Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Cars trapped in tunnel collapse outside Tokyo

TOKYO (AP) — Parts of a tunnel collapsed Sunday on a highway west of Tokyo, trapping an unknown number of vehicles as smoke from a fire inside initially prevented rescuers from approaching.

Video footage from cameras inside the tunnel, after the fire was apparently extinguished, showed firefighters picking their way through cement roof panels that collapsed onto vehicles inside the Sasago Tunnel, about 50 miles (80 kilometers) outside the city.

About 25 vehicles were inside the (2.5 mile) 4.3 kilometer-long tunnel, some of them trucks stopped by the tunnel's collapse.

Police spokesman Yoshihiro Fukutani said they were still seeking details about the situation inside the tunnel.

Police vehicles, fire trucks and ambulances were massed outside the tunnel's entrance. A man who said he saw the collapse and alerted authorities to the emergency told NHK television he managed to escape after he was ordered to flee. The roof and windows of another vehicle parked on the roadside outside the tunnel were crushed, and the injured occupants reportedly taken to a hospital.

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Average wireless bill increased 7% in 2012 , 70% of subscribers now own smartphones

We all love our smartphones, but they are a costly addiction to support. According to Consumer Reports, American wireless subscribers saw their wireless bills increase by 7% between 2011 and 2012, and the big culprit is the continued proliferation of smartphones. Overall, 70% of wireless subscribers who took part in Consumer Reports’ survey owned smartphones this year, up from 50% in 2011. As the publication notes, “upgrading from a plain cell phone at a major carrier isn’t cheap” since “you have to buy the smart phone itself (usually $ 100 to $ 400 when signing a two-year contract) and fork over $ 70 to $ 110 a month for a plan with data service… a lot more than a basic phone plan, which generally costs $ 40 to $ 70 a month.”

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Glen Campbell considering more live shows in 2013

NASHVILLE, Tenn. (AP) — Glen Campbell may be wrapping up a goodbye tour but that doesn't mean he's done with the stage.

Campbell is considering scheduling more shows next year after playing more than 120 dates in 2012.

The 76-year-old singer has Alzheimer's disease and has begun to lose his memory. He put out his final studio album, "Ghost on the Canvas," in 2011 and embarked on the tour with family members and close friends serving in his band and staffing the tour.

Campbell's longtime manager Stan Schneider said in a phone interview from Napa, Calif., where the tour wrapped for the year Friday night, that recent West Coast shows have been some of the singer's strongest. Campbell will break for the holidays and if he still feels strong he'll begin scheduling more shows.

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JLo tones down concert in Indonesia

JAKARTA, Indonesia (AP) — Jennifer Lopez wowed thousands of fans in Indonesia, but they didn't see as much of her as concertgoers in other countries — the American pop star toned down both her sexy outfits and her dance moves during her show in the world's most populous Muslim country.

Chairi Ibrahim from Dyandra Entertainment, the concert promoter, says the American pop star's "Dance Again World Tour" was performed in the country's capital, Jakarta, on Friday in line with promises Lopez had made to make her show more appropriate for the audience.

Lopez, changed several times during her 90-minute concert along with several dancers, who also dressed modestly without revealing their bare chests or cleavage.

Lopez is set to perform in Muslim-majority Malaysia on Sunday.

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Kenya village pairs AIDS orphans with grandparents

NYUMBANI, Kenya (AP) — There are no middle-aged people in Nyumbani. They all died years ago, before this village of hope in Kenya began. Only the young and old live here.

Nyumbani was born of the AIDS crisis. The 938 children here all saw their parents die. The 97 grandparents — eight grandfathers among them — saw their middle-aged children die. But put together, the bookend generations take care of one another.

Saturday is World AIDS Day, but the executive director of the aid group Nyumbani, which oversees the village of the same name, hates the name which is given to the day because for her the word AIDS is so freighted with doom and death. These days, it doesn't necessarily mean a death sentence. Millions live with the virus with the help of anti-retroviral drugs, or ARVs. And the village she runs is an example of that.

