DSM5 ASD "Essentially Everyone Gets In"

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That's interesting, if you have a link to it I would like to read more of the article. The director of Grasp publicly identified a couple of years ago on NPR that he was going to have a difficult time calling himself autistic because of the DSM5 change and went on to describe one extreme end of the spectrum with folks like Einstein and Edison and the folks he described on the "other extreme end of the spectrum"; the description of those folks included adult diapers and head restraints. Then he went on to state: "This is very hard for us to swallow" per the pride people take in being diagnosed with Asperger's syndrome. But, interestingly, after that he went on to describe that he supported the consolidation of the diagnoses because "health care professionals have struggled to find a way to separate Asperger's from autism" and "Every time they've tried to draw that line it's been proven false in practice." I think his opinion was isolated, even among the members of the organization he directs. It's unfortunate that he used the word "we" and didn't keep his opinion isolated to himself. As he identifies there are several thousand members in the organization he directs.

http://www.npr.org/templates/story/stor ... =123527833

More recently the GRASP meeting with the DSM5 working group was described as supportive of a consolidated Autistic Spectrum Disorder, but an argument was presented not to narrow the requirements for a consolidated diagnosis as described in the link below. The Autism Society and ASAN supported similar recommendations, so the organization wasn't to far in the fray with their recommendation.

http://grasp.org/profiles/blogs/underst ... 5-a-report

After the decision was made to finalize the DSM5 the GRASP organization representative responded with this statement linked below in support of the ICD10 diagnostic criteria instead of the DSM5. My understanding is that the National Autistic Society is the UK is following along with similar sentiment, although the DSM5 will not be required for insurance purposes in the UK like it is in the US, and it is not currently as widely used there, as it is in the US.

The GRASP organization overall seemed to be fairly respectful of the DSM5 committee in their meeting as reported with them, but the statement, as linked below, after the APA did not comply with their recommendations, included a description of the APA as a wh***, per that organizations actions. If the committee members saw that comment I doubt they were too happy about it, or the first comment provided back in 2010 regarding the extreme ends of the spectrum.

http://grasp.org/profiles/blogs/dsm-5-u ... e=activity

I see this type of thing as unfortunate because not everyone who self-diagnoses that reports substantial difficulties can afford or has access to a diagnosis. I also see it as unfortunate that Dr. Lord appears to have generalized what seem like a relatively few number of "Aspie voices" from the comment from Swedo to the majority of the rest of those identifying with the Asperger's diagnosis, many of who already refer to themselves as Autistic and some who do freely identify their difficulties on the spectrum.

The Aspie.com site is actually a site that belongs to the author of the book "Pretending to be Normal", an individual who identified as self-diagnosed. But, it is not an online autism community. That makes me wonder if Swedo was referring to the Grasp meeting or another very small group of individuals. If Swedo was referring to Grasp the comments did not seem to reflect what was reported in that meeting in the link above. I have a feeling that she was referring to the Grasp organization but if so there seems to be substantial miscommunication on either her part or in the report of the meeting by the Grasp organization.

At this point I think it is worth noting that 4 out of 11 of Kanner's cases were identified as children of psychiatrists and Han's Asperger a very famous psychiatrist, has been identified with some of the same symptoms he described in children, in his childhood. I'm not going to armchair diagnose any of these DSM committee folks with an Autism Spectrum diagnosis, but it seems there may be a difficulty in certain areas of the expression of empathy in social communication that don't immediately take into account larger populations of people outside of one's own perspectives.

There seems to be that sense of unwitting delay in "emotional maturity" in social communication as part of a "neurodevelopmental" disorder that in itself as a phrase could reasonably be taken as offensive by some as a stereotype of the spectrum, but it is part of the core deficits that both Hans Asperger and Kanner described as a literal difficulty, not a pejorative description, in what they described as "autistic disturbances of affective contact" and "autistic psychopathy".

