DSM-V Contradiction
Verdandi
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Location: University of California Sunnydale (fictional location - Real location Olympia, WA)
27 Jan 2012, 8:15 pm
antimuda wrote:
I am not denying the right of the APA to act as its own lexicography. I can not find an alternative definition issued from the APA or a scholarly work in the field that could be used to reasonably establish an alternative definition. If you could find such a reference please post it.
In the absence of an alternative definition, the dictionary definition must serve. The purpose for the DSM is to "provide a common language and standard criteria for the classification of mental disorders". In such that it uses ambiguous terms which open to different interpretations it has failed its purpose.
In the absence of an alternative definition, the dictionary definition must serve. The purpose for the DSM is to "provide a common language and standard criteria for the classification of mental disorders". In such that it uses ambiguous terms which open to different interpretations it has failed its purpose.
The use of "limit" with regards to a disorder is hardly a controversial or ambiguous usage, however. You're making a big deal about this word even though there's no indication that it will be used in the manner you have described.
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If most people can complete a test in an hour and achieve a score that accurately reflects their abilities and knowledge and you cannot then you are limited.
To this I will in fact agree to the extent that I am 5'7 and am limited in my ability to dunk a basketball. However this limit does not effect my ability to play the sport.
As it relates to a more practical example the purpose of the SAT is to determine how well students are prepared for college level academics. The additional time does not limit the function of the test in its determination. Thus the impairment and the accommodation to adapt to the impairment does not limit the student.
This statement makes no sense. How is the requirement for more time not a limitation? Without the additional time, someone who needs it cannot be accurately assessed and their abilities will be underestimated. Accommodations do not mean an absence of limitations. They are, in fact, very explicit acknowledgements of limitations. Just as wheelchair ramps do not mean that someone who needs a wheelchair is not limited in terms of mobility, a longer period of time to take a test does not mean that someone who needs that accommodation is not limited.
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A childhood history has more information than when you started to speak or how. That is a factual statement: It includes your performance in school, your relationships with other children, your relationships with your family, your behavior over time.
Speaking represents a discrete measurable event the new criteria does not. For instance if we look at
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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
For the purposes of brevity lets look at the starting range, "difficulties adjusting behavior to suit different social contexts". Part of the growing up process and one a common challenge to parents is teaching the proper behavior to children. It is unfortunately a common sight when one eats at a restaurant, attends a religious service or sits in a Starbucks cafe to observe children behaving inappropriately(running around, screaming etc) and their poor parents trying to do everything in their power to make them behave. These behaviors would be proper in other situations. This is a common behavior to all children and not necessarily of ASD. What differentiates the two are the context, details and frequency of the behaviors. Retroactively these nuanced differences would be difficult to establish and would be prone to memory errors particularly as they relate to the exceptional. (If you are curious on the topic I can provide several interesting books and papers on the topic of memory errors.)
Speaking does not represent a discrete measurable event. I spoke early, but a lot of my speech was imitative and much of it did not reflect that I understood everything that I was saying, only that what I said was a possible response to something I heard someone else said. Even though this does fit the communication criteria for autism currently, I was diagnosed with AS because I started speaking full sentences earlier than most children.
As for your example of children running around and screaming in a restaurant, that is not typically the kind of atypical social behavior that gets one diagnosed with autism. It's not just "misbehaves in restaurants," it goes beyond that. I, for example, did not usually misbehave in restaurants, but I did tend to do the same thing in every social context: I'd go off by myself and read. No matter what. I did it in school, I did it at home, visiting relatives, when relatives were visiting, and so on. That's not the only example I can produce, but it's relevant to my own history.
And yes, memory is subject to distortion over time, and this is something else psychiatrists are most likely aware of, but I think the problem here is that you're describing these symptoms as "reporting single incidents" when the way autism is diagnosed (via the ADI-R and ADOS) is used to establish a comprehensive history and hopefully bypass the tendency toward cognitive bias and memory distortion. Even if individual memories are inaccurate, the sum total of multiple recollections is more likely to produce an accurate picture.
You're catastrophizing.
27 Jan 2012, 8:30 pm
What concerns me about the DSM change is that it appears to move the focus towards "disability" and away from "disorder".
A person can be diagnosed and treated for depression, anxiety or ADHD because of minor impact in a person's life. But with autism it seems that many professionals take the view that either you are disabled or you have no problem. The DSM works like an algorithm--doctors find the best fit for the patient. The new revisions are a disservice to individuals who will now be diagnosed and treated for other disorders that don't truly match up with the real source of the problem.
