Please help me clarify AS diagnostic criteria

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As you may already know, the DSM-IV criteria are as follows:

1. qualitative impairment in social interaction
2. restricted, repetitive and stereotyped behaviors and interests
3. significant impairment in important areas of functioning
4. no significant delay in language development
5. no significant delay in cognitive development, self-help skills or adaptive behaviors (other than social interaction)
6. criteria are not met for another specific pervasive developmental disorder or schizophrenia.

As I'm limbering up for a visit to my GP to ask for a referral, I thought I'd take a look at my own self-observations and try to see which ones were the most diagnostic. My wife did the same thing. We could both think of things that fit the first 2 criteria, but curiously, neither of us could think of anything pertaining to the 3rd criterion, i.e. "significant impairment in important areas of functioning" - then I realised that neither of us really understand what that particular one means.

So my question for Aspies is, what have you observed in yourselves that you would see as fitting that 3rd criterion? My problem with it is that it all seems to hinge on what is meant by "important," which to me is so subjective that I've no idea what they mean - important for survival, for happiness, or what? I'm very much a creature driven by specific examples, so mostly I'm interested in those, though any clarification would also be of interest.

I know, I probably ought to do as the NAS recommend and use the Triad of Impairments as the basis for my observations, but for some reason I can't get my brain round that one - for me there seems to be no difference between the first 2 legs of the triad, i.e. social interaction and social communication - and I don't see why they make such a distinction, it just seems to add an unnecessary leg to the triad, so my mind balked at it and I thought that the DSM IV looked a little more logical, as well as being more directly applicable to a diagnosis. (secondary question: is my confusion over these matters something to do with my apparent AS? It's a type of problem that seems to follow me about, and from my point of view the world seems full of these apparently stupid explanations which nobody else sees anything wrong with. My wife (mostly NT) just seems to want to ignore diagnostic criteria and use her intuition but I can't seem to do that.

Thanks

dude, it means do you have a sensory problem(IE loud noise, bright light, rough fabrics)
heres a link to the wikipedia article, it will probably help.http://en.wikipedia.org/wiki/Aspergers_ ... cteristics

3. significant impairment in important areas of functioning

Let's see my drivers liscence expired in March and I obsess about getting it renewed every day but freak out when ever I get up to do something about it, does that count as "impaired functioning."???????????

My interpretation is that it is asking about "real problems" caused by first two. It *is* hard to pin down and I don't think the problem lies with you in any way

An analogy: If you had a trait whereby you could never, ever learn a word of a foreign language, this need not be a problem in itself. Not until you were forced to go abroad for some reason. Now you have a "significant impairment in your functioning" in this foreign country.

The first 2 parts are listing the traits. This section is wanting examples of how the traits in the other sections adversely affect the quality of your life. It shouldn't be too difficult to find examples as, by definition, if no adverse symptoms, you wouldn't be looking for a diagnosis! The difficulty is maybe that the "significant impairments" are *so* obvious, you can't see them? How about career problems? Relationship problems? Problems making and keeping friends? Avoiding social occasions you know you should go to but can't face?


All of the above - and more! Underachieving in career is a typical example. Not at a career level that matches ones qualifications, experience and skills primarily due to being 'unpopular' for some 'unknown' reason. Same goes in relationships. Having a first real girlfriend at a much older age than your peers e.g. 85% of posts on the 'love and dating' forum. Few, if any friends. Finding that what you believe were good friends disappear from your life for no reason that you are aware.

Upsetting people in social situations without intending, for many reasons. e.g. Not knowing what "the group" is talking about so being silent for long periods. Getting upset at things others say about you that you find personally offensive, yet later everyone says was "clearly just a joke and you were wrong to get so upset". Often being told "you shouldn't have said that about them" and having no idea why what you said was taboo. Noticing people avoiding talking to you, yet not knowing why. Always being the one standing alone, looking at groups of people gathered around the room. Getting the courage to join a group....just as they all drift away to other groups leaving you alone again and ultimately just wanting to run as far away as possible and never interact with another human being again.

etc etc ....there would be loads of examples around WP that may relate to you but you haven't consciously noticed.



I think you are probably right on this. Of course it depends on the exact person the other side of the desk, but they will be using the criteria as an objective guide. Well, they *should* be doing that. I suspect at least some of the increase in diagnosis is due to an instinctive feeling that something is awry, rather than really adhering to the criteria.

