aghogday
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 Posted: Sat Apr 07, 2012 4:14 am Post subject: Re: Not autistic under DSM 5! |
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| Rascal77s wrote: | | I just want to say that having 5 friends in school and 0 outside is not normal peer relations. A kid from school is an acquaintance if all activities are centered around school during school hours. There's a big difference. I agree that many people also don't do anything outside of work with their co-workers but the majority of them have friends outside of work, that is the difference between NT and ASD. |
Sorry for the confusion, by out of school I meant the transition between school and work; it's often a time of isolation for the most social of human beings.
I agree that acquaintances at school and acquaintances at work are not necessarily indicative of actual friendships, outside of school hours or work hours.
However, there is more opportunity to develop and maintain friendships when a individual is of school age, because an individual is normally exposed to many different types of individuals some who may be compatible for a friendship after school hours. Work environments may only include a few people, for potential friendships.
Adult opportunities for face to face friendships outside of the work environment, overall, have decreased in modern societies, with virtual activities replacing some of those face to face opportunities from the historical past.
This friendships thing is not likely getting easier for the majority of individuals, outside of virtual activities, and the school years.
However, statistically most individuals actually diagnosed with ASD's, at this point in time are still in school because of the expansion of the spectrum in just the last couple of decades along with the continued enhancements in detection in the last decade. Soon to change though as hundreds of thousands of individuals make the transition into adulthood in the coming decade. |
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aghogday
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| Posted: Sat Apr 07, 2012 4:16 am Post subject: Re: Not autistic under DSM 5! |
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| FishStickNick wrote: | | Interesting. I'm undiagnosed, but I seem to meet the DSM-IV criteria; I *may* also meet DSM-V's. Are these criteria for diagnosing adults or children, or both? |
Both. |
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TPE2
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| Posted: Sat Apr 07, 2012 10:35 am Post subject: Re: Not autistic under DSM 5! |
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| aghogday wrote: |
The key issue now is that one can be diagnosed with Aspergers without non-verbal communication impairments and without impariments in deveoping and maintaining peer appropriate relationships. |
Lorna Wing, the "inventor" of "Asperger's Syndrome", wrote:
| Quote: | | Perhaps the most obvious characteristic is impairment of two-way social interaction. This is not due primarily to a desire to withdraw from social contact. The problem arises from a lack of ability to understand and use the rules governing social behaviour. These rules are unwritten and unstated, complex, constantly changing, and affect speech, gesture, posture, movement, eye contact, choice of clothing, proximity to others, and many other aspects of behaviour. The degree of skill in this area varies among normal people, but those with Asperger syndrome are outside the normal range. |
Apparently, according to the person who created the label, the essence of AS is a severe impairment in socialization created by an underlying impairment in understanding of implicit social rules, specially non-verbal communication.
Then, if the essence of AS is this, both problems in non-verbal communication and in developing and maintaining peer appropriate relationships seem to be fundamental to have AS.
It is in the RRBI chapter that I think the question can be more polemic - I don't see much of a solid reason to that chapter requiring 2 symtoms (why not 1? why not 3?). |
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zette
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| Posted: Sat Apr 07, 2012 11:11 am Post subject: |
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Here's the DSM V criteria for the new social communication disorder. My concern is that if my son is reclassified because he only has 1 RRBI (sensory, others are present but extremely mild), this new disorder doesn't come close to capturing the issues he needs help with. For instance, based on this criteria there would be no reason for the school or our insurance to provide OT for his sensory problems.
| Quote: | A. Social Communication Disorder (SCD) is an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.
B. The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination.
C. Rule out Autism Spectrum Disorder (ASD). Autism Spectrum Disorder by definition encompasses pragmatic communication problems, but also includes restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed.
D. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). |
Also, if motor skill delays are one of the "triad of impairments", why aren't they one of the options used to make a diagnosis? |
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Cascadians
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| Posted: Sat Apr 07, 2012 11:23 am Post subject: |
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Re social interaction: it is coming from a strange angle. What about those who tried to make friends, were able to initiate eye contact and make conversation but cannot make friends because NTs shy away, no reason given, but obviously the Aspie is weird or different enough to be shunned.
The language is articulate and polite; the body language nothing out of the ordinary; but the Aspie's perceptions and view of life is just different enough to be coming from another planet to the average NT.
The severe impairment comes from NT reaction. |
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TPE2
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| Posted: Sat Apr 07, 2012 11:35 am Post subject: |
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| zette wrote: |
Also, if motor skill delays are one of the "triad of impairments"... |
I think they aren't. |
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League_Girl
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| Posted: Sat Apr 07, 2012 12:36 pm Post subject: |
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| zette wrote: | Here's the DSM V criteria for the new social communication disorder. My concern is that if my son is reclassified because he only has 1 RRBI (sensory, others are present but extremely mild), this new disorder doesn't come close to capturing the issues he needs help with. For instance, based on this criteria there would be no reason for the school or our insurance to provide OT for his sensory problems.
| Quote: | A. Social Communication Disorder (SCD) is an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.