27 Jan 2012, 9:01 pm
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But with autism it seems that many professionals take the view that either you are disabled or you have no problem.
I think it's more a case of recognizing that ASD, including AS, is something that you're always going to have, and your ability to overcome it will inevitably and always be at least somewhat brittle.
For a real-world comparison, somebody with a cochlear implant is still legally deaf, even if they can understand spoken language through sound alone. Why? Because the nanosecond their battery dies, or their external sound processor unit fails, they're as deaf as they were the day they were born.
The same is true of Aspies. Even if you can be fully medicated to fix attention, executive function, anxiety, and nonverbal communication, and after intensive therapy while on that medication you learn to interpret the information you're now able to perceive and process, you'll still be totally screwed if your meds run out and can't be replaced. Actually, you'll be worse, because the meds will have allowed you to get yourself into a position where you HAVE to reliably function at that higher level, and without the meds that make that level of performance possible, your new & improved life would disintegrate within a matter of days.
Yes, ASD -- even relatively mild cases of AS -- is a very real lifelong disability. We can rationalize it as an evolutionary difference until we're blue in the face. Capital One is still going to rape us with late fees whenever we get wrapped up in something for a few days and totally forget to make the month's credit card payments before midnight on the due date.
Insofar as how uncorrectable something has to be to qualify as a 'limit', there are plenty of other examples of situations that can be worked around, but are still considered to be "limits". A paraplegic is always going to be viewed as facing limits, EVEN IF he goes out and buys an iBot or robotic exoskeleton that allows him to move around easily and climb stairs. Like an aspie without meds, or a deaf person whose CI's batteries have died, the paraplegic with a dead battery in his Segway-like robotic wheelchair or exoskeleton is at least temporarily screwed. Brittle work-arounds are not cures, no matter how well they work in the meantime.
and, for anybody who's never heard of iBot...
[youtube]http://www.youtube.com/watch?v=O7otewMk9pc[/youtube]
_________________
Your Aspie score: 170 of 200 · Your neurotypical (non-autistic) score: 34 of 200 · You are very likely an Aspie [ AQ=41, EQ=11, SQ=45, SQ-R=77; FQ=38 ]
30 Jan 2012, 10:13 am
aghogday-
Again thank you for your complete and thoughtful responses.
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Diagnoses obviously have been missed, because Aspergers has only been available as a diagnosis for about 18 years. This revision was recently added as a result of research, and advisement that many would be excluded from diagnosis, if the change was not made. How else could adults be diagnosed? Would it be fair to exclude them, because the diagnosis wasn't available when they were children?
This is perhaps a clinical question, but why must the symptoms have been present in childhood? There is an entire body of knowledge around how ASD (broadest possible sense) manifests itself in adult populations. Isn't the purpose of a diagnosis and possible treatment to improve the standard of living for the individual in the present time? How would an individual who meets DSM-V criteria a,b and d be classified? Interesting in the ICD the condition is labeled as "Childhood Autism"
If regard to the ICD vs DSM. As noted in the articles you have posted, there has existed a cross index that has allowed for proper "coding" of conditions based upon the DSM criteria to the corresponding ICD criteria. However the ICD Criteria for ASD is
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A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:
receptive or expressive language as used in social communication;
the development of selective social attachments or of reciprocal social interaction;
functional or symbolic play.
B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)
1. Qualitative impairment in social interaction are manifest in at least two of the following areas:
a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavior according to social context; or a weak integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).
2. Qualitative abnormalities in communication as manifest in at least one of the following areas:
a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);
b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;
c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
d. lack of varied spontaneous make-believe play or (when young) social imitative play
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;
b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;
c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;
d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate).
C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders; schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).
receptive or expressive language as used in social communication;
the development of selective social attachments or of reciprocal social interaction;
functional or symbolic play.
B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)
1. Qualitative impairment in social interaction are manifest in at least two of the following areas:
a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavior according to social context; or a weak integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).
2. Qualitative abnormalities in communication as manifest in at least one of the following areas:
a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);
b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;
c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
d. lack of varied spontaneous make-believe play or (when young) social imitative play
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;
b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;
c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;
d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate).
C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders; schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).
Also interesting to note in regard to the ICD, F84.5 - Asperger’s Syndrome is still listed.
