APS Past President Morton Ann Gernsbacher is a Vilas Research Professor and the Sir Frederic C. Bartlett Professor of Psychology at the University of Wisconsin-Madison. Gernsbacher is a leader in the field of cognitive psychology. Her research focuses on the cognitive roots of language comprehension.
For more information about Gernsbacher and her research, visit www.GernsbacherLab.org.
The DSM-5 officially comes out in May. Do you have any insights about what’s going to happen with diagnoses for conditions like autism?
This is an important question, and one that many researchers, clinicians, and persons currently with and without diagnoses, are speculating about. What we know is that the diagnostic criteria will change in some ways – and will stay somewhat the same in others. One of the largest changes will be the consolidation of what used to be several diagnoses into one. Most striking will be the consolidation into Autism Spectrum Disorder of Asperger’s Disorder and what is currently called PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified).
One justification for that particular consolidation was the difficulty in diagnosing Asperger’s Disorder and PDD-NOS. Let’s take the case of Asperger’s Disorder. One of its previous diagnostic criteria was that the individual did not have a “clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).”
However, the criterion of no “clinically significant general delay in [early] language [development]” was very hard to apply. First, it required detailed developmental records, such as a daily diary of the words and utterances a child spoke when she or he was age 2 and 3. Most people don’t have such detailed records, particularly if they’re being diagnosed as adults. Short of detailed developmental records, a person’s memory was relied upon. But most of us can’t remember very much from when we were age 2, much less how many words we were speaking. Even parents were notoriously poor at remembering this information, unless they kept a detailed diary.
Third, how the criterion of no “clinically significant general delay in [early] language [development]” was operationalized varied quite a bit. Even the parenthetical examples of “single words used by age 2 years, communicative phrases used by age 3 years” were hard to operationally define. How many single words? One? Two? Twenty? And what counts as a communicative phrase? Does ‘go bye bye’ count? And, again, how many phrases by age 3?
The difficulty in applying this diagnostic criterion and the others that used to distinguish Asperger’s Disorder from Autistic Disorder or PDD-NOS was demonstrated in a large national study published in 2011. The study enrolled over 2,000 children at 12 different university research centers. All 2,000 of the children were diagnosed by highly experienced, well-trained clinicians, who were told to apply the exact same DSM-IV diagnostic criteria at their research center.
However, the application of the criteria varied from clinician to clinician (and research center to research center). Some clinicians gave the diagnosis of Asperger’s Disorder nearly a fourth of the time. But at another research center, the clinicians never gave any diagnoses of Asperger’s Disorder. In between those two extremes, there was also variation in the frequency with which one diagnosis versus another was given.
Therefore, the difficulty in reliably diagnosing Asperger’s Disorder is one of the reasons it is being consolidated into a broader diagnosis of Autism Spectrum Disorder. However, it remains to be seen whether the new diagnostic criteria of the DSM-V will be more reliably applied. And it remains to be seen whether individuals who previously met diagnostic criteria will no longer meet diagnostic criteria, and vice versa.
What led you to research autism and what has been your biggest challenge with this area of research?
I trained in graduate school (nearly 35 years ago) as an experimental psychologist. My goal was to understand human cognition, such as the attention you’re using right now to read the words on this page, the language processing you’re using to understand the content I’m trying to share, and the memories you’re forming of what I am communicating.
During the second half of my career, I began using brain imaging techniques like fMRI to study these basic cognitive processes of attention, language, and memory. Around the same time that I was incorporating brain imaging into my research, I also began focusing on diverse brains.
I’m excited for your Bring the Family Address at the APS Convention this year! Could you provide a bit more detail on what you’ll be discussing?
Thank you for sharing your excitement. I’m excited, too. Let me tease you with one of the phenomena I’ll be talking about. Many of us, particularly those of us who study psychological science, even if we’ve taken only a course in introductory psychology, are familiar with the color coded cartoon drawings of the brain. Those color coded areas are regions of the brain that have architectural boundaries, and they’re called lobes.
Although it’s tempting to want to consider each lobe as having a different job, the brain is more complex than that. However, there’s one lobe that has some of the greatest specificity. In fact, centuries before we had our fancy brain imaging machines, we’ve known that the lobe that’s farthest toward the back of the brain has as its chief responsibility processing visual information. And that’s why that region is known as the occipital lobe.
But what about blind persons – particularly persons who have been blind from birth? If the occipital lobe’s usual job is to handle a lot of the visual processing, what do the occipital lobes of blind people do? Do their occipital lobes just lie dormant?
One of the most exciting discoveries from the past few years of brain imaging research is that the brains of blind persons are amazingly flexible organs. They use the occipital lobe for other functions, like higher-order reasoning, judgment and decision making, and language comprehension. They don’t let that prime real estate go to waste. To me, that discovery is one of the best exemplars of what we mean by neural diversity.