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eikonabridge
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21 Sep 2019, 11:48 am

Autism diagnostic criteria

According to DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, autism is currently diagnosed with two main set of manifestations, expressed as part A and part B.

Quote:
Part A: 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):

- 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.
- 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.
- Deficits in developing, maintaining, and understand 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.

Part B: Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Translating in the language of two-fluid model, we see that part A is essentially addressing the reduced interaction between phonons and thoughtons (ideons, eddions, conceptons and vortons), whereas part B is mostly addressing the presence of vortons. We see that the diagnosis criteria of autism in DSM-5 suffers some shortcomings.

First of all, the application of part A excludes the BAP (Broad Autism Phenotype) community. It also excludes other autistic people, anywhere on the spectrum, that are well-developed enough to have good social interaction skills. In my opinion, whether autism exists or not, only depends whether the superfluid phase is present inside the brain. Phonon interaction with thoughtons, which is responsible for social interactions, is not a valid criterion. Part A is sign of underdevelopment, and not a sign of autism. Autism is autism (the existence of the superfluid phase), underdevelopment is something completely different (the lack of phonon-thoughton interaction).

I therefore believe that part A should be completely removed from the diagnosis criteria of autism.

A better arrangement for part A would be to put it under a section about diversity in general learning strategies, together with other conditions, such as short-term memory issues of many epileptic people. We have to accept that different people have different ways of learning and different ways using their brains. For instance, in my personal case, I couldn’t make the hard [g] sound (voiced velar stop) in my native language when I was a child, no matter how hard my mother tried to teach it to me. However, as soon as I started to learn Spanish, I was able to make that sound on my first day. This was because I had to learn Spanish visually first. When I learned the Spanish alphabet, it allowed me to see the letter g with my eyes and hear its sound at the same time in sample words. That is, I only needed to be taught visually for me to be able to make the hard [g] sound. If someone can learn a given skill in a particular way, and it doesn’t matter which particular way, then the person does not have a “learning disability.” Instead, our society would be the one that has “teaching disability” because we haven’t yet figured out how to develop our children. The fact that so many autistic children are not social, reflects the “teaching disability” of our school systems, because, after all, these children surely can be developed and be made social, if we just develop them via their attractive vortons, like grown cotton candies from paper cones.

The second problem is with part B. That part only addresses the vorton component of the superfluid phase, and is missing out the concepton component. For people that have extraordinary ability in linking ideas across multiple disciplines, or for people that carry various forms of synesthesia, but that don’t exhibit restricted/repetitive behaviors/interests, those people would be excluded from being diagnosed with autism. An example of such a person would be Richard Feynman, who had grapheme-color synesthesia. Feynman once described his synesthesia with the comment: “When I see equations, I see the letters in colors…” Feynman has an extremely social personality, and is not known to have abnormal restricted/repetitive behaviors, except perhaps his broad interests in science and technology plus some minor personal quirks. Feynman is famous for his ability to explain complex physics ideas to the laymen, best illustrated by his dipping an O-ring into a glass of iced water, when he testified in the US Congress regarding the 1986 Challenger space shuttle disaster. The ability to find analogies and the existence of correlated sensations (e.g. synesthesia), are reflections of conceptons at work. The fundamental difference between Albert Einstein and Richard Feynman is: Einstein's brain works with vortons, whereas Feynman's brain works with conceptons.

I therefore believe that part B must be expanded to include concepton-related manifestations.

Ultimately, the diagnosis of autism should be made via objective methods, such as EEG (electroencephalography). I would refuse to believe that superfluid phase of the brain doesn’t have EEG manifestations.

There may be a concern that with the new approach, the definition of who is autistic might be too broad. But, that concern is unwarranted. Neurotypical people definitely holds the majority. There is a reason why humans had little technological breakthroughs during the first 200,000 years after the arrival of Homo Sapiens. Civilized societies only happened in the last 10,000 years. The relative proportion of the autistic subpopulation is dictated by the Square-Root Law from the size of early Neolithic agricultural tribes, right after the invention of bow and arrow, and the arrival of organized warfare. Given that Dunbar’s number stands at around 150, which if often taken as the typical size of hunter-gatherer tribes, then three times that number would bring humans into a different level of societal organization. That is, the proportion of autistic people should stand at around 1/√450=0.047~5%, or about 5 percent of the general population. Therefore, there should be no concern that the superfluid definition of autism would be too generalized.