As Allen Frances notes in the psychologically today article, "The more precise the diagnostic code, the more information about the patient is communicated to the system, allowing for more sensitive research, administrative, and reimbursement decisions. " Therefore words do have meaning and consequences. Any ambiguity in the language and differences between the applicable standards further exacerbates the problem.
30 Jan 2012, 11:32 am
Verandi-
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I know what you're talking about. That is what I was talking about. It's a possible problem no matter what, which is what I said further up. Pointing out that it's a real problem when I agreed it's a problem is confusing.
My point in objection to criteria C, which requires the presence in early childhood, is simply that I do not understand the clinical value of such a history particularly as it is prone to error. This forum and books by Attwood, Elders, Willey and others are testament to the fact there is a body of literature regarding how the conditions are manifested in adult populations. My general question is why can't the diagnostic criteria be adapted to reflect this?
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The use of "limit" with regards to a disorder is hardly a controversial or ambiguous usage, however. You're making a big deal about this word even though there's no indication that it will be used in the manner you have described.
My position is that DSM needs to provide clear, concise and accurate criteria for making a diagnosis. The introduction of the term limit, I have argued does not help to refine the meaning of the criteria. Based upon your interpretation along with others on this thread, the standard would have the same application if the word was omitted. My only contention is that if the term 'limit' adds no additional content or nuance then it should be omitted.
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This statement makes no sense. How is the requirement for more time not a limitation? Without the additional time, someone who needs it cannot be accurately assessed and their abilities will be underestimated. Accommodations do not mean an absence of limitations. They are, in fact, very explicit acknowledgements of limitations. Just as wheelchair ramps do not mean that someone who needs a wheelchair is not limited in terms of mobility, a longer period of time to take a test does not mean that someone who needs that accommodation is not limited.
The point I was trying to make was that the limit must apply to functioning. My height limits my ability to dunk a basketball not play the sport of basketball. For the purposes of the SAT test, the function of the test is determine how well students are prepared for college level academics. You are correct, requiring additional time does limit the ability to finish the test on time it does not limit the functioning of the test. The DSM requires that the "symptoms limit and impair daily functioning".
The criteria does not preclude the existence of any limit. The criteria restrict limits the space to only daily functioning. As discussed above daily functioning is difficult to determine and lacks a universal standard and applicable test. In regard to your wheel chair example, thanks to the ADA if functioning is defined as the ability to enter a building, then being in a wheel chair does not limit functioning.
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That's not the only example I can produce, but it's relevant to my own history.
The point of my statement was that the context and details are the event are critically important. Your example appears to highlight that fact.
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And yes, memory is subject to distortion over time, and this is something else psychiatrists are most likely aware of,...
Aware of perhaps but even the judicial system is still attempting to come to terms with the implications for instance as it relates to eye witness testimony. (See The Problem With Eyewitness Testimony)
Finally in regard to the ADI-R, it is concerned with current behavior. The question I believe still remains, what is the clinical benefit of demonstrating the presence of symptoms in childhood?
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Catastrophizing is an irrational thought a lot of us have in believing that something is far worse than it actually is.
http://psychcentral.com/lib/2007/what-is-catastrophizing/
I believe I have laid out a rational argument for a contradictions found in the DSM-V. I have presented supporting definitions and documents to advance my contentions. As I have said repeatedly, I am not a clinician and personally do not feel that the changes will effect the relationship between a doctor and an individual. However words do have meaning. It is my belief that the APA when revising the DSM should have created a more robust standard that was not vague in its language nor subject to common omissions in memory.
30 Jan 2012, 11:55 am
The definition of a disability from the Americans with Disabilities Act of 1990 is
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"a physical or mental impairment that substantially limits a major life activity."
Notice the inclusion of the word limit. Now compare this to DSM-V Criteria D
Quote:
"Symptoms together limit and impair everyday functioning." "
I believe it is reasonable to assume that "everyday functioning" is a "major life activity". Therefore the diagnosis is conclusively now a disability.
Given the similarities between the definitions, it seems reasonable to assume that the committee deliberately incorporated similar language. This would explain why the term 'limit' was added in the DSM-V. In this case the term does have meaning, without that term in the definition it would not meet the legal requirement for a disability.
30 Jan 2012, 4:17 pm
antimuda wrote:
aghogday-
Again thank you for your complete and thoughtful responses.
