In Children with Asperger's could lose diagnostic identity we see still more evidence, this time in Alabama, of the stigma attached to the fact that the vast majority of persons with Autistic Disorder, unlike those with Aspergers Disorder diagnoses, also have intellectual disabilities or cognitive impairments. Once again the story tells of concerns held by some that those with Aspergers will be stigmatized by being lumped in with those with Autistic Disorder in the DSM-5 New Autism Spectrum Disorder. In expressing these concerns the subjects interviewed contribute to the stigmatization of those with Intellectual Disability generally and specifically to the many persons with Autistic Disorder and Intellectual Disability:
"It's difficult to say where Asperger's ends and autism begins," Mulvihill said.
That difficulty - and the stigma attached to autism - is partly why some adults with Asperger's are not happy about the proposed change in the DSM, Crane said. While those individuals on the high-functioning end of the autism spectrum might show only slight symptoms, those on the other end of the spectrum are profoundly affected by the disorder.
Being classified as autistic can make it even more difficult for high-functioning individuals to develop relationships with their peers.
Crane said despite their various challenges, autistic children are highly intelligent.
"These kids are definitely the scientists of tomorrow," said Crane, who established the Riley Center after her son was diagnosed with autism. "They're brilliant. That's why early intervention is so important."
The comments by Crane of the Riley Center are a perfect example of the denial that is so prevalent in any public discussion of Autistic Disorder. The main difference between Autistic Disorder and Aspergers is in the area of intellectual disability. By definition in the current version of the DSM-IV a person with "autism" criteria AND Intellectual Disability will be excluded from an Asperger's Disorder (DSM-IV, Diagnostic Criteria for Asperger's Disorder 299.80) diagnosis (as set out on the CDC web site):
"E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
I have written frequently on the refusal of so many parents, professionals and persons with very high functioning autism disorders to acknowedge the high rates of intellectual disability in persons diagnosed with Autistic Disorder as that disorder is currently diagnosed in the DSM-IV. The 2006 Canadian Psychological Association brief to a Canadian Senate committee examining autism stated that:
"Symptoms and Impairments:
• Cognitive impairment is present in about 80% of persons diagnosed with Autism and general intellectual functioning is most often below average. Persons diagnosed with Asperger’s Disorder have average to above average intellectual functioning."
The CPA figures with respect to Autism (Autistic Disorder) appear consistent with the CDC figures with respect to the entire autism spectrum:
"Data show a similar proportion of children with an ASD also had signs of intellectual disability than in the past, averaging 44% in 2004 and 41% in 2006."
The 41-44% figure for the entire spectrum includes those with Aspergers diagnoses who, by definition, do not have intellectual disabilities or cognitive impairment. They are also approximate the numbers provided set out in the ICD-10 for persons with respect to Childhood Autism F84.0:
"F84.0 Childhood Autism
A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder occurs in boys three to four times more often than in girls.
...
All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases."(Bold highlighting added - HLD)
A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder occurs in boys three to four times more often than in girls.
...
All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases."(Bold highlighting added - HLD)
These figures contradict the denial of intellectual disability inherent in Crane's generalizations that "autistic children are highly intelligent", "these children are definitely the scientists of tomorrow"and "they're brilliant". Such statements deny the reality of the close association between Autistic Disorder and intellectual disability and are clearly reflections of the stigma attached ... not to autism per se ... but to intellectual disability. It is the connection between autism and intellectual disability that creates concern for many with Asperger's Disorder about merging Asperger's and autism in the DSM-5. It is that frequently expressed and highly publicized concern that contributes to the stigmatization of those many persons with Autistic Disorder and Intellectual Disabilities.
The US National Institute of Mental Health states with respect to Autism Spectrum Disorders in the section titled Problems That May Accompany ASD:
"Mental retardation. Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language subtests."
