Baron-Cohen Asperger Article in NYT

Post Reply New Topic

And all of psychiatry nowadays is viewed from a neurobiological perspective. Researchers all across the world believe that autism is a neurodevelopmental disorder, meaning that it is indeed a neuroscientific word and concept.


There are many, many studies out there that have used mixed groups. In order to complete studies, in order to gather enough participants to make a study, it is very common to just have an "autism group" that is composed of mixed diagnoses. Does this lead to confounds and possible type-I error? Unfortunately, yes.


Tantybi, I greatly enjoyed your post. I enjoyed the joke that your husband made in the delivery room. Actually, though, I just found the medication that works for me (Anafranil) last year. I struggled with my OCD a lot in college, especially my freshman year. And I struggled with OCD even worse in middle school and high school. AS gives me some benefits in life, such as the special interests, obsessive focus, and large capacity for memorizing facts, but nothing good comes of clinically significant OCD, unfortunately.
-OddDuckNash99-

Last edited by OddDuckNash99 on 16 Nov 2009, 11:03 am, edited 2 times in total.

heh, ergo indeed.

anyway, so wouldn't that make a plethora of other disorders part of the spectrum as well? like downs syndrome, williams syndrome? prader willie syndrome? etc...

your 'definition' is one of semantic convenience, nothing else.

After reading a bunch of these posts.....

I have to admit that I never really thought about the effects of lumping everything into autism would have on research.

I was all for the idea at first because of the inconsistencies in diagnosis, and I think it would be a benefit to the world of Psychology because too many shrinks out there just really don't know enough about the subject. I've seen one too many posts on the WP on people's bad experiences with a psychologist, and more than once have I read someone claim their psychologist said they couldn't have Aspergers because they talk.

But now when you get into the realm of Pyschiatry, this kinda does add too much confusion to the research. The whole purpose of having Aspergers separate from Autism to begin with was because scientists speculated that the genetic makeup of Aspergers was different than autism. I do think they have a hard time with studies enough as it is because...

A. most diagnostic criteria is based on behavior and subject to a huge gray area of opinion (both of the person making the diagnosis and of the person giving out the information to which the diagnosis is based since most behavior that it is based on happens outside the clinical practice)

B. the diagnostic information has changed a lot throughout the years making it difficult to distinguish between Aspergers and Autism in previous studies in years prior to Aspergers being a diagnosis

C. We are kinda approaching this bassackwards (taking people diagnosed based on behavior and looking for biological differences as opposed to just finding the biological differences first and then studying the behavior). For all we know, there are a plethora more subgroups like Aspergers in the genetic/biological realm all of which produce similar behaviors (probably with distinct differences, but we would never know that until we make a biological distinction).



I'm starting to think the easiest solution isn't in regards to the DSM as much as the research methods. If a diagnosis of behavior is important to the study, then maybe they need to be creating groups based on other methods than someone else's diagnosis (whether it be there own diagnosis or maybe a questionnaire of behavior or something to that effect). Either way, there are so many factors that influence a person's behavior that I think our research needs to find a way to control those variables (or eliminate them) for biological screening purposes (I mean from the study, not the individuals...lol).

And that, Tantybi, is Baron-Cohen's argument for not doing away with distinctions prematurely.

Maybe the reason the criteria don't work is because behavior is too variable, and brain differences can be based in diverse areas but can produce similar behavior.

I've been reading quite a few studies of subjects with Asperger's and/or High Functioning Autism recently, and they keep saying that diagnosing using the DSM-IV behavioral guidelines can't consistently differentiate between Autism and Asperger's, so therefore accurately making distinctions is not possible. I believe that accurate diagnosis is possible, and helpful distinctions can be made, but it needs to be cross disciplinary and to take into account much more than behavior.

Z

And all of psychiatry nowadays is viewed from a neurobiological perspective. Researchers all across the world believe that psychotic disorders are neurobiological disorders, but this does not mean that “psychotic disorder” is a neuroscientific word or concept.

