they changed it again

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Just checking because of timing: Was this in response to me?

I think it was a reply to the OP.


I like you. Let's have a picnic somewhere.

I think I've exhausted myself in these types of threads. I'm against the extremely mild AS, just want to know to feel better about self type of people.
I really don't care who I offend.
I know AS can be impairing for some. But it does make sense to not want to overdiagnose the disorder, because that's what it is - a disorder.

Nope. It was just meant in referrence to this "changing it again." It isn't a change, and isn't as far as I know "again." The DX criteria as far as I've read so far, has never changed. DSM-IV is the first DSM to contain AS as a DX. And that's still in force.

Didn't mean to look like i was yelling either. It's important to understand that the proposal isn't "official" yet.

That said, I used to think the new entry was a bad idea, but once I read and analyzed the rationale behind it, I think it's going to be a lot better.

The rationale makes it pretty clear that the intention is NOT to exclude anyone already being DX'd on the spectrum.


Have you seen this line yet?

"A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”.

Now that's funny! Goes to show at least the APA has a sense of humor about itself.

ooOoOoOAnaOoOoOoo wrote:

I think I agree with this too but I originally thought League Girl meant what about people are still impaired like how now PDD-NOS is for people who have impairments but not perfectly fit any one category.

That's what I thought was meant.

Pensieve and MrXxx,

Thanks. Sometimes it's hard for me to tell.

That "cleave a meatloaf at the joints" comment is priceless.

Anyone who is impaired has a disorder, regardless of whether they have AS or PDD-NOS. It's all the same thing, anyway. It's just different manifestations and levels of severity. Someone with PDD-NOS could be more AS like at a certain time, PDD-NOS like at others. It leaves them asking "which do I have, PDD-NOS or AS?" The answer is: BOTH! It's because it's autism and they are demonstrating various traits associated with autism at various times. That's why the diagnoses are so confusing and why it should all be under one diagnosis.

Exactly. As I said -- the severity tabs say NOTHING about how much support you need to get through the day in general. They only refer to sociability and to restricted interests and repetitive behaviors. And while they each briefly mention support, the severity thing isn't about how much support you need overall, it's about how severe insociability and repetitive behavior are even in the presence of support, and how much support you need with THOSE TWO THINGS ONLY. Totally different concepts. It's not like I commented without reading the thing good grief.

Last edited by anbuend on 29 Jan 2011, 7:13 pm, edited 1 time in total.

I don't really see what the problem is. It seems to include all of the relevant current criteria plus sensory issues and rigid routines. So it's seems pretty clear that everyone with an AS diagnosis will be included in the new criteria. If not, then maybe you never had it in the first place?

I don't see them trying to exclude people to save money or whatever, if anything they have broadened the criteria to include people, who may not have been diagnosed before.

The problem is that in the past you had to meet only two social criteria not three even for an autistic disorder diagnosis. Meanwhile they've removed the communication criteria. So lots of people who got autism, AS, and PDDNOS won't be included as it stands now. Even if they had it what most would call severely. Also autistic people who were diagnosed largely on the strength of the communication criteria are out of luck because most of those criteria are not in the new version. And that's just the beginning.

Meanwhile (on the topic of how much help you need to get through the day), people who need total care because of autism can be rated mild and people who need nearly none can be rated severe. So it's obviously not about how much help you need to get through the day. It's just about how much help you would need for social or repetitive behavior stuff to be more normal (if you even got the help -- which many people don't even if they never initiate social contact and engage in constant repetitive behavior). Not that I think severity can be easily ranked in any way but claiming that these criteria cover the help autistic people need to get through the day just shows ignorance of the kind and amount of other help autistic people need. If I just needed help to be social and stop stimming (as if I want to) then... my world would be way so much different.

The social criteria now is social/communication criteria; two have become one. Within the three criteria are subdomains which are expected to fit those that are currently diagnosed. Nowhere are they suggesting that anyone will need to be rediagnosed, instead they suggest that the existing diagnosed people should meet the new criteria, per my previous post in this topic that included this information from the DSMV website. The existing conditions of Childhood Disintegrative Disorder, PDD NOS, Autism and Aspergers will be subsumed under the new diagnostic title.

No psychiatrist is going to do it on their own unless someone seeks a re-diagnosis. Who would pay them for this? Why would anyone go in for a re-diagnosis and pay an additional fee, if a re-diagnosis is not going to be required? The people that are doing the revisions understand the logistics of this factor and consider it when making the revisions.

As long as there is not a requirement for re-diagnosis; there is no significant legitimate concern that anyone that has an existing diagnosis of Autism, Aspergers, Childhood Disintegrative Disorder or PDD NOS will be dropped.

And as far as people who are now diagnosed with a disorder who are okay with it and think they are fine, that's good but technically they are still diagnosed with a disorder. This opinion in itself is not going to cause them to be dropped; the psychiatrist has already made a decision that this individual has a disorder.

