Something Interesting about AS and Autistic Disorder...

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This last Friday I had taken a trip with my caseworker to the St. Louis State Psychiatric Hospital because she has mentioned that the original building of the old hospital has a small library which holds many psychological/psychiatric journals and they also have a xerox machine at 10 cents a copy (double-sided).

Well, we went and of course I was in heaven. She pointed out the Journal of Autism and Developmental Disorders. Long story short, I printed out a research article entitled Repetitive Behavior Profiles in Asperger Syndrome and High-Functioning Autism.

This article (which basically disproved their original hypothesis and found there were no differences in Repetitive Behavior profiles in the post-developmental delay years between High-Functioning Autistics and the non-language delayed and/or self-care delayed Aspergers) got me thinking about the DSM and ICD criteria for Autistic Disorder and that, indeed, speech delay is not a requirement in order to receive a diagnosis of Autistic Disorder. I then brought out my mini-DSM-IV-TR and was struck by the revelation (a revelation perhaps not so new to others I'm sure) that the middle set of criteria, which are qualitative impairments in communication (more specifically (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others and (d) lack of varied, spontaneous make-believe play or social imaginative play appropriate to developmental level) are both very open to interpretation. Now, since only 1 criterion is required to be met in this particular section along with 5 others from the total of the criteria, it occured to me that since Aspergers also has marked impairment (though perhaps not as marked) in these areas like communication skills and their fluency as well especially in social imaginative play, that many Aspergers individuals would technically fulfill the criteria of Autistic Disorder. And this disorder of course is supposed to take precedence over diagnosis of any other PDD.

I just thought this was interesting. Given that this apparent flexibility often gives the diagnositician leeway, this is good so that he/she can render the diagnosis which will provide the services for the child/teenager/adult or that which will come with less stigma attached (or whatever other reasons might come up).

However, these same criteria lists are used in research, and I can only imagine this lack of specificity might only complicate results rather than make things clearer. Perhaps stricter criteria within research settings might be something to consider??

What do you think about all this in general?

I would like to find a good book on how to interpret the DSM-IV criteria - written for professionals. See what the professionals are being told - go straight to the source.

I know that when I was given my diagnosis, I didn't fit into any convenient pigeonholes (whereas I know of three others on the spectrum who were diagnosed by the same psychiatrists as Asperger's specifically). I was told that some aspects of mine were mild and some were not - hence just "ASD", though they could probably just as well have said "PDD-NOS".

A better solution than stricter criteria at the diagnosis stage might be individual testing of compartmentalized aspects of the spectrum before a study is performed. For instance, for a study on social skills on the spectrum, take a general sample of anyone with a spectrum-related diagnosis, but test for general social skills as part of the study and then categorize data based on those results instead of making arbitrary distinctions based on the participants' original diagnoses.

When I was doing my practicum in applied psychology and diagnosing people with various disorders myself the way we used the DSM was to get sort of a general idea of what a disorder may be and then looking it up in the DSM and seeing if someone met the criterion - sort of like playing connect the dots or something . . .

The danger of that, of course, is that, really, if you have a preconcieved notion of what sort of person someone is you can pretty much pigeonhole them anywhere you want . . .

How did you decide if an action or trait was severe enough to meet one of the criteria? ...since most people have certain traits, to a minor degree.

Yes, the DSM-IV is very ambiguous, and the two overlap a lot, like Venn diagrams. A friend of mine fits both Asperger's and Autistic disorder, and was given the Autistic disorder, as per the DSM-IV, where Autistic disorder takes precedence. Of course, Rett's and CDD take precedence over Autistic disorder, so there is a clear hierarchy within the DSM-IV.
The one thing that confuses me is that point you pointed out.
"2 (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others"

Don't most Asperger's people fit that criteria? I have never understood that point. Personally, I can't wait until they bring out the new DSM-IV. It will be a very interesting read.

My DX of Asperger's was based on the age when I started talking by 2 docs when they researched my history and would have otherwise DX'd HFA, had I not started talking and giving monologues at an early age. My current doc simply refers to me as being autistic.

I just noticed it and really have to comment. I really wish people would not call Autism a disorder.

If one uses a definition of "disorder" as that which causes a level of impaired functioning in the given environment, then I think "disorder" is accurate for a good many ASDers.

I think the problem beyond the word is that many nonASDers are under the impression that a "disorder" should be cured or prevented. This is what I am against. Not the label per se.

dis·or·der (ds-ôrdr)
n.

An ailment that affects the function of mind or body: eating disorders and substance abuse.
A disturbance or derangement that affects the function of mind or body, such as an eating disorder or the abuse of a drug.
v. dis·or·dered, dis·or·der·ing, dis·or·ders
To disturb the normal physical or mental health of; derange.

I was under the impression that austism is just a matter of being "wired differently." It certainly isn't an ailment.

DeepThought, to be honest I don't put much stock in conventional definitions if they don't make sense to me. Especially in regards to psychology and psychological disorders.

Given that every brain functions and is wired differently, it seems better to base it off impairment of functioning, itself. Even the DSM stipulates that a diagnostitician should not give out a diagnosis unless typically one or more areas of functioning (usually social, occupational, or other areas of functioning) are impaired. Generally speaking, the main purpose of a diagnosis is to realize better treatment plans/strategies for the individual. Not simply a label.

Thus basing "disorder" off of level of functioning due to a specific set of symptoms seems best (at least to me). It would be good to get others' opinions as well.

Discuss, discuss.

I think we all need to stop defining ourselves by some logical label.

Despite unfortunate side effects, labels do have their uses and do essentially make life easier (not all-perfect, but nevertheless easier).

I'll use myself as an example: it is much easier explaining odd or inappropriate behavior of mine to someone with simply saying "I have Aspergers Syndrome" rather than going through each individual symptom. Plus, with my saying so, the other person is more likely to be more understanding.

Labels have a function. But they also have their drawbacks. But I'd like to see anyone come up with something better. Labeling cans, labeling jars. I like it so I know what I'm about to eat. It's a similar, albeit more complicated, thing with Aspergers.

If distinct symptoms appear to occur together more than frequently, a single name is the most effective way of referring to it and treating it without having to restate each individual symptom as though unrelated.

We (my companion and I) have found that many people have no clue what Asperger's Syndrome is and it seems that anytime she has had the need to tell someone that I have Asperger's Syndrome, she then ends up having to explain things. Since my doctor simply refers to it as Autism (if it were not for my verbal history - docs say I am verbally gifted, whatever that means) I would have been DX'd with HFA, so now she just says "he's autistic" and there is a lot less explaining involved.

DeepThought, yes. I often find myself explaining the term as well to those unfamiliar by saying "Asperger's Syndrome is a form of High-Functioning Autism" and I really haven't come across anyone these days who hasn't heard of Autism, especially with the more recent news coverages and everything. So after that brief descriptor, they have a better idea. (I did a presentation on Aspergers in one of my classes and I took a poll. They had all heard of the term Autism, and no one had heard of Aspergers or of the Autism Spectrum. That was of about 12 people.)

But it's actually kinda fun when they ask for clarification, because then they ask more about the specificis of the disorder and then I can be as pedantic as I like about one of my favorite subjects.

(Honestly, sometimes I'll make my first description sparse just so they ask and I have the opportunity of playing professor, hehe.)