This is link to article with Swedo quote: LINK

I don't know what group of people Swedo is referring to, but there are people who have AS or self-diagnose with AS and don't want to be lumped in with autism.

As for the social communication problems of DSM committee members, I can only say that it is verry merry berry normal for neurotypical people to display a lack of empathy towards autistic people.

Thank you for that link.

It is normal for any person to show a lack of empathy depending on how they feel about the other person or perceived group that person is part of, for almost an unlimited number of reasons, but it would also be an armchair analysis to diagnosis any of the committee members as neurotypical.

There is no observable difference in the communication or behavioral characteristics between Catherine Lord, Swedo, Ne'eman, or the Director of Grasp. The only reason anyone would know the last two in a congressional hearing is on the spectrum is because they disclose that information. Very often people that do not openly identify as on the spectrum, are automatically assumed as being in an "NT" category One study in the US and one study in Sweden indicate that up to thirty percent of the population meets at least one criterion/autistic trait of the DSMIV-TR criteria.

It's impossible to identify an individual as neurotypical, per neurology, as a common neurology for either autism or those diagnosed without autism has not been identified. Of course, it's possible to identify a person as neurotypical if one limits that definition by one that does not possess an official diagnosis. But even there, it is impossible to identify unless one discloses information they do not have a diagnosis. There are actual psychiatrists that have disclosed that they are diagnosed with Asperger's syndrome, but very few have publicly disclosed this.

Also, I'm not suggesting that anyone including the director of grasp was intending a lack of empathy in their social communication, or that in general that they lack empathy, as the feelings for some discussed in both conversations did not seem to be considered outside of their personal perspective at the time the comments were made. I have no idea if that was an intentional/malicious lack of expression of empathy; it is possible that it was unwitting in all cases.

The avenue of internet social-communcation can increase that potential because the comments are often disconnected from face to face interaction with those who are directly impacted. One recent longitudinal study for college adults shows a 40% reduction of the expression of empathy for others in the last 3 decades with a sharp drop off in the last decade.

It is possible that the move away from face to face interaction plays some role in this per the expression of empathy for others, if only a significant one. Difficulties with empathy can be associated with hundreds of medical/neurological/psychological conditions. The 85% prevalence of Alexithymia in autism, appears to be a key association that is studied as leading to a difficulty in feeling and or expressing empathy among some individuals on the spectrum. That condition is not limited to individuals on the spectrum either, but it is measured highest among those with ASD's.

Interestingly, brain studies done on people on the spectrum measured with lower levels of affective/emotional empathy in the emotional centers of the brain were assessed with high levels of alexithymia, while those that were not assessed with high levels of Alexithymia were measured as having higher levels of affective/emotional empathy.

The potential causes of Alexithymia are considered potentially biological/and or environmental. A stronger biological factor has been considered potentially associated with ASD's. "A lack" of empathy per that specific nomenclature is not a basic criteria of ASD's, however the lack of expression of empathy for others, is described in the social-emotional reciprocity basic criteria, with further details of severity in the diagnostic characteristics, and associated features section of Autistic Disorder in the DSMIV-TR, quoted and linked below:



https://sites.google.com/site/gavinboll ... for-autism

http://en.wikipedia.org/wiki/Alexithymi ... ic_illness

If 30% of the population has a single autistic trait, that this doesn't make then neuroatypical. Barring other possibilities like ADHD or schizophrenia, they're still neurotypical.

Yes, it is possible to be mistaken. In my case I have been referred to and referred to myself as neurotypical, and I don't have any "hard feelings" over this mistaken categorization. It is not reasonable or rational to be paralyzed to inaction by uncertainty or the possibility of error. Most people are NTs, so statistically, referring to someone like Catherine Lord or Susan Swedo as NT is simply playing the odds.

