News Article: Is the Definition of autism too broad?

[Datura]

https://theconversation.com/is-the-...sm-narrowing-what-we-think-of-as-normal-47310

An article in which the new diagnostic criteria for autism are questioned and concern is raised regarding the implications.

 

[King_Oni]

Well, at least this articles takes away some work I wanted to do, in lining up the differences of autism per edition of the DSM. Can't complain about that, lol

Looking at the topic;

I guess there's a truth to it, but it goes beyond just autism. With the amount of "illnesses" that we can diagnose someone with, there's barely a sense of "normal" where someone is not being in therapy or medicated anymore. I sometimes feel it's a bit like we just want to poke around long enough on someone so we can put a label on someone; just to get someone into the medical industry for one reason or another.

Perhaps it's a bit of a tinfoil hat conspiracy thing here; but one might wonder if adjusting the notion of normal and increase in definitions (even by broadening criteria) isn't part to have everyone be pathologised one way or another; heck, it would make it a lot easier to take out anyone who might be "undesireable" in society if everyone is being pathologised. But perhaps I should ditch my hat and just start writing dystopian fiction.

What I'm noticing is that there's a big issue in general when it comes to what we consider autistic, how someone qualifies for support and what kind of service there actually is. I mean, some of us are diagnosed, and I'm not going to doubt the validity of that, but do not receive the support they need, but either end up with a generalized program or none at all. Funny how the criteria might accomodate more people in a medical sense, but the practical sense; when it involves money, adjustments and support is lagging far behind. I mean; we're all good to pay for medical bills and diagnosis sessions, but when "we" need support that should come from say, the governments around the globe, suddenly, there's a big problem and it's too expensive and not sustainable.

I often wonder if there's a hidden agenda (as it seems that tinfoil hat is still on) to all this, because it doesn't make a lick of sense from my perspective.

What I fear when the diagnosis for autism becomes so broad, is that in the future they decide to revert and make the diagnosis so strict, going to a situation where almost no one is qualified anymore; and thus creating a really high threshold for anyone who might actually need any kind of support and only the really severe cases receive ample support with a giant grey area they'll just ignore until it either adapts or perishes.

 

[Progster]

I didn't think that Asperger's was introduced to the DSM until 1994 in the DSM IV, but in the article it states that it was introduced in 1987.

 

[DogwoodTree]

but one might wonder if adjusting the notion of normal and increase in definitions (even by broadening criteria) isn't part to have everyone be pathologised one way or another;

I think people, in general, want to be pathologized. If they can "earn" a label, they're more likely to qualify for assistance and other "freebies" (whether or not they get them), not the least of which is pity. The medical industry is just trying to meet those demands of the people.

 

[King_Oni]

I think people, in general, want to be pathologized. If they can "earn" a label, they're more likely to qualify for assistance and other "freebies" (whether or not they get them), not the least of which is pity. The medical industry is just trying to meet those demands of the people.

As long as we need to be pathologized in order for the environment to function for someone on an individual basis, I suppose the need for everyone to want to be labeled is quite obvious.

Wouldn't it be great if the world would just function fine for everyone without having to rely on services to make the existence of oneself more bearable? (yeah, this sounds awfully dramatic, lol)

 

[Ylva]

The Venus Project sounds better and better.

 

[AsheSkyler]

Between so many wanting freebies, several just wanting to wallow in self-pity rather than take care of themselves, and plenty more too lazy and pathetic to exercise any control or responsibility, I'm not surprised there has been a lot of diagnoses. Nor am I surprised they've made it harder for those who genuinely need help to get what they need.

Not that I'm saying I need help with my neurology or I'm being hindered with that. I've got nothing to gain or lose in the matter.

 

[RidingDutchman]

The more I read about the DSM-V the happier I get that the Netherlands and other countries in Europe (for as far as I know, only sure about the Netherlands) decided to ignore the DSM-V and continue to work with the DSM-IV.

My psych is a specialist on autism and Asperger's and she appears to be really against the DSM-V criteria. It really supports to the view of "everybody has some kind of disability if you search hard enough"

 

[Wireless]

I may be wrong to think this, but isn't it difficult for women to be diagnosed anyway?
Doesn't it just come down to what the psychiatrist thinks and how they interpret the criteria?

