Social communications disorder..is it on the spectrum?

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whirlingmind
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07 Jun 2013, 11:25 am

This is taken from the DSMIV:

Quote:
299.80 Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" --presentations that do not meet the criteria for autistic disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.


I believe many clinicians also use PDD-NOS if the presenting adult does not have access to childhood history, so the clinician either is unhappy to diagnose AS as there is no proof of developmental trajectory or they assume it is late onset. This does not mean that the person in question does not have AS.

Without seeing your sources, I don't know how correct you are in saying that PDD-NOS is the most commonly diagnosed disorder. However, even if that were the case, of course there are plenty of reasons, including the above, as to why this doesn't mean it is necessarily correctly diagnosed.

I do believe also many non-expert clinicians have used PDD-NOS as a kind of catch all because of their inexperience or outdated beliefs

The thing about repetitive stereotyped behaviours (presumably this is what you mean by SRB?) is, that as autistic people are known to have problems explaining their feelings (and I know this from personal experience) that until you find out that what you are doing isn't 'normal' it would never occur to you to identify it as such a behaviour. So a clinician could easily mistakenly believe you didn't have the relevant traits - heck you could even believe it yourself if you couldn't identify them.

Also, I think it's a grey area about RSBs, e.g. take literalness (although a different trait, the principle applies), all the information on literalness explains it as misunderstanding metaphors, and my eldest child displays her literalness in other ways too, so if a clinician asked if she misunderstood metaphors, if I never use metaphors with her I would say no and they might incorrectly record that she didn't have literal understanding.

So likewise, everyone displays their traits in individual ways, including SRBs, and if a clinician asked "do you have a routine that you have to do" and that individual didn't have a routine, but had something else that could be categorised as an SRB they would say no. Stimming is also an SRB but if you have a small stim that isn't the stereotypical rocking or hand-flapping you might not identify it as a stim or the clinician might not.

The logical connection between social impairment and SRBs is the genetics and the brain wiring!

I don't quite follow your point about those studies you linked to but until science knows all there is to know about autism I don't think they should be drawing any conclusions about the links between the various deficits of autism, and certainly not breaking bits off into separate disorders.

I just think SCD is a mistake.


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GhostsInTheWallpaper
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07 Jun 2013, 12:20 pm

whirlingmind wrote:
@GhostsInTheWallpaper: see my post above.

You just sound like an Aspie to me, that may be on the milder end - or be in the right environment to enable you to not go beyond your coping skills to start displaying traits to extreme. Additionally, don't forget every Aspie is unique, with their own strength of traits, you just may be lower on some and higher on others. That doesn't necessarily make you not an Aspie.

I don't know. I feel like I really am somewhere in between. I think all distinctions of this sort are to some degree artificial, because it's kind of arbitrary where you draw the line. It's like distinguishing between different ranges of the electromagnetic spectrum...there are always kind of gray areas in between, say, visible and infrared (very near-infrared which is easy to image in optical cameras but can't be seen by the human eye) or radio and far-infrared (the sub-millimeter wavelength range). My sisters, who are both of the opinion that I'm basically Aspie, keep telling me "it's a spectrum." And yes, that's true. But so is non-autistic wiring. And some of my most recent friends pretty much perceive me as completely normal, and were surprised to even hear I had problems as a kid. (Then again, women with autistic traits do tend to be notoriously hard to pick out in many situations.)

So, in the end, it's complicated, and I'm glad that they've come up with an officially recognized "in-between" category because it explains my childhood and adolescence way better than anything else I've come across. (The next-best explanation would be mere insecurity, but I think there was more going on - quirks that showed up too early to be just that.) I'm not sure if they're right to call it "not on the autism spectrum," but I don't think I would have ever quite met the diagnostic criteria for Asperger's. Not even necessarily Asperger's in women as described by Rudy Simone, although I have noticed some similarities.


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WerewolfPoet
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07 Jun 2013, 12:41 pm

What would one be diagnosed with if one exhibited self-harm, stereotypical behaviors, restricted interests, and hypo-and-hyper sensitivities, but did not exhibit social difficulties to the extent at which is presented in the DSM-V criteria for ASD?



GhostsInTheWallpaper
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07 Jun 2013, 12:42 pm

WerewolfPoet wrote:
What would one be diagnosed with if one exhibited self-harm, stereotypical behaviors, restricted interests, and hypo-and-hyper sensitivities, but did not exhibit social difficulties to the extent at which is presented in the DSM-V criteria for ASD?