What is interesting about the NIMH comment is that it ties mental impairment to language disabilities, another area that distinguishes Autistic Disorder from Asperger's Disorder in the DSM-IV. It is a relationship that is glossed over by those who wish to disavow the obvious relationship between autism and intellectual disability. By contrast an Italian study, published in the Journal of Intellectual Disability Research has expressly underlined the relationship between autism and intellectual disability:
Abstract
BACKGROUND: In 1994, the American Association on Mental Retardation with the DSM-IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD-10. Prevalence of PDD in the general population is 0.1-0.15% according to the DSM-IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments.METHOD: Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) seems to be a very good instrument for classifying and diagnosing PDD.
RESULTS: The application of the PDD-MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%.
CONCLUSIONS: The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID. (bold highlighting added -HLD)
The denial of the Intellectual Disability connection to autism, as in Autistic Disorder, will be completed in the DSM-5 and will result in further stigmatization of those with Autism and Intellectual Disability. It will also contribute to the trend to conduct "autism" research excluding persons with autism and intellectual disability the "vast majority" of those with autism as it is currently defined. The study reports in these cases tend to generalize their findings to the entire autism spectrum of disorders despite the exclusion of intellectually disabled autistic subjects. The informed, mature and enlightened approach of studying the connection between autism and intellectual disability suggested by the authors of the Italian study will never see the light of day.
The intellectual disabilities of so many with autism, and the very serious challenges they face, will simply be ignored for fear of stigmatization. The Alabama example is only one of many examples of such stigmatization.
There will be more.
16 comments:
"These kids are definitely the scientists of tomorrow"...
This is bullshit of a most monumental kind. People with Asperger's that have "clinically significant impairment in social, occupational, or other important areas of functioning " required for the diagnosis, do not become anything other than unemployable.
You are fighting the ND straw-man. They are not representative of Asperger's - the people who are aren't giving evidence to congressional committees 'cause they're too scared to leave the house.
"[quote] The main difference between classic autism and Asperger's syndrome is that children with Asperger's do not experience the language delays [end quote]."
Mental impairment is defined as the display of an intellectual defect,as manifested by diminished cognitive, interpersonal, social, and vocational effectiveness and quantitatively evaluated by psychological examination and assessment. Cognitive impairment causes problems in mental functions, including intelligence, judgment, learning, memory, speech, and thinking.
Intellectual disability is determined by a specific set of skills: 1) Conceptual skills—language and literacy; money, time, and number concepts; and self-direction; 2) Social skills—interpersonal skills, social responsibility, self-esteem, gullibility, naïveté, social problem solving, and the ability to follow rules/obey laws and to avoid being victimized; and 3) Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.
There are a number of children and youth diagnosed with Asperger Syndromeby licensed and accredited medical practitioners who will never become the "scientists of tomorrow" because their level of mental and cognitive impairment coupled with intellectual disability renders them very disabled. In such cases, this is where a parent can confirm that "the main difference between classic autism and Asperger's syndrome is that children with Asperger's do not experience the language delays."
The problem is that Asperger Syndrome has become the "diagnosis du jour." There appear to be a number of cases where Asperger Syndrome ought not be diagnosed as the cause of the problems school and parents are seeing in some children.
The bigger problem lies with those adults who are self-diagnosed with Asperger Syndrome, as a great number of those individuals seem to be unable to understand the overwhelming challenges that face parents and families raising children, youth and disabled adults with classic Autism.
You know harold, I agree with you whole-heartly! I read your blog constantly but don't have the time nor energy to actually reply(I have four children with all different disabilities ranging from autism to down syndrome and anywhere inbetween) I'm afraid of this new DSM, individuals with aspergers don't have any cognitive or intellectual deficits, and compared to indivudals that do, what will become of the spectrum itself?
My child is the one I worry about the most, and more children just like mine who far in the middle of it all. What becomes with all of them who don't fit the criteria for either high functioning nor very low functioning either?
My child; has a cognitive ability of a 7 year old, an intellectual disability, several learning disabilities, does not understand danger, still will bolt at any chance they've got, constantly bites themselves, and bangs their head, is considered socially aloof to a point except if my child is carrying one of their favorite toys (they love to carry around with 24/7) to show people but that is about it when it comes to social interaction, however is verbal enough, isn't considered severe but is far from mild/high functioning either. They are potty trained, and can help take care of his/her pets.