This is perhaps a clinical question, but why must the symptoms have been present in childhood? There is an entire body of knowledge around how ASD (broadest possible sense) manifests itself in adult populations. Isn't the purpose of a diagnosis and possible treatment to improve the standard of living for the individual in the present time? How would an individual who meets DSM-V criteria a,b and d be classified? Interesting in the ICD the condition is labeled as "Childhood Autism"
If regard to the ICD vs DSM. As noted in the articles you have posted, there has existed a cross index that has allowed for proper "coding" of conditions based upon the DSM criteria to the corresponding ICD criteria. However the ICD Criteria for ASD is
Also interesting to note in regard to the ICD, F84.5 - Asperger’s Syndrome is still listed.
As Allen Frances notes in the psychologically today article, "The more precise the diagnostic code, the more information about the patient is communicated to the system, allowing for more sensitive research, administrative, and reimbursement decisions. " Therefore words do have meaning and consequences. Any ambiguity in the language and differences between the applicable standards further exacerbates the problem.
Again thank you for your complete and thoughtful responses.
Quote:
Diagnoses obviously have been missed, because Aspergers has only been available as a diagnosis for about 18 years. This revision was recently added as a result of research, and advisement that many would be excluded from diagnosis, if the change was not made. How else could adults be diagnosed? Would it be fair to exclude them, because the diagnosis wasn't available when they were children?
This is perhaps a clinical question, but why must the symptoms have been present in childhood? There is an entire body of knowledge around how ASD (broadest possible sense) manifests itself in adult populations. Isn't the purpose of a diagnosis and possible treatment to improve the standard of living for the individual in the present time? How would an individual who meets DSM-V criteria a,b and d be classified? Interesting in the ICD the condition is labeled as "Childhood Autism"
If regard to the ICD vs DSM. As noted in the articles you have posted, there has existed a cross index that has allowed for proper "coding" of conditions based upon the DSM criteria to the corresponding ICD criteria. However the ICD Criteria for ASD is
Quote:
A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:
receptive or expressive language as used in social communication;
the development of selective social attachments or of reciprocal social interaction;
functional or symbolic play.
B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)
1. Qualitative impairment in social interaction are manifest in at least two of the following areas:
a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavior according to social context; or a weak integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).
2. Qualitative abnormalities in communication as manifest in at least one of the following areas:
a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);
b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;
c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
d. lack of varied spontaneous make-believe play or (when young) social imitative play
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;
b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;
c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;
d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate).
C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders; schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).
receptive or expressive language as used in social communication;
the development of selective social attachments or of reciprocal social interaction;
functional or symbolic play.
B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)
1. Qualitative impairment in social interaction are manifest in at least two of the following areas:
a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavior according to social context; or a weak integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).
2. Qualitative abnormalities in communication as manifest in at least one of the following areas:
a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);
b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;
c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
d. lack of varied spontaneous make-believe play or (when young) social imitative play
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;
b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;
c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;
d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate).
C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders; schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).
Also interesting to note in regard to the ICD, F84.5 - Asperger’s Syndrome is still listed.
As Allen Frances notes in the psychologically today article, "The more precise the diagnostic code, the more information about the patient is communicated to the system, allowing for more sensitive research, administrative, and reimbursement decisions. " Therefore words do have meaning and consequences. Any ambiguity in the language and differences between the applicable standards further exacerbates the problem.
The truth is, that just the experience of life, can create behaviors associated with criteria A,B, and D.
Continued Stress can cause Repetitive behaviors, and people become socially inhibited both in interaction and communication, for many reasons other than neurological ones.
A neurological test isn't available, so symptoms present from childhood, is the closest approximation of biological origin.
However, life itself, and neuroplasticity, create unique neurology for every individual, which in part is what happens when a person is subjected to continued, unrelenting chronic stress. Along with so many other environmental factors, just in the culture, that mankind has never been exposed to before, along with all of the byproducts that come with it.
Those behavioral issues closely associated with Autism can be as troublesome for those without the childhood history, as those whom have succumbed to the environmental pressures.
No doubt psychiatrists are aware of all of this, and at this point in time the childhood association is the only way to approximate evidence that the behaviors are of innate neurological origin. It appears to only be useful from the standpoint of classifiying the condition as a neurological disorder, that will likley be a lifelong condition.
I agree that non-matching transactional codes do cause real significant problems for some people, just wanted to clarify that the diagnoses from the DSMV will still be acceptable, and likely widely used in the US, and the codes will be contorted to match as well as possible.
