Baron-Cohen Asperger Article in NYT

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There actually is a difference in social behaviour by those who had/have a speech delay compared to those without. It all just comes under a lack of social reciprocation though, and that's why they see that they all should be merged under the ASD umbrella. If you're odd in social behaviour and mannerisms, and you just talk on and on about your interest regardless of the listener's feelings, you lack social reciprocation; if you don't interact with people at all (aloof, meaning you actually can't interact socially), or you only accept an approach from another person by answering their questions without adding anything to the social interaction, you also lack social reciprocation.

Someone without a speech delay will never be of the aloof kind for most of their lives (they may be when a toddler, or when stressed later on in life, but not all of the time), whereas the person with the delay in speech can be aloof their whole lives.

But again, it's all a lack of social reciprocation, and the end result is often the same (see: social isolation).

To add to what Cohen said,

Science actually has picked up a physiological difference between autism and Asperger's (the brains are different between the two groups), just not genetic.

But when they did that study, what criteria did they use to distinguish between AS and HFA? Or was it a study between LFA and AS (in which case the problem is still unresolved, the AS subjects may have been HFA)? If they only used people's official DX, considering the professionals' problems with the AS/HFA division, this science is useless. It simply states that some autists have different brains, but not how it applies to this debate.

It seems to become circular. In order to find out what the difference is between AS and autism, people use flawed criteria to divide people into groups and then try to draw conclusion based on those groups to validate whether the groups are useful. Bad science, IMO.

They used the development of phrased speech, those with AS having no delay, and those with HFA having it; the children were matched by IQ and other factors.

I'll get the study:

Thanks for the article quote, I love it when people can pull the article they're referring out of their hair (um so to say)

One thing though, how big were the groups and were the differences statistically significant? What statistical tools did they use?

I hope you don't mind my asking, but as my academic career starts to form I've come to understood the importance of statistics and although studies may be very meticulously carried out, sometimes even renowned scientists fail to use appropriate statistical analysis. Or rather, sometimes they leave the analysis out because it shows the results to be random rather than significant.

That still doesn't rule out the possibility that there are degrees of autism rather than distinct groups.

Let's say you're trying to group numbers; and you want to prove that high numbers shouldn't be called numbers because they are a different thing from low numbers; so you test the numbers for how many factors they have. On average, the high numbers have more factors per number; so you say, "Well, I just proved my point!" But have you? Are high numbers qualitiatively different from low numbers, or do they just tend to have more factors? Factors are a property of all numbers. The higher numbers tend to have more of them, and there's no abrupt change from low numbers to high numbers, but a gradual gradient.

A gradient a little like this, in fact.

Similarly, speech difficulties are a property of all autistics. People with HFA just tend to have more of them. (Show me an Aspie who didn't have problems with slang and idiom, pedantic speech, odd inflection/rhythm, conversational give-and-take, volume control, etc., and I'll show you a misdiagnosed case of PDD-NOS or social anxiety disorder...)

They didn't test these two groups against a group of people with speech delay but no autism. The test they did could easily have shown a low ability with language in the brains of the speech-delayed autistics that it would have shown just the same in the brains of people with simple speech/language disorders.

Plus: Selection. How did they pick their subjects? I'm going to assume they picked only the most obviously speech-delayed people, versus the most obviously not speech-delayed people, so as to maximize the possibility of picking up results. But when you do that in a spectrum, deliberately picking people at the opposite ends of the range you're interested in, differences you find may be differences in some factor that everyone has.

I don't consider this study conclusive.

I whole-heartedly agree with Baron-Cohen's disagreement with taking AS out of the DSM-V. I am not even entirely convinced that Asperger's is a form of autism, to begin with. I feel it is more a form of Nonverbal Learning Disorder. I don't really associate myself with being part of the autism spectrum, as I don't have 100% evidence that Asperger's IS autism to begin with. Regardless of that issue, studies have already found descriptive differences between Aspies and HFA individuals that have nothing to do with a speech delay in childhood. For example, it has been shown several times that those with AS are naturally more clumsy and uncoordinated. In addition, HFA individuals often have a higher PIQ than VIQ, and it's usually the opposite in Aspies. This further suggests that AS is a form of NVLD. I was diagnosed with both AS and NVLD, the latter being a diagnosis solely on my IQ scores and scores on achievement tests. However, I feel that I am better described as a subset of NVLD known as "Asperger's Syndrome with visual-spatial deficits."

As a neuroscientist, I think it's a travesty that people are planning to lump AS and autistic disorder together into one diagnosis. That is blurring the spectrum far too much. For example, somebody who has moderately severe AS and somebody else who has moderately severe autistic disorder have different problems, different strengths and weaknesses. Just because both of them are "moderate" in their individual disorder's severity does NOT mean that the severity is equivalent. That is like saying that somebody who has severe paranoid schizophrenia is just as impaired as somebody who has severe disorganized schizophrenia, the latter of which is far more debilitating.