And finally, the original diagnosis can meet the required criteria of an impairment that limits and impairs everyday functioning. This doesn't mean that the person can't work or take care of themself. The impairment of social/communication abilities can be considered to impair the everyday function of interacting with others. The same applies to Repetitive and ritual behaviors. These impairments do not have to be severe to limit functioning, as indicated in the severity tab.

Of course, all of this could change in the future, depending on further revisions.

As far as people who are seeking a new diagnosis, once the new criteria comes out, I'm sure there will be a debate among some of them as to whether or not they should of waited for the new criteria to come out before they got diagnosed.

Sorry, for the lengthy post but I would hate for anyone that already has a diagnosis to be overly concerned about this.

Don't fit this. Phrased too narrowly. No deficit in social-emotional reciprocity; you scratch my back and I not only understand the principle involved but will scratch yours. Also, none of the descriptions describe what I would consider social-emotional reciprocity. Abnormal social approach, yes, but not failure of normal back and forth conversation. Don't think "reduced sharing of interests" ought to be used to describe a group whose members are famous for monologuing about their interests. I share my emotions, but you don't know how to read them. Even so I have ways of communicating them. I do indeed share. Reduced affect? Honestly, I show emotion with different body parts sometimes. How many NTs would guess that if I tug on the brim of the hat I'm wearing, it's because I'm overloaded? But since it's a highly-visible behavior that consistently indicates one emotion (that or the sun is in my eyes), it is body language. "Flat affect" means something on me, too, when I have it (which is not often). But not what people think it means.



I use an internally-consistent system of visible, communicative body language which I read with ease when exposed to. Therefore, I have no deficits. However, my body language is nonstandard, so NTs can't read it. I can read theirs quite well, but not as well as they can read each other. You can't say I have deficits in these areas. If a native speaker of English, who uses it without difficulty, moves to China, you don't say he has deficits in his ability to speak.



First of all, how can you call "an apparent absence of interest in people" a "deficit in developing and maintaining relationships," and how has no one else pointed out what an awful thing to say that is?? I have no interest in heroin. Do I have a deficit in developing and maintaining a heroin addiction?

Anyway, I have no idea if I fit this criterion. Oh, and you're missing a period.

CRITERION A: NOT MET.



See, I get the awful feeling this is supposed to include stims, which are different every time but look rather similar (and to NTs who don't care, and are prejudiced, they look exactly the same). As for actual repetitive behavior, actually doing the same thing over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over...

Well, after the first three "over and"s, I was just having fun doing the same thing repeatedly. I decided to keep on and not backspace to make a point. Normally I'd ignore it and get on with typing. I don't do repetitive things all that often, but I do sometimes, and they're really fun!!



Question. Would "ritualized patterns of verbal or nonverbal behavior" include the sorts of things NTs do, or just nonstandard things, because obviously there's nothing wrong with it if it's normal, but clearly any deviation from the norm in any way is inferior...

Anyway. What do you mean by "small changes?" I don't have extreme distress at small changes. I have extreme distress at huge, upsetting changes that turn my whole world upside-down. Stuff that other people might mistakenly consider "small changes," but stuff which is NOT small. Also, it's not about change. It's about predictability and comfort. It's also about control. Every person alive seeks all three of those. I need a little more predictability and control sometimes. So that means other people just changing things without warning is upsetting. I also like sameness, but not nearly to any ridiculously extreme degree. I will stick with how things are as opposed to changing them, just for the sake of maintaining sameness, and I will do a lot of that, more than many NTs. But I can deal with very major changes, so long as:
1. I have warning.
2. They're positive or neutral. (Making life better, or at least not worse.)
3. I'm the one making them.

When both of the first two criteria are met, I can often deal without the final one, but it's much easier that way.

I don't have excessive adherence to routines. My executive function is too awful to allow me to create them. When I can, I do indeed do things the same way over and over and over and over and-- okay, okay... but anyway. So I do things the same way. I like sameness. I like repetitive movements. I like sitting still. I like pairing two experiences and then always doing them together. I like having the same experience again. I like going to a restaurant more than once in the same weather and ordering the same food. (I even once made a routine of going to Indian restaurants on Wednesday afternoons to try new dishes. Apparently, trying new things is not at all incompatible with doing the same thing over and over again. It's not very intuitive, that.) But I can't synthesize routines very well. I can't get organized. So it's hard to make this happen. So it doesn't.

Anyway, none of what I (or many others) do by way of resisting change is excessive. But that doesn't mean no one else would perceive it that way.



Unusual objects? What makes an object unusual in this context?

