"My Name is Khan"

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I'm 19 minutes into this movie and already I have re-diagnosed the character as PDD-NOS

Would anyone like to concur or dispute this?

In the movie he's diagnosed as autistic, right? Why change it to PDD-NOS if he's already diagnosed autistic? It's not like PDD-NOS actually has a set meaning.

He is diagnosed as having AS (with a pre-moving disclaimer which basically says writers embellished it), though he has characteristics far more common of those down the spectrum.

For one, he has profound echolalia and exhibits it as a profound language delay. I know many people with AS may repeat words to themselves, especially as children, but not really in the manner exhibited in the movie. In fact when people with AS do have a speech anomaly, it usually manifests in the form of a monotonous voice, verbosity, or stiltedness, the latter two of which I've been accused of on many occasions.

Also, he walks like rainman. I've never seen anyone with AS walk like this, no matter how odd their gait was, unless they also had some form of cerebral palsy.

He implies people with AS can't cry. I think the people in the parents forum would disagree with this.

He will not look in his mother's general direction, I suppose to emphasize the issue with not looking people in the eyes, though I feel this is severely overstated. I have never known anyone with AS, including myself, who will not look at their own mother. Even most individuals I know with HFA will look at their own mother.

PDD-NOS is used when a person does not fit into one category or another.

There ARE those of us who fit very neatly into categories and AS is a specific category, which the character clearly does not meet.

[Note that where I talk about categories here, it doesn't mean I agree with them, I'm just talking about the official way they're used.]

I know people diagnosed with AS who have echolalia, (I don't know what you mean by speech delay, do you mean he took a long time to learn how to talk, or that he takes a long time to talk? -- the first one is what is meant in the diagnostic criteria), who walk extremely strangely (stranger than Rainman), have trouble crying, and won't look at anyone. I even know a couple people diagnosed with AS who can't talk at all. (Because there is a movement disorder that can be part of some people's autism, and it can cause loss of speech in adolescence or adulthood even if they had no speech delay to begin with.) And lots and lots of people diagnosed with AS who have intermittent speech (since what people's speech is like after the time period a speech delay is counted in is over, is rarely something people look at in diagnosis). Heck, my psychiatrist who had no speech delay had blatantly obvious echolalia (he would always repeat people's last few words after they said them), and I don't even know if he is autistic at all (he has ADD and had some social and speech problems growing up, but I don't know how many or what kind).

The criteria for AS don't actually say anything about how severe someone's social traits seem to be. There are people with AS who pass as almost completely neurologically typical, and people with AS who pass only as having an intellectual disability and are indistinguishable from some people who have been diagnosed as autistic or even those considered low functioning. There are people with AS who can fake eye contact and people with AS who can't look at anybody. There are people with AS who are incontinent, people with AS who have incredibly odd-looking gaits, and people with AS who stim all the time and don't talk to just about anyone unless absolutely necessary (and then talk pretty oddly). (I have met all of the above sorts of people, I'm not talking theoretically here.)

AS criteria specify no speech delay (meaning, it didn't take people longer than a certain amount of time to learn to speak initially), IQ above 70, and normal rate of self-care development in childhood (meaning the person may still have serious problems with self-care skills even if they learned the first few, and actually some professionals have tried to get that piece of the criteria removed because most people diagnosed with AS have self-care problems). The speech delay thing can also mean that the person needs to not have certain very specific language issues in early childhood (usually they don't care about later), but not all professionals listen to that part. AS criteria do not specify how unusual someone's body language or social skills are. They don't specify whether and how much the person stims. They don't specify anything other than those three things. A person can have quite extreme traits and still be AS if they had those other things.

I notice whenever a movie or book comes out with someone diagnosed with any form of autism in it, there are people who take issue with the characterization as "too severe" or "more typical of lower functioning people", and other people who say the person was "too mild" or "more typical of higher functioning people". They even sometimes do this to real autistic people who have been in the media (which baffles me because it's not like someone wrote us to represent a condition, we just happen to be however we are).

And I think both reactions can be a sign of not really knowing a wide enough variety of autistic people to realize how different even people who all share one spectrum diagnosis can be.

But if he did have a speech delay in early childhood, and he does have all those other traits you described, he probably meets the criteria for autism, in which case it'd be that, not PDD-NOS.

(PDD-NOS generally applies to several groups of people. People whose traits are incredibly mild, which it doesn't sound like his are. People who have a severe condition of some other kind, like CP or intellectual impairment, that means they are incapable of doing some of the things that would make them meet the criteria for autism, but they do meet the criteria that they are able to meet. People who meet the criteria for AS, except they have a speech delay or low IQ or impairment in self-care skills, and yet they don't meet the criteria for autism either. I'm assuming you mean that last one, but exactly how doesn't he meet criteria for autism? It's also used for people who meet some of the criteria for some of the things, regardless of how extremely, but somehow just miss being diagnosable. Unfortunately it's often also used by doctors to mean "doesn't meet my stereotype for an autistic person". Or (as it once was in my case, before an eventual diagnosis of autism) because they are worried about insurance not covering certain things because autism is seen as too severe. Or about a parent reaction. Etc.)