Sensory processing disorder? Not sure if that's a DSM-5 category or not, but it's gotten some fame in special needs circles.


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ANicL
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07 Jun 2013, 4:41 pm

Ill post later, my brain is about to explode with all of this information :D


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07 Jun 2013, 5:36 pm

whirlingmind wrote:
Without seeing your sources, I don't know how correct you are in saying that PDD-NOS is the most commonly diagnosed disorder.


http://www.cdc.gov/mmwr/preview/mmwrhtm ... ss6103a1_w [Table 3]

http://en.wikipedia.org/wiki/Autism_spe ... idemiology

Quote:
However, even if that were the case, of course there are plenty of reasons, including the above, as to why this doesn't mean it is necessarily correctly diagnosed.

I do believe also many non-expert clinicians have used PDD-NOS as a kind of catch all because of their inexperience or outdated beliefs


http://www.ncbi.nlm.nih.gov/pubmed/14726723

Quote:
Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors.


http://crackingtheenigma.blogspot.pt/20 ... d-nos.html
Quote:
As you can see in the far right column, group differences were particularly marked on the RSB scale. Indeed, the authors found that only two of the 66 PDD-NOS kids had clinically significant RSBs and both of these children were very close to also meeting the communication criterion, which would have given them a full autism diagnosis. The remaining 64 PDD-NOS kids fell well short of criteria for RSBs and achieved their PDD-NOS diagnosis by virtue of having both social and communication difficulties.

The authors acknowledge that this isn't a huge sample and that kids weren't selected at random from the community so it might not give a totally accurate picture of the prevalence of the different diagnostic categories. However, their results suggest that what we currently term PDD-NOS should not be thought of as simply a milder form of autism. Nor is it, as the name suggests, merely a rag-bag miscellaneous category for kids whose difficulties can’t quite be pinned down. Rather, the PDD-NOS label appears to broadly correspond to those individuals facing social and communication difficulties in the absence of the RSBs that characterize autism and Asperger’s.


Quote:
The logical connection between social impairment and SRBs is the genetics and the brain wiring!


Attending that (with the exception of the particular cases of Rett's and Fragile X Syndroms) nobody identified the genes and/or the brain differences that produce simultaneously social problems and RSB, I think we can't say that - it is possible that the two symptoms are the result of the same genetical/neurological difference, or are the result of independet genetical/neurological difference.



Ettina
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07 Jun 2013, 10:10 pm

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Before the DSM5 i had aspergers and was not NT and on the spectrum, so now im totally not on the spectrum.. i dont feel like a NT at all, i see other people out there not struggling socially, THOSE are the NT people.


You seem really stuck on the idea that either you're an Aspie or you're NT. Seriously, that's not what NT means.There are plenty of ways someone can be neither an Aspie or NT.



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08 Jun 2013, 1:10 am

Ettina wrote:
Quote:
Before the DSM5 i had aspergers and was not NT and on the spectrum, so now im totally not on the spectrum.. i dont feel like a NT at all, i see other people out there not struggling socially, THOSE are the NT people.


You seem really stuck on the idea that either you're an Aspie or you're NT. Seriously, that's not what NT means.There are plenty of ways someone can be neither an Aspie or NT.


Examples? Well i know one would be having SCD, what are other examples of someone being not aspie or NT.


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08 Jun 2013, 7:05 am

ANicL wrote:
Ettina wrote:
Quote:
Before the DSM5 i had aspergers and was not NT and on the spectrum, so now im totally not on the spectrum.. i dont feel like a NT at all, i see other people out there not struggling socially, THOSE are the NT people.


You seem really stuck on the idea that either you're an Aspie or you're NT. Seriously, that's not what NT means.There are plenty of ways someone can be neither an Aspie or NT.


