DSM change justified due to pandemic of AS misdiagnosis

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Yeah, my initial reaction was that I thought that foxfield was saying that those domains weren't impaired at all, rather than a correlation between high IQ with milder impairments.

I find this notion hard to accept because I have a high measured IQ but I have been told several times by people online and who know me in person that I appear to have severe impairments. My experiences seem to corroborate this. I know that I also hide some of those impairments - I can't properly describe how difficult/frustrating/exhausting it feels to hold a conversation, but my therapist says that she doesn't see any outward signs of difficulty with regards to speech.

I am pretty sure, aspergers syndrome was around long before 1990, that is just when it was recognized as a mental condition. Also there is no substantial proof that misdiagnoses of AS is the reason they are changing the DSM. I am sure people have been misdiagnosed with it or some who think they have it based on just a couple minor traits but I think that is likely with any disorder.

To some degree we need to recognize that DSM IV and V are based on social contructs or operational definitions. They are designed to be a tool for definition provide a guide for treatment. It is describing differences in intellectual processes which we do not fully understand.

In the health care system they are also a guide for coding and services. BTW, most people with Asperger’s or other forms of high functioning autism do not receive payments in money in the US but receive some support at school or work i.e. accommodations which most likely are needed.

Individuals will differ to degree and in symptoms. We are different individuals after all and every brain is different. But more research is needed to understand the roots autism and other processing disorders like LD. I do believe these conditions exist and the problems the exhibit are true, but they are also social constructs too defined by a "profession." Note, in the 80s LD went through the same process BTW ie higher levels found, perhaps, because of more public awareness. This is actually a good thing as more students received the treatment they needed to be effective at school.

In sum, this suggests we need to be careful in moving people from one category to another etc. Personally, I think it is funny the Psychological Association on broadening the definitions of autism to a "spectrum" had to back peddle. This reinforces the concept that the DSM is a guide per say for the diagnosis and used for services received. Also, the case history needs to be taken the person needs to be accessed for their specific services to aid them as an individual and going beyond “this is a label” now go about your merry way. We are only now observing the effects of people in the work place with autism and LD as they grow and progress since 1990/1980.

Whether an older adult receives a diagnosis has to be personal selection and if it will benefit them ie. needing support. I also observe older women with high level autism coming together to support each other, acknowledging their differences, in a community sense, over a diagnostic sense. Community support perhaps is what they need at that time in their lives?

Last edited by Briarsprout on 22 Jun 2013, 5:56 pm, edited 1 time in total.

How do you not meet criteria for PDD NOS? It's a very subjective diagnosis. It's basically if you don't meet criteria for any other autism spectrum condition, but the clinician feels that you belong on the spectrum.



But we haven't identified a specific kind of brain wiring definitive of AS.

For your epilepsy example, if you show a certain pattern of activity on an EEG, you have epilepsy, even if there are no clinical symptoms. But you can't detect AS on an EEG, or an MRI, or any other means of directly measuring the brain. You can only detect it by observing certain patterns of behavior.

In a world where Aspergers and Autism are considered the same thing, I think you are right - probably people with low IQ will more likely to be diagnosed with Autism/Aspergers (and, apparently, almost 40% of the children diagnosed with ASDs have IQ lower that 70, perhaps meaning that, in real world, people with a lower IQ are indeed more likely to be diagnosed with an ASD).

However, in a world where Aspergers and Autism are considered different disorders, works in the opposite way - because Aspergers is supposed to be less impairing than Autism, these mean that people with low IQ are more likely to be diagnosed with Autism instead of Aspergers; ergo, people with high IQ are more likely to be diagnosed with Aspergers instead of Autism.

I've encountered questions as to whether the IQ scales that put so many autistic children below 70 are actually accurate, or whether it's the communication/language/processing deficits that make it difficult for them to understand the questions they might otherwise be able to answer.

The DSM-IV was a bit contradictory, because in the short description it says "no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood" and, in the full description, it says "the preoccupations are all-encompassing and interfere with the acquisition of basic skills".

Last edited by TPE2 on 22 Jun 2013, 6:02 pm, edited 1 time in total.

I think the criteria for PDD/NOS is

- meet social criteria of autism
- meet communication or repetitive behavior criteria of autism
- does not meet the criteria for other specific PDD
- does not meet the criteria for schizophrenia, schizotypal pd or avoidant pd

In practice, I think that there is essentially two ways of having PDD/NOS:

- meeting the social and communication criteria for autism, but not the repetitive behavior criteria (the new diagnosis of SCD is intended for that group)

- meeting the social and repetitive behavior criteria for autism/aspergers, but not the communication criteria for autism neither the "no clinically significant general delay in language" or the "no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood" for aspergers

Not from what I've read.