I have never encountered any credible research that does so. I know one project where the entire Autism sample group numbered only 30 and it still differentiated between the two groups and produced detailed findings specific to each sub diagnostic group in addition to findings that treated the Autism sample as a whole group. If there is so much otherwise credible research producing muddy results because of a failure to distinguish diagnostic category amongst Autistic subjects, you should have no problem producing some specific examples of such.

Does it actually happen in respect of research that is not of such poor quality that with or without such a flaw it would still be worthless (in respect of any credible research in other words)? I doubt it. I do not know of any influential research in the field that entails this error for the reason you are citing.


Yes, and the majority for DSM purposes are variants of PDD NOS.

These conditions do not include the particular constellations of impairments in the particular domains of functioning that are defining of the Autism spectrum.


It’s not my definition (I am not the source of the definition, nor responsible for its adoption and acceptance by the relevant practitioners and authorities in the relevant fields of practice and inquiry), and all definitions are of semantic convenience.


This is completely and utterly untrue.

Asperger Syndrome was added to the DSM because it was believed that there might_be a group of clinically impaired people who met the criteria in DSM III for Autistic Disorder (many of whom were possibly being diagnosed with a personality disorder when they presented clinically) but who were not getting such a diagnosis because they were uncharacteristically chatty and did not appear to be deficient or sub normal cognitively.

APA never claimed the two were distinct other than by virtue of assorting them on the basis of the distinguishing diagnostic criteria. On the contrary, APA intended that the inclusion would generate research on which APA could make a decision about whether or not these two categories should be separate or ought to be treated nosologically as one, or whether some other means of dividing the combined population would be better.

The decision APA is making now will be on the basis of such research, whereas the initial distinction was based on the need to generate such research.

A cautionary diagnostic tale is that of Kim Peek, the prodigious savant and inspiration for Dustin Hoffman's character in "Rainman." Before the movie (and considerable public attention), Mr. Peek was diagnosed as having autism due to his behavior and motor deficits.

Doctors knew that Peek was born with macrocephaly (an abnormaly large head), but in 1988 he had MRI scans that revealed agenesis of the corpus collosum, a condition in which the bundle of nerve pathways that connect the brain's hemispheres are missing, in addition to damage to the cerebellum. In 2004 NASA scientists performed computerized tomography and magnetic resonance imaging to create a three-dimensional image of his brain to better understand his savant eidetic (photographic) memory.

By 2008 Peek had a new diagnosis, based more on genetics and brain structure. The diagnosis is FG syndrome, a rare genetic X chromosome-linked syndrome.

So the man who inspired Rainman isn't autistic, Peek's APA-DSM autism diagnosis (the best available at the time) was not accurate, and the revised DSM-V will need revision as soon as it is published in 2012. Brain imaging and genetics are allowing more accuracy in diagnosis, but it is hard to let go of the reliance on old behavioral stereotypes. After all, NASA isn't offering to image our brains.

Z

RE: Kim Peek,

Kim Peek doesn't have an ASD, but the character in Rain Man sure does (his overall label would be the aloof variant of HFA with special abilities).

RE: Clinically diagnosed OCD and benefits,

I'm sure there's positives to OCD just the same as there are to an ASD. People with OCD have higher than average intelligence in most cases, for example (I've read this often), which isn't the same with any ASD (AS included. It's just that the interest makes people think that they're smarter than average, when in fact AS falls within normal on average).

In fact, a comorbid diagnosis of OCD with an ASD may just be a good thing if intelligence is what you're after.

It won't matter in research studies because the borders between LFA, HFA and AS are non-existant. They need to take even more radical steps and combine ASCs with OCD, ODD, ADHD, Dyslexia, Dyspraxia and the whole neurodiversity-spectrum. And then they can pull them all out of the DSM, because the basis is not medical, but personality-differences. After that, they can build new diagnoses that are both possible to find the causes for and to treat effectively with terapies. Such diagnoses might be heavy-metal poisioning, depression (oops that already exists), autistic mutism, and whatever. Then we can finally end the debate of curing personality-traits.

Personality-traits?

My father is dyslexic. He reads slowly, has difficulty spelling words, and was told from an early age that he was stupid. You think that is a personality-trait?