I also find it poor that the decision to take AS out of the DSM-V has already sort of been set in stone, despite the fact that the new edition isn't even scheduled to debut for a few more years. Think of the possible research findings in AS vs. autism differences that could be found during that time! Currently, the autism research literature is a virtual quagmire of conflicting findings. Why? Because researchers are doing the same thing as the DSM-V writers: lumping individuals with autistic disorder, HFA, and AS diagnoses all into one patient group. Study all three of these groups separately, and maybe answers will start to be shown...

I am hoping for biological diagnostic tests for neuropsychiatric disorders, in order to lessen stigma and to clear up issues such as this. And I think that the worst thing of all is that poor Hans Asperger's critical findings will, once again, go unrecognized. He found a different presentation than Leo Kanner did, and now, those differences are going to fall by the wayside. This whole thing just makes me very angry at the psychiatric community. Just as awareness about AS was beginning to be spread, it's just going to be taken away again... Shameful.
-OddDuckNash99-

So what about people on the diagnostic borderline, who can be diagnosed both AS and Autism? We aren't even the minority of Asperger's, but the majority! You don't have to have a speech delay to be diagnosed with HFA; you just have to have problems with communication. As children, most of us were far behind our peers in communication. There's so much overlap between AS and HFA that it isn't even funny.

You can't tell AS and HFA apart in many adults who have a diagnosis of one or the other. As kids, yes. Maybe you can lay odds based on whether you get a higher score on one or the other section of the IQ test. If you do diagnose by which way your IQ test split is, what do you do with people who score within ten points of each other on the subtests? At least some of us do.

I think it's the other way around: NVLD is on the autism spectrum, either Asperger's or PDD-NOS, depending on the specifics. Just like HFA, NVLD people have difficulties with communication thanks to their difficulty with everything but the denotative meanings of words. NVLD is basically a neurologist looking at Asperger's from a neurology standpoint; and Asperger's is so close to autism as to be obviously related. We need to take off the blindfolds and realize it's all the same elephant.

Motive?

One, learning about all the range is not possible here, and we have insider knowledge.

Two, Autism is clearly covered under Insurance and Medical coverage, Asperger's is not, so they are voting their pocketbook.

Looking forward, the psychiatric community is about to lose the market as Genetics and Neurology map out the Asperger's and outward group, BAP, as 10% of the population.

Asperger's was the goal post, and the psychiatric group is trying to move it outward to include Geek Syndrome and Half-Aspies.

They are trying to stake out new feeding grounds before Genetics and brain scans show that LFA to HFA have one set of origins, and Asperger's to BAP has another.

While including 10% of the population does sound like a fee generating move, their work has been to rubber stamp applications for Social Services, which this larger group does not use.

The path of Science is you will go speak to someone about your Genome. With twelve markers it will take Genetics to sort out the patterns. It will be Science, not opinion, based on thousands of others with the same combinations.

It is also likely to strike at the heart of the matter, pointing out what possible combinations could lead to Infantile Autism.

At 10% we are a minority, but due to a few cases which may not be related at all, we are all judged by the color of our skin, not the contents of our hearts and minds.

Psychiatry can only see the outward skin. Behavior compared to other more common colors.

Genetics looks at behavior as compared to all others in our group, and our common ancestors.

Research is showing common ancestors. We are a family.

All of our behaviors are made worse by being put in situations that most people can function in. There is another side, that we can function in situations that cause them distress. Social Isolation is one.

I seem to not be comdemed for my behavior, but for my lack of being social. I am supposed to understand what other people think, and want their company above all. I do not think they think, and want to avoid them.

As the paying customers, I think we will shop Genetics and forget Psychiatry.

The DSM marginlizes us, they are not looking for the good. Our Genome includes people who have done well, most of whom are at least getting by, and between the threat that I will become locked up if I do not follow the Psychobabble Religion, or the high ground reached by others of my Genome, I look upward.

While it can be difficult to live with a majority you do not relate to, it is not impossible. As single people they did have their way with us, but we are forming in groups, and science is on our side.

Baron Cohen points out they go against Science, Tony Attwood points out that Asperger's is socially acceptable, Autism is not.

I think they will lose a lot of customers over this move.

From appearance only, yes, the symptoms all appear similar. However, simply for the sake of science and a better understanding of the brain's normal functioning and its pathology, Asperger's and HFA/autism need to stay separate for the moment, in order to see how the different groups' brains differ. I feel that the research is currently blindfolded in the opposite way, and that they're treating all of the disorders as one, when we do not know that for sure. And if the groups aren't looked at separately, we will never know if they truly are different or a spectrum of the same underlying brain disorder.