Although all PDD NOS have social impairment to some degree, many don't have enough social impairment to meet autism criteria.

In addition, there are some PDD NOS kids who meet social criteria but have no restricted/repetitive behavior or communication impairment. They're what SCD diagnosis was designed for.

Plus, there are some PDD NOS kids who are too young or low functioning to show enough autism traits for a diagnosis, but less functioning-dependent traits are present. For example, a nonverbal 12 month old cannot meet communication criteria for autism, because them being nonverbal is not atypical for their age, and a nonverbal child can't show echolalia or other forms of atypical speech. They also can't show certain types of repetitive behavior, and 12 month olds don't form friendships with other children or play pretend or engage in social play. So a 12 month old who is showing many of the traits of autism that they can show might still not meet autism criteria, and be given a PDD NOS diagnosis instead. (If you've ever heard of a kid being diagnosed with PDD NOS as a toddler and then rediagnosed with autism at a later age, this is why.)

Right, although the criteria have been addressed by professionals while that bit of text not so much.

I also think that characterizing it as preoccupations causing the delays in acquisition is a bit off the mark. Some of these skills I didn't even understand the point for until I was in my early 20s. Some until later. Some I was completely unaware of. My mother believes she taught me things that I have no idea how to do.

It's also sometimes used for adults who meet some but not all the criteria for Asperger's, those who are just below the threshold. I've met some adults at an autism support group who would fall into this category and Tony Atwood also mentions this as one of the uses for the PDD NOS diagnosis in his book Asperger's Syndrome: A Guide for Parents and Professionals

PDD NOS criteria from DSM IV TR:
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.

So imagine a group of 1000 random people who believe that they have Asperger syndrome. A psychiatrist comes along and assesses whether they belong in the group or not. People will be removed from the group for two main reasons.

1) They are deemed too impaired in day to day life and in intelligence for a diagnosis of Aspergers to be appropriate. A diagnosis of autism is provided instead. These people tend to have a lower iq than the average iq of the group. Therefore removing them from the group raises the average iq of the group.

2) They are deemed not impaired enough for a diagnosis of Aspergers to be appropriate. They may be given another diagnosis, or no diagnosis at all. I am arguing that these people will tend (statistically) to have a higher iq than the average iq of the group. Therefore removing them from the group lowers the average iq of the group

All I am arguing is that effect number 2) exists. I am not denying the existence of effect number 1).

Also consider DSM-V changes to replace Aspergers with a autistic disorder on a severity scale.
Applying the same logic to diagnosing those with autistic disorder we find that effect number 2) obviously still exists. However, effect number 1) will cease to exist as Aspergers and autism have essentially been merged into a single disorder

Well, that's not quite true. Although they may not have said "this exact brain wiring means AS" they have identified particular brain differences. Read up on the intense world theory article on this site and I'm sure there was something about the wiring in that, and there are a variety of brain studies (including the famous one that identifies differences in autism @ rate of 90% accuracy which they are going to research specifically for AS, as well as all the scans and studies on the size of the amygdalla and ratio of grey/white matter and other differences). I can find links if you like but they have been posted on WP before.

As a child I had epileptic attacks and was sent for an EEG, I recently got a copy of my results as I knew they had been abnormal. I did some research and found that they correlate with the EEGs in studies of autistic children (and I have AS). So there clearly is a type of abnormal activity in the brains of people on the spectrum, and I think it's only a very short matter of time before they do identify actual specific wiring. You can already get QEEGs which map out which areas of your brain are functioning well and which aren't and although they are not diagnostic, there is a particular pattern of activity in people on the spectrum which would correlate with their autistic traits.

Last edited by whirlingmind on 23 Jun 2013, 4:58 am, edited 1 time in total.

Clinicians insisting on a childhood history where someone cannot provide one, no doubt have assumed this and DX people that have AS as PDD-NOS incorrectly. It's still subjective anyway, who is measuring and with what, whether it is "subthreshold" symptomatology? The clinician, and they vary widely in competence, experience, personality etc.

It's slightly ridiculous really, because many of us have alexithymia and flat affect, so how can a clinician tell how severe the level of impairment is (i.e. whether it exceeds the threshold) if someone cannot identify it easily themselves and does not show it obviously on their exterior?

The OP made an argument, and it was clarified in later posts. In fact, I'm not even sure the thread creator posted in the last 100 posts or so.

Can't this thread just join others like it in the dusty WP archives?