The DSM text says this in regards to Criterion C:

Simon Baron-Cohen says this in regards to such:


You must remember, normal people have problems with work; getting fired, having problems finding jobs, problems with co-workers; problems with interpersonal relations; divorces, difficulties in finding and keeping friendships and relationships, and problems with independent living; buying and affording a house, paying rent; losing the house, getting kicked out because they can't pay rent, and etcetera, etcetera.

Now, add Asperger's to "normal", and you have a person who can barely do one of these things above, and in many cases fails at that one thing.

Thanks - and I found this there:
Unlike the international standard, U.S. criteria also require significant impairment in day-to-day functioning
I'm in the UK, therefore I presume there's no need to worry too much about that particular criterion - so do UK diagnosticians use DSM-IV without that line, or something else?

In a way that invalidates the reason for my original question, as my main purpose is to distil my plethora of Aspie-like symptoms into the most convincing diagnostic examples....I don't want to send my GP to sleep with irrelevent crap or give him reasons for a DX that turn out not to be very good reasons. Even so, I'm still interested in answers to my original question - anything to clarify my thinking about my symptoms in relation to diagnostics is worth looking at. Lordy, this is more complicated than I thought!

Thanks for your replies so far - I'll take another look very soon and reply in more detail.

I think it might be difficult to get a referral if you are not experiencing problems. It depends on your area and GP really. If your GP has to fight to get a referral accepted, it will greatly improve your chances if you can demonstate you are experiencing difficulties.

The significant impairment criterion can be quite subjective. If you are experiencing little impairment, but much distress, I think they count that as well.

To obtain services, I had to detail how this applied to my case. I divided it into these areas of functioning: social, occupational and basic. Under social, I had poor conversational skills, not knowing how to behave socially, having no friends and poor relationships with family, and being unable to access social groups and maintain social contacts.

Under occupational, I had: only being able to maintain full-time employment for a few months of my adult life, nearly always being employed below my skill level, encountering much misunderstanding from supervisors and colleagues, great trouble in interviews, and how the accumulation of these experiences had impacted on my health.

Under basic, I had: needing prompting and help to maintain a reasonable standard of nutrition, not being able to use the phone, having much difficulty using public transport, not driving, and a few others I won't detail here.

They still refused any services, even though I also had a diagnosis, so I had to write to them again and my GP also had to write, backing me up.

Or better said, a NT person can have all of those problems, but they don't happen repeatedly.

I am very handicapped when it comes to careers and career advancement. My inability to connect with people at large has not only kept me from getting hired in jobs I otherwise was qualified for, but I've lost jobs essentially because I was not part of the group and that was a big factor in if I would ever work out. More so, my inability to "fit in" created stress within myself that impacted my job performance.

That is something that a NT person would never experience on a repeated basis. They might have it happen to them, but they would also have jobs that were a good match and they got along well with the people they worked with. I have never known that.

It's got to do with difficulties in/with:

Job, school, university/similar.

Cooking, shopping for necessities, taking care of yourself and such.

Driving, managing finances and managing with people from government/similar and so on.

Shutdowns, meltdowns, overloads which may cause loss of functionality, aggressions, avoidance.

Anyway,
I fulfil the criterion despite that I am described as utmost hf.

I don't know, but I have a similar thing about making a start in neutralising any perceived threat - last one I recall was making inquiries about an old pension policy, I'd moved house without telling the policy holders, and I'd heard a rumour that they'd gone bankrupt. I knew I should chase it up, but all I did was worry about it, until I finally got off my butt and started making the inquiries. It all worked out OK, and it'll provide a useful supplement to my income when I retire, but somehow making a start on chasing it up would just stress me out........I rarely let stress show on the outside, but it was enough to make me recoil from the task, I had to really push myself as if I were about to jump off a cliff, and had to take it in tiny steps. At the time I put it down to irrational anxiety of some sort, though I don't see how it's autistic, and it could be argued that it's not significant, as I did finally get the job done. No doubt my GP would just compare it to the stress of the average Joe during the recession and deem it not worth his attention.

More later folks

Yeah, that's a better way to put it. Someone with AS will always have problems with these things; sometimes it may be easier due to allowances made, but when they're taken away, it'll be as hard as it has always been.

That part impaired me in school and it effects our relationship but I do fine at work. It effected me at my last job but I had to learn to be flexible without freaking out so that's why I do well at my current one. Also my anxiety can impair me too and it leads me to meltdowns.