There were nearly 8.6 million STEM jobs as of May 2015, which represents 6.2 percent of U.S. employment. Considering that US is a technology-oriented country and also “imports” foreign talents in STEM fields, then the 6.2 percent figure becomes quite comparable with the putative 5-percent natural fraction of autistic people. That is, although there is no one-to-one guaranteed mapping between autistic people and STEM-field workers, it is fairly obvious that these two subpopulations strongly overlap with each other, so it is no accident that their sizes relative to the general population would be comparable. The STEM-field worker (a scientist or an engineer) is a stereotypical example of someone on the spectrum, and that has been true ever since the invention of bow and arrow.

This begs the question, why are we trying to teach verbal and social skills to our autistic children? Shouldn’t we be developing their technical skills first? Sure, there are always autistic children that become skillful in non-STEM areas, but the 80/20 rule applies here: our priority should be addressing the 80% of the autistic children, first. The outlier cases can be handled as special cases. But, we shouldn’t lose sight on the bulk of autistic children. The top 20% of our attention should be focused on addressing the top 80% of autistic children with STEM inclinations. That is the way it should be, and we are not doing a very good job, by letting neurotypical folks telling us how to raise autistic children.


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Juliette
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23 Sep 2019, 5:16 pm

I tend to agree with much of what you write. My overall thoughts on outcomes for a person born autistic ...

Autism is a difference in the order of child development due to different neurology, hence the term dis-order. Autism is a life-long difference. Autistic people are born autistic and remain so their whole lives, but with appropriate teaching and positive guidance, they can learn to fit and function in society. There are two major variables affecting the prognosis for life of a child born autistic:

1. The ability of his family to provide a highly structured, disciplined(note: this does not =spanking) upbringing. Autism must not be an excuse for bad manners/behaviour.

2. The innate intellectual capacity of the child. If a child receives strict parenting/social guidance/instruction, then his intellectual capacity is the factor that will hinder or allow him to become increasingly self-sufficient in society.

The higher the IQ, the greater potential for success in life. But, without appropriate social guidance/training in early childhood and beyond, an autistic person with a very high IQ can remain totally dysfunctional.

Provision of a highly structured daily timetable, making each day predictable to the child is essential and also aids in development of language/communication. Anxiety is our dominant emotion. We are extremely anxious people and need predictable structure. Changes can be frightening, but they still need to learn to cope with it and often must be pushed through their fears.

Be careful not to treat your child as an overgrown baby. Demand and expect appropriate social behaviour as she/he develops. Do not raise you voice or shout though, as you will raise his/her anxiety and you will be deemed as ‘unsafe’ and not ‘in control’. You must be in charge in your home. Control is vital. Either they are in control or you are. There is no middle ground on this issue. If you don’t take control, then they will.

Your child may be autistic/AS but he is also an individual. When he/she is feeling safe under your control, you will find a person with a different view of the world, with his/her own unique personality, sense of humour etc, but only if you provide the basic structure.



BTDT
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23 Sep 2019, 6:30 pm

Parents cling to the hope that with the right therapy, their kids will become "normal." Engineers and scientists, however well paid, fall out of what is considered "normal."



FranzOren
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17 Sep 2020, 11:26 pm

I think that it is possible to have ASD with neurotypical social skills or have ASD that does not fit the diagnostic criteria at all


For example, if you at least have restricted, repetitive patterns of behavior that caused you any distress from early childhood, you could be considered to have ASD.


My other point that the diagnostic criteria for ASD is a little too restrictive, because I think that since Autism is a spectrum developmental disorder, I think that it is possible to have ASD without having history of any communication defects from early childhood.


Even my psychiatrist explained to me that since Autism is a spectrum, you can have ASD without having history of communication defects of any sort, but one thing most with ASD ( including us) have in common is that they ( including us ) have restricted, repetitive patterns of behavior that caused them or us distress from early childhood.


My third point is that if anyone has Broad Autism Phenotype, they should have some form of Autism diagnosis, because the term broad autism phenotype describes an even wider range of individuals who exhibit problems with personality, language, and social-behavioral characteristics at a level that is considered to be higher than average but lower than is diagnosable with autism.


Even if you slightly had some problems with personality, language, and social-behavioral characteristics from early to late childhood, early to late adolescence and adulthood, I would still consider you to have history of developmental delay, regardless if it is diagnosed or not and also, because the DSM changed all subgroups of Autisms into a spectrum disorder, from very severe to very mild.

Also, it is possible to have any histories of developmental delays without qualifying for assistance.