On the Garbage that is the DSM-V

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Gedrene
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20 Nov 2011, 3:22 pm

btbnnyr wrote:

The new diagnosis does not insist that a person must have motor skills issues.

DSM V wrote:

Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.

So we have hypo-reactivity to sensory input and hyper-reactivity. This can be seen as a moto deficit in ways. Uncontrolled reactions to actual stimuli are deficits, although that may be arguable and coloured by the severity or ack of severity in normal human action. In general though it indicates deficit. Furthermore there is repetitive speech, motor movements, stereotyped speech and moreover echolalia. Now echolalia is a speech deficit that many autistics don't have.
So if we remove those two we are left with highly restricted, fixated interests. Well I don't know what to compare against but my interests are many and often quite specific so I might qualify. However I don't really qualify for number two so much. I have only one stylized pattern of speech and even that isn't common and is situational: Saying there is evidence isn't evidence.

That would have been enough in DSM IV but not in DSM V.

btbnnyr
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20 Nov 2011, 3:39 pm

Neither stimming or sensory sensitivities are motor skills deficits. I know what motor skills deficits are. I had severe motor skills deficits when I was little. I could not hold anything without my hands shaking a lot and dropped everything I tried to hold. That is a true motor skills deficit. The criteria for autism don't require that.

Gedrene
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20 Nov 2011, 3:42 pm

btbnnyr wrote:

I know what motor skills deficits are. I had severe motor skills deficits when I was little. I could not hold anything without my hands shaking a lot and dropped everything I tried to hold. That is a true motor skills deficit. The criteria for autism don't require that.

Not being able to respond quickly to stimuli is a motor skill deficit. Over-reacting to a loss in balance is a deficit because it causes more problems that it solves. Also I'd say that echolalia and unusual stereotyped speech or over-repitition are still a defict that many still don't have. It's too strict in general.

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20 Nov 2011, 3:46 pm

Here is what I think is a special interest: a topic or activity that you have to think about pretty much all of the time that you are conscious. It's the first thing that you think about when you wake up but are lying in bed before you get up. You think about it when you are brushing your teeth. You think about it as you are waiting for water to boil. You think about it in the shower. It's the last thing that you think about before you fall asleep. That is the intensity of the Asperger's special interest. The special interest can change over time, and you may have several of these that rotate in and out of your mind, but the intensity and focus must be there. When special interests interfere with your everyday functioning is when they become clinically significant. From the NT perspective, it doesn't take much for special interests to interfere with your social functioning, because NTs have such high expectations for social functioning.

btbnnyr
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20 Nov 2011, 3:48 pm

Gedrene wrote:

btbnnyr wrote:

But the criteria don't require stereotyped speech. That's only 1 of 4. And if you don't have stereotyped speech, you might still have stereotyped motor mannerisms to meet that criteria.

I think that the APA just listed "such as" items as examples of stereotypy or special interests, not as rigid requirements that everyone must meet to be diagnosed with ASD.

Gedrene
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20 Nov 2011, 3:51 pm

btbnnyr wrote:

Gedrene wrote:

btbnnyr wrote:

But the criteria don't require stereotyped speech. That's only 1 of 4. And if you don't have stereotyped speech, you might still have stereotyped motor mannerisms to meet that criteria.

it's two out of four. And what if someone an extreme example of one but not any examples of the others? That was the beauty of the asperger's diagnosis. Furthermore you need all the examples in the firsat part. What if they only have two?

btbnnyr
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20 Nov 2011, 3:59 pm

If you have a severe deficit in one trait, then perhaps you have another disorder (I don't know what) associated with severe deficits in that trait. Some people have sensory integration disorder, but no ASD. I'm pretty sure that my mother has sensory integration disorder, but she is NOT autistic. I also have sensory integration disorder, but I am autistic. So a person with severe deficits in one trait should be looking at a different diagnosis.

In the social/communication section, there is a range of behaviors that are allowed to meet the criteria.

e.g. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

I don't think it's difficult for adults with AS to meet the bolded one.

Gedrene
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20 Nov 2011, 4:09 pm

btbnnyr wrote:

I think when you ahve to say there is a different disorder just because you fit a small number but not all of the characteristics that's called not rnning witht he spirit of the diagnostic, and over-stringency. You have to see past labels and nderstand that some people just don't have problems because they have worked through them.

btbnnyr
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20 Nov 2011, 4:11 pm

I don't understand what is the spirit of the diagnostic? I thought the point of a diagnosis was to diagnose whatever the person has.

btbnnyr
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20 Nov 2011, 4:12 pm

Maybe you could list your traits here. Which one is your trait of high severity?

btbnnyr
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20 Nov 2011, 4:14 pm

For a certain trait, just because many autistics don't have it doesn't mean it shouldn't be part of the criteria. Many other autistics will have it. Not everyone has to be the same to be diagnosed with the same condition.

Gedrene
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20 Nov 2011, 5:18 pm

btbnnyr wrote:

Maybe you could list your traits here. Which one is your trait of high severity?

