Report of the DSM-V Neurodevelopmental Disorders Work Group

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"lack of social reciprocity"

I think this is an example of how the diagnosis can be affected by a lack of understanding by the person conducting it.
This is why the criteria (severity dimensions?) that are still to be added are so important and I believe it is impossible to judge the DSM-V draft without those criteria as they fundamentally affect how the criteria will be interpreted.

You are raising a reading of the criteria that is incorrect but I fear the type of problem that is very common in practice. Lack should not be read as a complete absence. If the criteria was an absence then that is the word that should be used here. Lack CAN be read as absence but it is a more widely used term which in this context would be more correctly interpreted as a deficiency "inadequate in amount or degree". This is also the reason that if you want to convey complete absence using the word lack a sentence usually involves more descriptors such as "lack of any", "complete lack".

Mantis, I hope you're right.. but I fear that since clinicians are attempting to narrow the spectrum, more people will be rejected on this basis.


As for clarifying level of severity, I would not trust them to do that. After all, they will probably code Asperger's like presentations as "mild," when I have a moderate case of AS and may have the same degree of impairment as someone with lower intelligence.

I know how to mimick "listening skills" even when I am not in fact listening, and I know how to parrot back phrases that may appear reciprocal, because I have trained myself.

I feel this is a real issue and making this criteria necessary, when it used to be optional (only 2 of 4 criteria were needed before, with "lack of social reciprocity" being one) will prove to be exclusionary, and it will be especially difficult to discern when girls who appear "fine" on the surface socially have deeper issues with understanding social interactions.

The truth is, they are trying to narrow the spectrum. From the workgroup, below:

http://www.psychologytoday.com/blog/dsm ... mic-autism

As the JadedMantis said, you can't really look at the criteria and say that's it, without reading how the book itself describes them. This is something people failed to do with the DSM-IV-TR, and the work group now say they're making the accompanying text with descriptors of each criterion across the spectrum, so all those now diagnosed with an ASD will still meet them. The expanded text will be more important than the criteria themselves in other words.

They say if you meet the DSM-IV-TR now, you'll meet -V.

I still don't feel as confident and reassured as you seem to be, since there is an effort to narrow the spectrum (see link above) and the new criteria is less sensitive to female-specific behaviors. That's why I feel the need to see whether we can help with the descriptors or re-phrase the criteria, to make it not exclude those who can mask social deficeits... hence, my petition.

(In other words, I want us-autistic females-to have input into the accompanying text descriptors.)

I have heard from several people that our diagnoses can't be taken away and we cannot lose disability benefits if the criteria is narrowed, since we were diagnosed before the change..

but that does not reassure me that autistic girls will be reliably diagnosed as the criteria is written now.

Lack of Social Reciprocity should be very obvious and easy to spot. Lacking it means you do not get along with other people. You can be withdrawn, or you can fight with them. You can argue, ignore, not want to go along with them. You could be a full fledged non conformist. Lacking social reciprocity covers more than just sitting in a corner alone, not wanting to talk with anyone.

Social Reciprocity means the child seeks out other children, and wants to get along and be accepted by them. They are able to figure out ways around disagreements and value friendships with other children. They don't want to bicker and are not viewed as "contrary".

Lack of Social Reciprocity is the child who has no friends, who gets into fights, gets picked on. They don't see why it's important to go along with 'the herd". They don't understand why arguing causes problems in relationships. They can't figure out why they can't make friends. These kids are considered to be bad seeds or troublemakers by teachers, but it could be they cannot figure out social interactions and you see the results.

Social Reciprocity is a vital part of childhood, that is why it's so important to identify kids who are having problems with it, and give them tools to effectively find ways to develop it. This is why problems with social reciprocity is central to diagnosing Asperger's.

If people are trained and know what to look for, it doesn't mean girls will go undiagnosed. It means the girls who really need services will be identified and receive them as early as possible so they can go on to make the most of their abilities.

I would like to belive this is so.

I had no friends, 1st grade through high school.
Still, in my 1st assessment I was told I couldn't be autistic because I had "social reciprocity," which they defined as having mutual conversations with others. It was a lifelong, treacherous undertaking for me to develop that. I've had four assessments since that show that I do have ASD, but I had to gather up my baby book and have the drs interview multiple relatives for them to get a full picture. It was that hard.

As a child, I felt shame about having no friends. So, I made up names of friends and stories about what I would do with the friends sometimes. I masked very well.

I fear I am more the norm than the exception. Females are being threatened by this criterion in many ways, depending on how it is defined. However, without the input of women and girls, it will not be defined in ways sensitive to our gender. That is why I started the petition.

You are one of the fortunate ones, Whitetiger, who found ways during your childhood to develop a healthy social reciprocity. Your experience illustrates why it's important to have diagnosticians who understand each phase of a person's life. I still struggle with social recipocity and my relationships are compromised because I don't fully understand it. If more effort would have been made during childhood, I might be better at it now. Who knows?

I am all for identifying kids who lack recipocity so they get an oppurtunity to develop it and might avoid isolation or other unhealthy coping skills.

Well, I didn't actually have social reciprocity as a child. I just had good faking skills.

As I wrote, I had no friends at all. I just faked for adults and professionals. I think we're better at talking to adults, anyway. But, I could fake brief conversations with peers pretty well, although not making them friends.

I am pretty reciprocal as an adult, which is when I was diagnosed.

The DSM criterion was changed to narrow the spectrum.. which will mean drs will be pretty biased toward excluding anyone who might not fit for any reason..

and girls will be overlooked more.

I think it will be interessted if people on the autistic spectrum will get other new diagnosis in the DSM, like a proposed "Sensory Processing Disorder" and there was one about motor development I believe.

If "lack" is taken seriously, the spectrum would be narrowed to an extreme extent. Lack of reciprocity would mean no giving and taking in social situations. None at all. Which means, a smile will NEVER be returned, you can NEVER be seen borrowing or lending toys, and also, to stay diagnosed in adulthood, this must be present always. What we do here with posting is reciprocity, which basically means none of us are autistic.

there is quite enough research done on Asperger to separate it into different subcategories. We all know that there are kinds of AS and other kinds of AS. Some have certain skill, the rest doesn't. I think the main issue is how important DSM participants consider investing time in thinking of this. Also it is quite confusing when you have other disorders involved. The ability to give details in the description is what makes diagnosis valid and accurate. In order to provide a better understanding, rather than simple categorization, about Asperger DSM V has to provide different possible symptoms, and how certain mixtures of symptoms can describe a certain type of Aspie. This is important for those who do not enjoy the syndrom, because we, Aspies, know ourselves, but the rest doesn't.