Page 3 of 3 [ 40 posts ]  Go to page Previous  1, 2, 3

Chichikov
Veteran
Veteran

User avatar

Joined: 27 Mar 2016
Age: 45
Gender: Male
Posts: 1,151
Location: UK

31 Mar 2016, 11:25 am

BTDT wrote:
What is a "significant impairment?"

Has job--this means not impaired significantly?

If it was as simplistic as that the diagnostic materials would say so. In reality it will simply be a judgement call from the professional doing the diagnosis.

This is one of the main problems with on-line tests....there are two things an online test can't tell you; if you are significantly impaired and (more importantly) what you don't have, as what you don't have also plays a part in diagnosis. Many conditions overlap and again it it up to the diagnosing professional to consider a range of possible issues, whereas the average person on the street who takes an on-line test is far more focussed on a single issue.

An on-line test will tell you your arm is injured because it hurts when you poke it. A professional doctor will tell you your finger is injured as it hurts when you poke anywhere.



Jo_B1_Kenobi
Velociraptor
Velociraptor

User avatar

Joined: 8 Jan 2016
Age: 49
Gender: Female
Posts: 412
Location: UK

31 Mar 2016, 2:00 pm

BTDT wrote:
What is a "significant impairment?"

Has job--this means not impaired significantly?

Well, for the state/government, this is all they really care about--whether or not you can hold a job so the state doesn't have to support you with money that comes from taxes.

But, many Aspies do in fact aspire to having more than just a job--such as having a real life relationship. But the state/government doesn't care about that.


I agree, I have held down jobs - I just can't do it in the long term - things always end up going wrong. Plus, although work is really important there is still lots more to life than work, especially having a real life relationship. The inability to do that I would certainly regard as a significant impairment.


Quote:
Autism is more than "impairments". Myself and many other people feel trivialised or worse by people who lump all of autism under "impairments".


I concur, vehemently :D


Autism is more than impairment but, for me certainly, it would be false to think that impairment is not a significant part of it, the bigger part of it in fact. I don't think it trivialises our unusual neurology or the many things we are really good at to say this. In this thread though, I feel that we're talking specifically about diagnosis, which is something we give to people who need help, because they are impaired in some way compared to the majority of people. So, getting back to Baron-Cohen, it seems reasonable to me for him not to give a diagnosis, which implies significant impairment, to someone who doesn't meet that criteria.


_________________
"That's no moon - it's a spacestation."

Diagnosed with Autism Spectrum Disorder (ICD10)


naturous_aspect
Emu Egg
Emu Egg

Joined: 30 Mar 2016
Gender: Male
Posts: 4
Location: London, UK

31 Mar 2016, 4:42 pm

Thank you all, for your replies on this topic of discussion. :)

Chichikov wrote:
"The criteria" state that you don't just need to have various traits, but that those traits cause significant impairments. To be perfectly honest, SB-C kinda has a point. Obviously you'd need to judge things on a case by case basis, I haven't seen the case he made those comments in relation to.

Where in "the criteria" does it say this?

In the programme, Horizon, he never qualified what he was saying by saying something like 'well we can't use it [the AQ50] to make the diagnosis alone'. Simon Baron-Cohen spoke very plainly of withholding diagnoses, which others have referred of him doing earlier within this thread (i.e. his appearance on Channel 4 News)

Let me quote what has been stated elsewhere on this, the review on the programme by Cos Michael - Asperger United #79, July 2014, p11
"The controversial point was the discussion with Simon Baron Cohen about whether all people with autistic traits need a diagnosis. He believes that it is up to clinicians to judge whether a diagnosis ought to be given or withheld, based on their assessment of how autistic traits affect the “everyday functioning” of the individual. This seems to be a contradictory argument: if a person is having sufficient difficulties that they are seeking a clinical diagnosis, it clearly is affecting their life. Unless the clinician is dismissive of the patient’s perspective, there is no case to consider."

Also, may I just highlight the relevant section from the Nikki Stephenson article in the Guardian I cited earlier:
"A common misconception around autism is that it is inextricably linked to intellectual disability ... An obvious cause of this discrepancy is that very intellectually able people are less likely to be diagnosed. Furthermore, some diagnosticians actively withhold diagnoses in those deemed to be coping."