You're right, I'm too close to it to see it clearly......I've lived so long not knowing what was wrong, that I found other explanations - the only people who accepted me for who I was, had strong socialist/anarchist leanings, so any social/employment problems I suffered were very easily explained by basic radical political thought - the really difficult thing is that there's more than a grain of truth in such thought. So now I have to untangle exactly what aspects of my misery are down to the AS/NT conflict, and of course it's not easy.

But to get to the point -

Career problems:
I somehow stumbled into a good Aspie niche doing research work in a university, even so I always found it painful, and after 18 years I couldn't stand it, so I left and jumped into a radical alternativist organisation in a new city. When that collapsed (mostly for non-Aspie reasons I guess), I had little choice but to return to a similar job - the strain has built up again until I'm now saving up for early retirement, perfectly prepared to live a frugal life just to get away from the pain of it all.

Relationship problems:
Two divorces, and a third marriage now apparently hanging by a thread, plus at least 3 more serious long-term relationships that collapsed. It's hard for me to know how far AS was responsible for all that, so long after the fact, but my current wife is pretty sure it's AS that's behind most of her problems with me. I know society is awash with breaking relationships, but I suspect my track record is beyond the norm, isn't it?

Problems making/keeping friends:
While I was among those socialists & anarchists, I had no problems at all, but where are they now? I guess I left them to follow a straight marriage, somehow not feeling quite whole without that. Before that, with my first serious girlfriend, we had a few couple friends and I was quite happy with that at the time. But I ddn't keep any of them, and since then, my social life has been consistently under par. Never completely isolated, but barely anybody has lasted.

Career level - after almost a lifetime, I'm still on a grade way below my abilities. I regularly see people younger and no brighter than I, in far higher positions. I've always seen it as a trade-off, a mediocre day's pay in return for less pressure. I always sensed that higher pay would lead to expectations I couldn't cope with. If it's tough at the top, well it's tough enough for me at the bottom, I couldn't stand anything harder. I got my first girlfriend at the age of 16, but she ended it after 2 dates, and the next one was via computer dating, also ended after a few dates, so although they gave me some appearance of normality, let's face it I wasn't exactly popular with the girls.


Hmm.....my mordant sense of humour used to get me into trouble so I stopped using it. These days I quietly shun so many people and social situations that it's hard for any social problems to arise......I try to stick to one-to-one stuff, and mostly it's beneath my dignity to try and fit in. One of the reasons I hate work is that it taxes my ability to steer clear of those who might wish to tease, there are some groups who would push me down to low status, I've seen them do it to others and I know I'm vulnerable if I stick around with them. I'm sure I've said tons of inappropriate things, though very rarely have I been told I shouldn't have. I try to stay quiet mostly, keeping up with the rapidly-changing flux of a social group is just too hard. Coping strategies abound - stick to a very small number of carefully chosen, "safe" people, heterogenous groups where everybody's so "strange" that I don't stand out; never, ever go to a big party, shun the mainstream, arrive late, leave early, spend lots of time alone to recuperate. I've never been at the point where I never want to be with anybody else ever again, but I have no great desire to be with more than one person at a time, except in a band of entertainers or maybe a small room of quiet people or a committee with a purpose.


Yes. My first instinct is to wade in and defend their Aspie traits, "protect" them by blaming the NTs, tell them they're fine, they don't need shrinks and they're not ill. It's hard to put down the sense of self-worth and Aspie pride long enough to set down my experiences as significant impairments.....half of me wants the DX, the other half rails against it and insists there's nothing wrong with me. Even writing this post has been hard, though I thank you for provoking it.



I'm sure my GP will deny my request if I don't get objective and convincing. He's like that. The shrink could be different, a lot will depend on whether we hit it off emotionally, I suspect. Oh well, I'm not bad at one-to-one, like I said.

Yes, these are all things that anybody can have trouble with from time to time, autistic or not. I guess I've covered all those things except independent living and housing security, which I don't seem to have had much trouble with. Of course having held down a job for most of my life has made rent and house buying pretty easy, as the money's always been there and I've always chosen places well within my means. There was a time I was under threat of eviction for a while, and I was lucky to have a friend who put me onto a great solicitor, or that might have gone pear-shaped, but that could have happened to anybody, basically I was silly enough to leave myself wide open to a ruthless landlord, though I saw the threat coming in the nick of time and another sympathiser helped me to change the locks.