30 Jan 2012, 5:04 pm
antimuda wrote:
The definition of a disability from the Americans with Disabilities Act of 1990 is
Notice the inclusion of the word limit. Now compare this to DSM-V Criteria D
I believe it is reasonable to assume that "everyday functioning" is a "major life activity". Therefore the diagnosis is conclusively now a disability.
Given the similarities between the definitions, it seems reasonable to assume that the committee deliberately incorporated similar language. This would explain why the term 'limit' was added in the DSM-V. In this case the term does have meaning, without that term in the definition it would not meet the legal requirement for a disability.
Quote:
"a physical or mental impairment that substantially limits a major life activity."
Notice the inclusion of the word limit. Now compare this to DSM-V Criteria D
Quote:
"Symptoms together limit and impair everyday functioning." "
I believe it is reasonable to assume that "everyday functioning" is a "major life activity". Therefore the diagnosis is conclusively now a disability.
Given the similarities between the definitions, it seems reasonable to assume that the committee deliberately incorporated similar language. This would explain why the term 'limit' was added in the DSM-V. In this case the term does have meaning, without that term in the definition it would not meet the legal requirement for a disability.
Autism is listed as one of the disorders in the legal code associated with the ADA that is considered as a condition that would consistently meet the disability criteria; an assessment of disability is still required in all cases associated with the ADA, regardless of condition, but it makes it much harder for a legal decision to go against someone when the condition is listed in the code.
There was some argument as to whether they meant Aspergers as well, because the nomenclature specifically stated autism, not all ASD's. It is possible that this played a role in the decision. However, there is no statement included like this in the criteria in the DSMIV for Autism Disorder, but it is understood to be inherently disabling per ADA definition, without the statement.
The ADA definition of disability was close to the DSMIV statement of overall impairment in an important area of life functioning, and Asperger's did meet the requirement's of disability when assessed as such, under the ADA.
But, no matter what, in the future, without a distinction between Aspergers and Autism, the code is already written to include Autism, as a condition listed and described as a condition consistently determined as a disability under the ADA.
Not sure if anyone would get the wrong idea, but of course this doesn't make a significant difference when one is assessed for SSDI disability and SSI. The variables are much more complex that those associated with the definition of disability under the ADA.
It's unfortunate, but some people hide their diagnosis of Aspergers in the workplace, rather than taking advantage of the ADA, because they are still more concerned about discriminatory practices, than the actual benefits provided by the Act.
I wonder if they will be even more likely to hide a diagnosis of Autism, or even more likely to avoid a diagnosis, considering, that overall, the term Autism is associated with a more severe disorder, in the general public.
The benefit of course, is that it is more likely that some will be able to gain support that seek it.
31 Jan 2012, 10:23 am
aghogday-
Quote:
The truth is, that just the experience of life, can create behaviors associated with criteria A,B, and D.
Each of the behaviors could individually manifest and the DSM likewise provides individual classifications (for instance Social Communication Disorder). The questions I believe are
1. Can criteria A, B, D can be met and have a different underlying root cause?
2. Would there be a different treatment regiment for an individual who in the present time frame, met the diagnostic criteria but it was attributable to a different condition/s?
3. What is the projected rate of false positives and how does that compare self reporting problems discussed earlier.
4. Is there another overlapping diagnosis that encompasses A, B and D?
As I have said repeatedly I do not have a clinical background. However my intuition is that an individual who presents symptoms in the present period will be treated based upon the current expression.
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A neurological test isn't available, so symptoms present from childhood, is the closest approximation of biological origin.
Other neurological conditions such as Schizophrenia and Bi-Polar disorder are lacking in this requirement. For ASD there are standard diagnostic instruments such as the ADI-R which are based primarily in current behavior. Why are these not sufficient?
Quote:
No doubt psychiatrists are aware of all of this, and at this point in time the childhood association is the only way to approximate evidence that the behaviors are of innate neurological origin. It appears to only be useful from the standpoint of classifiying the condition as a neurological disorder, that will likley be a lifelong condition.
Does not imply that if f-MRI scans were to increase in availability the childhood history would no longer be a requirement? (http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2011/05/31/study-suggests-special-mri-might-help-diagnose-autism (There are several scholarly works on the topic but they are quite dense) The reports show a high correlation between activation of certain areas in the brain when being exposed to various stimuli (ie pictures of faces) for individuals with ASD and control subjects. However the technology can only show the present state, it can not necessarily determine the prior states. Again is there a determine treatment regime for those with a history of expression and those without?
