Preliminary draft DSM-5 released

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An investigation by Howlin et al (2004) found individuals in childhood who had IQ’s below seventy had significantly lower attainment then those above. However the sample with an IQ of at least seventy had widely mixed up results. Those with an IQ above one hundred did no better or worse, in some examples those with lower IQ did significantly better then the one hundred plus sample. Non-verbal IQ has a good predictive association with positive outcomes for autistic children, but is not reliable. One indication shown in research is that non-verbal IQ below fifty nearly always results in dependent care (Gillberg and Steffenberg, 1987; Lotter, 1974a; Lockyer and Rutter, 1969; Rutter et al, 1967). An alternative proposed by Lord and Bailey (2002) was verbal IQ, claiming it to be more reliable and that good language skills by the age of five correlated with positive outcome. The Howlin et al (2004) study looked at this link and found a correlation between high verbal IQ and positive outcome was strong. It was noted though, that there were individuals who completely contradicted this prediction.

There have been small scale investigations carried out on autistic individuals within the normal IQ range. The study by Rumsey et al (1985) was conducted on fourteen inpatients. The entire group had marked difficulties in socialising and most were thought of as loners. Even those in the group who had reasonably high intellectual ability displayed inappropriate behaviour. Some were observed to talk to themselves or repetitive. Some of the individuals in the group did possess exceptional abilities in subjects such as foreign languages and mathematics. Yet, when measured (Vineland Sociality Maturity Scale 1984) it was found they had incredibly low attainment in relation to their measured IQ. They identified key areas of deficiency to be socialisation skills, self direction and achievement in employment. Only four of the men in the study had regular employment, three had got their jobs through parental negotiation.

A study by Szatmari et al (1989b) had twelve males and fourteen females. Half had been through the special school system the other half had attained college or university level education. Nine had never engaged in a sexual relationship. The authors acknowledged the study had downfalls due to the high attainment of the sample that consented to participate, so it could not be generalised. Due to a lack of data no link could be established to later functionality by the study. However, the authors do conclude that the study shows a positive outlook for autistic children of normal IQ, who can expect to make substantial improvements. They warn that this may take years and not necessarily be a complete improvement.

Another study by Venter et al (1992) focused on educational achievement of over fifty autistic children into adulthood. They noted that the sample had attainted a high level of academic improvement. Even the “low functioning” individuals in the sample were able to read, write and have basic math skills compared to one fifth of the study conducted by Bartak and Rutter (1973) twenty years earlier. Though in the adult aged sample studied by Venter et al (1992) nearly all were in employment, it was noted that most of their jobs were relatively low level occupations.

In London Mawhood et al (2000) conducted a study of nineteen autistic children, of normal non-verbal IQ, who presented with language disorders. The follow up took place in their mid twenties. They found five had been to college or university and three had full time jobs. All were reported to have problems forming social relationships, thirteen still had behavioural difficulties. These behaviours included ritualistic behaviour and obsessive tendencies. Most remained dependent on family or services, only three were reported to live independently.

Lastly, there are cross sectional studies which lack information on the childhood of the autistic people under study but provide interesting reading on their adult life. The work of Tantum (1991) described the situation of forty six individuals. They were of average intellectual ability, yet only two had been on to further education. All except one were living at home with parents or in residential care, one was married. A study of ninety three autistic individuals was made by Newson et al (1982) though due to the time period it took place in it lacks diagnostic data or IQ testing. Compared to Tantum’s (1991) group, this study had more individuals who had gone on to further education. Over one fifth were in employment and seven percent were living independently. The Newson et al (1982) study showed three quarters of the individuals were still living with parents at an average age of twenty three.

Hey, "direct link" refers to a correlation--it doesn't say anything about which causes which. Daniel's right; there's a link. Which way the link goes, no one knows. For that matter, why does it have to go either way? It could just be that both things are caused by whatever genetic factors create the whole autistic phenomenon.

Autistic people are more likely to be developmentally delayed. Developmentally delayed people are more likely to be autistic.

Well, how are you going to measure "severity", anyway? There are dozens of ways to do it, and they all come up with different answers.

Sure. Grab a bunch of people on the autism spectrum. Measure how old they are when they learn things--walking, putting on your clothes, cleaning your room, adding up some numbers, writing a story, etc. Compare them to a similar group of people who aren't on the autism spectrum. When someone is far enough behind average in multiple areas to cause problems, then that's developmental delay. (If it's just in a small number of areas, then it's a specific learning disability.) There are more people with developmental delays in the autistic group than the non-autistic group.

There is also a lower average IQ in the autistic group, but IQs don't really mean much when it comes to describing autistic people because it's extremely hard to measure IQs properly, and the IQs don't mean very much because of the big scatter in skills that's common on the spectrum. IQ is considered a criterion for developmental delay, though, so I have to mention it.

Autistic development isn't just a matter of higher rates of developmental delay; it's not that simple. The best way to define autistic development is more like "highly unusual" than "delayed". You will find, along with the developmental delays, and often in the same people who have the developmental delays, unusually high skill levels in specialized areas. When these specialized areas are in academics, you often see "giftedness" and a high score on IQ tests. Autistic development is often very uneven from one area to another--behind in one area, ahead in another is practically routine. So you can't really predict much based on developmental delays, especially in little kids.

"Severity" was first raised not by me, but rather in the post you supported. Since I was the one who expressed concerns about that post, it is incomprehensible to me that you would now ask me to justify it.

I guess I was being confusing. I wasn't asking you to justify it. I was just saying that it's unmeasurable, which is why I am going by the more well-defined presence/absence of "developmental delay".

The basic list:



As far as I'm aware, I meet it. However, "c." is going to undiagnose a lot of folk out there. If you're married or have a friend..., you're out.

I'll add, the lack of social reciprocity was almost a given in the DSM-IV, you just had to read the expanded text and see how it all applied to the diagnostic criteria. They said they're keeping the points short, and expanding on them in the text. Which is a good thing, as it stops people from taking it the wrong way and out of context.

My first thought was of the singer. That would be cruel!

For me, it seems they are describing a pathological form of ASD.

I think the new criteria are fine the way they are, but ONLY if they add a sub-clinical variant.

if you weren't diagnosed with the DSM criteria- you weren't diagnosed....

No, having and maintaining only one friend outside of the family/carers is seen as "normal" and within the confines of appropriate, as long as the age is around the same and all of that other superficial stuff is met. I've had some lengthy discussions with professionals on this matter, and what they see as appropriate.

c. Failure to develop and maintain peer relationships appropriate to developmental level

Whatever their interpretation may be (the professionals I've seen), there's only one way I can see that said criterion can be interpreted.



How else can it be taken in regards to "autism" (which is primarily a social disorder)?

You have a, "failure to develop", which is self-explanatory, a "and maintain", which again, is self-explanatory, and then on to "appropriate to developmental level", which again..., again, is self-explanatory. The previous DSM-IV-TR fails to describe it all that well, other than saying older individuals may desire peer relations, but that they lack the social understanding (it abruptly ends there).

It seems quite clear cut to me, i.e., can't make friends [around your same age] and can't maintain them if they're somehow made [by those around your same age].

I know of Attwood (who himself says AS marriage is a rare event), and also...the people who "have" Cassandra Syndrome, but if these people are no longer seen as disordered by what they can and can't do.... I don't know if Attwood had much say in these proposed changes.