 

[ShatteredUniverse]

I prefer the delineation between the different types of ASDs that the DSM-IV criteria provided. When I conduct official business concerning my diagnosis, I always specify that I (strongly) meet the DSM-IV criteria for Asperger's, in addition to my official diagnoses of ASD, because the umbrella term "Autism Spectrum Disorder", as used in the DSM-V, can be rather misleading and/or confusing for people who don't know just how wide a net said diagnosis casts.

 

[psychgirl95]

New diagnoses aren't being created just to be created. And previously "normal" behaviors aren't just being so-called pathologized for no reason. (That's not to say that the ICD and DSM are perfect though. I'm not saying that at all.) It's not a conspiracy or anything. Believe it or not, but there are legitimate reasons for most diagnoses included in the ICD and DSM. And no, it doesn't have to do with people "wanting" a diagnosis - unless you mean in situations where they quite literally need help, but can't get it simply because it's not in the ICD or DSM.

Also, as has already been pointed out, there are factual errors: Asperger's was added in 1994; PDD-NOS was added in 1987. She also makes this statement: "Three categories of diagnostic traits became two: social interaction and social communication became one category and the behavior category remained. No required number of traits are needed from the social interaction category for a diagnosis, but two are required from the behavior category."

In that case, either she or I are reading the criteria wrong because that's not what the DSM says. It clearly states the following:

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

So, basically, it's saying, to meet criteria, you must have examples of all three of those. The "Diagnostic Features" section under the ASD criteria goes into more specific detail about how people with varying levels of functioning (and at various ages) may meet the criteria. Now whether every clinician follows that criteria to a "T" or not, I can't say.

I honestly have to wonder about the author's professional credentials and actual experience with autistic individuals (from what I can tell, she just recently graduated with a interdisciplinary PhD). This is the first I've ever heard of anyone suggesting autism being too broad. Usually people find the criteria too narrow. Personally, I'm on the fence.

I don't disagree with all of the article (e.g., that autism rates have risen *partially* due to diagnostic changes), but the article seems very one-sided. The author doesn't even back up her claims. For example, she says, "The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the book psychiatrists use to determine diagnoses – was criticized for lowering the diagnostic thresholds for many conditions." Okay, well, specifically which ones? If you can't name them (at all/in general and/or you can't do it without going off-topic), then you really shouldn't bring up the topic. In my honors abnormal psychology class, we recently read an article similar to this where the author made the same claim. The examples she used turned out to be untrue. Another thing is, most people who write these articles overstate the importance of the DSM to psychiatrists.

Another example of it being one-sided is seen in this sentence: "These changes, along with better educational services and public awareness (thanks in large part to the film Rainman), marked a dramatic rise in autism prevalence, jumping from one in 2,500 in the 1980s to one in 250 in the late 1990s." Perhaps I'm reading this wrong, and I don't think I am, but it sounds like she's stating that the reason autism diagnoses have risen is only because of diagnostic criteria changes and things associated with them (like public awareness)? So, apparently, the possibility that more people are just being born with the condition isn't even worth mentioning? Makes sense. /sarcasm

And yet another thing worth mentioning (on the topic of rising autism rates) is that autism rates have risen in general. The author seems to focus on the DSM as if that proves her point, but it only deteriorates her credibility even more. For example, what about the ICD? Countries that primarily rely on the ICD have noticed autism rates rising as well, proving that the DSM changes can't be the sole reason for this increase in prevalence.

And by the end of the article, she's basically arguing that one of the positive things the medical community has done (recognizing high functioning autism - considering Kanner wrote about this way before clinicians actually recognized it) hurts those on the lower end of the spectrum, so, as a result, we should narrow the criteria, forgetting that there are people who aren't severely disabled, but yet still struggle and need supports. (Note how she says, "We are constructing a new reality of the disorder that does not accurately represent the most affected population. This could divert attention and resources from the people who need it the most – the significantly disabled.") Again, that totally makes sense. /sarcasm

The whole article is just ridiculous. I could go on, but I won't. But the fact that she has the nerve to call herself an "autism advocate" but yet ignores those of us who are high-functioning? Just smh.