My biggest beef with this whole thing really isn't the "is-AS-and-HFA-the-same-thing" issue. Honestly, it's that classifying AS, autism, PDD-NOS, HFA, and the like all as "autistic spectrum disorder of differing severity" is too broad. It's bad enough that we currently have the umbrella category of PDD-NOS, but now, everyone will just fall under "autistic spectrum disorder," regardless if they are a high-functioning, pedantic Aspie or a low-functioning Kanner's autistic who is not even able to speak or be toilet-trained. There clearly are different functioning levels within Asperger's, but since AS is mild compared to Kanner's autism, most likely, all people who are currently diagnosed with Asperger's Syndrome will be labeled in the future as "autistic spectrum disorder, mild." And most PDD-NOS subjects will also go under this category, blurring individual needs. Furthermore, if this classification happens in the way I predict, I feel that this new DSM system is going to hurt the Asperger's community, by having everyone see AS as being a "mild" condition. We all know that, as Aspies, we are lucky to have the abilities that we do, as compared to other autistics, but that does not mean that our lives are easy.
-OddDuckNash99-

Unless you've been living under a rock (possible, admittedly, if you're Aspie), you know that Asperger's is already thought of as an extremely mild condition--to the point that many people think it's completely made-up.

Brilliant, as always, Inventor. Great to hear from you!

Z

Too broad, indeed, ODN99. As I said earlier in this thread, I test and have abilities more like HFA. My performance IQ is a standard deviation higher than my verbal IQ, and my highest scores were in block design and picture arrangement. I evidently had/have a language delay that might be considered mild dyslexia that gave me a speaking delay and reading delay, and continuing difficulties with writing an spelling. Behaviorally, I have panic, social anxiety, and depression, as do many with any number of brain based differences, whether on the autism spectrum or not. I'm certain that I am on the spectrum, but as an adult with the ability to hold it together enough to pass for NT, (albeit an eccentric NT), a behavioral diagnosis was denied when I was evaluated at a center that mostly evaluates young children (how ASD was that of me to schedule an evaluation there??).

The areas where I feel I could have used assistance when I was young (or could use assistance still) are quite different than someone with a higher natural verbal ability and current diagnosis of Asperger's. In practical terms, the goal of any diagnosis should be to give people the specific help they need, as well as, perhaps, to find community. The goal of diagnosis could also be to emphasize and develop abilities, if anyone chose to emphasize some of the unusual strengths of those on the spectrum.

It is tragic that the psychiatric profession is myopic to the point of seemingly ignoring research in other fields such genetics and developmental biology. Instead, they seem to be saying "we made a mistake with the Asperger's thing, and since making behavioral distinctions sometimes doesn't work so well, we take it back." In effect, they will be loosing an imperfect, but recognized tool for helping those with a similar developmental profile.

Z

The problem is that the tool can be made better by creating schedules they can work with as opposed to having a separate diagnosis. That is, having HFA, LFA and possibly other schedules of development, they'll have better tools to target specific therapies. Having a separate diagnosis obfuscates this because of the confusion it creates in the profession. In essense, it is streamlining the whole process such that there is less confusion.

If he's talking about kids, does he really expect schools to say "ok your IEP is invalid now until you get re-assessed" or something? I'd expect the schools would simply re-write some words in some file to have an equivalent effect ("mild autism, w/o speech impairment, IQ>80, +whatever" instead of "AS"), and end up doing what they were already doing. The cost to the school system/state would lead them not to re-assess people anyway.

I think he's really worried about something else, though I'm not sure what.



I guess I see it the other way around.

For now it's behaviorally determined, and, as you say, no one knows how to differentiate the groups biologically. So maybe it's better to have one big category and work to subdivide it down biologically, rather that stick with historical/behavioral possibly artifactual categories, until they're shown to correspond to biology or not. The current divisons could be misleading -- maybe ASD's biologically break down into 3 or 7 categories instead of 2. And even if there are 2, it seems an unnecessary assumption that they naturally break down along the lines of AS & HFA.

Maybe what I'm proposing would be hugely disruptive to research, but in the long run pursuing a flawed paradigm might be worse.

Interesting topic.

I'm in my mid forties and recently discovered that I have a form of Autism................that perhaps isn't really Autism according to..............ummm who are they?

How wonderful;

I guess I can stop pretending to take things literally, start making eye contact with everyone and start 'having lunch' with lots of people on whom I depend emotionally, during which I don't discuss anything remotely interesting or significant.

Oh, hang on, I forgot, the DSM won't actually make the symptoms disappear..............

Well at least I won't have to do f***ing lunch and dissemble with the masses...........