Ettina wrote:
Quote:
A language delay rules out Asperger's (under DSM-IV), but autistic disorder also requires more of the other criteria to be met -- so it's possible to fit an Asperger's diagnosis except for the absense of language delay, but still not quite fit an autistic disorder diagnosis... and in that case, what should they do? Asperger's would still be a good fit, even though not strictly correct.. or they could call it PDD-NOS, which may seem unnecessarily vague.
Quote:
You cannot have a diagnosis of autism (officially) if there is no speech delay - you will always get either AS or ASD.
Neither of these is accurate, for reasons explained in
this study.
Autism diagnosis actually doesn't
require speech delay. Speech delay counts towards diagnosis, but a kid with normal speech milestones plus echolalia and/or difficulty with back-and-forth conversation would meet the language criteria of autism.
Which also means you can't have AS and not autism, because they haven't managed to find any kids who have social impairment and repetitive behavior meeting criteria for AS, who don't
also show either echolalia or conversational impairment.
In order to diagnose AS at all, clinicians have had to ignore part of the criteria (the 'does not meet criteria for autism' bit at the very end). So essentially there are no properly-diagnosed cases of DSM-IV Asperger Syndrome.
The study you quote is part of the argument about what speech delay in autism actually means.
When you include echolalia and pragmatics, etc you do indeed have a situation where anyone qualifying for an AS diagnosis also qualifies for an autism diagnosis which is precisely why AS is being removed from DSM V. Until this and other studies came out there was a schism between professionals about what having speech delay entailed and this study is one of those that helped resolve that issue amongst professionals. Until then an Autism diagnosis required delay in the ability to use verbal communication - ie. to use words to communicate - this is no longer the case but until we switch to DSM V there are some professionals who will not recognise this even though there are many good professionals who do regard other forms of delay as pertinent to the autism diagnosis and are now diagnosing ASD or autism rather than AS.
13 years ago my son was given a diagnosis of ASD(meeting the criteria for AS) (quite rare, most children got either AS or autism, it was very unusual to get ASD then) because his consultant wanted to diagnose autism but could not because he had precocious language development and was verbal with full sentences by 18 months. We were told outright that he had to have an AS diagnosis because of this even though there were clear delays in other areas of language development but that we were to work with him on the basis that he was autistic. 3 years ago, just before he went to university, he was reassessed as autistic because his language delays in other areas now count towards an autism diagnosis. This was not because he no longer needs language delay to get an autism diagnosis but simply because the understanding of what language delay actually is had improved considerably in the 10 years between assessments.
And of course, there is no need for the criteria to include language delay any more if it is not being used to differentiate between the 2 conditions.
Reducing the core criteria to 2 which are met by all people on the spectrum makes sense and brings in most of those who currently would get the PDD-NOS or atypical autism diagnosis without excluding those who are functioning at higher levels. If applied with reasonable care and awareness, the criteria should not exclude anyone with any of the spectrum conditions but it may take a while for professionals to adjust and recognise the subtleties in some people on the spectrum.
27 Feb 2013, 2:36 pm
