Is the Definition of Autism Too Broad?

[auntie]

Some psychologists think the definition of autism has become too broad. They say a term that encompasses people at all points on the cognitive curve is so broad as to be useless. Someone like me would not have been diagnosed with autism at all under the rules of DSM III. A few years later, with the arrival of DSM IV I was diagnosed with Asperger’s and later under DSM5 I was re-diagnosed on the autism spectrum. Has my diagnoses somehow taken something away from those with greater impairment who would have qualified for the autism label under DSM III?insert quote here

An interesting piece>

More here:

www.psychologytoday.com/us/blog/my-life-aspergers/201806/is-the-definition-autism-too-broad

[akafred]

Quite interesting.

Definitely an argument that can be made for other conditions like ADHD, dyslexia, etc that have ranges in symptoms and severity, gifts as well as detriments.

I definitely think biomarkers are the future of diagnosis and (tailored) treatments. I wish we were there, but we just aren't, and might not be for quite a while. But it is interesting and promising for sure.

[waverly]

I don't know the answer to that.

My neighbor just shared with me that she kept going to doctors and no one would help her with her son until he was hospitalized with depression. It was only then that he got an autism, ADHD, and depression diagnosis. The reason being because he would have fit in the Aspergers definition before they got rid of that. Able to speak and move normally, make eye contact, doing OK in school as far as I know. He is 10 or 11 and just diagnosed because his symptoms are on the milder side and he didn't ring any bells at the regular autism screenings. I wonder if they pieced it out a little bit if he would have been diagnosed sooner.

[auntie]

waverly,

That was how it used to go back around the time my son was initially diagnosed. A lot of kids with Aspergers hit the wall around 4th and 5th grades. It's when the social landscape morphs into something child-directed with subtle and sophisticated rules that are intuited rather than explained. It's also a time when the curriculum starts to favor higher order thinking and application rather than rote memory. Even with a dx and appropriate services and such, DS went through a significant depression towards the end of elementary. It's common.


Early on doctors and teachers just thought DS was very bright and spent a lot of time with adults. When he was initially dxd in 2000, the dev pedi rounded up all his fellows, residents and med students so they could see what a young child with Aspergers looked like since 10-11 was the earliest they were diagnosed as a rule. My cousin was diagnosed just before he turned 40; my doctor's brother was 52.

[funchicken]

waverly, I'm sorry your friend had so much trouble getting help for her son. My oldest was diagnosed at 10, as well. I think it's really hard to pick up on some of the subtle differences in kids who are high-functioning without observing them in social settings and group interactions. Most clinicians aren't able to replicate that in their offices, and a lot of the ASD inventories don't capture subtle social deficits. I also think a lot of clinicians, teachers, therapists, etc aren't familiar enough with how subtle, social-cognitive challenges can present themselves in kids on the spectrum--they don't understand the behavior they're seeing, so they don't pick up on it in the context of ASD.

I don't know the answer to the question of whether the definition is too broad either, but for us, understanding ASD better helps us understand DD better. And I hope that it will help her understand herself and her relationships with others better, too.

[freezorburn]

It will be interesting to see how future iterations of the DSM describe the spectrum. I think right now it's pretty challenging for laypeople.

DS is high functioning enough that he wasn't flagged for screening. We lived in the UK for the first several years of his life, and I got him into preschool around age 2. They have developmental checklists that they fill out, and I think in part these serve to screen for developmental issues. I think for the most part his separation anxiety was pretty intense, but not enough for anyone to think it was out of the ordinary.

He only got diagnosed because I went to consult a developmental psychologist on how to help him deal with the stresses of divorce. She happened to observe him in the waiting room, and noticed things others had missed. Poor eye contact, unusual speech prosidy, echolalia, scripting, etc He has responded well to ABA

Is his case making resources and support less available to those who are more severely affected? No way to know. I imagine the needs are very different for individuals who are more severely affected. I wouldn't begin to know how to find an answer to this question. Or, does a high(er) functioning diagnosis somehow diminish the visibility or understanding of autism, particularly for those who face more difficult challenges.

I think DS gets a lot of his traits from my dad. Particularly the speech-related ones. I wonder if my dad would have been diagnosed, had the understanding and tools been available at the time. I'm pretty sure that if my dad had any of the behavioral issues that DS has, that his parents probably beat it out of him. Whatever they did, it was effective because he grew up and went to med school and immigrated to the U.S., had a successful career and put three kids through college. But he is difficult to get along with and that has cascaded into a whole matrix of dysfunction in our family. I wonder if our family would be any different, had therapy been available to him during his developmental years.