What do you think of the recommended new DSM?

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mechanicalgirl39
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20 Aug 2009, 7:17 am

http://www.psych.org/MainMenu/Research/ ... eport.aspx

Do you like the idea of getting rid of the different syndromes and simply referring to them as mild, moderate or severe ASD?


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MONKEY
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20 Aug 2009, 7:33 am

Meh, I think the DSM is OK as it is, anyway I didn't even use the DSM when I was diagnosed.
I'm thinking, for those who used the DSM would they no longer be called as AS? Would they just be "less severe ASD" instead? And people who didn't use the DSM will still be AS? Or will these definitions be the same for all criterias?


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20 Aug 2009, 7:34 am

I like it but I can be moderate in social but mild in behavior. Where would I fit? In general I think it is a step in the right direction. Particularly because the characteristics bleed into each other so often anyway.



timeisdead
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20 Aug 2009, 7:37 am

The line is often blurred because there are some instances in which the new criteria won't accurately describe functioning level. What if someone is completely preoccupied by a special interest to the point of it taking over his life but this special interest has made him financially successful? What if this person is happy with his obsession taking over his life? What if it gives him never ending ambition?



ChangelingGirl
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20 Aug 2009, 7:38 am

I agree with the idea that AS, PDD and autisms hould be lumped together under one name. I am not sure what I think of the severity scale, since I'm not sure whether severity/number of symptoms correlates strongly to severity of impairments in daily functioning. I also don't like the inclusion of "subclinical" and "normal variation" - these are not significant and therefore don't belogn in a psychiatric handbook.



Danielismyname
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20 Aug 2009, 7:45 am

I'd fairly receive moderately severe going by this (if social communications applies to parents and siblings that is).

I like it.

I suppose the addition of subclinical and normal variant of personality is there for people who have BAP or "mild" AS.



idiocratik
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20 Aug 2009, 7:46 am

I kinda like things to stay specific.


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MONKEY
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20 Aug 2009, 7:48 am

idiocratik wrote:
I kinda like things to stay specific.


Yeah same here


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20 Aug 2009, 8:32 am

I like how that highlights the slight differences because it can explain that you has a most severe or moderately severe ASD before or now when you had a less severe ASD now/before. And I imagine it could encourage professionals to write 'eye contact is most severely impaired, speech is less severe impaired' and so on?

What do the Xs mean?

I also agree with that bit about the diagnosis of MR. Thinking of people with intellectual disabilities, their labels say very little and they also have unique profiles and skills which are not reflected by a diagnosis of 'mild MR'.


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anxiety25
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20 Aug 2009, 8:37 am

I kind of like how it's grouped up differently, but in general, we all have pretty much the same symptoms-or a lot of them in common anyway... so I think the original is just fine.



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20 Aug 2009, 8:42 am

I prefer it being a bullet point list. But I agree with the removal of 'what were you liek as a toddler', instead diagnosing based on how the person is at the time.

It could be extended a bit more, though. Maybe replace it with one criteria, and a number ranging from 1 to 100, with most people scoring somewhere around 85-90, and 1 meaning the person has very, very, very severe Autism.


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20 Aug 2009, 8:58 am

Not an AS checklist topic

No more magic bullets? A good assessor will use good judgmnt as well as the criteria set out by any DSM in use, as my psychologist did in his report, which, to his credit, was an assessment in terms of how Adult AS impacted on employment and education. Co-existing conditions should also be considered, as these are what make it hard for me to function in the large society.


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Danielismyname
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20 Aug 2009, 9:05 am

It'll probably rely more on the "expanded text", which will explain what an "ASD" is in-depth.

People tend to overlook the expanded text with the current one because there's a heap of information in the criteria themselves, which offer a somewhat decent view, just not the whole lot.



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20 Aug 2009, 9:53 am

Would someone with a bachelor's degree working as a janitor qualify as decreased employment capabilities? I mean I think my main problem is my executive dysfunction and my tendency to become stressed out and then fatigued.



Callista
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20 Aug 2009, 5:12 pm

Yes, I do think that qualifies. Being under-employed is significant, and "underemployed" can even mean someone who academically has a PhD working at the same level as people with bachelor's degrees because of social delays.

I kind of like it. I would prefer not to have it linked so much to IQ, though, because we still have the problem of someone with, say, Down syndrome and an ASD, being rated "severe" when it's actually that he's got global stuff going on that means you've got speech and self help skills coming in slower anyway. Second IQ gripe: It's often really hard to measure IQs in autistic people, and IQs are only loosely connected to ability to function in the community anyway. We've got autistic geniuses who need round the clock care, and people in the MR range who are living on their own with minimal supports; in between there's people with genius IQs who need moderate support and people with average IQs who somehow have advanced degrees thanks to Aspie perseveration... IQ really shouldn't be tied to it. Functional level--the level at which you can take care of yourself--would make more sense; like the intermittent, limited, intensive, pervasive scale.

If you categorize by functioning level, you end up with people who are strongly ASD lumped in with people who are mildly ASD and have some other disability.
If you categorize by ASD severity, you can't predict how much help they will need because of co-morbids and such.

So you need to yank that GAF out of axis 5 and stick it next to the ASD level as a "support level", like so:

Examples to illustrate what I'm thinking of--
"Moderate ASD, limited support"--person who can't drive or live on their own, but does fine in their own apartment with assistance in cooking, shopping, and a decent transportation service

"Mild ASD, pervasive support"--a child with developmental delay and mild autistic traits, who requires a great deal of help to take care of himself but only has mild communication deficits and repetitive behaviors

"Severe ASD, limited support"--Good self help skills, but no speech or ability to socialize, and self-care skills are only used in the context of a routine that is identical from time to time--may actually have a very high IQ, if testable; needs someone to help clean apartment, cook, shop, etc.

"Mild ASD, intermittent support"--Adult autistic, requires help with education and/or job placement, possibly with transportation or access to counselor/coach

"Severe ASD, pervasive suport"--Nonverbal, difficulty taking care of themselves, probably has SIBs to watch out for, huge executive dysfunction and sensory issues. Communicates via text to speech device; may have high IQ or isolated savant-like talent despite daily difficulty.

See what I mean? This would be a truly helpful diagnosis. It would define the strength of the ASD symptoms, and predict how much help the person needs, but it wouldn't categorize based on IQ because the IQ really can be all over the board within these categories! If severity<support, one can assume there is global developmental delay or another disability involved.


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