Furthermore, pulling things out simply because there is no recognized cause or cure makes little sense. People research these things every day, so just because there's no c&c now does not mean there won't be one in the future. Also, the point is not to necessarily identify the start or make the end - it's to recognize and properly label a set of symptoms that is present in multiple people in the population. When that diagnosis is made, it gives a wider understanding to others of exactly what difficulties someone has, and they can then attempt to compromise in order to provide a decent lifestyle.

And if someone is disabled due to their "personality traits" and can't work (let's just say an ASD in this case), who's going to give them assistance to live?

The whole point of disorders is the realization from others about the difficulties we have, and that it is a real disorder/illness, and we don't choose to be this way, and that they in their kindness, offer help to us.

I agree with Danielismyname about assistance, but there is more. Many do not need assistance, and treatments seem limited to assistance.

Many would not qualify for assistance for they have an income, American Plan at least. So it becomes a Welfare disability view that ignores treatment, and the non welfare majority who have some problems with the same things, to a lesser and lesser degree, but still a difficulty because of Genetic Biological personality traits.

Many go through life being said to be Odd, Ecentric, Different, which is as real a problem. It can be worse for they are not supported and sheltered, but are out in life every day, with a vast majority who all see them as different.

I am one, but starting at 59 I learned a whole lot about myself and that majority on Wrong Planet.

I am very unlikely to turn to a Psycholigist and say, "Some, no, most people think I am odd." I am a recluse with special interests, but so are most people my age.

By the disability standard, we are all considered disabled after 62.

From a human potential point of view, the 1 in 100 that falls into the Alphabet Soup of the DSM is only part of the problem. There is a much larger group with the same traits but due to economics or lesser degree, are nothing to the DSM. My claim is another 9 in 100.

Anything spread that broadly cannot be a disorder/illness/disability, it is a personality that is all someone has to live with. I also make claim that it's true name is Sub Species, a Genetic Varient.

What Baron-Cohen seems to be saying is, what we have is the best map we could make seeing only behavior, lets keep it so we have it to compare to the coming MRIs, Genetic studies, for they will only make sense if they do connect to shown behavior patterns.

The DSM admits confusion, it will not become less confused by making all one.

The difference is Science. The best model is the standard that is tested, and the new knowledge fits in a constant pattern. The coming overlay of genetics, MRIs, might well fit the known existing divisions.

This is no time to just dump 60 years of observation.

We do not want a proof that it fits the DSM, General Autism, or not, we want to know how those very human traits spread through the population.

In my case, I aced half of an IQ test, and cratered on the other half. I still came out intelligent, but some things just don't work well for me, and some work better than most anyone. That has been a good guide to life.

Learning of genetic varients with associated traits would work the same for a lot of people outside the DSM view of life.

The sub clinical versions are the most common, so for the greatest good for the most people, not the limited Mental Health field, which is rightfully focused on the disorder/diaability view to get people the help they need.

Funding and study has been focused on the worst cases. Research has been focused on the whole population. Myers-Briggs looked at everyone. Jung tried to find a sane man.

The coming results of study that were focused on the worst cases, they are very expensive, is now unfolding to enlighten the whole population, and how Asperger's grades out into the general population is a valid study. Half-Aspies have a right to know. Science is for everyone.

years ago I proposed, "The Theory of the Grand Fallacy." It states that everything is based on what everyone knows to be true. Complex structures are built upon this. Any mental structure can work, if you have enough true belivers. Everyone was wrong.

In this case, it is the Out of Africa Model. A new Species came and replaced all eariler versions.

The Multi Regional view is, the new Species bred with the existing lines, the best genes survived, spread, and there were many centers where varients expanded.

The Fallacy is, Homo Sapiens are not one Species, but a collection of breeds, each with it's own genetics and origens. As such they each have a character, personality, and world view. Genes cross all lines, they do not care about race, only what works.

Out of Africa fits with The Garden of Eden. Adam and his clone Eve, have children with the same DNA, as do their children, and on to all humans. It is just not so.

Genetics is showing that existing populations are groups of varient DNA. Hs is a collection of sub species. Superior genes grow and spread, but even then, early or late in the mix is different.

I have the Public Health view, we must treat the whole population. The goal is that each person comes closer to reaching their potential, and barriors are removed that hinder progress.

