Diagnostic Criteria

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Ok, i made a similar thread awhile back, but this is still bugging me.. Maybe i'm just focusing too much on the exact wording... i do kind of obsess on wording sometimes.... but, even if that's true, then that means that something must be wrong with the way the DSM is wording things. But, yeah... Has anyone else noticed that in the criteria in the most recent DSM, it seems like pretty much most people with Asperger's Syndrome are also going to match the criteria for Autistic Disorder? In fact, it clearly DOES NOT require any kind of speech delay.. And it looks like, to me, the vast majority of people who are diagnosed with AS actually do also fit the criteria that the DSM lays out for Autistic Disorder. I don't even have an official AS diagnosis yet, so there obviously wasn't anything that sent off red flags to too many people when i was little(and compared to a lot of folks here, i'm probably a pretty mild case), but it even looks like i could basically fit into the DSM's Autistic Disorder criteria. Barely, but still. For any of you diagnosed with AS, look over each of these criteria and tell me how well you fit. Because, with the DSM criteria for AS, you, supposedly, shouldn't be given an AS diagnosis if you match the Autistic Disorder criteria.

Autism criteria:

"A. A total of six (or more) items from (1),(2), and (3), with at least two from (1), and one each from (2) and (3):
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g.,by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder."


Results? Is this a flaw in the DSM, or is it just illustrating how grey the area between HFA and AS is? Or both?

1 and 3 are both in the AS criteria... But, i'm sure that a bunch of aspies can find at least one thing in 2 that fits. Speech delay is only one of the possibilities. Impairment in the ability to initiate or sustain conversations can easily apply to lots(maybe most) of aspies, though. Then, the other little thing that's different from the AS criteria... B. Aspies have the language part down... But.... how many aspies can really say that they didn't have "abnormal functioning" in social interaction before they were 3? I think that, considering aspies generally have problems with "social interaction," that the onset was probably before age 3 in most of them. And i'm sure lots(of not most) of aspies have at least 6 out of sections 1-3. Tell me, am i on to something here? Because something about this does not compute.

I agree that there is little use for these separate diagnoses. But apparently the psychidiots who created the DSM think otherwise.

Not a flaw.

If you read the expanded text, each criterion that's the same between the two manifest differently in appearance (it breaks them down point by point in the book).

Take this for example (direct from the DSM-IV-TR):

I just can't get the part where it says

The either suggests that it shuld be intensity or focus, or that there should be something else there. Is it just a mistake on the CDCs part?

Me. Because I was with baby sitters and in day cares since about a week after birth. That's why early education programs and autism awareness are so important. A lot of the screening can be done there, kids can get services before age five this way.

Here's a scenario: Suppose you have parents who bring their child to their pediatrician because something is off in their development and they suspect it could be autism but their child is talking, walking, interested in what's going on around them, has reached developmental milestones on time. Before 1994, diagnosticians would not know what diagnosis this was. They wouldn't have a "place" on the spectrum to put someone who is like this. I know, because I was this way. When I was four, autism was mentioned as a possible diagnosis but they shook their heads because I was more interactive than a child with autism.

I was showing signs of autism before I was 3 and my play skills were below the age level. Doctors thought autism when they took me in and they evaluated me and said I was suffering from autism. My parents didn't buy it. I had hearing loss was why. Then when I was eight I was being evaluated again so my parents can put me in a class with normal kids and the doctor wrote he doesn't agree with the autism diagnoses I had because my sociability was too developed.

Yes, it is intensity OR focus. This means that the criterion can is met if someone has an interest that they are absorbed into for more time than would be considered normal and to the exclusion of other activities (eg. if someone is obsessed with video games to the exclusion of spending time with friends), but the criterion is also met if the person has an interest that focuses around something odd (eg. someone is only interested in memorizing train schedules rather than being interested in trains).

There were signs for me at an early age, I know it. My mom bought me a toy organ when I was 2. All day, I would sit in my room and play on it. I was also very clumsy growing up, but my mother thinks it's because I needed glasses. She also thinks that my relatively late application of glasses led to motor skills issues. My thought about this now is that is probably not true.

Funny how parents can rationalize this stuff away. Makes sense, though. What else was she suppoesd to do?

Intensity OR focus? That is... interesting, especially in light of the 'socially acceptable obssessions' thread.

How_so?

So the same level of interest can fit the criteria if it's about toilet handles, but not if it's about say politics?

I'm not sure if most people could really meet both sets of criteria? Because I suspect you cannot.

AS after all requires:

while classical autism requires



So you either meet one or the other, but not both?

Social interaction before age 3 almost only consists of interaction with parents and environment. (Kids before age 3 don't usually play with each other.)

If you are impaired in that it can mean you didn't listen to your name, ignored everybody and so on in which case you would not meet the AS criterion about A. normal curiosity about the environment and B. probably also not the normal self-help skills (because you need to learn that from other people by imitation based on interaction).

Imitative play has a lot to so with interaction. It usually involves language too. A child imitates what it has seen, heard, learnt in everyday life. If it doesn't 'get' or is totally oblivious of basic stuff such as that things have names that parents tell the child, that there are greetings between people, how normal everyday things work because the child has seen an adult using it (silverware, making food, writing, driving a car), it can't very well imitate these.

So if you don't have normal curiosity about the environment, I don't see how you could have developmental appropriate imitative play before age 3. You could of course have only mildly impaired curiosity about the environment and show some imitative and even imaginative play and then diagnosing is hard.

Though: Just to point out, having no imitative play before age 3 doesn't mean you can't be extremely creative and imaginative.

Diagnostic Criteria for 299.80 Asperger's Disorder part II
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects

Where does it say anything about the stereotyped or restricted pattern of interest being odd?