B. The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination.
C. Rule out Autism Spectrum Disorder (ASD). Autism Spectrum Disorder by definition encompasses pragmatic communication problems, but also includes restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed.
D. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). |
Also, if motor skill delays are one of the "triad of impairments", why aren't they one of the options used to make a diagnosis? |
Does he have sensory processing disorder? Can he get help for that too? |
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Sora
away away
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| Posted: Sat Apr 07, 2012 1:06 pm Post subject: |
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| XFilesGeek wrote: | | Didn't Hans Asperger also say girls couldn't get "autistic psychopathy?" |
Yes/no.
I wonder whether it's just an anecdote that he supposedly said that.
What he did say (rather, what he wrote in his initial paper) was that most individuals with autistic psychopathy seem to be boys.
Then he wrote that he (they) definitely found similar patterns as that of autistic symptoms, in particular the social and communication impairments, in girls but that none of the girls they had seen to that date had presented with the full manifestation as in the first three case studies that are discussed in his paper.
Of note: those first three would probably be said to have severe AS on here if going by how people rate characters from films and books and documentations is anything to go by.
Then he also wrote that several mothers of boys with autistic psychopathy were indeed markedly autistic (that's how he wrote it) themselves. He wrote that he/they didn't have an explanation for that yet.
The conclusion that Asperger then drew is that it may be a coincidence that under his cases so far happened to not have been an "autistic girl" - that autistic girls are likely rarer than autistic boys - or whether it might be that the autistic traits of girls show only after puberty (note: he did find autistic women after all as mentioned above) - he says he and whoever else worked with him an contributed didn't know that at that date (1944).
Asperger also theorises in that context that the autistic psychopathy appears like an extreme variation of male intelligence.
That practical work and concrete thinking are strengths often found in girls whereas logical and abstract thinking are often found to be strengths of male intelligence. Whereas girls and women are more intuitive and emotional according to him, boys and men with autistic psychopathy seem to have such immense abstractive abilities that at the same time they seem to have lost the intuitive ability to "tune in" and meet expectations of their environment as those supposedly require a large amount of (social) instinct/intuition.
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Sweetleaf
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| Posted: Sat Apr 07, 2012 1:10 pm Post subject: |
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| DaBeef2112 wrote: | I didn't ask the dr that made my diagnosis if i would still qualify under dsm-v but I'm certain I would based on my own reading.
What bothers me is the loss of the label Asperger's. While I personally feel that Asperger's and Autism are in fact the same thing, in my experience the general population thinks Autism and mental retardation are one in the same. While I haven't told too many people of my condition the few I've told that knew something about Asperger's knew that it was often associated with intelligence. When I told the others that didn't know what it was that it was a form of Autism they all said "but your too smart to have that..." |
Well would a better approach to be to educate people that Autism and mental retardation are not the same thing. For one mentally retarded people should not be looked down on for it and autism should not be viewed as that disorder since it's not.....but yeah I think it would be better that people get that out of their minds so they don't think you can't have autism if you're intelligent.
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Orr
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| Posted: Sat Apr 07, 2012 1:42 pm Post subject: |
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I agree with Sweetleaf, this aspect is a positive change. People seem to think that people with autism lack intelligence. WTF?
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EXPECIALLY
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Age: 29
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| Posted: Sat Apr 07, 2012 2:24 pm Post subject: |
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| Sora wrote: | | XFilesGeek wrote: | | Didn't Hans Asperger also say girls couldn't get "autistic psychopathy?" |
Yes/no.
I wonder whether it's just an anecdote that he supposedly said that.
What he did say (rather, what he wrote in his initial paper) was that most individuals with autistic psychopathy seem to be boys.
Then he wrote that he (they) definitely found similar patterns as that of autistic symptoms, in particular the social and communication impairments, in girls but that none of the girls they had seen to that date had presented with the full manifestation as in the first three case studies that are discussed in his paper.
Of note: those first three would probably be said to have severe AS on here if going by how people rate characters from films and books and documentations is anything to go by.
Then he also wrote that several mothers of boys with autistic psychopathy were indeed markedly autistic (that's how he wrote it) themselves. He wrote that he/they didn't have an explanation for that yet.
The conclusion that Asperger then drew is that it may be a coincidence that under his cases so far happened to not have been an "autistic girl" - that autistic girls are likely rarer than autistic boys - or whether it might be that the autistic traits of girls show only after puberty (note: he did find autistic women after all as mentioned above) - he says he and whoever else worked with him an contributed didn't know that at that date (1944).
