Article on inconsistency in diagnosis and the fate of AS.

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I came across this article recently which highlights the inconsistency in diagnostic methods between various autism centers.

http://news.yahoo.com/where-child-teste ... 14331.html

The article states that at one clinic, a child needed to have an IQ over 70 to be diagnosed with AS, while at another clinic, and IQ of over 115 was required.

It also attempts to use this to promote the idea that AS should be abolished in the DSM-V.

I have a few issues with all of this. First of all, the deciding factors that dictate whether a person has AS or HFA is clearly articulated in the DSM-IV; specifically, a clinically significant language delay excludes one from a diagnosis of AS, as does a delay in non-social life skills or lack of curiosity about the world. This implies the individual should be of at least average intelligence but, though many IQ tests have found those with AS to be of above average intelligence, it certainly shouldn't be a determining factor in diagnostic practices.

My second issue is with the concept that AS should be abolished simply because clinicians can't do their job right. Should we just roll all rashes and skin ulcers into one disorder because dermatologists don't know what they're looking at? Should we call we abolish the terms apples and oranges and just refer to them as different levels of fruit because farmers can't be bothered to learn the differences between apples and oranges enough to know what they're growing?

I'm surprised psychiatry hasn't been laughed out of medical schools by now to be honest with you.

I've studied the dsm between autism and aspergers and it seems the biggest difference is in autism:

With Asperger's the delays can start occurring as late as maybe 8?

While in autism, there's additional criteria with category B, but I'm thinking that anyone who fulfills 2 symptoms out of category A is likely to have at least 1 symptom from category B. What I'm saying is take out section II, majority of us aspies could be diagnosed under autism criteria.

Diagnosing someone is often very unclear and highly subjective. In order to get an autism diagnosis, your delays have to have been present before age 3 and sometimes its hard to track the childhood history to that early. There's not a huge difference in the diagnostic crieria. I personally think its ok to encorporate aspergers with autism but they should create different crieria for HFA and LFA. Isn't rather hard to create a diagnostic crietria for such a broad range of people?

I practically yelled at my shrink about how unscientific much of the autism field is.

Using IQ as a cutoff makes no sense, one, because IQ is not in any of the DSM criteria and, two, it is being shown that IQ tests are not accurate for autistics.

Your analogy about rashes could be turned the other way. Having all these categories is like categorizing the same type of rash differently because it is on a different part of the body.

My concerns (quotes from the article):

This would impede scientific research as well as determining eligibility for services.


See above.


So having social problems may be more important in PDD-NOS than in AS?

Actually the same type of rash on a different part of the body often implies a different cause or pathology.

I am greatly amused that people are proposing doing away with AS diagnosis in the DSM, when the pharmacuetical companies keep inventing new diseases that they can sell pills for. Autism has no cure, there are no pills for it, so there's no money to be made from it.

Could you elaborate on this?

You're taking the analogy too far. Poison ivy on my crotch hurts more than on my arm. But it's still poison ivy.

The point is that there are valid arguments for collapsing the diagnosis. It just so happens there are some valid arguments for keeping separate categorizations. There is no compelling winner in the debate as of yet.

Personally, I'm more concerned with treatment and education. Labels aren't the only thing at stake here. If the autistic community is better served by collapsing the diagnosis, I'm cool with that. If it's not, then I'm not cool with it.

Autism is just autism.

The fact that anyone is including IQ scores in Autism evaluations is ridiculous. DSM does not, and never has, said ANYTHING about IQ. This reveals the huge amount of ignorance and stereotyping happening in the professional community. The only reason I can think of that any of them are considering IQ in the DX, is because stereotypes exist and professionals are buying into them. This should NOT be happening. DSM is not unclear about this. IQ is never mentioned in it, and therefore should not even be considered.

This problem won't be solved by DSM-V, but that doesn't mean that simplifying the process with the new criteria is a bad idea.

Caveat emptor. "Let the buyer beware."

It's pretty obvious that nobody is really checking up well enough on these idiots to be certain they're actually following the DSM criteria.

