Page 1 of 1 [ 9 posts ] 

Sheldon
Emu Egg
Emu Egg

User avatar

Joined: 21 Aug 2010
Age: 48
Gender: Male
Posts: 6
Location: Cambridge, MA

09 Mar 2012, 9:06 pm

In case not already known, in March 2012 issue of New Scientist magazine there is an article titled "Where Next for Autism?"
Seems more of an op-ed essays of point and counter-point.



Rax
Sea Gull
Sea Gull

User avatar

Joined: 15 Nov 2011
Age: 27
Gender: Male
Posts: 226

10 Mar 2012, 5:20 am

1) How are people suppose to give a reasonable reply to this
2) I am thoroughly surprised that no one had taken your name before hand.


_________________
You laugh because I am different, I laugh because you're all the same.


nat4200
Veteran
Veteran

User avatar

Joined: 10 Jan 2011
Gender: Male
Posts: 704
Location: BANNED

10 Mar 2012, 5:38 am

Redacted



Last edited by nat4200 on 21 Apr 2012, 1:05 am, edited 1 time in total.

Orr
Veteran
Veteran

User avatar

Joined: 11 Jun 2011
Age: 47
Gender: Male
Posts: 569

13 Mar 2012, 4:16 pm

In the two part article, Fred Volkmar, credited as director of the Child Study Centre at Yale University School of Medicine, and chief of child psychiatry at Yale New Haven Hospital, reports that analysis by himself and his colleagues concluded that many people would lose their diagnosis under the new regime [of DSM-5], and adds that two more groups have produced similar findings, while other papers are in review.

Francesca Happe, a professor of neuroscience at the Institute of Psychiatry, King's College, London, writes that the reason for folding the subgroups into a single category of ASD, is clinicians showing little agreement in telling the subgroups apart, and that the newly proposed diagnosis is complemented by a detailed description of an individual's profile of symptoms and associated difficulties.

Also mentioned is a new category of 'social communication disorder', for those with some of the difficulties of autism, but without rigid and repetitive behaviour - described as being 'poorly described by the very diverse DSM-IV category of PDD-NOS'. Francesca finishes with,'We hope the result wil be a clearer and simpler diagnostic system, and better recognition and diagnosis for those with autism spectrum disorders across all ages and ability levels.'


_________________
'You seem very clever at explaining words, Sir,' said Alice. 'Would you kindly tell me the meaning of the poem called "Jabberwocky"?'


nat4200
Veteran
Veteran

User avatar

Joined: 10 Jan 2011
Gender: Male
Posts: 704
Location: BANNED

15 Mar 2012, 6:02 am

Redacted



Last edited by nat4200 on 21 Apr 2012, 1:40 am, edited 1 time in total.

Feralucce
Veteran
Veteran

User avatar

Joined: 24 Feb 2012
Age: 50
Gender: Male
Posts: 2,143
Location: New Orleans, LA

31 Mar 2012, 4:43 am

I am not sure why people are up in arms... They are not talking about dropping our diagnosis, but moving it to a different category... or am I missing something?


_________________
Yeah. I'm done. Don't bother messaging and expecting a response - i've left WP permanently.


aghogday
Veteran
Veteran

User avatar

Joined: 25 Nov 2010
Age: 63
Gender: Male
Posts: 11,563

01 Apr 2012, 3:42 pm

Feralucce wrote:
I am not sure why people are up in arms... They are not talking about dropping our diagnosis, but moving it to a different category... or am I missing something?


According to the study by Volkmar 76% of the individuals studied with autistic disorder retained their diagnosis, 28% of individuals with PDD NOS retained their diagnosis, and 25% of individuals with Aspergers retained their diagnosis.

The current required criteria for Aspergers is 2 out 4 required criteria from the Social Interaction category and 1 out 4 criteria for the Restrictive Repetitive behavior (RRB) category.

In the DSMV revised ASD diagnosis 3 out of 3 criteria are required in a new social-communication category and 2 out 4 criteria are required in the RRB category.

Currently for Aspergers one can be diagnosed with no non-verbal communication impairments, and no impairments in developing normal peer to peer relationships. These two requirements are mandatory in the DSMV revision for ASD.

In PDD NOS studies show the majority of individuals diagnosed exhibit no RRB behaviors. Since 2 criteria for RRB's are mandatory in the DSMV, as long as they have the pragmatic problems with non-verbal communication they will likely be picked up by the New social communcation disorder.


Currently close to 70% of individuals diagnosed with ASD's are estimated diagnosed with PDD NOS. If Volkmar is correct and close to 70% of those with PDD NOS lose their diagnosis; that in itself reduces current ASD diagnoses by 50%. So, instead of 1 in 88, we might be eventually looking at 1 in 170 or even lower rates of ASD's among the eight year olds tested by the CDC supported research, that arrives at the 1 in 88 statistic.


For those individuals diagnosed with Aspergers that do not have problems with non-verbal communication, technically they would lose their Aspergers diagnosis and they would also not meet the criteria for Social Communication Disorder.

