Tuesday, April 13, 2010

"But Officer I'm a Good Boy" - Severe Autism Reality Hits Home in Oklahoma as the APA Prepares to Substitute Aspergers for Autistic Disorder in the DSM-5

While many major news outlets, Holllywood and the American Psychiatric Association  (in the DSM-5)  are doing their best to convince the world that autism disorders are really just a different way of thinking, that autistic persons are all socially awkward but brilliant success stories waiting to be profiled,  reality hits home for those who are severely affected by autism disorders and the parents who care for them as it did last week in Oklahoma for Stephen B. Puckett, a 28 year old severely autistic man, and his family.

Credit is due to NewsOK (The Oklahoman online) and Age of Autism for reporting the story of Stephen B. Puckett whose autism disorder induced violent behavior at an Oklahoma hospital (OU  Medical Center)  resulted in him being arrested and  taken in handcuffs to an Oklahoma City Jail where his lawyer states that he spent three days in a straight jacket on suicide watch. NewsOK reports that Age of Autism readers responded to that site's coverage with messages of support for the family. A video of Mr. Puckett's mother talking about the situation and changes needed can be found at the NewsOK web site.

The hospital had refused to admit Mr. Puckett after he suffered seizures as a result of his autism. When Mr. Puckett kicked and scratched hospital police officers he was hauled away in handcuffs by police and spent three days in jail in a straightjacket on suicide watch.  As he was being taken away the Oklahoman reports that  Mr. Puckett was heard to say to one of the arresting officers "but officer I'm a good boy". 

Ultimately charges were not laid against Mr. Puckett.  Oklahoma County first assistant District Attorney Scott Rowland refused a police request to file charges recognizing that there were mental health issues involved and not wanting to have Mr. Puckett placed in the general prison population. Stephen Puckett's mother has called for legislative policy changes so that hospitals can not refuse to admit people suffering from autism induced seizures. 

What is also needed is recognition by  the American Psychiatric Association that intellectual disability and cognitive impairment, seizures and other issues are often part of autism disorders.  It is wrong headed and dangerous for the APA to remove any mention of intellectual disability from the description of autistic disorder in the DSM5.  The APA currently plans to separate Intellectual Disability from Autistic Disorder and replace it with  the high functioning form of autism now known as Aspergers.  This will not help society or hospitals in Oklahoma understand that as many as 75-80% of persons diagnosed with what is today known as Autistic Disorder are also intellectually disabled or cognitively impaired or that many suffer from seizures and meltdowns such as those that occurred in the OU Medical Center.   

Autism reality is being replaced in the DSM-5 by psychiatric profession convenience (clinical utility) to the detriment of those most severely affected by autism disorders whether they live in Oklahoma in the US or Fredericton, New Brunswick here in Canada. The APA whitewashing of autism realities is well underway and will continue with the APA substitution of  Aspergers for Autistic Disorder in the DSM-5.


Socrates said...

I see you've modified your claim that 80% of the Spectrum has ID - to 80% of those with AD have ID.

Unknown said...

Socrates, you see wrong. I have contended that 75-80% of persons with AUTISTIC Disorder are also Intellectually Disabled consistent with the 2006 Brief of the Canadian Psychological Association to the Canadian Senate.

That information is also consistent with two recent CDC findings that 41-44% of persons with Autism Spectrum Disorders are also Intellectually Disabled.

Obviously Aspergers, the addition of which expanded the Pervasive Development Disorders category in the DSM-IV, by definition excludes persons with Intellectual Disabilities.

Are you offended by the fact that so many persons with Autistic Disorder are also Intellectually Disabled?

Anonymous said...


What a reality check, I pictured Justin while reading as it can certainly heppen to him. Intellectual disability is certainly part of autism for many.
I fear what is happening with the changes being made to DSMIII thru APA.
To many people with Asperger's are speaking on behalf of all with ASD. it is just wrong.

Thanks again for a great post.


eLbe said...

Thank you so much for highlighting this story! My brother suffered severely from Autism - seizures, only spoke about 5 words, violent outbursts, repetitive behavior, and was never fully potty trained - he passed away 8 years ago. The media, Hollywood, and some nonprofit organizations continue to only shed light on high functioning/aspergers individuals - what I like to call 'The pretty picture' of Autism - all it does is further ostracize those on the low end needing the MOST assistance!!

Ian MacGregor said...

Dawson, G. (2008). Early behavioral intervention, brain plasticity, and
the prevention of autism spectrum disorder. Development and
Psychopathology, 20, 775–803.

introduced a model which not only describes intellectual disability as comorbid, but also language impairment.

If things continue, the only true autistics will be those writing blogs.

Gupta, A. R., & Slate, M. W. (2007). Recent advances in the genetics
of autism. Biological Psychiatry, 61, 429–437.

In the above paper the authors note that the genetic mutations associated with autism cause both social and mental impairment, and that such things as improper synapse development cause both.

The paper
Autism Overflows: Increasing Prevalence and Proliferating Theories
Lynn Waterhouse
Neuropsychology Review, Volume 18, Number 4 / December, 2008
DOI: 10.1007/s11065-008-9074-x

Is a good one on this subject.

I am caught somewhere in the middle here. I believe autism is too widely defined, but the difference between a person with low-functioning autism such as my daughter and someone who is high-functioning is the amount of damage caused by the expression of the genes of autism, that a developmental switch was turned on too early or too late in both cases, only slightly in the case of the HFA person, but for a longer time in the LFA person.

Anonymous said...

I think probably rather it is a case of the genetic load required to bring on autism insome individual's is higher than in others in which case for those individusls the genetic hit to normally functioning genes would be greater and therefore more damaging to normal functioning.

I also think it is fair to say ceirtain kind of more widespread brain damage can mimic the more specific impairments that exist in hfa.

That said, there is nothing inherently intellectually impaired about saying "but im a good boy" the social deficits alone of asd's could make someone think that was a good thing to say, even were they highly intelligent.