31 Jan 2012, 11:17 am
Based upon the ADA compatible definition of limit (: http://www.ilr.cornell.edu/edi/hr_tips/article_1.cfm?b_id=27&h_id=4&view=true#hid4
Quote:
An impairment is only a “disability” under the ADA if it substantially limits one or more major life activities. An individual must be unable to perform, or be significantly limited in the ability to perform, an activity as compared with an average person in the general population. The nature and severity, duration, and impact of the impairment would all be relevant factors to consider.
The EEOC has taken the position that some impairments, for example, blindness or deafness, are inherently substantially limiting. Many other impairments, however, may or may not be disabling depending on their impact on the particular individual’s functioning.
The EEOC has taken the position that some impairments, for example, blindness or deafness, are inherently substantially limiting. Many other impairments, however, may or may not be disabling depending on their impact on the particular individual’s functioning.
Quote:
In short, an impairment or its resultant effects must be sufficiently severe and sufficiently long term (at least several months) to rise to the level of disability, but need not be permanent.
Example: An individual has a ten-pound lifting restriction because of a back impairment. She would generally be viewed as being substantially limited in the major life activity of lifting because most people are able to lift amounts in this weight range.
Example: An individual has a thirty-five pound lifting restriction because of a back injury. He would generally not be viewed as substantially limited in the major life activity of lifting since this does not constitute a significant restriction on the ability to lift, work or engage in other major life activities when compared to the average person’s abilities.
Example: An individual has a ten-pound lifting restriction because of a back impairment. She would generally be viewed as being substantially limited in the major life activity of lifting because most people are able to lift amounts in this weight range.
Example: An individual has a thirty-five pound lifting restriction because of a back injury. He would generally not be viewed as substantially limited in the major life activity of lifting since this does not constitute a significant restriction on the ability to lift, work or engage in other major life activities when compared to the average person’s abilities.
So in the case of the new DSMV revision, the word limit does have a meaning
31 Jan 2012, 12:03 pm
aghog-
I have been through the ADA http://www.ada.gov/pubs/adastatute08.htm. The statue does say
Quote:
(1) Disability
The term "disability" means, with respect to an individual
(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment (as described in paragraph (3)).
The term "disability" means, with respect to an individual
(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment (as described in paragraph (3)).
Quote:
Mental impairments include mental or psychological disorders, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.
The inclusion of autism appears to be only associated case law. The commentaries on the ADA state
Quote:
Neither the
statute nor regulations interpreting and implementing the
ADA attempt to list all covered disorders or conditions.
A comprehensive listing would be almost impossible
given the number and variety of possible impairments.
statute nor regulations interpreting and implementing the
ADA attempt to list all covered disorders or conditions.
A comprehensive listing would be almost impossible
given the number and variety of possible impairments.
In one such case Taylor v Food World (and referenced in other locations), the Social Security Administrations's Listing of Impairments (Blue Book), is used to determine a "listed impairment". If there is a direct ADA listing could you post the link?
I mention Taylor because it sets a legal precedence for Asperger's to be a qualifying disability.
If you are intersted on ASD and Aspergers in the workforce, I highly recommend looking through the slide deck by Todd Van Wieren, Ph.D.
http://www.google.com/url?sa=t&rct=j&q= ... QV1U5-KeNA
01 Feb 2012, 8:27 pm
antimuda wrote:
aghog-
I have been through the ADA http://www.ada.gov/pubs/adastatute08.htm. The statue does say
The inclusion of autism appears to be only associated case law. The commentaries on the ADA state
In one such case Taylor v Food World (and referenced in other locations), the Social Security Administrations's Listing of Impairments (Blue Book), is used to determine a "listed impairment". If there is a direct ADA listing could you post the link?
I mention Taylor because it sets a legal precedence for Asperger's to be a qualifying disability.
If you are intersted on ASD and Aspergers in the workforce, I highly recommend looking through the slide deck by Todd Van Wieren, Ph.D.
http://www.google.com/url?sa=t&rct=j&q= ... QV1U5-KeNA
I have been through the ADA http://www.ada.gov/pubs/adastatute08.htm. The statue does say
Quote:
(1) Disability
The term "disability" means, with respect to an individual
(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment (as described in paragraph (3)).
The term "disability" means, with respect to an individual
(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment (as described in paragraph (3)).
