Changes in Autism Nosology: Stigma, Knowledge, Contact, and the Removal of Asperger’s Syndrome from the DSM-5.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder diagnosed in one in every 59 eight-year-olds (CDC, 2014). Further insights into the heterogeneous nature of ASD have contributed to the revised diagnostic criteria. Research has documented evidence to classify the disorder as a spectrum with severity ranges (Lord & Jones, 2012; DSM-5, American Psychiatric Association, 2013) instead of a categorical system comprising Pervasive Developmental Disorder—Not Otherwise Specified, Asperger’s Syndrome, and Autistic Disorder (DSM-IV-TR, American Psychiatric Association, 2000). However, classification under an umbrella diagnostic label represents individuals with a wide range of symptoms and may assume homogeneity (Lord & Jones, 2012). This conceptualization can promote stigma and pessimistic attitudes (Corrigan, 2007). Indeed, individuals previously diagnosed with Asperger’s Syndrome have raised concerns regarding stigma that may be associated with ASD (Linton et al., 2014).

Objectives: This study examined undergraduate students’ perceptions of a label of ASD compared to Asperger’s syndrome or no diagnosis. It was hypothesized that participants would associate increased stigma with ASD compared to Asperger’s syndrome. Additionally, no diagnostic label would promote greater stigma than assigned diagnostic labels.

Methods: Raters included 71 undergraduate students from Roosevelt University. Participants were randomly assigned to read a vignette adapted from prior research (Ohan et al., 2016) about a student with one of three labels (i.e., ASD, Asperger’s Syndrome, No Diagnosis). Participants also completed questionnaires, including an adapted Social Distance Scale (SDS) (Bogardus, 1925), which assessed their comfort level with the individual, the ASK-Q (Harrison et al., 2017), which assessed participants’ knowledge of ASD in general, and additional questions regarding level of contact with ASD.

Results: Differences in comfort level ratings between the three conditions were assessed using one-way ANOVAs. Post-hoc comparisons were conducted following significant multivariate differences. Results revealed more positive ratings for the Asperger’s compared to the ASD condition on a number of SDS items. Participants rated being more comfortable residing in the same hall as an individual with Asperger’s than an individual with ASD (p=.01). When asked about comfort as a child’s caretaker, group differences revealed higher ratings for the Asperger’s condition compared to the ASD condition (p<.05). No group differences emerged between the Asperger’s and ASD groups when asked about going to dinner or a sporting event (ps>.72). Significantly higher positive ratings were associated with both ASD and Asperger’s conditions compared to No Diagnosis (ps<.05). All results remained significant when covarying for ASK-Q and contact scores.

Conclusions: Results demonstrate the impact of diagnostic labels in different social contexts, and support the need for education surrounding the change in diagnostic criteria. Having greater responsibility and more prolonged exposure increased stigma in the ASD condition compared to the Asperger’s condition. Short-term interactions did not raise the same concerns and were rated similarly between the ASD and Asperger’s conditions. Diagnostic ambiguity may result in greater discomfort than concrete diagnostic labels, suggesting the benefit of obtaining a diagnosis. Additional research on the perception of the ASD label should be conducted to better understand stigma associated with ASD.