as much as you’d like. But such self-diagnosis is also not valid or equivalent to a clinical diagnosis from a mental health professional.

I’m sorry to be the bringer of bad news, but the only person who could objectively diagnose Nugent — a mental health clinician — never did (at least according to the limited information he provided in his blog entry).

Mental disorder diagnoses are not simple things. An experienced clinician brings all of their wisdom and years of seeing similar children and young adults into play when deciding whether a mental disorder diagnosis is appropriate. So while you can indeed screen yourself to see if it’s something that you should go see a professional about (for instance, using one of our screening quizzes), it’s not something you can do to yourself — or your family members — with any degree of accuracy or objectivity.

Asperger’s, like most mental disorders, must also cause significant distress and impairment in at least one area of your life. In other words, YOU have to actually feel like this is a serious problem. If you are you, and you’re okay with whatever “you” is, it is virtually never appropriate to diagnose a mental disorder (there are some exceptions to this, but for most people, it’s the general rule).

So while I’m sorry to hear of Nugent’s young adult Asperger’s diagnosis — and I agree, such diagnoses should be made more conservatively — I think this story best illustrates the dangers of unqualified (or biased) professionals making mental disorder diagnoses. If your mom or dad thinks you might have a problem, go see a clinician who is experienced and a specialist in the area of your concern.

I would include most family physicians and general practitioners in this category of professionals who shouldn’t be diagnosing mental disorders as well — the folks responsible for prescribing the majority of anti-depressants in the U.S.

The best person to get a mental health diagnosis from? A qualified mental health professional, preferably a psychiatrist or psychologist.

Learn more about Asperger’s Syndrome.

Read the full blog entry: I Had Asperger Syndrome. Briefly.