"AIDS is not a word that we should be using. At the beginning when we came up against HIV, it was a terminal disease and people were presenting at the last phase, which we call AIDS," said Sister Mary Owens. "There is no known limit to the lifespan now so that word AIDS should not be used. So I hate World AIDS Day, follow? Because we have moved beyond talking about AIDS, the terminal stage. None of our children are in the terminal stage."

In the village, each grandparent is charged with caring for about a dozen "grandchildren," one or two of whom will be biological family. That responsibility has been a life-changer for Janet Kitheka, who lost one daughter to AIDS in 2003. Another daughter died from cancer in 2004. A son died in a tree-cutting accident in 2006 and the 63-year-old lost two grandchildren in 2007, including one from AIDS.

"When I came here I was released from the grief because I am always busy instead of thinking about the dead," said Kitheka. "Now I am thinking about building a new house with 12 children. They are orphans. I said to myself, 'Think about the living ones now.' I'm very happy because of the children."

As she walks around Nyumbani, which is three hours' drive east of Nairobi, 73-year-old Sister Mary is greeted like a rock star by little girls in matching colorful school uniforms. Children run and play, and sleep in bunk beds inside mud-brick homes. High schoolers study carpentry or tailoring. But before 2006, this village did not exist, not until a Catholic charity petitioned the Kenyan government for land on which to house orphans.

Everyone here has been touched by HIV or AIDS. But only 80 children have HIV and thanks to anti-retroviral drugs, none of them has AIDS.

"They can dream their dreams and live a long life," Owens said.

Nyumbani relies heavily on U.S. funds but it is aiming to be self-sustaining.

The kids' bunk beds are made in the technical school's shop. A small aquaponics project is trying to grow edible fish. The mud bricks are made on site. Each grandparent has a plot of land for farming.

The biggest chunk of aid comes from the United States President's Emergency Plan for AIDS Relief (PEPFAR), which has given the village $2.5 million since 2006. A British couple gives $50,000 a year. A tree-growing project in the village begun by an American, John Noel, now stands six years from its first harvest. Some 120,000 trees have already been planted and thousands more were being planted last week.

"My wife and I got married as teenagers and started out being very poor. Lived in a trailer. And we found out what it was like to be in a situation where you can't support yourself," he said. "As an entrepreneur I looked to my enterprise skills to see what we could do to sustain the village forever, because we are in our 60s and we wanted to make sure that the thousand babies and children, all the little ones, were taken care of."

He hopes that after a decade the timber profits from the trees will make the village totally self-sustaining.

But while the future is looking brighter, the losses the orphans' suffered can resurface, particularly when class lessons are about family or medicine, said Winnie Joseph, the deputy headmaster at the village's elementary school. Kitheka says she tries to teach the kids how to love one another and how to cook and clean. But older kids sometimes will threaten to hit her after accusing her of favoring her biological grandchildren, she said.

For the most part, though, the children in Nyumbani appear to know how lucky they are, having landed in a village where they are cared for. An estimated 23.5 million people in sub-Saharan Africa have HIV as of 2011, representing 69 percent of the global HIV population, according to UNAIDS. Eastern and southern Africa are the hardest-hit regions. Millions of people — many of them parents — have died.

Kitheka noted that children just outside the village frequently go to bed hungry. And ARVs are harder to come by outside the village. The World Health Organization says about 61 percent of Kenyans with HIV are covered by ARVs across the country.

Paul Lgina, 14, contrasted the difference between life in Nyumbani, which in Swahili means simply "home," and his earlier life.

"In the village I get support. At my mother's home I did not have enough food, and I had to go to the river to fetch water," said Lina, who, like all the children in the village, has neither a mother or a father.

When Sister Mary first began caring for AIDS orphans in the early 1990s, she said her group was often told not to bother.

"At the beginning nobody knew what to do with them. In 1992 we were told these children are going to die anyway," she said. "But that wasn't our spirit. Today, kids we were told would die have graduated from high school."

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On the Internet:

http://www.trees4children.org/

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Why Obama is pushing for stimulus in 'fiscal cliff' deal

How about a little government economic stimulus?