I understand that many of the items on the AQ50 might simply be indicative of personality type, and some of the more quirky attributes could well be the result of 'traumas' - of the kind that might be resolved by psycho-analysis. Clearly this is where the full assessment comes in, to identify the person has answered truely and that those markers really are indicative of the cognative differences associated with aspergers/autism.

Although I would hazard enough to say that anyone scoring highly on the AQ50 would be having difficuties integrating with wider society... the idea of someone getting a high-score and 'doing fine' is to me an oxymoron.

I don't know what the diagnostic pathway is like for other people in other parts of the world - but myself I was referred on from a psychological therapies service which I attended following a period of depression. The issue of my current circumstance, or mental state, was not touched on in the autism assessment. There would be no basis for them to determine whether I was 'doing fine' or not.

Of course, because what really appears to be Baron-Coren's thinking is: 'i think too many people are getting diagnosed with the syndrome, and i want to reduce the number'

If a person meets the diagnostic criteria, a developmental history has been identified and the psychiatrist recognises within that person those cognative differences associated with the syndrome, then a diagnosis must be given, so that person can then decide the level of support that they do/do not require. For him to advocate prejudging a person's need beforehand based on an arbitrary, hand-wavey, subjective value judgement is unacceptable.


o0iella wrote:
As Autism is a lifelong condition it is unethical to withhold a diagnosis if the person fits the criteria. The person could be coping now, but a change in circumstances could make the person not cope in the future.

This, I think, is the most pertinent point that has been made so far.



ASPartOfMe
Veteran
Veteran

User avatar

Joined: 25 Aug 2013
Age: 62
Gender: Male
Posts: 19,579
Location: Long Island, New York

31 Mar 2016, 7:28 pm

Clinitions not diagnosing people who meet the criteria but are seemingly doing well is partly a result of the feeling a lot of people have that many seeking an Autism diagnosis desire the diagnosis be trendy, make excuses or rip off hard working taxpayers in order to obtain undeserved benefits.


_________________
Identified and joined WP August 26, 2013
DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity

"The lunatics have taken over the asylum" - The Specials


AspieUtah
Veteran
Veteran

User avatar

Joined: 20 Jun 2014
Age: 57
Gender: Male
Posts: 6,118
Location: Brigham City, Utah

31 Mar 2016, 7:41 pm

Such clinicians seem to agree with the fees they are paid despite exercising their free speech in terms of convincing themselves that the exhibited characteristics aren't real (or, more likely, believing that they are helping the greater good by acting in ways to prevent diagnosing the entire spectrum, instead of the more apparent parts of it). Personally, I suspect there are too many clinicians who are simply, truly, just incompetent.


_________________
Diagnosed in 2015 with ASD Level 1 by the University of Utah Health Care Autism Spectrum Disorder Clinic using the ADOS-2 Module 4 assessment instrument [11/30] -- Screened in 2014 with ASD by using the University of Cambridge Autism Research Centre AQ (Adult) [43/50]; EQ-60 for adults [11/80]; FQ [43/135]; SQ (Adult) [130/150] self-reported screening inventories -- Assessed since 1978 with an estimated IQ [≈145] by several clinicians -- Contact on WrongPlanet.net by private message (PM)


Chichikov
Veteran
Veteran

User avatar

Joined: 27 Mar 2016
Age: 45
Gender: Male
Posts: 1,151
Location: UK

01 Apr 2016, 3:04 am

naturous_aspect wrote:

Chichikov wrote:
"The criteria" state that you don't just need to have various traits, but that those traits cause significant impairments. To be perfectly honest, SB-C kinda has a point. Obviously you'd need to judge things on a case by case basis, I haven't seen the case he made those comments in relation to.

Where in "the criteria" does it say this?