/end rant from psychology/neuroscience major who is actually completing an honors thesis on ASD.

 

[King_Oni]

The more I read about the DSM-V the happier I get that the Netherlands and other countries in Europe (for as far as I know, only sure about the Netherlands) decided to ignore the DSM-V and continue to work with the DSM-IV.

My psych is a specialist on autism and Asperger's and she appears to be really against the DSM-V criteria. It really supports to the view of "everybody has some kind of disability if you search hard enough"

I'm not sure if The Netherlands is actually ignoring the DSM V by itself, but more likely the fact that therapists in office now got their degrees with the DSM IV or older and doing all kinds of courses to upgrade their diagnostics procedures is a costly thing to do. I'm sure they will keep an eye out for new disorders that are added, but in general they'll still keep looking at the ones they graduated with.

I've ran into a few older therapists in the past who still used definitions and such from the DSM III. I don't mind it as much, as long as they don't full on ignore what's new.

 

[RidingDutchman]

I'm not sure if The Netherlands is actually ignoring the DSM V by itself, but more likely the fact that therapists in office now got their degrees with the DSM IV or older and doing all kinds of courses to upgrade their diagnostics procedures is a costly thing to do. I'm sure they will keep an eye out for new disorders that are added, but in general they'll still keep looking at the ones they graduated with.

I've ran into a few older therapists in the past who still used definitions and such from the DSM III. I don't mind it as much, as long as they don't full on ignore what's new.

From what got explained to me by my former psych was that it was a conscious decision by the higher organization to not (yet) take the step to approving DSM-V and continue to work with IV until further notice and studies. I haven't checked this fact so I don't know the details

 

[dragonwolf]

I honestly have to wonder about the author's professional credentials and actual experience with autistic individuals (from what I can tell, she just recently graduated with a interdisciplinary PhD). This is the first I've ever heard of anyone suggesting autism being too broad. Usually people find the criteria too narrow. Personally, I'm on the fence.

And by the end of the article, she's basically arguing that one of the positive things the medical community has done (recognizing high functioning autism - considering Kanner wrote about this way before clinicians actually recognized it) hurts those on the lower end of the spectrum, so, as a result, we should narrow the criteria, forgetting that there are people who aren't severely disabled, but yet still struggle and need supports. (Note how she says, "We are constructing a new reality of the disorder that does not accurately represent the most affected population. This could divert attention and resources from the people who need it the most – the significantly disabled.") Again, that totally makes sense. /sarcasm

According to her bio, she recently got the PhD, but has been in the field for 15 years -- https://theconversation.com/profiles/jennifer-sarrett-181531

From what I see in her bio and the article, she strikes me more as an "Autism parents advocate." IE - she's an NT, with an NT's perspective, who has an NT's idea of what is "really Autism." Her bio does put her as more on the neurodiversity side of things, though her comments about whether "higher functioning" Autistics are "really Autistic" or "Autistic enough" and whether the diagnosis is too broad in the article suggest to me that she sits somewhere more in the middle between us and the more typical A$ types of people who seem to think that if you can talk and you don't have a meltdown on a daily basis, then you're not "really" Autistic. She's at least not that bad, but I'm still a bit wary of her commentary. And...like most NTs (especially those in medicine), it seems to me that she's still kind of ignoring what we're saying about how we perceive the world and how we would like to see these issues solved.

*shrug* That kind of thinking always strikes me as odd. Does someone with a broken leg still have a broken leg and need some amount of help regardless of whether it's a hairline fracture or a compound break? Why is Autism treated in such a way that if we were to apply it to a broken bone, then hairline fracture wouldn't "really" be broken, and the person would have to make do without so much as a splint, simply because it's not a compound break?

 

[zurb]

You're getting very close to the NZ public health system now. Of course there are limited funds and long waiting lists so there has to be some prioritization of who gets treatment. (Unless you have money or insurance of course, and then you will be treated by exactly the same doctor without delay.)

 

[dragonwolf]

You're getting very close to the NZ public health system now. Of course there are limited funds and long waiting lists so there has to be some prioritization of who gets treatment. (Unless you have money or insurance of course, and then you will be treated by exactly the same doctor without delay.)