That may sound incongruous considering the budget deficit and the push from Republicans to cut government spending.

But President Obama’s first offer to avoid going over the "fiscal cliff" holds out the hope of at least some stimulus. This would include extending the 2 percentage point Social Security payroll tax cut, boosting a tax incentive to businesses, establishing a $50 billion bank for long-term infrastructure projects, and extending unemployment benefits.

RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered

The total bill: about $255 billion out of the federal government's pocket – an amount the GOP would likely say needs to be offset by spending cuts elsewhere.

The argument in favor of such stimulus? The tax measures, at least, could minimize the drag on the economy from Mr. Obama's proposed tax increases on the wealthy.

“The increases in the top two income tax brackets would put a drag on consumption, so I think, from the Obama point of view, the spending or tax cuts are designed to offset that drag to consumption,” says Michael Brown, an economist at Wells Fargo Securities in Charlotte, N.C.

But to some budget experts, Obama’s list seems more like an opening round of negotiations, where he has asked for a lot more than he will get.

“It looks to me like these are bargaining chips,” says Pete Davis of Davis Capital Ideas, which advises Wall Street firms. “Even most Democrats had given up on the prospect of getting the payroll tax cut extended.”

Mr. Davis considers the odds of most of the stimulus proposals passing Congress “very low.”

What's needed most, say others, is just buckling down and negotiating an end to the fiscal cliff. “Cancelling the fiscal cliff is economic stimulus,” says Stan Collender, a budget expert and partner at Qorvis Communications in Washington.

If Obama's stimulus were passed, however, here is a look at the impact the four elements might have.

SOCIAL SECURITY PAYROLL TAX CUT

The largest chunk of the Obama plan is the extension of the payroll tax cut. This is the money that comes out of an individual’s paycheck as a contribution to Social Security. Two years ago, in an effort to stimulate the economy, Congress decreased the individual contribution from 6.2 percent to 4.2 percent. The employer’s contribution of 6.2 percent remained unchanged.

The Obama administration estimates extending the cuts would cost the government as much as $115 billion in revenue.

The argument for extending the tax cut is that it helps lower-income workers who live paycheck to paycheck. “The difference in the paycheck might be the ability to pay the electric bill for someone or the chance to go to a sit-down restaurant once a month,” says Chris Christopher, an economist at IHS in Lexington, Mass.

The argument against continuing the cut is that it is weakening the Social Security Trust Fund. In order to make up for the loss of contributions, the government taps the general tax revenues, says Pamela Tainter-Causey, a spokeswoman for the National Committee to Preserve Social Security and Medicare.

“It sets up Social Security to compete for funding from the general fund,” she says. “It’s a perfect set up for people who are gunning for the program and claim we can’t afford it now.”

BUSINESS TAX INCENTIVE

The second largest program proposed by Obama would be the extension of accelerated depreciation for business, which would cost the US Treasury about $65 billion in fiscal year 2013, according to the Congressional Budget Office.

Two years ago, business was allowed to accelerate the write-off of 100 percent of its spending on certain capital equipment. Capital spending on equipment and computer software soared by 18.3 percent in 2011.

Then, this year, the benefit to business was cut in half to 50 percent. Capital spending sank in the third quarter by 2.7 percent compared with the same quarter the prior year. With business interest in using the tax break diminishing, economist Gregory Daco of IHS says “it’s a goner.”

INFRASTRUCTURE BANK

Obama has also proposed a $50 billion infrastructure bank. The idea is to fund roads, bridges, tunnels and other large projects that last for a long period of time. “At the moment the funding is done on a cash basis – you have to pay for it as you build it,” says Mr. Collender.

Democrats have been trying to get Congress to fund the bank for the past 10 years, he says. “It does not have a chance of getting through the House," which is controlled by the Republicans, says Mr. Collender.

UNEMPLOYMENT BENEFITS

And, finally, Obama wants to extend unemployment benefits, which would cost about $30 billion.