Quote:
Mental impairments include mental or psychological disorders, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.
The inclusion of autism appears to be only associated case law. The commentaries on the ADA state
Quote:
Neither the
statute nor regulations interpreting and implementing the
ADA attempt to list all covered disorders or conditions.
A comprehensive listing would be almost impossible
given the number and variety of possible impairments.
statute nor regulations interpreting and implementing the
ADA attempt to list all covered disorders or conditions.
A comprehensive listing would be almost impossible
given the number and variety of possible impairments.
In one such case Taylor v Food World (and referenced in other locations), the Social Security Administrations's Listing of Impairments (Blue Book), is used to determine a "listed impairment". If there is a direct ADA listing could you post the link?
I mention Taylor because it sets a legal precedence for Asperger's to be a qualifying disability.
If you are intersted on ASD and Aspergers in the workforce, I highly recommend looking through the slide deck by Todd Van Wieren, Ph.D.
http://www.google.com/url?sa=t&rct=j&q= ... QV1U5-KeNA
While the ADA itself does not list disabilities that meet the definition, US Code Title 29 PART 1630—REGULATIONS TO IMPLEMENT THE EQUAL EMPLOYMENT PROVISIONS OF THE AMERICANS WITH DISABILITIES ACT was ammended and put into effect March 25, last year; it does provide a list of impairments that should normally meet the definition of disabilities under the ADA, and Autism is included.
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=83e0ea4a62b22c4cc11f8f2fa84b660c;rgn=div5;view=text;node=29%3A4.1.4.1.20;idno=29;cc=ecfr
Quote:
(3) Predictable assessments —(i) The principles set forth in paragraphs (j)(1)(i) through (ix) of this section are intended to provide for more generous coverage and application of the ADA's prohibition on discrimination through a framework that is predictable, consistent, and workable for all individuals and entities with rights and responsibilities under the ADA as amended.
(ii) Applying the principles set forth in paragraphs (j)(1)(i) through (ix) of this section, the individualized assessment of some types of impairments will, in virtually all cases, result in a determination of coverage under paragraphs (g)(1)(i) (the “actual disability” prong) or (g)(1)(ii) (the “record of” prong) of this section. Given their inherent nature, these types of impairments will, as a factual matter, virtually always be found to impose a substantial limitation on a major life activity. Therefore, with respect to these types of impairments, the necessary individualized assessment should be particularly simple and straightforward.
(iii) For example, applying the principles set forth in paragraphs (j)(1)(i) through (ix) of this section, it should easily be concluded that the following types of impairments will, at a minimum, substantially limit the major life activities indicated: Deafness substantially limits hearing; blindness substantially limits seeing; an intellectual disability (formerly termed mental retardation) substantially limits brain function; partially or completely missing limbs or mobility impairments requiring the use of a wheelchair substantially limit musculoskeletal function; autism substantially limits brain function; cancer substantially limits normal cell growth; cerebral palsy substantially limits brain function; diabetes substantially limits endocrine function; epilepsy substantially limits neurological function; Human Immunodeficiency Virus (HIV) infection substantially limits immune function; multiple sclerosis substantially limits neurological function; muscular dystrophy substantially limits neurological function; and major depressive disorder, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, and schizophrenia substantially limit brain function. The types of impairments described in this section may substantially limit additional major life activities not explicitly listed above.
One still has to be assessed, but autism is considered a condition that inherently limits one in brain function, a major inherent function in life, so per the law here, in the US Code, the assessment should be simple and straight forward for those conditions listed.
As I remember the ASAN organization expressed displeasure that ASD's weren't used as a term, when the code was modified last March, to ensure by legal definition that Aspergers would be defined as such, but once the disorders are consolidated in the DSMV, under ASD, that becomes a moot point.
It's not likely that many recognize this benefit, although ASAN is protesting some of the changes in the DSMV, I am sure they can see how the DSMV is a beneficial change in respect to the ADA and coverage for Aspergers.
It makes it much easier to win the issue, as long as one has an official diagnosis, if the employer fights to deny the claim based on ineligibility for disability.