There's always a certain amount of prioritization. Even the US, the guy having a heart attack is going to get top billing in the ER before just about anything else. Prioritization of how many resources a person is eligible for, based on their ability to function independently within their community, is fine.

The problem that I have is that a lot of these people who think that Asperger's or HFA isn't "really" Autism is that they are basically saying that because we are verbal and have some degree of ability to function within society, we don't need any help. It's basically saying that if you're not having a heart attack or other life-threatening condition, you don't belong in a medical facility at all (not even so much as a doctor's office).

 

[Ste11aeres]

I'm going to say something different which is...that maybe pretty much everyone does have a disorder of one sort or another. And the reasoning is that humanity is a teeny bit messed up, a teeny bit not right in the head. It always has been that way.
Kind of the mental equivalent of how throughout our life we will always be affected at times by physical diseases, whether that be serious diseases, or even just things like the common cold.
Perhaps being truly disorder-free is the anomaly in reality.

Edit: I don't mean that someone having a diagnosable disorder doesn't matter. And I don't mean that everyone faces equal difficulties.

 

[dragonwolf]

I'm going to say something different which is...that maybe pretty much everyone does have a disorder of one sort or another. And the reasoning is that humanity is a teeny bit messed up, a teeny bit not right in the head. It always has been that way.
Kind of the mental equivalent of how throughout our life we will always be affected at times by physical diseases, whether that be serious diseases, or even just things like the common cold.
Perhaps being truly disorder-free is the anomaly in reality.

Edit: I don't mean that someone having a diagnosable disorder doesn't matter. And I don't mean that everyone faces equal difficulties.

Yeah, I kind of agree with that. Nature is pretty good at making its inhabitants (as collectives) good at surviving, but it's not an exact thing by any measure. That margin of "error" (used here, "error" simply refers to anomalies that may or may not be conducive to survival in the given natural environment) results in variations that may or may not be great for the individual. Add civilization on top of that, where you don't have natural pressures to weed out the really detrimental "errors," and you end up with a wider margin of "error."

This, of course, means that what society deems as "normal," is pretty much anything but -- nor does it actually exist in any one individual -- and is more of a mean of the most common differences among one another in the dominant subgroup.

Public school is a prime example. It really sucks for just about everyone, except for those who happen to fall closest to the mean. The farther of an outlier you are, regardless of whether it's on the "struggling to keep up" or the "retained this from three years ago and bored silly" end, the less the school system's defaults actually works for you and the more you'd benefit from a "special education" subsection.

 

[Judge]

Of course definitions of autism are increasingly too broad.

The more societies earnestly attempt to attain "universal healthcare", the more likely it is that such systems will inevitably prioritize those illnesses most immediately construed as toxic and catastrophic to human beings.

Which conversely equates to that which isn't so immediately harmful, will likely be much less prioritized. Thus the more ambiguous the diagnosed condition, the less priority it will have in terms of tangible medical care offered. A deliberate dynamic of budget limitations on the part of government and taxpayers. Where bean counting bureaucrats have more influence in health care policy-making than do medical personnel or scientists- by design.

If one's issues are neurological in nature, expect real help only under the most perceivable dire circumstances. The rest are essentially expected to fend for themselves, as best they can. For most of us, I believe this will remain our reality- in whole or in part.

 

[dragonwolf]

Of course definitions of autism are increasingly too broad.

The more societies earnestly attempt to attain "universal healthcare", the more likely it is that such systems will inevitably prioritize those illnesses most immediately construed as toxic and catastrophic to human beings.

Which conversely equates to that which isn't so immediately harmful, will likely be much less prioritized. Thus the more ambiguous the diagnosed condition, the less priority it will have in terms of tangible medical care offered. A deliberate dynamic of budget limitations on the part of government and taxpayers. Where bean counting bureaucrats have more influence in health care policy-making than do medical personnel or scientists- by design.

If one's issues are neurological in nature, expect real help only under the most perceivable dire circumstances. The rest are essentially expected to fend for themselves, as best they can. For most of us, I believe this will remain our reality- in whole or in part.

Such bean counting isn't exclusive to universal healthcare, I assure you.