My child is autistic, but if you've met them sometimes they can carry a simple conversation, maybe repeat a couple phrases, but mainly seem very off. In this new DSM though I'm afraid he/she will be labelled severe, when in no way my child is considered severe compared to somebody such as your son or forgotten just like the rest of the individuals like my child. In no way they are considered anywhere near mild or high functioning compared to somebody such as someone with aspergers. What will become of all of those individuals like my child who falls right inbetween it all? How come there is not much talk about those individuals?
My child was once a nonverbal, spitting, uncontrollable feces smearing, aggressive, consistantly rocking autistic. He/she improved to a point, although never ever able to be fully independant, but enough where they can maybe one day live in an assisted living environment or at most group home setting.
I would love to hear from you(harold) and everybody else about those individuals who are not high functioning like most aspergians, and who are not profoundly affected like your son, realize there is more then top and bottom, there is a middle, and it seems the middle is what makes up most of the 1 in 100 statistics. So why is there never any talk about these individuals?
You know harold, I agree with you whole-heartly! I read your blog constantly but don't have the time nor energy to actually reply(I have four children with all different disabilities ranging from autism to down syndrome and anywhere inbetween) I'm afraid of this new DSM, individuals with aspergers don't have any cognitive or intellectual deficits, and compared to indivudals that do, what will become of the spectrum itself?
My child is the one I worry about the most, and more children just like mine who far in the middle of it all. What becomes with all of them who don't fit the criteria for either high functioning nor very low functioning either?
My child; has a cognitive ability of a 7 year old, an intellectual disability, several learning disabilities, does not understand danger, still will bolt at any chance they've got, constantly bites themselves, and bangs their head, is considered socially aloof to a point except if my child is carrying one of their favorite toys (they love to carry around with 24/7) to show people but that is about it when it comes to social interaction, however is verbal enough, isn't considered severe but is far from mild/high functioning either. They are potty trained, and can help take care of his/her pets.
My child is autistic, but if you've met them sometimes they can carry a simple conversation, maybe repeat a couple phrases, but mainly seem very off. In this new DSM though I'm afraid he/she will be labelled severe, when in no way my child is considered severe compared to somebody such as your son or forgotten just like the rest of the individuals like my child. In no way they are considered anywhere near mild or high functioning compared to somebody such as someone with aspergers. What will become of all of those individuals like my child who falls right inbetween it all? How come there is not much talk about those individuals?
My child was once a nonverbal, spitting, uncontrollable feces smearing, aggressive, consistantly rocking autistic. He/she improved to a point, although never ever able to be fully independant, but enough where they can maybe one day live in an assisted living environment or at most group home setting.
I would love to hear from you(harold) and everybody else about those individuals who are not high functioning like most aspergians, and who are not profoundly affected like your son, realize there is more then top and bottom, there is a middle, and it seems the middle is what makes up most of the 1 in 100 statistics. So why is there never any talk about these individuals?
You know harold, I agree with you whole-heartly! I read your blog constantly but don't have the time nor energy to actually reply(I have four children with all different disabilities ranging from autism to down syndrome and anywhere inbetween) I'm afraid of this new DSM, individuals with aspergers don't have any cognitive or intellectual deficits, and compared to indivudals that do, what will become of the spectrum itself?
My child is the one I worry about the most, and more children just like mine who far in the middle of it all. What becomes with all of them who don't fit the criteria for either high functioning nor very low functioning either?
My child; has a cognitive ability of a 7 year old, an intellectual disability, several learning disabilities, does not understand danger, still will bolt at any chance they've got, constantly bites themselves, and bangs their head, is considered socially aloof to a point except if my child is carrying one of their favorite toys (they love to carry around with 24/7) to show people but that is about it when it comes to social interaction, however is verbal enough, isn't considered severe but is far from mild/high functioning either. They are potty trained, and can help take care of his/her pets.