Biological differences in neurology across the animal kingdom has been identified in up to 20% of those described as sitters vs rovers. The behavioral differences can be identified from an early age. The correlation between sitters and introverts is strong, but not a guarantee that the personality traits are matched up with the behavioral differences, that are identified as resulting from a difference in neurology. The specifics of that neurology is associated with the dopamine reward centers of the brain; similar general associations have also been identified in those considered introvert as opposed to extrovert. There are obviously environmental/cultural factors at play, like there is with almost every biologically influenced difference.

Of course I'm talking neurology here, not a diagnostic difference. There are still people who strictly identify neurotypical as meaning without a diagnosis of autism, and a gradient of others who do or do not include this or that group with an identified condition.

However per modern medical science there is no identified typical neurology, only remarkable findings on brain scans that are identified. Some individuals diagnosed on the spectrum show the same unremarkable findings on brain scans that anyone else without a diagnosis of any kind in the general population.

Sitters and Rovers have different neurology, significant enough different neurology where this trait stays consistent in most animal populations. So there is obviously an adaptative benefit for survival. It likely at least in part is the attribute of a more cautious nature, and the benefits that might accrue from caution to live to reproductive age. Some Sitters with that biology eventually adapt and become extroverts; some don't. So, it is relatively hard to identify that behavior into adulthood for those that have the associated biology/neurology

The status of "neurotypical" or "neuroatypical" cannot be determined by diagnosis or self diagnosis alone, at least per actual neurology.

Individuals that even have what it takes to be an actual psychiatrist, moving through medical school, and practicing in perhaps one of the most mentally stressful professions known to mankind likely do not have anything close to typical neurology, whether or not it can be seen on a brain scan, even if they started out with it at birth if it could be medically defined, as they have been able to adapt to incredible intellectual and emotional stresses, that most people could not imagine on a day to day basis.

It's pretty safe to say that most would not and could not be diagnosed with an autism spectrum disorder because of general perception of their extreme functioning levels in everyday life, however as far as the neurology that underlies their abilities, it could be very similar between one person with or one person without an actual diagnosis of many different neurological conditions. Until there is an actual medical test for typical neurology, it is all speculation and construct of the limited information known about neurology to this point, as to who may or may not have what could be called typical or atypical neurology.

You're overcomplicating what is actually not a complicated issue, and I don't see what purpose such meandering serves.

The point of the term "neurotypical" is to identify the fact that some people do not have autism. Neurodiversity has been expanded over the years so that some people refer to people with ADHD, dyslexia, Tourette's syndrome, etc. as being neuroatypical as well, and some people seem to think anyone with a diagnosable mental illness is neuroatypical (although I think at that point, the term is meaningless).

The purpose of "neurotypical" in contrast to autistic is to identify the fact that autistic people tend to think and perceive differently from people who aren't autistic (that is, neurotypical). And to identify the fact that people who are not autistic tend to find it easier to negotiate and function within society than autistic people do. This is similar to the usage of straight in contrast to gay, lesbian, and bisexual, in that it identifies and marks the unmarked majority as being part of the same set of classifications, not outside/above them.

Saying that neurotypical people exist does not mean saying they all have identical neurology any more than identifying autistic people means all autistic people have the same neurology. "Typical" is typically a range. Typical IQ, for example, ranges from 85-115, and is not simply 100. Neurotypical refers to the typical range of executive function, understanding social cues, levels of repetitive behavior, sensory sensitivity and so on. It is virtually impossible to argue that the majority of people do not have these in typical ranges because that is what typical means. Autistic people are outside the typical range in these things, hence not being neurotypical.

A debate over how it's not possible to say whether anyone is neurotypical because we can't scan their brains is just going in rhetorical circles and completely ignores why the word exists and what it actually describes. The number of introverts or "sitters vs. rovers" or people with a single autistic trait are irrelevant, because people who fit in each of these categories can still fall within the typical range for the relevant neurological traits.

http://en.wikipedia.org/wiki/Neurotypical

My point was not against the term neurotypical in the way it was originally defined, I attempted to clarify that in my post here:



My argument was against this commonly evolved definition that neurotypical now means "fully neurologically normal", as referenced above in Wiki.

