Wednesday, November 21, 2012

Don't be Afraid of the New Autism Diagnosis

Cathy Lord, in a piece that she wrote for the Huffington Post, said:

In the DSM-5, we propose a new way of looking at these disorders, merging them into a single diagnosis of autism spectrum disorder. We believe this will create more accurate diagnoses and improved access to services. It should also improve research into ASD, because there will be less diagnostic confusion

And I agree.  I feel that there has be undue anxiety regarding a variety of issues.  There are a host of reasons why these changes are being implemented.  For example:

  1. Research suggested that there was considerable confusion among researchers, doctors, psychologists and psychiatrists regarding the criteria of PDD-NOS, Autistic Disorder, and Asperger Disorder.  Often we saw "graduations" of one disorder into the other, which tended to be problematic, often leaving people with the complex task of attempting to identify a label instead of looking to begin interventions and help the children and adults in need.
  2. Emergent research suggests that Asperger Disorder and Autistic Disorder, as currently defined in the DSM-IV differ only in levels of language and/or IQ (one may argue that IQ as a construct is heavily influences by language, but that is a debate that I would leave for some of my other colleagues).  The Neurodevelopmental group of the DSM-5 argued that they did not want  diagnostic decisions to be based on IQ or language. One can argue that there is a paucity of studies that have looked at this difference (Relying on memory, I can recall roughly 15 articles in the period from 1994 - 2012), and I would argue that the reason more research is not being published in peer-review publications is that these studies are finding no difference except in language and IQ.  
  3. Others have bemoaned the fact that there the DSM is dropping Childhood Disintegrative Disorder (CDD).  While there isn't a good base of experimental data to support this difference, we see that emergent case study research suggests that CDD is probably the norm.  That is to say, the group hypothesized that autism is an auto-immune disorder which kicks in within the first few months of a child's life, similar to MS which kicks in in the fourth decade of someone's life.  This might explain parents' descriptions of the disorder.  A fascinating hypothesis, which may be the key to explaining such parental reports.

I agree with Cathy Lord and the work that her Neurodevelopmental group has engaged in.

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