My child is autistic, but if you've met them sometimes they can carry a simple conversation, maybe repeat a couple phrases, but mainly seem very off. In this new DSM though I'm afraid he/she will be labelled severe, when in no way my child is considered severe compared to somebody such as your son or forgotten just like the rest of the individuals like my child. In no way they are considered anywhere near mild or high functioning compared to somebody such as someone with aspergers. What will become of all of those individuals like my child who falls right inbetween it all? How come there is not much talk about those individuals?
My child was once a nonverbal, spitting, uncontrollable feces smearing, aggressive, consistantly rocking autistic. He/she improved to a point, although never ever able to be fully independant, but enough where they can maybe one day live in an assisted living environment or at most group home setting.
I would love to hear from you(harold) and everybody else about those individuals who are not high functioning like most aspergians, and who are not profoundly affected like your son, realize there is more then top and bottom, there is a middle, and it seems the middle is what makes up most of the 1 in 100 statistics. So why is there never any talk about these individuals?
You know harold, I agree with you whole-heartly! I read your blog constantly but don't have the time nor energy to actually reply(I have four children with all different disabilities ranging from autism to down syndrome and anywhere inbetween) I'm afraid of this new DSM, individuals with aspergers don't have any cognitive or intellectual deficits, and compared to indivudals that do, what will become of the spectrum itself?
My child is the one I worry about the most, and more children just like mine who far in the middle of it all. What becomes with all of them who don't fit the criteria for either high functioning nor very low functioning either?
My child; has a cognitive ability of a 7 year old, an intellectual disability, several learning disabilities, does not understand danger, still will bolt at any chance they've got, constantly bites themselves, and bangs their head, is considered socially aloof to a point except if my child is carrying one of their favorite toys (they love to carry around with 24/7) to show people but that is about it when it comes to social interaction, however is verbal enough, isn't considered severe but is far from mild/high functioning either. They are potty trained, and can help take care of his/her pets.
My child is autistic, but if you've met them sometimes they can carry a simple conversation, maybe repeat a couple phrases, but mainly seem very off. In this new DSM though I'm afraid he/she will be labelled severe, when in no way my child is considered severe compared to somebody such as your son or forgotten just like the rest of the individuals like my child. In no way they are considered anywhere near mild or high functioning compared to somebody such as someone with aspergers. What will become of all of those individuals like my child who falls right inbetween it all? How come there is not much talk about those individuals?
My child was once a nonverbal, spitting, uncontrollable feces smearing, aggressive, consistantly rocking autistic. He/she improved to a point, although never ever able to be fully independant, but enough where they can maybe one day live in an assisted living environment or at most group home setting.
I would love to hear from you(harold) and everybody else about those individuals who are not high functioning like most aspergians, and who are not profoundly affected like your son, realize there is more then top and bottom, there is a middle, and it seems the middle is what makes up most of the 1 in 100 statistics. So why is there never any talk about these individuals?
Hi Anonymous. You wrote: "I would love to hear from you(harold) and everybody else about those individuals who are not high functioning like most aspergians."
It's sad to see how much damage has been done to the diagnosis of Asperger Syndrome to the detriment of those children who are, most assuredly, cognitively or intellectually deficiemt. For those individuals whose only difference from an individual with classic Autism is that they did not experience language delays, the stereotype of the little genius who is awkward in social settings does them a great disservice.
You also wrote: "In no way they are considered anywhere near mild or high functioning compared to somebody such as someone with aspergers."
Asperger Syndrome is not "Autism Light" as the media and certain advocacy groups would like it to be portrayed. In fact, Asperger Syndrome as described in the above paragraph is as debilitating to that individual as classic Autism is.
The thing to keep in mind is that there are varying degrees of severity within the Asperger Syndrome diagnosis just as there are varying degrees of severity within the classic Autism diagnosis.
Yes, that trend to exclude Autistics not just with ID, but also those with medical problems, from studies is disturbing.
Early this year a GFCF study was done and it excluded Autistic people with bowel disorders, even though that is the very population whose parents report benefit from the diet. Of course the study showed no benefit and it was heralded by Web MD and others as, see diet is unnecessary. Meanwhile, I am acutely aware of how things fall apart for my son and myself even neurologically if we eat those foods.