It's a safe bet that Lord is not diagnosed as autistic, and I attempted to make it clear in my previous post that I was not suggesting that Lord was autistic, but it is not a safe bet that her neurology is fully normal, or typical. Qualified professionals, physicians and/or neurologists have tools to approximate the assessment of potential abnormalities in neurology.

And, whatever "atypical neurology" exists that cannot be currently determined by medical tests for people diagnosed on the spectrum may be shared similarly with people on the broader autism phenotype with one, two, three, four, five, or six traits of autism, some of whom that may not be assessed as clinically impaired in a major area of life functioning. At this point there is no way to measure that, other than looking at behavior. Behavior that can be mimicked by anyone, without any assessed neurological abnormalities. Or, behavior that is not even observable in some people diagnosed on the spectrum, as they have learned to mimic other people's behavior that is considered typical behavior by most. It is considered an invisible disability for some for good reason.

There was nothing unusual at all about the director of grasp or ASAN's social communication in the recent congressional hearing, other than the comment the director of grasp gave about Asperger's making him sound more intelligent than he was. The only person in any of the panels that had any observable difficulty in social-communication with others was the individual representing the CDC.

There are many people in the world that socially communicate in front of public audiences, but relatively few that do it as well as those two individuals on the spectrum in the hearing.

They don't deserve to be undiagnosed for that, as that is between their professionals and them, but it is clear evidence that it is currently virtually impossible to determine whether or not someone is not on the spectrum or what some might refer to as "NT", by observing their external social communication and/or behavior, or even their life/working history and activities as the director of grasp reported he played in rock bands and ran the streets with juvenile delinquents in youth, roamed Europe after college, was an international diplomat, and plays minor league baseball approaching 5 decades of life; currently happily married with children directing a global charitable organization, as well as indicating he knows what it feels like to be the smartest person in the room and the toughest fighter on the block.

http://www.thefreelibrary.com/GRASP%3A+ ... 0300722543

At least from observance of recent social communication, Lord by all objective observable measures from an arm chair analysis seems as non-autistic as the director of Grasp. But, that cannot be measured by observation of social communication and behavior alone from an armchair view. That is for the professionals to figure out, not folks in the general public, with no clinical experience. The same applies to who is or isn't fully neurologically normal.

The diagnosed or not diagnosed status when disclosed is clear cut and simple per what used to be defined as neurotypical. But, there is substantial warranted complexity in what I described above, on these fully normal neurological assumptions described in Wiki from the autism community coined and evolving definition of the term neurotypical.

It seems whoever wrote the article really has no idea what they are on about, but then if I am not mistaking the new York times is a pretty mainstream news source so it cannot be counted on for reliability. Its as if people actually think the DSM alone is used to diagnose disorders, and not only that but undiagnose people? I don't get it, one would have to be a terrible psychiatrist or psychologist to diagnose only using the DSM which basically just organizes outward symptoms and behaviors that can be observed from an outsider and there is more to most mental disorders than that.

It is the diagnostic bible.

I hate this proposed change and think its totally stupid and reflects the terrible understanding of what Aspergers actually is and of the brain itself.

Based on what?

Can you elaborate on your question a little please?

I wrote a few of my opinions on the AS brain here

I personally favor retaining the distinction. They present and are treated so differently that they should retain their distinct mentions. It seems a backwards step to take out the very real and obvious distinction between the two. Personally, I think all final arguments are on hold until we get proper/better brain imaging/scanning. When we understand the brain fully the world will be a massively different place and its probably not that far away.

http://www.psychiatry.org/practice/dsm

Many people have the idea that the "Diagnostic Criteria Sets" published, that can easily be found on the internet is all there is to the diagnostic text in the DSM, but there is much more that is copyrighted and not usually available to the general public in the "Descriptive Text" including: "Diagnostic Features"; "Subtypes and/or Specifiers"; "Recording Procedures"; "Associated Features and Disorders"; "Specific Culture, Age, and Gender Features"; "Prevalence"; "Course"; "Familial Pattern"; and "Differential Diagnosis."