My first employer expressed disappointment in me after my upgrading to a position where I was in charge of a couple of other staff - I knew he wanted me to get them working hard, it was spelled out to me during the interview, but even if my sense of ethics had allowed that, I couldn't have commanded that degree of "respect." Knowing that I'd "let him down" scared me and was a big reason why I left, and now I've returned to the same kind of work, I've failed to the same level - there's thankfully no longer a requirement to be so directly in charge of anybody on that level, but I'm too pathologically honest to even apply for the upgrading that would get me back to where I was.

It could be said that I'm pathologically egalitarian, a rigid ethic that makes it impossible for me to wield or respect notional authority in a hierarchical world. If an employer pushes me into sudden changes in working patterns or hours, or sudden travel demands, or expects me to take part in any work-related social events, I either blow it, refuse to comply, or get unduly stressed out. Even with the nicest bosses, if I find the work's going beyond my rigid idea of the original agreement, I have the same problems, and it's all I can do to convince myself that it's not some evil capitalist conspiracy, though frankly I suspect that it's sometimes exactly that, but sometimes it's just human error.

I've never been in a work situation where I've got on well with my colleagues, I've grown to like a few individuals but there's a tension there all the time, and even in voluntary work and co-operatives it's been the same story. I've never been in any collective endeavour where it's worked smoothly - I'm sure I've done useful things for them, but only at a very low level, like helping somebody push a heavy trolley from A to B - the rest of the time, I'm only any good when I'm left alone to get on with a requested task in my own way, and the more others interact with me, the worse my performance gets. Shared tasks don't work out - either it's done my way or their way, and that embarrasses me or demeans me so I just want to do it myself. As for meetings, I dread them, can't go straight to a meeting after focussing on something else (need time immediately before it to prepare myself mentally), and while I'm there, most of it goes in one ear and out of the other, they never make it clear enough for me and the subject matter darts about all over the place.

If I hadn't been overqualified I doubt I'd have got the jobs I did get - most of my interviews were pretty poor, misunderstanding hints, slurping tea (which I gather I was NOT expected to even take with me into the interview room), bouts of pathological honesty (saying "I'm a bit of a maverick in some respects but it can't be helped" is apparently not the way to impress ).

School started off OK but it just got harder and harder as the expectations of my "maturity" were ratcheted up, lousy reports in secondary school, couldn't understand most of the lessons at all, had to teach myself from the textbooks in the end, got good 'O' levels that way, then the 'A' level courses were even worse, I tried the same dodge but got very low grades, was bright enough for university but chickened out because I could see it coming. I already covered jobs.

Mostly I live on salad sandwiches, used to be just cheese but people said I'd die so I concocted a standard healthy sandwich which seems to keep me quite healthy, though people seem to think I should have cooked food. When I do cook, it takes me all evening to make a bowl of soup because I just go into obsession mode and start with raw ingredients - it's great soup but naturally I don't do it very often. I seem OK with shopping, very spartan about, all the essentials are there but it'd drive anybody else up the wall.

Medically I think I keep myself healthy, on my terms I don't feel impaired but the average person would worry. I have to keep re-thinking whether my wife's just a fusspot or whether she's right to keep trying to "correct" my clothes, eating habits, grooming, interior decor, etc. - I feel almost certain she's wrong, but trying to see it from a modern NT perspective, maybe not........logically my way of living is probably fine, nobody's going to catch anything, but the subjective look and feel of it is that everything's rather odd. Probably the worse offense was many years back when I kept an un-neutered tomcat in a rented room, and he stank the whole place out, I didn't notice till a friend warned me the landlord would go nuts, funnily enough the friend was scruffier than I was. But nobody was going to die.....it's all so relative isn't it? I'm sure I've raised a lot of eyebrows but I've always figured they were all judgemental snobs.

Driving - I did that quite well and safely when it was a routine journey, but on a new route I'd not be able to split my attention between navigating and road safety - I know that so I always used to let safety come first and the journey could take 3 times as long as it should.

Finances - I'm just a miser, so I've always got enough spare cash for the bills, I'd be in trouble if I were running my finances near to the red and borrowing like a lot of people do routinely.

Government officials and authority figures I have a lot of trouble with, they scare me so I have to rehearse it all really carefully.

Shutdowns, overloads which may cause loss of functionality, aggressions, avoidance - guilty on all counts. No meltdowns though.