How do they get away with biased research time and time again? I don't understand. This is precisely why I am not a science fundamentalist and never will be. I would like to be able to dismiss it and basically be all, "so what, I have my kid on his medically necessary diet"...but, as you know, it goes well beyond that. The facilities won't keep kids on their diets after the parents are gone if all they have to go on is shoddily designed studies. Then it is antipsychotic city.
Hi elyse, thank you for replying. I've only met a couple individuals with aspergers disorder, they were nowhere near my child is or was for that matter. They interacted, their IQ was either average or above average(from what I experienced), no obvious cognitive deficits, and their stimming asn't as "profound" as somebody with autistic disorder for example(non-stop rocking, flapping, biting themselves, etc). Although, my point and message I was attempting to get across wasn't saying aspergers as being "autism light" as you described. There is though more then "language delay" differences between aspergers and classic autism. I.e. cognitive disabilities, and intellectual impairments is not seen in individuals with aspergers disorder.
My point though, was that there is not much talk about the middle of the autism spectrum! There is only talk about aspergers(mild or refered to high functioning compared to very severe) and profound classic autism. Nothing about the inbetween of what usually does make up most of what those statistics are about!
My child doesn't stim very much, by stim I mean, flapping nor rocking(we have crossed that bridge of changing those stims to clapping or gentle swaying). My child although has obvious cognitive deficits along with an intellectual disability. He/she does not understand real danger, for example the other night ran out in the middle of the street, almost got hit by a car, did not comprehend it, instead giggled and jumped up and down as a plane flew above them like it was the best thing in the world. My child is the type that would not realize why they were in trouble after repetitively telling them that it is wrong, as they decided to strip off their clothes in the middle of the mall because he/she was hot or wet. My child doesn't understand "social differences", they'd walk right up to anybody and lick he or she, or at worst jump on them, we've had incidents where my child actually walked up to a random person in a tightly packet shopping store, and sat on them like that person was a couch! My child still cannot take care of themselves, let alone handle a simple outing by his/herself. Something simple as changing one's clothes can be a huge chore. My child is the type of child who still will play non-stop hide and seek doesn't matter with who or where or when for that matter(that entails even when your in a busy court room, while sitting there praying it doesn't take longer then an hour, as your trying to keep your grown child to stop crawling on the floor to where the judge is sitting to engage in a game of hide and seek!). The type of child who would spend hours on hours in a baby toy isle pressing all the buttons enjoying the toys as if they were the recommended age for that toy. My child is 19! I can't even begin to list about what my child does that makes them more disabled then a typical higher functioning individual, it would take me the entire night.
However; since my child can engage in this hide and seek play, can communicate even if its not always appropriate, is potty trained,is cognitively aware to a point, had developed a peer to peer relationship even if its with another disabled individual, does not engage in the "obvious" stimming most profoundly autistics do, has a job, and can do a simple chore as put out the trash, they are not considered severe. They are stuck in the middle of the spectrum...........
I have to continue posting because my computer would not allow as much as I typed.................
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Continued from previous post.......
The same middle, most do not discuss. It took me years to get my child to this point and stage. I even spent loads of money on 1:1 tutoring just for my child to learn how to type so they can be "computer savy" as almost the rest of the world is. It just takes some pushing, and I can even get my child to answer your post him/her self! My point though as I've stated before isn't about aspergers and autism, the differences, it is about the lack of information that is spread across the internet about individuals who fall between the two disorders. Although I love to read Harolds point of views on intellectual disabilities and autism, because there isn't much studies done on that side either. I'm sorry if you took my post wrong, I'm just assuming and going out of a limb here, you are an individual with aspergers disorder? if so I do apologize if I came across sarcastic or not to the point, I'm just a simple mother trying to advocate and find more resources/information for my child who is far from typical high functioning(especially these day and ages) and far from typical profound autism either.
you make a very good point here. My own son is autistic, and it seems your constantly battling with education, health and more.