Anyway, I think they're talking about special interests. I'm not totally sure if mine can be described as circumscribed (since the boundaries are fuzzy; some parts are definitely in the special interest; those fade into the parts that are related and interesting and get read up on but not obsessively; and those fade into tangentially related stuff I find interesting but which is definitely not part of my special interest, but may sometimes get studied; and those fade into things totally unrelated to my special interests). I think they're definitely perseverative, though. But they're not highly restricted. They vary, and so over the course of my life, I either have had or currently have all of the following as special interests (PARTIAL lists of related topics it's made me read up on without taking on as special interests):

Psychiatry and psychology (tangential connections: medicine, Psychiatric Survivor movement)
Writing (tangential connections: ...everything known to man; for stories, I have had to research burns, wolves, love potions, mental illness, Oregon, plate tectonics, climate/weather, deserts, gems/crystals/precious whatevers, language, blindness, medieval Europe, the mixing of new-world and old-world critters post-Columbus, the Victorian era, quantum physics, organized crime, Parkour... so technically writing has made me read up on all of those)
Fish (initially, it was specifically Betta splendens, with fish in general as a tangential connection, but those other fish were just as interesting... honestly any fish that are tangential connections will become special interests given enough time... but anyway, non-fish tangential connections: biology, nitrogen cycle, the environment, reintroduction)
Anime and manga (tangential connections: art, Japanese)
Japanese language (tangential connections: Japan and Japanese culture, anime-- yep, feedback loop, I can have one for a special interest and be sort of interested in the latter, and then it can change-- learning languages, why people half a world away from each other separately came up with the idea to deep-fry everything)
Fandom in general and various specific fictional works too numerous to list, but generally science-fiction and fantasy (tangential connections: Wagner's Ring Cycle, the middle ages)
The Bible
Politics (NOTE: do NOT try to talk politics with me; it was so depressing, especially to be obsessed and think about it constantly, that I had to quit paying attention to save my sanity)

Anyway, my point is, they're quite varied. Combined with occasionally going to the library for interesting books, I'd say I'm decently well-rounded, albeit in unusual ways. My interests, then, are not "highly restricted."



I definitely fit this!

CRITERION B: I DON'T KNOW.



Indeed. Is it just me or does this seem like a rude way to phrase it, thought?



Not met. Definitely causes some bad things, but also some good things. I happen to be in a good environment right now, one where I can use my strengths to my advantage but don't have to do things I'm not capable of.

I can't disagree with your assessment of yourself, but in terms of the current criteria for Aspergers do you think you meet the current requirements. Based on the things you commented about the DSM V proposed revisions for the Spectrum, do you meet the requirements for the items highlighted below. I can't see how the highlighted criteria are significantly different from the criteria in the DSM V that you didn't think you met.

Asperger’s Disorder
A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) 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

(2) failure to develop peer relationships appropriate to developmental level

(3) 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 to other people)

(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

It's kind of more about the precise wording. I don't know, are you meant to interpret the criteria loosely? I always thought it was "all of these statements have to be literally true in the most narrow interpretation thereof" and that kind of makes the difference. Some time after I was diagnosed I went over the criteria to see if I agreed. I don't know what relationships appropriate to my developmental level are right now, but at the time I was looking these over, I definitely had failed, and failed often and hard, to form them. I don't know now, because I have a social life that I consider satisfactory, but which is not typical. Also, for the DSM-V you have to meet all three, whereas for the DSM-IV you only need two.



Some time after I was diagnosed I went over the criteria to see if I agreed. I don't know what relationships appropriate to my developmental level are right now, but at the time I was looking these over, I definitely had failed, and failed often and hard, to form them. I don't know now, because I have a social life that I consider satisfactory, but which is not typical. I also, at that time, hadn't realized I had an instinctive, internally-consistent body language that I used and could read in others.

But even so, it seems like just an overly-bigoted way of saying "doesn't use NT body language" and... I mean, I can't use eye contact to regulate social interaction, for instance. I can't make it. This way gives the impression that they mean not being able to use, or being bad at using, specific behaviors that NTs do, while interacting, to make that interaction work. The DSM-V sounds way more like it means across-the-board can't use body language.



DSM-IV only required that two criteria be met. DSM-V requires all three.



I guess now I think about it it does say "restricted" but other than that it really, really sounds like an overly-formal, rather typicalist description of a special interest. And it basically says that you have an "encompassing preoccupation" rather than saying that your interests are narrow... IDK, it seems like the difference between saying "you have red skin" and "your skin is red." I might well have red skin if I get sunburned or step out of a hot shower. However, my skin is unlikely to be red-- I also have non-red skin, mostly of varying shades of brown. You know?