This will not come from the DSM model. A lot of it can be explained by varient genes, and gene incompatability problems. Not all mixes produce superior varients. A little genetic knowledge could stop the most sever forms, very LFA.

Jewish people have some known gene problems, and they do check before marriage and children. In the near future I think everyone will.

Baron-Cohen is right in saying keep the old pattern to check against the new genetics.

It will not stop the disabled from getting the help they need, and it will further Science.

Yeah, if you don't need assistance, that's cool, but taking a label where many do, and calling it a personality quirk, is effectively taking it away from them; they'd be making people homeless.

I like how they're thinking of making a "disabled" ASD and an "able bodied" ASD in the new DSM-V, which is one good thing that I think many would like, even if the removal of AS bothers a lot of people.

They do seem to be trying to move the goal posts. ASD Lite, expand the franchise.

Tony Attwood has, his books reach more than any mental health system. I like the Australian system, but in America, that is more office hours and more sales for drug companies. Mal treatment, and no real benefits.

I am of two minds. I do think help is needed to a larger population, and learning from them. In a list of problem areas, for some it is disabling, others through situation have developed a work around. Just having is not enough, I want all of the what is it, how does that work? The same trait can run from disaster, to annoyance, to being used.

Tony Attwood and Temple Grandin have sold tens of millions of books because they educate that larger market. Remissions and Dx upgrades are well known, so there are a series of steps from life damaging to using it.

I have lived through social exclusion, I am a recluse with narrow focus, and special interests that have taken over my life for long years. I also write books, and those same traits are just what are needed for the solo labor of producing a book.

My brain is overweighted to systems, but that abnormal behavior is why I can fix complex machines, which I could not afford to just buy new. Having my own printing and binding compensates for not being able to deal with the world of publishing and printing. Sales calls, not anything I am good at, have been replaced with internet marketing.

Those I have met through life were the camera repair man, the watch repair, machine shops, where focus and knowledge turned into income. They were people who would now be Dxed, but in the old days, just had to find a way to get by. They lived in the back of the shop, did not socialize, but made a living and funded their special interests.

Everyone has the same problem, what is the best use of your time?

Over the whole of people it is called the economy. Particularly at the Disabled/Able Bodied line, it is a social cost, or a source of production. A broad view of ASDs has produced some economic winners, so it is in the best interest of all to develop that field.

I find this lacking in the DSM view. Just one small step away the same tests are used for employment aptitude. Job testing does look for weak areas, and tells the applicant what they need to work on, how, and what strengths they have to market. The DSM seeks weakness, then amplifies it to disability, for that is where thier paycheck comes from.

As there are a lot more that need the job performance view, it should be larger. As for disabled, Stephen Hawkings is, but we still got some work out of him.

Treating the whole population with the view of helping each reach the best possible life will drive the economy. A ruling of disability should not be an end, a lifetime check. There is still a lot of function left, and often those traits only need the right project to be high performance skills.

I find the DSM takes a short sighted and narrow view of human potential

And woe to those who appear to function well when they are working on their right project, but seek a DSM diagnois to understand and try to improve themselves when their functioning decreases while attempting the wrong project.

You're spot-on, Inventor. Diagnosis is there more for elevating weakness to disability, rather than developing the strengths that we possess.

Z

You don't need a medical label that someone else made to understand and/or improve yourself if you yourself don't possess the qualities that make the disabling label itself (you'll learn nothing anyway).

It's all about help with a medical label, and that "help" is in ways of basic to moderate survival, not "help" in the ways of personal insight and philosophical pondering (sure, that can be a byproduct, but that's still a minute thing compared to the help you garner from having the label).

It's pure necessity.

If I'm suddenly able to work like the rest of humanity, make a simple sandwich, attend school, pass a simple written test, handle going to the shops without burning in the melting pot, and whatnot (let alone actually talking to someone), they can have my silly label back, as I wouldn't need or want it then.

^ I agree. The label is to enable me to access support and receive such things as adequate nutrition and relative independence. If I hadn't grown up with great difficulty functioning in some way, I can't imagine wanting to have sought any label.