In the current suggestion for DSM5 there will be a separate diagnosis that seems to be similar to Semantic pragmatic disorder. I think it will be called Social communication disorder (I couldn't find the suggested revisions at the moment) and it will clearly be separated from the autism spectrum disorders. I have see discussions that this diagnosis will be include some people from the autism spectrum that no longer fulfill the new criteria for ASD.

My understanding, based on a presentation I heard last week by one of the members of the Neurodevelopmental Disorders DSMV working group, is that the most recent proposal was to have criteria for a diagnosis of Social Communication Disorder. This diagnosis would fall under the larger category of Communication Disorders and not under the category of Autism Spectrum Disorder. Autism Spectrum Disorder is intentionally singular, and requires symptoms in both the social communication domain AND the repetitive behaviors, interests, and activities (RRB) domain. For a diagnosis of Social Communication Disorder, the Autism Spectrum Disorder diagnosis would need to be ruled out. Thus, if an individual showed social/pragmatic symptoms of the type seen in ASD but did not meet criteria in the RRB domain, they likely would meet criteria for Social Communication Disorder. This might include some individuals who previously met criteria for PDD-NOS, but should not include anyone who previously met criteria for Autistic Disorder (high functioning or not) or Asperger Disorder, as both of these diagnoses require symptoms in the social domain and the RRB domain under the DSMIV criteria. The final version of the DSMV is due out soon, and the draft criteria for all DSMV diagnoses have been removed from the website (DSM5.org) in preparation for that.

This is a great question. Looking at a draft of the DSM-V, Dr Watson is absolutely correct in that the distinguishing feature is the lack of repetitive behaviors and mono-focused interests, spared overall cognitive abilities and a singular deficits in the individual's ability to comprehend and act upon "verbal and non-verbal communication in naturalistic contexts." Such deficits cannot be expained by deficits in syntactical processing and production as well as intellectual deficits. Dorothy Bishop is undoubtedly the foremost expert on semantic-pragmatic language disorder/impairment. Her work dates back to the late 1980's and well worth reading.

In my humble opinion, I think that the creation of the SCD (social communication disorder) was in part created to be able to "absorb" individuals who might have otherwise received a diagnosis of Asperger Syndorme or PDD-NOS. The nullification of Asperger as a viable diagnosis has left a gap, although clinically, it's application generally gives clinicians a kind of short hand when treatment is initiated. At least in my experience, when I have worked with someone diagnosed with Asperger's, I have a better idea of what not to work on. The other difficult thing about Asperger Syndrome is that many of the diagnostic label's core features bleed into other diagnostic entities. Asperger Syndrome shares a number of characteristics with schizotypal personality disorder and the confusion can go both ways. Basically, the creation of SCD allows for Asperger's to be more effectively subsumed into the broadened diagnostic criteria of Autism Spectrum Disorder.

The other thing I believe might come from the creation of SCD as a separate disorder is its faculty as an Axis II diagnosis. It would give a great deal of information to clinican's who might see it as an Axis II when the Axis I is a conduct disorder, oppositional defiance disorder, borderline personality disorder, schizotypal, ADHD, ADD and other defined disorders where contextually appropriate interaction impedes the individual's ability to successfully navigate their environment.

These are just my thoughts. Thanks for reading.

To my understanding, the main reason for creating a general Autism spectrum disorder, and not keeping Asperger, Autism and PDD-NOS as seperate, is that the Task force feels that the scientific evidence is pointing in that direction. There are a several studies that shows that different clinicians will diagnose the same individual with different PDD diagnosis, e.g. one clinician will say autism with normal range IQ and the other will say Asperger syndrome.

From what I have read from the Task force, the SCD diagnosis is not to be considered to be related to ASD, and it's creation has nothing to do with the ASDs. Fransesca Happe, who is part of the Task force has said that some in the PDD-NOS group, might fall in to the SCD group though.

There has been a lot of complaints from researcher about this change and many feel that a lot of patients that today have a PDD diagnosis in DSM-IV will not have a ASD diagnosis in DSM 5. I have seen some studies showing that most (~90%) will stay in the autism spectrum, but I have also seen studies showing that below half in the PDD-NOS group will stay in the spectrum.

In many countries social benefits are related to having an autism spectrum diagnosis and they will probably lose these benfits if they no longer have an ASD diagnosis.