I happen to like the fact that ID is being kept separate. Therefore when I go to the school and say "Teach him" I didn't get "well he's severely autistic = severely ID therefore piss off". Instead I got "want me to take away the book ABA wanted him to read during circle time instead of paying attention. You want me to teach him like I did his brother." And she did too.. and kicked ABA out 6 wks in.
Yes, the little one has delays. His IPRC says right on it "Communication - Autism, Other - Developmental Delay" got the psychometry testing to go along with it. Yes, according to the tests his IQ score 9mths ago was in the 60's and due to his communication problems probably still is. But he's not "stupid" and to flag him and say "severely autistic, too stupid to teach here", does more harm than good. Everyone, I asked afterwards, from school board spec ed & psychometrist, to teacher to Ped... when I mentioned the IQ test told me "ignore it, it doesn't tell what he can or cannot do". To constantly refer to the capabilities or outcome of a child based on a standardized test for NORMAL people... makes me cringe at best.
Instead I am getting "communication delay... let's see how we can get over, around, through, electronics etc" it.
He will NEVER live on his own without a major miracle even if we do teach him to "talk" properly on his own or with a device... that's autism... that's the executive functioning issues.
Autism is executive functioning, social and communication delays. Autism is not intellectual disorder. Intellectual disorder may be part of someones Autism, but it is not autism. And finally, it appears they are going to separate the 2. Which will be nice to get all those ID children and adults out of the autism waitlists so the rest of us can get the services we're entitled to. I appreciate the fact they were there b/c our re-dx of "speech and language delayed with global delays" for the elder (NLD now) was "it's only a LD we don't have to do anything until Gr 3" with an ASD dx it starts in kindergarten with an IPRC.
I could careless about studies... they mean nothing... b/c at the end of the day the truth is "if you've met one child with autism, you have met ONE child with autism" period. Not one is wired the same, not one therapy helps them all.... So I just worry about my "one's".
FW2 said:
"I could careless about studies... they mean nothing"
OK FW2 your opinions will be given the weight they deserve after a remark like that.
thank you very much for the interesting post, Keep sharing.
Hi again, anonymous. You wrote: "Although, my point and message I was attempting to get across wasn't saying aspergers as being "autism light" as you described. There is though more then "language delay" differences between aspergers and classic autism. I.e. cognitive disabilities, and intellectual impairments is not seen in individuals with aspergers disorder."
I have to disagree with you that cognitive disabilities and intellectual impairments are not seen in individuals with Asperger's. In many cases, you are correct.
However, there are those with Asperger Syndrome who do, indeed, have cognitive disabilities and intellectual impairments. They also happen to be those with AS who, along with the cognitive disabilities and intellectual impairments, stim quite a bit.
Yes, they are a minority, but rest assured that there are those with AS who suffer considerably more than very high functioning, very vocal adult Aspies would like others to believe.
Good article - raises some great points. I do believe that the stigma of autism is mostly a mental-impairment stigma (I think there's a lot of "stimming" stigma as well.) An intellectual-snob I know has an "Aspie" adult kid who is really just a moderate-functioning autistic. (Bad diagnostician years ago) God forbid he admit his son shares a diagnosis with my daughter, who despite a lower iq test score and 14 years difference in ages is in many ways "highter functioning" than his son.
So, I agree that there's a stigma against intellectual disability. But what is the answer? You say lumping the 2 groups together means we ignore the realities of intellectual impairment for fear of hurting the Aspies' feelings. But if those with intellectual disabilities were separated out and made a subsection of autism, wouldn't the problems remain? If the stigma remains, you'd still have the same doctors shying away from the subsection diagnosis for fear of the stigma.
(As an aside: I think the statistics for the number of intellectually-impaired autistics (75%) are inflated. Too often those iq tests are measuring nothing more than the autism itself: refusal to respond or inability to structure a response to a question is scored exactly the same as not knowing the answer. My own autistic daughter has gained 15+ iq points in the past few years, and its not because she's gotten smarter. She has learned the game, figured out what the tester is looking for, and perhaps has gotten a little more obedient -ha!)
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