Asperger also theorises in that context that the autistic psychopathy appears like an extreme variation of male intelligence.
That practical work and concrete thinking are strengths often found in girls whereas logical and abstract thinking are often found to be strengths of male intelligence. Whereas girls and women are more intuitive and emotional according to him, boys and men with autistic psychopathy seem to have such immense abstractive abilities that at the same time they seem to have lost the intuitive ability to "tune in" and meet expectations of their environment as those supposedly require a large amount of (social) instinct/intuition. |
Yep. I was into his findings for a little while, I thought some of it was so interesting for the time period.
Anyway, the autistic behaviors that he did describe in women and girls are now being diagnosed as AS by many. Tony Atwood describes the way it manifests in girls and he diagnoses women who have learned to "disguise" their AS but in Asperger's day these same women just wouldn't have been considered autistic, he still acknowledged the traits.
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aghogday
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| Posted: Sat Apr 07, 2012 7:17 pm Post subject: Re: Not autistic under DSM 5! |
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| TPE2 wrote: | | aghogday wrote: |
The key issue now is that one can be diagnosed with Aspergers without non-verbal communication impairments and without impariments in deveoping and maintaining peer appropriate relationships. |
Lorna Wing, the "inventor" of "Asperger's Syndrome", wrote:
| Quote: | | Perhaps the most obvious characteristic is impairment of two-way social interaction. This is not due primarily to a desire to withdraw from social contact. The problem arises from a lack of ability to understand and use the rules governing social behaviour. These rules are unwritten and unstated, complex, constantly changing, and affect speech, gesture, posture, movement, eye contact, choice of clothing, proximity to others, and many other aspects of behaviour. The degree of skill in this area varies among normal people, but those with Asperger syndrome are outside the normal range. |
Apparently, according to the person who created the label, the essence of AS is a severe impairment in socialization created by an underlying impairment in understanding of implicit social rules, specially non-verbal communication.
Then, if the essence of AS is this, both problems in non-verbal communication and in developing and maintaining peer appropriate relationships seem to be fundamental to have AS.
It is in the RRBI chapter that I think the question can be more polemic - I don't see much of a solid reason to that chapter requiring 2 symtoms (why not 1? why not 3?). |
Technically, to begin with, per Wing, both requirements should have been mandatory, however the DSM decided that one could be diagnosed with neither.
While non-verbal communicative issues are considered inherent issues, the ability to develop and maintain relationships, is difficult for individuals with Aspergers, but some come across individuals that they are compatible with and accept their differences.
My point on the school environment, is that there is more potential for it because of the number of individuals one comes into contact with. The environment may be more likely to influence the ability for friendships than the inherent aspect of non-verbal communicative issues. Particularly for those that went undiagnosed with this issue, in the DSMIV.
While I'm sure that the 2 out 4 RRB's are going to effect individual diagnosis, as reported here in this thread. The one study that has been published that went from 12 of 26 losing their diagnosis to 25 out of 26 retaining their diagnosis, was reflective of the change of 3 of 3 to 2 of 3, in part A. Ideally, for the maximum number of individuals to retain their diagnoses the 1 out 4 RRB's would stay the same as well.
The problem with adding a new sensory issues criteria to the category of RRB's is that if only one criteria were required, in effect, one could be diagnosed without any of the RRB's previously described in Autism Disorder. It makes it almost effectively impossible to reduce the number of RRB's required to one unless the sensory issues criteria is removed.
Changing the criteria to 2 out 3, for Catgeory A, seems to assist in the greatest retention of diagnoses, from the research that has been done on the subject, but this would mean that someone diagnosed with Autism Spectrum disorder, would not be required to have an inherent communication difficulty. That seems pretty unlikely.
There may be no effective answer for those individuals currently diagnosed with Aspergers without significant impairments in non-verbal communication difficulties and impairments in developing and maintaining friendships, unless another category is created where non-verbal communication impairments are a mandatory requirement.
The biggest problem will likely be for the small percentage of individuals currently not diagnosed with non-verbal communication difficulties with Aspergers, they would not likely fit the criteria for Social Communication Disorder either. |
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Callista
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| Posted: Sat Apr 07, 2012 7:41 pm Post subject: |
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It seems to me that if you don't have any speech/language, communication, or socialization issues, you probably shouldn't be diagnosed with an autism spectrum disorder. If there is a significant impairment, then there ought to be some kind of diagnosis; but autism has always had some kind of communication/socialization element and I don't think it makes sense to change that.
There are other diagnoses for single traits: Sensory integration disorder for sensory sensitivity; stereotypic movement disorder for stimming. For someone who has trouble only with speech/language but not with non-verbal communication there are the various disorders that involve producing and understanding speech. Someone who has problems with friendships, but not with communication, is likely to have social anxiety or social phobia.