Under current law, if Congress does nothing, the maximum number of weeks in which an individual could receive jobless will drop to 26 from the current 73 weeks for states with unemployment over 9 percent and 63 weeks for states with unemployment over 7 percent.

If Congress does nothing about the program during the lame-duck session, some 2.1 million jobless will lose their benefits in the first week of January, says Judy Conti, a federal advocacy coordinator at the National Employment Law Project (NELP) in Washington. By the end of the March, she says, another 900,000 people will lose their benefits.

“Forty percent of the unemployed are long term unemployed,” she says. “They have been out of the workforce for over six months.”

RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered

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Apple overcomes last hurdle, iPhone 5 cleared for sale in China as Android continues to dominate

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he's a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America's battlefields and an "honest conversation about the country's history."

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Suu Kyi decries crackdown that injured protesters

MONYWA, Myanmar (AP) — Opposition leader Aung San Suu Kyi publicly criticized the forcible crackdown on protesters at a mine in northwestern Myanmar and said Friday that the public needed an explanation of the violence that injured dozens, including Buddhist monks.

At the same time, she indicated in her speech to villagers that the protesters may have to accept a compromise for the sake of national honor.

Now serving in parliament after years as a political prisoner of the long-ruling junta, Suu Kyi received a hero's welcome in the town of Monywa, where residents were rattled by the government's biggest crackdown on demonstrations since reformist President Thein Sein took office last year.

She was scheduled to visit the area before the crackdown to hear the protesters' grievances and said she would try to negotiate or mediate in the conflict over the mine, which protesters say is causing environmental and social problems.

Speaking to a crowd of more than 10,000, Suu Kyi made the point she did not want confrontation but said people had the right to ask why the authorities cracked down so harshly on the non-violent protesters.

"I want to ask, 'What was their purpose of doing this?' Frankly, there's no need to act like this," she said, and people in the crowd shouted back: "Right!"

"I'm not saying this to agitate people," she continued. "I never persuade people by agitating. I explain to people so that they can decide by thinking."

Activists and Buddhist monks who contend the Letpadaung copper mine is causing environmental and social problems had occupied the mine for 11 days before police used water cannons, tear gas and smoke bombs to break up the protest early Thursday.

Weapons that protesters described as flare guns caused severe burns to protesters and set shelters ablaze. A nurse at a Monywa hospital said 27 monks and one other person were admitted there to be treated for burns.

Suu Kyi visited with injured protesters Thursday, as well as meeting with mining company officials and local activists. She was to meet security officials Friday.

She has taken a soft line on the conflict over the project, noting that many people asked her to help stop the project at once, but saying she did not know details of the original contract and a parliamentary investigating committee had yet to do its work.

She went on to suggest that Myanmar should honor the contracts establishing the project, especially since they involved a neighboring country. The mine is a joint venture between a military-controlled holding company and a Chinese mining company.

She said the deals were done under the previous military regime without taking into account the wishes of the people, and "We are suffering as a result of these," but that Myanmar should honor its commitments nonetheless.

She said that even in some cases where the people's interest was not taken into account, the agreement should be followed "so that the country's image will not be hurt."

"You can't decide that you can't keep the promise that you didn't give," she said.

The government's position is similar, with senior officials publicly stating that that the protesters' demands to stop operating the mine risked scaring off foreign investment in Myanmar's long-neglected economy.

Although she is head of the parliamentary opposition, Suu Kyi has usually counseled moderation in problematic issues.

The protest is the latest major example of increased activism by citizens since the elected government took over last year. Street demonstrations have been legalized, and are generally tolerated, though detentions have occurred in sensitive cases.

Political and economic liberalization under Thein Sein has won praise from Western governments, which have eased sanctions imposed on the previous military government because of its poor record on human and civil rights.

However, the military's position in Myanmar's government remains strong, and some critics fear that democratic gains could be temporary.

The mine is a joint venture between China's Wanbao Mining Copper Ltd. and the military-owned Union of Myanmar Economic Holdings Ltd., and most people here remain suspicious of the military and see China as an aggressive and exploitive investor that helped support its rule.

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