Examples? Well i know one would be having SCD, what are other examples of someone being not aspie or NT.


http://www.psychiatry.org/File%20Librar ... -5-TOC.pdf

DSM-5 Table of Contents

Section II: Diagnostic Criteria and Codes
Neurodevelopmental Disorders
Intellectual Disabilities
Intellectual Disability (Intellectual Developmental Disorder)
Global Developmental Delay
Unspecified Intellectual Disability (Intellectual Developmental Disorder)
Communication Disorders
Language Disorder
Speech Sound Disorder (previously Phonological Disorder)
Childhood-Onset Fluency Disorder (Stuttering)
Social (Pragmatic) Communication Disorder
Unspecified Communication Disorder
Autism Spectrum Disorder
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Attention-Deficit/Hyperactivity Disorder
Other Specified Attention-Deficit/Hyperactivity Disorder
Unspecified Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Specific Learning Disorder
Motor Disorders
Developmental Coordination Disorder
Stereotypic Movement Disorder
Tic Disorders
Tourette’s Disorder
Persistent (Chronic) Motor or Vocal Tic Disorder
Provisional Tic Disorder
Other Specified Tic Disorder
Unspecified Tic Disorder
Other Neurodevelopmental Disorders
Other Specified Neurodevelopmental Disorder
Unspecified Neurodevelopmental Disorder



Ettina
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08 Jun 2013, 10:23 am

Quote:
Examples? Well i know one would be having SCD, what are other examples of someone being not aspie or NT.


ADHD
Schizophrenia
Down Syndrome
Williams Syndrome
psychopathy
bipolar disorder
Fetal Alcohol Spectrum Disorder
Hydrocephalus
Agenesis of the Corpus Callosum
Sensory Integration Dysfunction
Klinefelter's Syndrome

The list is endless, really.



managertina
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08 Jun 2013, 12:47 pm

All this leads me to think is that the DSM 5 is really convoluted. It is making my mind melt!

But can a diagnosis ever be taken away?

Also, does it really not also depend on where you feel that you fit?

I have a friend who believes its not the label that counts: it's what you do with it that counts.

Myself, I like having a label.

Perseveration is like one of my best things to calm down.

Would a person with severe visual processing delays, aka a person who scores slower than 1 percent of the population on a visual task, score as Autie?

Because I have some social difficulties, some executive functioning issues (as in, I cannot seem to stay organized and things just take me slower) and visual processing delays.

Also, some folk with Asperger's might get an HFA diagnosis too.



Ettina
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08 Jun 2013, 5:09 pm

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Would a person with severe visual processing delays, aka a person who scores slower than 1 percent of the population on a visual task, score as Autie?


Not from that alone. I've read case studies of developmental visual agnosia where the child is clearly not on the spectrum.

However, visual processing delays are certainly more common among autistics than non-autistics. They're part of the NVLD profile, which seems to be present in about a third of higher functioning autistics.



managertina
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08 Jun 2013, 9:56 pm

Yeah, I have visual processing delays that go along with social communication issues. And a slight monotone that has improved, and i used to have difficulties with gross and fine motor coordination, though not enough to need therapy but enough to make me never chosen for school team sports. Which has also improved a lot. My social issues are not as prevalent at this workplace. I was also told at my last workplace that I took too long to make decisions, and that i was very resilient and would not give up. I had some anxiety-based (?) OCD symptoms too. and that I lacked attention to detail and talked too much.

I got an HFA diagnosis last year because the psychologist (I am a girl by the way) told me that my symptoms matched some of those that her nephews had, and she felt that HFA was a yes.

I laugh that I am now a supervisor, but have not changed too much. I also was told that I talked like an English teacher when I was a teen.

Is there a copy of the DSM 5 posted online with their exact descriptions of autism and social communication disorder and NVLD?



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09 Jun 2013, 2:08 am

Bah, screw it all, im still an aspie in my mind, and i dont care what anyone thinks.


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Ettina
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09 Jun 2013, 8:25 am

Quote:
Is there a copy of the DSM 5 posted online with their exact descriptions of autism and social communication disorder and NVLD?


Unfortunately, they haven't put NVLD in the DSM 5.

However, autism criteria here:

https://sfari.org/news-and-opinion/news/2012/proposed-dsm-5-criteria-for-autism-spectrum-disorders

And SCD here:

http://monroe.patch.com/groups/alan-vaglivelos-blog/p/bp--autism-and-social-communication-disorder (at the bottom of the page)



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22 Jun 2013, 4:09 am

Thank you Ettina, ive clicked on the link you provided, let me quote something from there that caught my interest:


"Level 1

‘Requiring support’



Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.



Rituals and repetitive behaviors cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest."

It says "Resists attempts by others to interrupt RRB's or to be redirected from fixated interest"

I ask to what extent does one have to "Resist inerruptions? "


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Your Aspie score: 160 of 200
Your neurotypical (non-autistic) score: 57 of 200
You are very likely an Aspie