Psychiatrist Expects Few Changes with New Asperger’s Designation

David C. Ruck, M.D.

PINEHURST – Dustin Hoffman’s Oscar-winning performance as the statistics-obsessed “Rain Man” gave Asperger’s syndrome one of its earliest public faces. The tragic assault on a Connecticut elementary school late last year gave it another, much grimmer one.

According to a child and adolescent psychiatrist with FirstHealth of the Carolinas, however, neither depiction of a psychiatric diagnosis that is about to be placed under the umbrella of the autism spectrum is especially accurate. Asperger’s syndrome, says David Ruck, M.D., is a complicated condition that can have many symptoms and involve numerous treatment approaches. And, he points out, contrary to the fears of some parents of Asperger’s children, its imminent autism grouping shouldn’t have any effect on access to available services.

“It’s going to make diagnostic clarity,” he says of the change.

A lifelong condition that can stabilize over time, Asperger’s syndrome (or disorder) is noted by a social awkwardness that includes repetitive behaviors, interests and activities (such as the “Rain Man’s” focus on numbers and his insistence that certain activities be done only at certain times). Since Asperger’s patients often develop normally in language, motor skills and intelligence, they are generally considered “high-functioning” and have been found to share common traits with such notable figures as Albert Einstein, Madame Curie, Benjamin Franklin, even Bill Gates and Elvis Presley.

“They don’t pick up on subtleties of communication,” Dr. Ruck says. “They don’t understand jokes and puns.”

With the May 2013 publication of the American Psychiatric Association’s DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), Asperger’s syndrome will lose its designation as an independent diagnosis and take a place on the autism spectrum. Because of the change, many parents are concerned that their child will lose access to critical educational and treatment opportunities.

Created by the American Psychiatric Association, the DSM is a common-language guide of mental health disorders that outlines causes and related information as well as some research on treatment options. Many mental health professionals use the manual to determine and help communicate a diagnosis after an evaluation, and American hospitals, clinics and insurance companies generally require a five-level (axis) DSM diagnosis.

Under the current DSM-IV manual, children can be diagnosed either as having autistic disorder, Asperger’s syndrome or PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified). In the new manual, however, all three disorders will fall under the umbrella of Autism Spectrum Disorder.

Dr. Ruck agrees with mental health professionals and advocates who expect the change in status will be a positive one that could actually lead to an increase in services by clearing up ambiguities in diagnosis and treatment.

“It’s not expected to make a significant difference in educational services,” he says. ‘It’s going to tighten up the criteria and get everybody reading off the same sheet of music.”

Asperger’s syndrome was thrust into the national spotlight in December 2012 with reports that the alleged gunman in the Sandy Hook Elementary School shootings had been diagnosed with the condition and that it somehow contributed to factors that led to the slayings of 26 students and school personnel. However, Dr. Ruck believes the attack required a level of planning and violence that is just as rare in individuals with Asperger’s as it is in the general population.

“In general, a kid with Asperger’s is no more likely than anyone else to show this explosive, targeted behavior,” he says.

David C. Ruck, M.D., is a board certified psychiatrist with FirstHealth of the Carolinas. He can be reached at (910) 715-3370.