01 Feb 2012, 10:20 pm
Let's be honest. With any kind of high-level professional career in a state with at-will employment laws, the only place where the ADA *might* save you is if you get a firm job offer contingent on getting an "acceptable" rating from a "personality test" like MMPI (which is so egregiously biased against introverts, let alone Aspies, it blows my mind that it's even legal to whisper that test's name anywhere in America), then get the offer withdrawn because MMPI scored you as a schizophrenic sociopath and pathological liar (among other things), because you over-analyzed questions that a NT would see as logical opposites, and gave conflicting answers to too many control pairs. THEN, you could probably invoke the ADA, argue that MMPI is is biased and that you're really a perfectly harmless (if socially-clueless) Aspie, and get hired anyway.
_________________
Your Aspie score: 170 of 200 · Your neurotypical (non-autistic) score: 34 of 200 · You are very likely an Aspie [ AQ=41, EQ=11, SQ=45, SQ-R=77; FQ=38 ]
01 Feb 2012, 10:59 pm
dr01dguy wrote:
Let's be honest. With any kind of high-level professional career in a state with at-will employment laws, the only place where the ADA *might* save you is if you get a firm job offer contingent on getting an "acceptable" rating from a "personality test" like MMPI (which is so egregiously biased against introverts, let alone Aspies, it blows my mind that it's even legal to whisper that test's name anywhere in America), then get the offer withdrawn because MMPI scored you as a schizophrenic sociopath and pathological liar (among other things), because you over-analyzed questions that a NT would see as logical opposites, and gave conflicting answers to too many control pairs. THEN, you could probably invoke the ADA, argue that MMPI is is biased and that you're really a perfectly harmless (if socially-clueless) Aspie, and get hired anyway.
It can be of benefit after one is already employed, if accommodation is needed for something as simple as someone playing loud radio music, if one has been assessed with Aspergers, with sensory difficulties.
I know of one individual that experienced such a circumstance in a 100K+ job in the Medical Field. A surgeon was playing fairly loud music, during surgery; she couldn't stand it because of sensitivity to noise, and she invoked her rights under the ADA, to get the music turned down.
There were other social interaction issues as well. She is a very strong person though, and was able to deal with fall-out among peers who couldn't fathom, that she was in a 100K+ job with a form of Autism. Even in a hospital environment. most of the employees had no idea what Aspergers was. A trained psychologist came in to educate the fellow employees.
The ADA can be a pretty powerful tool, if one is willing to use it. It's likely though that many hide their diagnosis that are successful in their jobs; that sentiment has been expressed on this website. For some the fear of discrimination later on down the line is more of a fear, than any benefit from ADA protection.
At least in the future, it appears that it will be easier to invoke, for individuals diagnosed with Aspergers, when the DSMV goes into effect.
btbnnyr
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Posts: 7,359
Location: Lost Angleles Carmen Santiago
02 Feb 2012, 11:09 pm
I don't understand where there are any contradictions.
Criterion C: Adults who meet the criteria for Asperger's Syndrome or ASD in adulthood without having a childhood developmental history consistent with an autism spectrum disorder, aka autism, are not autistic and therefore cannot possibly have Asperger's Syndrome or ASD and should not be diagnosed with Asperger's Syndrome or ASD. Autistic traits must be present in early childhood. I agree with that. Otherwise, the person is not autistic and developed social problems and RRB later for any number of reasons. The only exception is childhood disintegrative disorder, which can onset in late childhood, but this disorder is rare and involves its own easily identifiable developmental course and high severity of traits. For an autistic person, it is not at all difficult to identify autistic traits in a retrospective manner. Most likely, the autistic traits had been identified long before the person ever heard of autism, but the big picture of the person being autistic had not been seen due to the lack of knowledge of autism during the time period when the person was a child.
Criterion D: Yes, needing help to up your level of functioning to that of your peers is an impairment. Without help, you would be significantly limited in everyday functioning. e.g. Someone might need a flexible work schedule due to overload/shutdown issues, or otherwise, she cannot work. Without help, she cannot work. If she has no ASD diagnosis, then she gets no accommodations anywhere, so she cannot work. That is limiting. Once you have an ASD diagnosis, you can get accommodations, and you can raise your level of functioning. Clinicians do not operate like if you have help and can work, then you are not limited. One of the first things that my clinician asked me was what accommodations I would need to raise my level of occupational/educational functioning. If I did not need any, then there would have been no need for diagnosis. It turned out that my childhood history and adulthood experiences showed that I did and do need that help, e.g. IEP in grade school and junior high. Otherwise, I cannot function up to any level near my potential. The point of the diagnosis is to have a reason to get the accommodations. Otherwise, no accommodations ---> significant limits in functioning.