It's up to us, and parents of those with Autistic children to educate ourselves enough to recognize quackery when we see it.

Steady on. Maybe these idiots are referring to Baron-Cohen's book which says:

In Asperger syndrome, IQ is at least average …

In classic autism, IQ can be anywhere on the scale …

He then goes on to say that, in his opinion, what counts as average IQ should be 85 or greater. He acknowledges that many clinicians use 70 as the breakpoint, which corresponds to the article the OP linked.

In the article, it says "<<Given the subtle distinctions among the subtypes of autism spectrum disorder, it is not surprising that clinicians were not consistent in how they applied these diagnoses,>> Dawson said. <<In the future, it is likely that we will no longer attempt to classify individuals in the autism spectrum into different subtypes.>>"

I know that the current diagnostic criteria of autism provides for classification for severity levels, and the proposed ASD will also use classification, a more sophisticated one, if I'm not mistaken. But, if a professional says that they are no more going to classify ASD individuals into subtypes in the future it seemingly contradicts it.

Research needs statistical data, and the more detailed and consistent the data they collect about individuals the better. I know that details are recorded and made available for research (with consent) about many individuals anyway, but determining attributes of subtypes and doing the grouping may serve as a guideline and basis for further studies.

Eligibility for services may depend on how authorities (the government and local authorities) see it. If, say, AS is eligible for a given service while PDD-NOS isn't (or AD vs. AS), it would be a problem for all those who work in a position at a competent authority as well as for those who now only have a single ASD diagnosis. Such authorities wouldn't be keen on being bothered by seemingly inconsistent details of ASD diagnoses. They can't be blamed for it. The proponents of DSM-V should come up with a solution for it.

Last edited by OJani on 08 Nov 2011, 4:35 pm, edited 1 time in total.

Simon Baron Cohen's books are not the DSM. Sorry.

I've not stated anything about whether IQ is or should be a factor. What I said was pretty simple. DSM is what DX's are supposed to be based on. DSM does not mention IQ. Ergo, professionals that are using IQ's are writing their own rules.

If every professional were allowed to do that, we may as well toss the DSM in the garbage, and just let them all turn the process of DX'ing into complete anarchy.

If a doctor feels IQ should be a factor, then let that doctor present his arguments and studies before a board of his/her peers, and let it become included in the DSM.

There HAS to be some kind of order to the process. Just read the article. Look what happens when they all make up whatever rules they want.

It doesn't work.

I recall reading somewhere that the IQ>70 thing is one way that the criterion about "significant delay in cognitive development" ends up being interpreted. Not defending it, just FYI. I think the criticism about verbal IQ tests being questionably accurate with autistics is a good point.

Another factor that brings down the IQ scores of autistics is sensory overload and brain shutdown in the presence of strange people and unfamiliar environments during the testing.

Actually, I recall the same thing from when I first started digging deep into what Autism, AS et. al. really are. The number 70 comes to mind, but so does the number 115.

At the time, I didn't even know what the DSM was. Over the past few years, I've learned more about it, Asperger's papers, Uta Frith's book, Lorna Wing's role in bringing it even more to the forefront, and the historical development of the meaning of the word Autism itself.

Basically I look at it this way, and everyone, of course, is free to look at it differently:

There is a core body of work and documentation for which consensus exists. There is a HUGE body of work outside that core body of work, for which consensus only exists among smaller groups of professionals. A lot of the latter is made up of highly educated opinions, but opinions nonetheless. I can't make a lot of sense of the world or anything in it without some kind of rules. I look toward that body of work for which the most consensus exists. That is the DSM. I've not found any evidence that the DSM ever mentioned anything specifically about IQ. Even if it did at one time, it doesn't anymore, and that is THE book of consensus.

I'm certain that some professionals feeling the need to quantify things is behind IQ being used, and the clause you quoted is probably what they are trying to quantify. The problem is, as the article makes clear, the quantification is too subjective. I think it's a big mistake to consider IQ's at all. I think there are very good reasons for IQ's not being in the DSM in relation to Autism.