DSM vs. Gillberg

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"Negative symptoms" are symptoms caractrized by the absence of something - the flatt effect, the social isolation ("positive symptoms" are caractrized by the presence of something - delusions, hallucinations in schiz, obsessive interests and routines in AS)

I just came across a diagnoses on the autism spectrum called McDD or Multiple-complex Developmental Disorder. Apparently, autisms continuity with schizophrenia has been a matter of debate, anduntil the late 1970's, as equinn has said, children with autism were often labeled as having childhood schizophrenia.

McDD seems to be a much lesser known disorder than other autism-spectrum diagnoses. It is a combination of schizophrenia and autism.

Here is the article:

http://en.wikipedia.org/wiki/Multiple-c ... l_Disorder

The idea that I have is that McDD is a diagnosis that was proposed and never really "gained wings".

And, in practice, what is the real difference between McDD and Schiziophrenia (or, eventually, Schizotypal Personality Disorder)? Apparently, only the age of onset.

The difference is that those of us with McDD have autism as well as schizophrenia. This means we fit into both groups, not just the schizophrenic community.

Well, at least some of the variants of the criteria refered in wikipedia could be very similar to a "pure" schiziophrenia spectrum disorder. Imagine that:


A. Regulation of emotion. (Affective symptoms) – two or more of the following.
1. Depressive symptoms such as consistent depressed mood, feelings of sadness or emptiness, thoughts of death, little interest or pleasure in activities, chronic fatigue, feelings of worthlessness or guilt.
2. Manic symptoms such as racing thoughts, irritability, distractibility, psychomotor agitation, impulsivity, sleep disturbances, feelings of grandiosity or extreme self worth, risky behavior.
3. Anxious symptoms such as recurrent panic, intense inappropriate anxiety, dissociation, diffuse tension, paranoia, unusual fears and phobias that are peculiar in content or in intensity.
4. Severely impaired regulation of feelings.
5. Significant and wide emotional variability with or without environmental precipitants.

B. Consistent impairments in social behavior and development (Autistic symptoms) - at least two from (A) and one from (B) or (C).
(A) Qualitative impairment in social interaction.
1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. Failure to develop peer relationships appropriate to developmental level
3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
4. Lack of social or emotional reciprocity
(B) Qualitative impairments in communication.
1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. Stereotyped and repetitive use of language or idiosyncratic language
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities.
1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
3. Stereotyped and repetitive motor mannerisms
4. Persistent preoccupation with parts of objects

C. Impaired cognitive processing (psychotic symptoms) – two or more of the following.
1. Delusions, including fantasies of personal omnipotence, thought insertion, paranoid preoccupations, overengagement with fantasy figures, grandiose fantasies of special powers, referential ideation, and confusion between fantasy and real life.
2. Hallucinations and/or unusual perceptual experiences.
3. Negative symptoms (anhedonia, affective flattening, alogia, or avolition)
4. Disorganized or catatonic behavior such as thought disorder symptoms, easy confusability, inappropriate emotions/facial expressions, uncontrollable laughter, etc.
5. Disorganized speech.

The only thing in that that is specifically "autistic" in McDD is the B-(C) "Restricted repetitive and stereotyped patterns of behavior, interests and activities", but, apperently (if the wiki article is correct) this is not required for a diagnosis.

However, I recognize that reading a diagnosis criteria is not the best way of of understanding a pathology, specially because many things only can be proper understanded by a professional.

The negative symptoms are pretty much the same thing as AS in outward appearance. Simple Schizophrenia/Chronic Schizophrenia was what they diagnosed the majority of people with AS back in the day (source: neurologist with some studies to back her up).

The flat-affect is the poverty of speech, the monotonous voice, the lack of eye contact, the lack of facial expression, the lack of shown emotion, and etcetera, all of which are there in AS.

AS has the repetitive behaviours (people with Schizophrenia can do the motor mannerisms from Autism), which is usually that narrow interest, plus being there from childhood. Whereas Schizophrenia has hallucinations and/or delusions, unless it was of the "Simple"-type, which they removed from the latest DSM (it's still in ICD-10). I'm guessing that they removed it because AS will catch those who were diagnosed with it in the past but had symptoms from childhood, or a personality disorder like Schizoid or Schizotypal will catch young-adults with such.

A=bipollar, B=autism and C=schizophrenia.

This is way over the top.

There was a reason why kids were not diagnosed with psychosis at a young age.
It is way too subjective and dangerous.
People misdiagnosed with psychotic disorders have fought to be understood properly. this multidiagnosis allows practioners to squeeze them into a category that includes autism and severe depressive and schizophrenia.

Developmental disoders should not be joined with the other two. Would we do this with a down syndrome child? Of course not.

McDD, never heard of it before, I might show that to my therapist. I currently diagnosed with Schizoaffective. I meet all 5 for A, regulation of emotion, Part B section (A),number 2 maybe 1 and 4... and section (C) numbers 1 and 3. And 1 and 2 from section C.

What's weird about me is I don't have negative schizophrenic symptoms, I just have positive ones.

As a kid, I had severe meltdowns, no social skills, always wanted to talk about favorite subjects and nothing else, ADHD like stuff etc... as an adult I have grown away from those symptoms into my psychosis ones, though my school records claimed I had some psychosis symptoms back then. What's that called? :?:

Actually, I think I fit the DSM, but NOT gilbergs. They aren't the same. And the DSM says NO clinically significant problems with self help skills. That means roughly normal. It may be LOW normal, or high normal, but not much worse than low normal.

Personally, I don't like either. The DSM leaves out many key AS symptoms, but I feel the Gillberg criteria are too stringent and place too much focus on social deficits. I'm obviously an Aspie, but I have mild social deficits. However, I am of moderate severity because of how my special interests, need for routine/sameness, and sensory issues are a lot more pronounced than in some. I wouldn't get a diagnosis of AS from Gillbert, because I don't fulfill criteria "5." And I think it's silly how you only have to fulfill one requirement in some of the other numbers. Also, I don't like how Gillberg's criteria talk about a speech delay. I'm a believer that AS has a lack of speech delay, and that HFA has a speech delay.
-OddDuckNash99-

2ukenkerl,

No, they aren't the same, and Gillberg's has a higher symptom threshold needed. However, they both say that AS is the child/adult who has a single interest and has a serious impairment in social interaction; Gillberg's being harder to meet than the DSM, of course.

I don't meet Gillberg's because I didn't have delayed motor development; I was advanced.

Even THERE, the DSM says "Qualitative impairment", and gilberg says "Serious impairment". And even the idea of "motor developmennt" is vague. I mean I walked early, and can generally do day to day things with no problem. I could even say I seem to do some things better than many. But catching something isn't among them. It seems that the DSM allows for someone more mild, that can almost seem normal, and gilberg requires a definite and obvious set of problems.

I don't see why you don't think there is a difference between the negative symptoms of schizophrenia and the symptoms of autism. Psychologists can just get the two confused and make a misdiagnoses because clinical diagnosis is difficult. Psychology is a very vague science.

Autistic people don't have symptoms such as ahedonia (inability to feel pleasure), disorganized thinking, and loss of motivation.

Believe me, I have lived with both kinds of symptoms, they are different.

2ukenkerl,

"Severe" is found throughout the text from the DSM-IV-TR as it explains how the qualitative impairments manifest.