Some of the primary fears I've been seeing around here lately with the DSM-5 is that people are afraid that if their diagnosis changes they'll no longer get the help they need, or no longer be recognized as having real differences. But I don't see it happening that way; as long as there is some kind of problem that needs to be addressed, there'll be a diagnosis. If you fall into the gaps between categories, then there'll be miscellaneous categories to use, just like we use PDD-NOS now.
As far as people with pre-existing ASD diagnoses, it seems like the most likely course will be that, due to your current ASD diagnosis, you'll be automatically put into the new ASD category, without any re-evaluation needed. That will result in a few who don't strictly fit the new criteria, but there are always a few who don't strictly fit the criteria but who are diagnosed anyway because that's the label that fits best without using a -NOS diagnosis.
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btbnnyr
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| Posted: Sat Apr 07, 2012 8:47 pm Post subject: |
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| I think that the three social criteria are fine, as long as the application is not too rigidly interpreted by the diagnostic clinician, like you definitely cannot have ASD if you have a friend or significant other. Deficits in developing relationships is more like if you are autistic, then your success rate in developing relationships is going to be much lower than the success rate of an NT otherwise similar to you, for many many many reasons, from yourself not being able to read the social cues indicating that someone wants to befriend or date you to others not being accepting of your weirdness. I am sure that I have missed out on relationships with accepting people just because I failed to recognize the signs that someone was interested in a relationship with me, and I did not reciprocate the advances that I did not recognize to begin with. Problems with non-verbal/verbal communication and social-emotional reciprocity are going to lead to a low success rate in developing and maintaining relationships, but that should not mean no relationships at all. |
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aghogday
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| Posted: Sat Apr 07, 2012 8:51 pm Post subject: |
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| Callista wrote: | It seems to me that if you don't have any speech/language, communication, or socialization issues, you probably shouldn't be diagnosed with an autism spectrum disorder. If there is a significant impairment, then there ought to be some kind of diagnosis; but autism has always had some kind of communication/socialization element and I don't think it makes sense to change that.
There are other diagnoses for single traits: Sensory integration disorder for sensory sensitivity; stereotypic movement disorder for stimming. For someone who has trouble only with speech/language but not with non-verbal communication there are the various disorders that involve producing and understanding speech. Someone who has problems with friendships, but not with communication, is likely to have social anxiety or social phobia.
Some of the primary fears I've been seeing around here lately with the DSM-5 is that people are afraid that if their diagnosis changes they'll no longer get the help they need, or no longer be recognized as having real differences. But I don't see it happening that way; as long as there is some kind of problem that needs to be addressed, there'll be a diagnosis. If you fall into the gaps between categories, then there'll be miscellaneous categories to use, just like we use PDD-NOS now.
As far as people with pre-existing ASD diagnoses, it seems like the most likely course will be that, due to your current ASD diagnosis, you'll be automatically put into the new ASD category, without any re-evaluation needed. That will result in a few who don't strictly fit the new criteria, but there are always a few who don't strictly fit the criteria but who are diagnosed anyway because that's the label that fits best without using a -NOS diagnosis. |
Currently PDD NOS statistically comprises about 70% of ASD's. Some studies show that the majority of PDD NOS cases, have no RRB's, a mandatory requirement of the revised criteria.
Re-evaluation is required for many individuals with PDD NOS in the school environment for those that are receiving special education services, on a routine basis, with or without changes in the DSMV revision.
This is part of the demographic that the government supported study used to come up with the 1 in 88 statistic. The individuals that visit this website are of no consequence to that statistic, which is entirely comprised of 8 year olds, receiving services in the school environment for the developmentally disabled.
Whether or not these children receive the same insurance benefits, for therapies like ABA, in the home environment, if they are re-evaluated as having Social Communication Disorder, is an issue that at this point has no clear answers.
There has been a great deal of legislation that require insurance companies to insure those with ASD's for these type of therapies; it's questionable if the government will expand those legislative requirements for Insurance companies to cover SCD.
Not likely they will lose services in the school system over this. But it is likely that many individuals with PDD NOS, that are part of the 1 in 88 statistic, without any RRB's will eventually lose their ASD diagnosis, if the revisions stands as is.
I would agree that many of those that are not being provided government services, which comprise most of the individuals with a diagnosis, visiting this site, will not likely require an immediate re-evaluation, since psychiatrists are not likely going to do it for free or demand it, when not required by a third party source.
However if at any time, government resources are sought out, a current assessment will be required; it's a government requirement; it's not likely that the majority of psychiatrists or other diagnosing professionals are going to commit fraud and risk the consequences to protect anyone's diagnosis, in these cases.
For those mildly affected, the ADA, is usually the only government resource available, and it does require a current assessment when one takes advantage of it. |
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