I don't have one trait of high severity. TO be honest I don't care about the diagnostic system for my purpose. However the fact is that for people who only have a few characteristics of high severity or normal severity they will be excluded.

btbnnyr
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20 Nov 2011, 7:04 pm

Gedrene wrote:

btbnnyr wrote:

Maybe you could list your traits here. Which one is your trait of high severity?

Multiple autistic traits of varying severity tend to go together in people who are autistic. In people who are not autistic, autistic traits can be isolated.

An autistic person with high severity in one RRB trait is extremely unlikely to have such low severity in all three of the other RRB traits that he cannot be diagnosed with what he has. He will not be excluded.

An autistic person with high severity in one social criterion, e.g. total lack of initiation or response to social interaction, is going to meet the other two social criterion with high severity as well.

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21 Nov 2011, 3:17 am

btbnnyr wrote:

People who have only scattered symptoms in isolation are probably not on the spectrum at all. In people with AS, multiple of the symptoms go together, because the behaviors are all caused by the same thing in the mind. My lack of understanding of NT ToM causes my behavior to meet all three of the social/communication criteria in the DSM V and all four in the DSM IV. My hyperfocus on everything causes both my special interests and my routines and rituals. Even without my stereotypies and sensory issues, I would have met the DSM V criteria with only two functions, or lack thereof, in my mind causing my autistic behaviors.

I forgot to get back to this discussion today, but I agree with much of what you posted.

Gedrene
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21 Nov 2011, 7:27 am

btbnnyr wrote:

An autistic person with high severity in one RRB trait is extremely unlikely to have such low severity in all three of the other RRB traits that he cannot be diagnosed with what he has. He will not be excluded.

An autistic person with high severity in one social criterion, e.g. total lack of initiation or response to social interaction, is going to meet the other two social criterion with high severity as well.

That is untrue. One can have a deficit in maintaining relationships as it is called but not in recriprocation and be autistic. They are similar only because they are part of one category. They are independent, otherwise they would not be put as seperate points. This is what the DSM IV allowed for.

You are also begging the question. You are saying that they are all traits needed because otherwise it wouldn't be autism. However that's just declaring that the criteria are correct because the criteria say so. THe fact is however that one can be an aspie without having bad posture etc, but the new diagnostic doesn't allow that.

I don't have bad posture. I am not stiff. I can smile just fine.

MrXxx
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21 Nov 2011, 1:37 pm

Gedrene wrote:

MrXxx wrote:

The problem is not the criteria changes. They don't specifically exclude anyone who would currently qualify as Autistic.

yet the fact is that changing the criteria to only have autistic is the problem. It is cutting out the mild people, as I ahve already shown, and to suppose otherwise.

False. It is not cutting out the mild people. You're analysis is wrong. The new criteria are BROADER than the old. Plus, you have not even taken into account that the new DSM-V criteria also includes severity levels. No need for that if what you say here is true.

Gedrene wrote:

MrXxx wrote:

There are already a large number of Autistics not being diagnosed.

Apples and oranges. You're going to cut out the mild because enough people aren't being diagnosed with what they should have. That's not only an unrelated issue, but it's counter-productive. Simplifying something for trained psychologists seem laughable. It's like cutting out the detail to help the lowest common denominator.
The fact is that the new diagnosis cuts out those who have some of the issues but not all.

It is most definitely not an unrelated issue. It is THE issue. This is a large part of the reason that the criteria are being changed. Too many actual Autistics are NOT being diagnosed now, because the whole system of diagnosis is too convoluted and confusing. Simplifying it to include, and NOT exclude anything already being used as criteria, in one single diagnosis, with levels of severity, allows for far more people to be diagnosed with the new criteria that are being totally missed with the current criteria.

Read the rationale for the changes.

Gedrene wrote:

MrXxx wrote:

I questioned the proposed DSM-V criteria myself for a while, but I now believe we need to give it a chance. There really isn't much point in crying that the sky is falling when we haven't even been hit on the head with anything yet

Why is it that when someone doesn't actually have an actual argument they say that a rational complaint is crying? Really should anyone be so crass?
You say that no one can know what will occur no because it hasn't occured yet. Have you heard of the word prediction? Predictions can often be very good you know. And the fact is that you have failed to debunk the obvious fact that the stringent system will cut out the aspies.

No, it won't. You're getting too hung up on the term "Asperger Syndrome." It's just two words, that have ALWAYS been defined as a form of Autism. If you have Asperger's Syndrome now, you have Autism. Changing how we refer to it doesn't change what it is. Nobody will stop you from calling it AS. The new criteria also won't stop doctors from using the term.

If you are Aspie now, you will still be Aspie under the new criteria.

Gedrene wrote:

MrXxx wrote:

I really believe now this is all much ado about nothing.

Percipi est esse. Congratulations, a logical fallacy. And a cliched remark of style to sound credible too.

Whatever. You're doing far more to sound credible than I am. I'm just not buying your logic, and you don't like that. Get over it.

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