DSM IV

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

And to pre-empt people who want to take the "DSM V doesn't say that" argument, DSM V doesn't say aspergers even exists so I'm afraid you can't cherry pick the sources that suit your argument :)



gonewild
Sea Gull
Sea Gull

User avatar

Joined: 11 Aug 2013
Gender: Female
Posts: 204

01 Apr 2016, 11:24 am

Simon Baron Cohen is a disturbing person who has huge influence. He "trashes" female Aspergers, claiming we are not female because we have "male brains" and (totally nuts) we simultaneously fall on the opposite end of his "male brain theory" - which designates females as psychotic. One is either a male Asperger (classic) or a psychotic female with a male brain. I guess he had to make up this bizarre view of AS because females are at last being diagnosed, and to protect his male brain theory, he had to somehow "accommodate" females. Most of the "psychology" of AS is pure BS, if not outright scams and malpractice.



ConceptuallyCurious
Velociraptor
Velociraptor

User avatar

Joined: 19 Aug 2014
Age: 24
Gender: Female
Posts: 494

01 Apr 2016, 12:25 pm

Well, 10 years ago the DSM IV did say that you need significant impairment. When thinking of assessments a decade, you have consider what the thinking was at the time.

I would request a second opinion. You're entitled to one.

The DSM 5 has been updated to allow people people who have symptoms masked by strategies. Using masking strategies may tire you, or you may have a history of burning out. (A history of not being able to hold a job for long would be a significant problem).

Nevertheless, I do believe that people who have sub-threshold autism traits that have never caused them difficulties don't need a diagnosis. A clinical diagnosis of autism isn't a special social group for anyone to join, in the same way that someone who enjoys colour co-ordinating their wardrobe wouldn't be diagnosed with OCD.

If you're not using masking strategies and you don't have difficulties in functioning... you probably don't have autism. The diagnostic criteria is entirely made up of things that make functioning difficult.


_________________
Diagnosed with:
Moderate Hearing Loss in 2002.
Autism Spectrum Disorder in August 2015.
ADHD diagnosed in July 2016

Also "probable" dyspraxia/DCD and dyslexia.

Plus a smattering of mental health problems that have now been mostly resolved.


Chichikov
Veteran
Veteran

User avatar

Joined: 27 Mar 2016
Age: 45
Gender: Male
Posts: 1,151
Location: UK

01 Apr 2016, 1:40 pm

gonewild wrote:
Simon Baron Cohen is a disturbing person who has huge influence. He "trashes" female Aspergers, claiming we are not female because we have "male brains"

He neither says that nor thinks it, your whole argument is based on a misunderstanding of his theory.



naturous_aspect
Emu Egg
Emu Egg

Joined: 30 Mar 2016
Gender: Male
Posts: 4
Location: London, UK

02 Apr 2016, 8:29 am

Chichikov wrote:
naturous_aspect wrote:
Where in "the criteria" does it say this?
DSM IV
"The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning."

And to pre-empt people who want to take the "DSM V doesn't say that" argument, DSM V doesn't say aspergers even exists so I'm afraid you can't cherry pick the sources that suit your argument :)


For your information, I was assessed under ICD-10 F84.

Just a cursory look up on the phrase throws up this, critical journal review: http://ajp.psychiatryonline.org/doi/abs ... 56.12.1856
"the generic use of the clinical significance criterion should be reconsidered"

The DSM comes in for considerable consternation, even before questioning the 'significance criterion'. Jon Ronson's "The Psychopath Test" (intriguing book, check it out!) goes into some detail of the development of DSM III, painting a picture of a somewhat ad-hoc brainstorming exercise, going as far to suggest as being the cause of a disorder epidemic.

I can appreciate misdiagnosis/over-diagnosis being a concern, particularily in the U.S. where the very ego-driven nature of american society could well lead towards a trend to identify with different syndromes or disorders

However, if you are suggesting this is the key part of the criteria then I think it is a problem, because it provides the scope for very subjective, inconsistant evaluations determined mostly on the norms & social/political sensibilities of the psychiatrist.

I have seen it referred to, of this 'autistic burnout' phase that can happen to those who are most effectively getting through life and passing for normal i.e. the 'doing fine' of Baron-Cohen's parlance. Only the other day a report indicated a 800% increased risk of suicide amongst those diagnosed and without a learning disability.
http://www.sciencemag.org/news/2016/03/ ... er-average
What does that say for those that have gone undiagnosed?

Anyhow these are my thoughts on the matter