Something about the diagnostic tools seems flawed to me....

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Looking up a few papers, I'm a bit confused.

Taking the RAADS-R (Ritvo) test, for instance. A set of questions regarding "Aspie traits", each with three to zero points, scoring one for symptoms during childhood, two after the age of 16, three for both childhood and still persisting.

That strikes me as rather odd, as a good chunk of those symptoms could very well be apparent during childhood, so it wouldn't make very much sense to consider someone "more likely to be autistic" when showing the symptoms only as an adult.

And then there's Cohen's AQ test. Where the "strongly agree" and "strongly disagree" don't matter at all, it's one point or zero per question, regardless how much or little you agree with it.

That makes me wonder whether those tests in general are rather arbitrary, or actually just intended to get certain answers/reactions out of the patient (like the puzzle tests, which aren't about problem solving, but the interaction with the interviewer).
If that's the case, that'd explain why misdiagnosis seems to be rather common. If it's up to the docs interpretation rather than an objective tool, it leaves a wide margin for human error.

So, what do you think about it?

The problem I see about evaluations by a doctors opinion, is that children all have good an bad days. A kid who IS autistic could have a day when his behaviors are less apparent, and a kid who isn't autistic could be having a really bad day.

Pretty much, especially considering how much they focus on socialising..."oh, you fit the pattern and are slightly less social than a shy NT, thus we put a diagnosis on you".

Seriously though, take RAADS for instance, there's so many question regarding the social stuff that you can be very well above the cutoff without answering a single question from the other categories.

Another thing that seems odd is this part of the DSM definition:

Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

okay, that sort of makes sense. However, I'd say while unlikely to have both schirophrenia and autism, it's probably not mutually exclusive.

Most people here are already under the impression that they're all flawed. xD

I personally think the whole screening tools thing is flawed anyway. I'm not saying they can't be useful, and it does help the clinician to focus on the right areas, but they could have maybe studied e.g. 500 children to decide what questions to ask, but the population of e.g. 1,000 Aspies would bring a wider variety of possibilities and it's not one size fits all.

It's bad enough that we take things literally too so could give the wrong answer because of that. An example is, in I think the EQ, there is a question asking whether you cut up worms as a child. I was going to put no, but then I thought about it and thought "well, I did drown worms and cut the legs of spiders so I'd better put yes" and obviously I was correct to do so, because it's the behaviour that is being noted not necessarily the specific example.

This therefore brings into question how the tools are used. If a clinician is good, s/he will understand the relevance and explain other examples that could apply, but if they run through it like a checklist and don't analyse it properly or use some creative thinking (something which seems hard come by in clinicians) they could score it wrongly. You may say that the screening tool is only a part of the assessment, not all of it, and that is true. However, in the case of my 11yo daughter who just had an assessment at CAMHS, they relied very heavily on the screening tools, ignored a vast amount of history I had sent them in writing on file because they didn't want to read it, her being a more passive subtype and having a good vocabulary, meant that they found her diagnosis inconclusive. I am now having to fight them about this, as she absolutely has AS. The staggering thing about it is, her assessment consisted of an interview of just about an hour of her with the psychologist and slightly over an hour of me discussing her developmental history with the psychiatrist. This is crap. A proper assessment should take several hours and all the time the psychiatrist interviewed me she kept checking the time and wanting to draw it to a close, as if she had other places to be and considered my daughter's assessment unimportant! That's the NHS for you.

Dr Judith Gould at the NAS (National Autistic Society in the UK) says:

"The difficulties in the diagnosis of girls and women arise if clinicians continue to use the narrow definitions set out in the International Classification Systems. It cannot be stressed enough that diagnosis and full assessment of needs cannot be carried out by following a checklist. Proper assessment takes time and detailed evaluation is necessary to enable a clinician to systematically collect information which not only provides a diagnostic label, but more importantly, a detailed profile of the person."

Some of the questions on the screening tools seem so rigid and there is so much more they could ask. What they need to do, is read some anecdotal writings of Aspies/auties about individual experiences to start getting the picture of what they should be asking. They should also make it a rule that a screening tool can only be e.g. 10% of the assessment process.

By the way, what's the point of that question supposed to be?

From the often cited "lack of empathy", which we already know isn't quite true, it's still quite a stretch to "likes to cut up living things". I'd say people can have plenty of empathy for other beings and still lack any for worms...or be complete sociopaths without doing anything like this.

It seems like one of the clichè symptoms, if you ask me...

It is about the empathy. I think because the view is that a child will start showing lack of empathy in that way, and progress to being like that with people, or it's one aspect of their overall current lack of empathy if they are already unempathetic with people. Maybe it's a bit like when they say psychopathic murdering adults often seem to have a history of animal cruelty as a child and those were early warning signs. I know that's a more extreme example but just to illustrate where I think they are coming from. I don't know if other NT children do stuff like I did as a child with worms and spiders, but I am female, and it seems more like a male thing to do. I do test with having an extreme male brain, and my NT husband recently took the brain gender test and he comes out as slightly less male brained than me!

Test here: http://www.channel4embarrassingillnesse ... in-gender/

I have always been scared of spiders (and didn't like worms) but it was about more than just "doing away with" creatures I didn't like or was scared of, I was fascinated to see what would happen to a spider without legs, which I think is a very Aspie trait, to want that knowledge. The ironic thing is, I'm really squeamish...having said that, I really like programmes such as NCIS and CSI which can be a bit gruesome.