Ongoing interesting discussion. Apparently the widespread angst related to individuals with Asperger syndrome potentially no longer meeting criteria for ASD under the DSM5 criteria led the working group to add a footnote saying that anyone who previously met criteria for Asperger under DSMIV would meet criteria for ASD under DSM5. So, unless something changes in the final editing, that should be part of the DSM5 publication. But I think Adam is correct regarding PDD-NOS, and likely it is hard to know how many individuals with PDD-NOS will be affected. The criteria for PDD-NOS in DSMIV is just that the individual has a severe and pervasive impairment in one or more of the social, communication or RRB domains but is "subthreshold" in meeting the criteria for another diagnosis for a PDD or childhood schizophrenia, schizotypal personality disorder, or avoidant personality disorder. So PDD-NOS has always been "messy" as a diagnostic category, and research has shown that even very experienced clinicians are not impressively reliable with one another in diagnosing PDD-NOS.

As Adam noted, the decision to eliminate Asperger syndrome as a separate diagnosis is because the research has not indicated meaningful differences in other aspects of functioning or outcomes between Asperger and autistic disorder (with high IQ) based on the criteria that were used for differentiate between them in DSMIV. The group was basing their recommendations (across the board) on the research that has been done to date, but certainly recognize that more research will be done and that future revisions of the DSM will reflect that research. Also, despite the use of research evidence, the decision on "where to draw the line" for diagnostic categories likely will always involve some amount of arbitrariness for diagnoses that are based on behavioral symptoms rather than on a biological marker. For instance, evidence suggests that language impairments, ADHD, bipolar disorder, and schizophrenia may all have some shared heritability with ASD. While it doesn't make sense to try to lump all of those diagnoses into a single mega-category, if they share some heritability, then we might expect also to see some overlap in behavioral symptoms.

Good suggestion from Brian to look at Dorothy Bishop's work. She has contributed prolifically to our understanding of pragmatic language impairment and to our overall knowledge of the differentiation and overlap among language impairments and ASD. Undoubtedly her research was influential in the recommendation for a new DSM5 diagnosis of social communication disorder.

Thank you for all inputs by Adam Helles, Linda Watson and Brian Roper. So what I'm given is that the diagnosis of SPD will possibly come under Social Communication Disorder category in DSM V, a distinct diagnostic category under Communication disorders, separate from ASD.

I'm aware of Dorothy Bishop's work and my case categorization have been based on the inputs from her article "Autism, Asperger's ans Semantic pragmatic disorder, Where are the boundaries?" as well as Rapin and Allen's description of SPD.

Hence, to summarize, those with Aspergers will have socialization problems, RRB's, but no delay in communication and VIQ better than PIQ, but in the case of SPD, Socialization problems (to some extend) Communication and social communication probs(semantic and pragmatic difficulties) problems are dominant with delayed language development and PIQ better than VIQ, in the absence of RRB's.

Regarding VIQ>PIQ for AS: I would say both clinically and empirically there is no evidence for that distinction. On a group level you will find more indivuals with VIQ>PIQ with AS than with autism, but the overlap is huge and on an individual level it has no bearing regarding diagnosis, but it can effect outcome. I have met a great number of individuals with As that has VIQ=PIQ and some with VIQ

I agree with above that Dorothy Bishop has done the most to clarify the relationship between autism and SPD then pragmatic language impairment and now S(P)CD in DSM V. I wonder how the Chiidrens Communication Checklist (2) will be developed to help with the distinction as currently it is very good at differentiating PLI from specific language impairments and of course receptive language disorders have a number of similarities with ASD- with more secure attachments and normal non-verbal communication compared with ASD. I am also wondering about the impact on diagnostic algorithms such as 3DI popular in the UK. There is concern that moving the PDD NOS group off the autistic spectrum will result in fewer resources to help and from a clinical perspective those that were on the hinterlands of diagnosis still were functionally impaired with high rates of comorbidity- as seen in the DAMP discussions with Professor Gillberg.

For those still following, I have had two clients previously diagnosed with AS who were rediagnosed by rehabilitation agencies as SPD. As a result of the 'new' diagnosis, they were denied services, despite the clearly stated 'grandfather' clause that affirms the diagnosis stays if ever provided under the IV. This is not good.