The DSM is not designed as a cookbook to diagnose people; clinical experience is also required. However, there is no testing required to diagnose a person with an autism spectrum disorder in the US. Clinical experience, the DSM manual, and observation of the described behavioral impairments by a qualified professional with the credentials to diagnose, is all that is required for a diagnosis in the US.

Here is an example of the other information from the DSMIV-TR, not easily found with an internet search, linked below.

https://sites.google.com/site/gavinboll ... for-autism

https://sites.google.com/site/gavinboll ... -aspergers

Could you concisely state your concern? It seems like you are arguing that because one can't know for sure, it's not appropriate to refer to specific people as NT. I already stated my disagreement with that particular argument, and I already said - indirectly, as I did not have the wiki in mind - that I do not agree with the wiki's definition because it is too broad and meaningless.

For that matter, this entire discussion as to whether it's appropriate to refer to Catherine Lord as NT or not is a sidetrack. Both you and the person who used the term "NT" seem to agree that Catherine Lord was being insulting to at least a portion of the autistic population, so now it comes down to semantic debate over which words were appropriate to use in saying so. NT's not going away, so...what's left?

[youtube]www.youtube.com/watch?v=1sONfxPCTU0[/youtube]


grrrrr

Last edited by Rascal77s on 15 Dec 2012, 8:44 pm, edited 3 times in total.

I suppose the links are worth taking a look at....anyways that is what I was saying the DSM alone cannot be used to diagnose someone. Also, what testing would there be? There isen't an exact obvious simple difference between neurotypical and autistic brains so even if there was some sort of brain scan added as a required test for diagnoses it wouldn't work to well I don't think.

I am attempting to objectively address the complexity of the issue, not a personal concern.

I was discussing the point that armchair diagnoses of if someone is not on the spectrum are not reliable, and there is no commonly understood definition of what "fully neurologically normal" even means other than the assessment of no abnormalities or remarkable findings by a qualified professional.

I have no significant personal concern with the term Neurotypical, when people use it as it was originally invented and defined to describe the general population that isn't diagnosed with an autism spectrum disorder. I also have no significant personal concern if people use it with this more recent definition, but there is no scientific basis for a concept of "fully neurologically normal" that can be casually observed in a person from an armchair view.

And, I have no way of determining how the individual that first used the term in the conversation actually defines it because it is defined differently by many people and was not clarified by that person. However, it is a commonly described topic that people can and do relate to

It is relative to the topic, per the general concept of armchair diagnosis, as to specifically what Catherine Lord means by her statements quoted in the past, because Catherine Lord made a sweeping generalization in her quote that more than half the people that use Aspergers, would not meet the DSMIV definition of Aspergers. And the comment addressed from Swedo, that appears to potentially have generated this sweeping generalization, certainly did not reasonably support it, if so.

My point was Lord can't reasonably armchair diagnose people she has never even met or talked to in life, and by the same token there is no objective basis to armchair diagnose the neurology of any specific individual, including Lord, other than when they report they have a neurological disorder.

And in addition, just how complex and close to impossible that would be to attempt if someone tried to find a basis for it from a casual observation of behavior and/or communication. Ne'eman and the Grasp Director represent excellent examples of this issue that can be viewed over and over at someone's leisure to see if they can pick out some characteristic in social communication or behavior that could identify either of those two individuals with any kind of neurological disorder or any other disorder, from armchair analysis.

The analogy is there appears to be no unique quality about Lord that gives her the ability to do this, either without even observing the population (over half of the people that use Aspergers) she is referring to in her quotes. From the statements that exist, it appears she is suggesting that over 50 percent of the people identifying with a self-diagnosis of Asperger's syndrome are wrong. I don't think most of those people would agree with her assessment, and at least in this case, I don't see a scientific basis for it.