Clinically significant impairment?

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From the DSM 5 I suppose the ICD 10/11 would have something similar.

"D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.


I wonder what qualifies as 'clinically significant impairment' . At the age of 62 I can count the number of friends I have had on one hand . Occupationally I've never worked. How much that is due to a chronic and severe mental illness or possible ASD I don't know.

How did your ASD assessment turn out that you had done recently?

For me significant social impairment means close to a total inability to interact with others irl.

Well no decision was made. I think this was because of the lack of info re early childhood. I'm booked in to do the ADOS on May 3rd .

I've googled and can't find a definitive description of it. Does it necessarily follow that distress would have to go along with impairment? Or can you be impaired without being distressed?

I did worry in my assessment that this aspect would trip me up, since I didn't know what they were looking for exactly. I mean I live independently, I've got two degrees (BSc and MSc), I'm doing a PhD, I've held down various jobs (although I usually end up quitting when it gets too much and they're always low paid). I have precisely two actual friends, and haven't ever had a proper relationship...but these things don't really bother me (to the extent that I don't really get lonely), so my feeling was maybe they'd think therefore it is not a problem. We didn't talk much about it in the assessment to be honest, I think I mentioned difficulties with sensory issues (relatively small things like needing to go off into another room when there were too many people, not liking the bus because of people talking) and difficulties with friendships and getting on with people-getting bullied at university for example-and that was about it.

But I got a diagnosis...so still don't know what they were looking for, but it is probably not as big a deal as you are worrying about. I think they're more looking for any sort of evidence of difficulties, rather than an overarching sense that your life is a train wreck and you're completely unable to do particular things in order to count as being 'impaired'.

Really?

I am disappointed for you. I was rooting for you to get a decision- up, or down, - whatever it would have been (that you're on AS spectrum, or not). And I had a comparable situation- examined late in life, lack of both parents to give first hand testimony about my early childhood, and like that. But I still got a definite decision- that being that I do have aspergers.

It probably means that it's less clear cut I'm on the spectrum compared to you. I think if it was a definite 'no' as opposed to '?' then I wouldn't be booked in for the ADOS.

I do think having a chronic severe mental illness in my case might well muddy the waters .

"Clinically significant" means that it impairs your ability to complete tasks that are necessary to function independently. To be "impaired" in a particular task/skill means that it cannot be done adequately. It's basically synonymous with "incompetent."

As far as I can tell based on my experiences, emotional distress is not an important aspect of impairment. It is only your ability or inability to perform certain tasks that is used as a measure of the significance of any given symptom. Whether or not that inability is clinically significant in the context of autism will depend on a) whether it is a necessary function, and b) whether it hinders your performance to the extent that, without accommodations, it can not be completed to a typical standard. If a person can't handle concerts because of the noise and lights, but their sensory difficulties only become apparent in this extraordinary and unnecessary environment, it wouldn't count as a clinical impairment. If a person doesn't have the social skills to rise to the top of their workplace but can interact well enough to work alongside colleagues and under supervisors, it wouldn't count as an impairment.

An example of a clinical sensory impairment would be the inability to walk down the street because the noise of traffic results in disorientation that makes independent navigation dangerous. An example of clinically significant social/communication impairment would be the inability to receive and respond to instructions from a supervisor, making holding a job without accommodations impossible. "Impairments" are defined and measured by laymen according to ease of function these days, but that's not how it works in a clinical setting.

All I know is I'm reckoned to have very poor social skills. I live independently but get quite a lot of support from my stepdaughter and granddaughters . I also get support to keep my flat clean twice a week from someone my stepdaughter knows.

My care plan states the support is to enable me to continue living independently in my flat.


I would not have been able to get to the ASD assessments without my stepdaughter .

I've also been worried about this criterion, since I'm going to speak with a psychologist in about a week about whether or not I am on the spectrum. I have a job, can pay bills, and live in a city. Here's a list of 'impairments' I have to present to the psychologist. I'll let you guys know what she says about them.

- My job is solitary (I work alone in a lab). In the past, working in an environment with many people has led to serious anxiety and at least a couple of meltdowns. I have been able to work in the service industry, however.
- I have trouble interacting with people, particularly in processing what is being said and responding in a way that linguistically expresses what I am meaning to say. I think I come across as ignorant a lot.
- When I have had coworkers, I usually have problems with them assuming I am aloof or bossy because I only interact with them to get a job done, not socially.
- I struggle with understanding/retaining verbal instructions from my boss (or others), so I carry a notebook around and write things down.
- I cannot be in crowded, public places for long (I get disoriented and panicky). This impairs my ability to go grocery shopping or get out of my room in general (other than at ridiculous hours of the night/day).
- I rely on my two friends (who live with me) to schedule/attend any social function or go out to eat/explore the city/etc...
- My extreme interests in certain topics often impair my ability to focus on things that need to be done.
- I overreact to small changes in the environment, like a cheese knife breaking or someone moving my cup from the edge of the sink to inside the sink. A change in plans can cause me to have a shutdown (though shutdowns/meltdowns are not frequent for me).
- I REALLY struggle with personal hygiene, but have been getting better at it as I get older.
- I was reading about autistic imagination issues, in that there can be difficulty imagining multiple outcomes to situations. I think I struggle to make plans for the future and have anxiety about outcomes changing if I don't follow certain routines in my life. Not sure if this is an 'impairment.'