The character, by DSM-IV definition, cannot have AS because he exhibits diagnostic criteria consistent with autistic disorder and for one to have AS, they must not meet additional criteria for another pervasive development disorder.


The criteria for autistic disorder that the character meets is...highlighted in red....

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)


(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

You are correct that the diagnostic criteria does not state severity. However, if we choose to accept that many with AS may engage in some mild sub-clinical form of echolalia without excluding themselves from an AS diagnosis, then we would also have to accept that level of severity should have some baring on diagnosis.

I am willing to accept your claim of the former, on the condition of my claim of the latter.

Severity only connects with diagnosis in a few very specific domains--namely, early speech development cognitive disability, and adaptive skills. Anyone who is severely impaired, but not in those specific areas, can technically be diagnosed Asperger's.

This means that, oddly enough, you can have traits identical to someone with Asperger's, but because you also have, say, Down syndrome (which involves cognitive disability), you can't be diagnosed Asperger's. There are people like this--mental retardation plus what would be Asperger's if it weren't that they had developmental delay, even if these delays matched the speech and adaptive skill delays of the same sort that people with a similar sort of cognitive disability but without autism... It's very odd, and yet more evidence, at least to me, that there's nothing particularly special (at least nothing that can be used to categorize autistics) about how old you are when you learn to speak.

Incidentally, I'm diagnosed Asperger's (by most doctors) and I have that same configuration you're talking about, Chronos: Developed speech on time, but couldn't hold a conversation until I was eight or nine, and used lots of scripts and pattern-matching rather than making up my own original sentences every time I spoke. I am hyperlexic and only learned to speak properly once I started reading and getting language patterns down, which was around the age of four. I still tend towards unnecessary repetition or repeated use of the same phrase, even in writing, and have to edit carefully to avoid the problem.

I recently went back and read some of the books I read when I was younger (and by "younger" I mean not just very young but up to my late teens) and was amazed to realize how much subtext I missed back then. Even as recently as two years ago, I was missing things I catch now. Just goes to show that language development doesn't stop once you learn to answer a question and string together a coherent sentence.

Perhaps another clinician would feel you better meet the criteria for autistic disorder....one of the reasons they wish to do away with the AS diagnosis in the DMV-V is due to inconsistent application of the diagnostic criteria.

However the impending changes to the DSM are a topic for another thread.

Many NT children can't hold a conversation at the age of 8, though usually for other reasons that lack of fluency of language, for example shyness, or if they feel their place in the conversation is a submissive one, as often is the case when they are speaking to an adult they don't know very well. They will expect the adult to lead it frequently.

But the character in the movie has the above delays quite severely and into adulthood.

WTF is "subclinical" echolalia?

All I was saying, anyway, is that if he meets those two criteria for autism, he probably meets the entire criteria for autism, and therefore doesn't have to be labeled PDD-NOS, but rather just autistic.

I'm guessing he's referring to echolalia that doesn't interfere with the ability to communicate, nor stands in for regular communication? Probably the kind that seems like a habit, where you repeat someone else's words to understand them. Heck, there's therapists that deliberately use that strategy.

[youtube]http://www.youtube.com/watch?v=_uNDm6YfN2k[/youtube]

I don't mean to drag this thread too OT, but what is the difference? That is, is repeating someone's words in order to understand them NOT echolalia? (genuine confusion, not sarcasm, BTW)

I decided on PDD-NOS because the youngest he is portrayed in the movie is around the age of 8 or so I felt it was the more conservative diagnosis in light of the lack of information.

But I do agree as I had originally stated, he does not have AS.

I raise the issue because I believe the majority of people with AS do not come across in the manner portrayed in the movie. Should I tell someone I have AS and they do not know what it is, I simply explain and I am the first concept of someone with AS they have (and from what I can tell I'm fairly well representative of most people with AS)

However if they have seen the movie (which is a lot of people in my area actually), and I tell them I have AS, I'm confronted with stern doubt and a host of misconceptions, and if I do convince them I actually have it, they are then afraid I will have nervous breakdowns in the middle of the street and think I fear the color yellow.

Sub-clinical echolalia is when you repeat words to yourself in such a fashion that it goes undetected by most people.

And the trailer presents him as less dramatic than he is actually portrayed in the movie.

I thought that was subvocalized (inaudible), rather than subclinical (less than a doctor would consider "real" echolalia).

As far as people not believing you because they've seen a movie, that would happen even if he met the AS criteria but was just different from you. It happens to people who meet the autism criteria too. Moving him to a different diagnosis won't change it.