At the time I was initially going over these criteria, it did. But anyway, I'm sick of this awful criterion anyway. Why? Because whether or not you're impaired is as much a function of your environment as of your skills. It's not my skills that make me non-impaired right now. Well, it is-- someone could be in my situation and impaired because they lacked skills I have... but then, I could be in other situations and be impaired. But for another thing, for the benefit of all [url=http://www.wrongplanet.net/postt146071.html]dandelions (I here use the word where many people would refer to autistics, because I refer to "us" or "people like me" or "my group of people who think in many ways, most more similar to my way of thinking than to the most common" and I do NOT mean "what psychiatry calls autistic")[url], I think we need dandelions to share their experiences, and to be studied as a whole group, regardless of whether or not they've been lucky enough to be in an environment where they aren't impaired. In fact, arguably, unimpaired dandelions are even more important to study, so we can learn why they're unimpaired. Also, it's annoying to try to argue that it's fine to be autistic, but have the definition of autism basically say "it isn't fine to be autistic."



Pass criterion D with flying colors. I actually don't know if I fit criterion E; I have a sneaking suspicion that I don't, depending on your definition of "age-appropriate self-help skills" and "adaptive behavior" and "social interaction." But I couldn't say.

Criterion F... okay, let's look. Schizophrenia requires two or more of: delusions (do not have), hallucinations (do not have), disorganized speech (no more than everyone), grossly disorganized or catatonic behavior (do not have), "negative symptoms, i.e., affective flattening, alogia, or avolition" (have this). That's only one where two must be met. Don't need to go over the rest. But criteria for autism...


This is verbatim from the other criteria. Have two.



Do not meet.



Do not meet.



Do not meet.



Do not meet.



Also verbatim.

So it requires six, and I have three.



I do not recall whether or not I even met anyone my own age when I was not yet three. I do not recall being not yet three. I think there were some issues with social interaction when I was three, but I managed to do okay until I was eight. Very young children are very forgiving. So I guess I don't meet this one. I only meet it with the caveat that's in the Asperger's criteria, that the issues might not be an issue at very young ages.

AAAAARRRRRGGHHH!! !! I wrote a very long, detailed post. It did not show up. I clicked edit to put this message there, but apparently the site thinks my whole post is indeed still there, because that's what was there for me to edit it. So it does actually think it's posted what I said.

The gist of it is, yes, I do fit.

Edit, copy/paste, save edited post?

I am not a doctor, but hey, I'll at least try to interpret these about myself

I am not sure about abnormal social approach. I have a failure of normal back and forth conversation through an excessive sharing of interests, so I'm not sure how that works. If it's outside my interests, I definitely have a failure of normal back and forth communication, as I am pretty likely to zone out and just pretend to listen unless it's urgent enough to hold my attention. I do have issues with social-emotional reciprocity since I basically have to flip through memorized/learned responses in order to respond to emotional situations.



I don't really make eye contact consistently. I do it more with family, but it's really awkward/uncomfortable even then, and I am not sure I hold it for the right amount of time. With other people, it's much harder. I am not sure what my body language is like and didn't think there was anything off about it before recently, so I don't know. I do know people often misread my intentions and assume I'm thinking or really mean things I do not think or really mean, so perhaps. My understanding of facial expressions and body language is spotty, but gets increasingly difficult with more people. Too many people and I just zone out.



I have difficulties maintaining relationships, to the point that it's really easy for me to forget to stay in touch with people for weeks or months at a time. Sometimes years, but at that point I've probably lost them as friends anyway.

I have issues with adjusting to different social contexts, to the point that I dislike going into certain kinds of social contexts - I am not sure I will attend my niece's wedding for this and one other reason (my sister invited my abusive father), and I am not sure I can adjust to such a social setting due to the high degree of small talk and socializing and probable lack of any discussion of my own interests. Even if said abuser wasn't present, I'd be inclined to avoid. I've been the same about birthday parties and funerals.

I do not think I have a total apparent absence of interest in people, but I think it's pretty clear that being around people is not high on my daily criteria. I have friends, and I talk to family, but I don't go out of my way to socialize, and mainly prefer to be alone. I am interested in people, but most of the people I communicate with are online.



I do all of these to some degree, but I am not sure any of them would count as impairing. Unless "obvious" counts as impairing, and then stimming might count, even though I think my stims in front of other people are pretty minor.

I do repeat phrases, but not too frequently. Often enough to notice, but alone it happens far more often. Plus repeating phrases that are irrelevant to whatever I'm doing (usually taking a bath, or using my computer).

So I am assuming no.



I don't have a routine in the sense of a strict daily schedule, but I have daily expectations that are routines with a bit of examination. If I don't have warning about visitors, for example, I get really upset/angry and avoid them entirely. Other disruptions have been far more dramatic and caused me even more trouble. I tend to do things I like in the same way every day, have some ritualized patterns of behavior that may or may not qualify here.



Yes to this. See how many posts I have in under two months? Yeah, autism's my current interest.



Yes to this. Especially indifference to cold and pain, adverse response to sound and light, etc.



Yes.



Yes.