There is no clear indication if a person would be diagnosed with anything if they do not have problems with non-verbal communication, across autistic disorder, aspergers, and PDD NOS.

ASAN, the Autism Society of America, and Autism Speaks are up in arms about this. Autism Speaks is funding a study to reanalyze the data from South Korea,1 in 38, to see how the current DSMV guidelines would impact that data set.

Volkmar suggests that very few individuals with what is understood as high functioning autism would qualify for an ASD under the new guidelines. If Autism Speaks replicates Volkmars results, they will be armed with that information to challenge the DSMV working group on their assumptions that do not appear to meet standard logic.

At least one individual from the DSMV working group, has acknowledged the issue with PDD NOS, and offers Social Communication Disorder as an alternative, but for some reason the DSMV working group continues to suggest that virtually everyone will retain their Aspergers diagnosis, however that suggestion assumes that almost everyone currently diagnosed with Aspergers has problems with developing normal peer to peer relationships and nave no significant issues with non-verbal communication.

That's not logical considering that one can currently be diagnosed with Aspergers without 1 of those 2 criteria or without both of those criteria.

There are other issues with the new ASD diagnosis as well, that don't necessarily apply to everyone currently diagnosed with aspergers, as the symptoms must be present in early childhood (not fully manifesting themselves until social requirements exceed capacity), and that the symptoms must limit one in everyday functioning.

It will probably be longer than a decade before most everyone is re-diagnosed or newly diagnosed with the new criteria. It is a big issue though, for those that require supports based on diagnosis, with periodic re-assessment to continue supports as a requirement.



Feralucce
Veteran
Veteran

User avatar

Joined: 24 Feb 2012
Age: 50
Gender: Male
Posts: 2,143
Location: New Orleans, LA

01 Apr 2012, 4:52 pm

Thank you for the break down.

I hate to say these words... But for once, I am on the same side as Autism Speaks


_________________
Yeah. I'm done. Don't bother messaging and expecting a response - i've left WP permanently.


aghogday
Veteran
Veteran

User avatar

Joined: 25 Nov 2010
Age: 63
Gender: Male
Posts: 11,563

01 Apr 2012, 6:30 pm

Feralucce wrote:
Thank you for the break down.

I hate to say these words... But for once, I am on the same side as Autism Speaks


The 70% figure for PDD NOS applies to the kids in the 1 in 88 group analyzed by the study supported by the CDC, however the 1 in 88 is limited to children in the school system that receive support that are considered to have developmental disabilities.

Since the 1 in 88, only picks up kids with Aspergers that are receiving services in the school system; a common criticism of the government numbers is that they don't appropriately capture statistics for Aspergers and other higher functioning cases of ASD's.

Fortunately, Autism Speaks is also funding the most comprehensive study to date to analyze scan the general population for individuals diagnosed and not diagnosed with ASD's, before the DSMV goes into effect.

If it were not for this study, we might not ever know realistic statistics for Aspergers, in the US, considering it won't likely be a stand alone diagnosis in the near future.

In discussions here there are a few individuals that have stated they have friends and have no problems with non-verbal communication, but it appears to be a minority of individuals. And, as I remember, I believe most of them were self-diagnosed.

Judging from Vokmar's analysis of only 25% retaining their diagnosis for Aspergers, there must be higher numbers of individuals in his study with no diagnosed non-verbal communication impairments. And, also a significant number that do not have significant problems developing and maintaining peer relationships.

The ability that some individuals have to develop and maintain peer relationships may be what is actually sinking many of the Aspergers diagnoses in Volkmar's study.

Considering that Aspergers initially described the condition of one of non-verbal communication problems, it's a little unsual that it wasn't made a mandatory requirement for the disorder in the DSMIV or the ICD10 from the get go. There has been a push to change that for over a decade now. It has always been a requirement for the Gilberg criteria for Aspergers. However, at this point none of the diagnostic classifications have a mandatory criteria for impairments in developing and maintaining friendships.

http://apt.rcpsych.org/content/7/4/310.full

And back to the point of Autism Speaks. ASAN and the Autism Society, don't have nearly the influence of Autism Speaks, per financial resources, government influence, and influence in the medical community.

Autism Speaks does have the potential of influencing change in the DSMV criteria, that ASAN and the Autism Society of America would likely not be able to effect.

Simply because Autism Speaks has the resources to do an actual study, to provide hard numbers to potentially replicate the Volkmar study that has been criticized by the DSMV working group, and others for limitations in methodology.

The mandatory requirement for impairments in developing and maintaining peer appropriate friendships, probably deserves a closer look in the DSMV. Many people on this site have remarked that they have lots of friends. More than I ever could imagine having.

Technically, if one does not have impairments in the ability to develop and maintain peer level appropriate friendships they don't meet the mandatory diagnositic criteria for Autism in the DSMV. This really seems to be a problem more for small children, than older individuals that have adapted and found ways to do this.

Maybe Autism Speaks can help to get this changed from a mandatory requirement to one out of a selected group of requirements. Otherwise I can see a real problem with it, at least judging from the accounts I have heard on this site from people that have mentioned they do have friends.