Friday, February 04, 2011

Will Criteria D Actually Be Required in Diagnosing the New Autism Spectrum Disorder Level 1?

In order for the New Autism Spectrum Disorder to be diagnosed pursuant to the DSM-5, Criteria A, B, C, and D must all be met.  That is what the DSM-5 says according to the web site.  But will Criteria D, Symptoms together limit and impair everyday functioning actually be present in practice?  Or will psychiatrists and psychologists diagnose Level 1 Autism Spectrum Disorder without any real limit or impairment in everyday functioning?

I had previously asked if any of the well known, apparently very high functioning persons with autism or Asperger's Disorder would lose their diagnoses under the new criteria.  The other side of the coin, of course, is the possibility that Criteria D will not be required in practice.  

I have met persons with Aspergers who clearly have limitations in everyday functioning and I am not suggesting that anyone with Aspergers could not really meet a limited and impaired everyday functioning test.  There are, however, some very successful persons with a high functioning autism or Aspergers disorder who do not have any obvious limit or impairment including some who can function in high level government, legal and media settings. Presumably everyday functioning is an everyday, common sense, criterion. But how some of these people were diagnosed with an ASD even under the current DSM-IV criteria is beyond my understanding as a layperson. Given the careers that some have built as spokespersons for the autism community, will public pressure  be exerted for professionals to go easy on Criteria D in diagnosing the New Autism Spectrum Disorder?

Will Critieria D actually be required in practice in diagnosing the New Autism Spectrum Disorder under the DSM-5?  I guess the answer will be found in future prevalence studies and debates. 


Kim Wombles said...

This version is better than the original revision, but it still raises questions, doesn't it? Will this be the final revision? What about kids with serious social deficits without the repetitive behaviors (or how are we going to define repetitive behaviors)?

I would suspect that the implementation or the decision to label will not change much with current practitioners. There's inconsistency now in how individuals are diagnosed.

I think that D is written into the level 1. In order to be diagnosed with autism, support and assistance are required--if a person doesn't require assistance, then they don't have a disorder.

So what does that mean for folks who are definitely on the broader phenotype but are successful? I don't know. Temple Grandin is successful, but it's not clear how much assistance she requires to be successful, for example. Baron Cohen has written that two individuals with the same traits/behaviors may not both need the label: if one is successful, doing well, the label isn't needed. If the other needs assistance or has not found a niche to be successful, the label is needed (even though the traits/behaviors are identical).

It's a muddy area. And it won't be settled with the DSM-V.

Anonymous said...

I do hope criterion D will be mandatory. I don't believe people without impairments in daily life should be diagnosed with a mental/developmental disability. OTOH, I don't hope laypeople will be used to diagnose people over the Internet. You and I don't know how well so-called high-profile autistics function in their independent living, their ability to form relationships, etc.

@ KWombles: people who have social impairment but no repetitive behaviors can be diagnosed with social communication disorder in the current proposal for DSM-V.

Unknown said...

Astrid I agree laypersons can not diagnose ... period. We can, and have a right to, ask questions though about the autism condition of persons who claim to speak on behalf of autistic persons based on their personal experiences.

Ari Ne'man, to pick an example, has no, or very little, obvious difficulties with everyday functioning, appearing in major media publications, graduating university, and participating in public committees. He stated on behalf of autistic people that "WE don't wan to be cured".

He has every right in the world to say that on his behalf, assuming he has a condition to be cured of, but he has no right to speak on behalf of those who are severely affected and disabled by autism disorders and declare on their behalf that they don't want to be cured.

Mr. Ne'eman and a host of other very high functioning persons present themselves to the world as "autistics" while those who really need help remain invisible ... along with the challenges they fact, challenges not faced by Mr. Ne'eman.

When Mr. N and others present their condition as the basis for influence public perception of autism disorders they should be prepared to be questioned about their condition because their public representations on the subject affect others ... including many less fortunate than them.

Autism Mom Rising said...

This makes me concerned for children with Aspergers, many of whom in there own ways need services as badly as kids further down the Spectrum. I don't want to ever see them denied. But perhaps people should be re-evaluated as adults. If services have done their job and someone has no obvious impairments as adults they way label them as significantly disabled.

I share Harold's concern about the high functioning adults, some of whom use their influence to speak for the entire Spectrum. I always say, though, that they need to do what they feel they need to do and we need to do what we feel we need to do. So, say, if someone testifies before a commitees that Autism is not a disability we just bring our very impacted children to said committee meetings or hearings, just let them be themselves, and the juxtaposition will be obvious. It will be clear to decision makers that the very high functioning do not have the same condition as our children. In this vein nobody is trying to dampen anyone else's voice and we all just do what we gotta do.

michael said...

While it is important in a broader context that a professional performs the diagnosis, the laymen will very often perform diagnosis. You don't need a huge qualification to match symptoms to behaviour.

And in afrika, the diagnosis only has meaning as so far as the parents developing a strategy for assisting there child. We do not recieve assistance