My issue with DSM-5-TR's ASD criteria.

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FranzOren
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01 Jun 2024, 10:22 pm

That is actually a good point and if makes sense.



FranzOren
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04 Jul 2024, 9:15 am

ProfessorJohn wrote:
That is certainly possible, I suppose. I guess one problem is that we still don't know enough about ASD to know if it can lie dormant and then be triggered by environmental events later on. And that would be hard to determine. Do we know the exact genetic sequence associated with ASD? We would need to know that and be able to measure that in people to know who is predisposed or not. Then we would need to know the person's case history to know they weren't showing symptoms before the event, etc.

The more recent DSM manuals try to base any changes they make on empirical research, and trying to answer your question would be tough from a research standpoint. Doesn't mean we won't ever know that, though.

And if we can later determine that it might lead to a whole new disorder, something like "Stress Induced Autism Spectrum Disorder', since the treatment for it would probably be different than for those who had been demonstrating Autism since birth


Technically, you are born with Autism Spectrum Disorder, which is a neurodevelopmental disorder, but the milder symptoms might not appear until late teenage years or adulthood/or a person is diagnosed with PDD-NOS, because doctors don't understand if communication delay is caused by Autistic Disorder or MR.



FranzOren
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04 Jul 2024, 10:33 am

The diagnostic criteria for Autism Spectrum Disorder in DSM-5-TR need to be changed, to also include people who developed an understanding of social cues on time, but have deficits in social-emotional reciprocity.


Current diagnostic criteria for Autism Spectrum Disorder in DSM-5-TR:


A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by all of
the following, currently or by history (examples are illustrative,
not exhaustive; see text):


1. Deficits in social-emotional reciprocity, ranging, for
example, from abnormal social approach and failure of
normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or
respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for
social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to
abnormalities in eye contact and body language or deficits
in understanding and use of gestures; to a total lack of
facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding
relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making friends;
to absence of interest in peers.




B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history (examples are illustrative, not
exhaustive; see text):


1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).
57

2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively
circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment (e.g.,
apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with
lights or movement).



Current diagnostic criteria for Social (Pragmatic) Communication Disorder:



A. Persistent difficulties in the social use of verbal and nonverbal
communication as manifested by all of the following:


1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).





We can remove the diagnostic criteria A for Autism Spectrum Disorder and change it into this:


1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).





So, this is what the diagnostic criteria for ASD should look like:


(At least two symptoms of persistent deficits in social or other communication, for Autism Spectrum Disorder)



1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).


Diagnostic criteria B symptoms for Autism Spectrum Disorder:


(And at least two symptoms of diagnostic criteria B for Autism Spectrum Disorder)


1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).

57

2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively
circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment (e.g.,
apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with
lights or movement).



AutisticBarbie
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04 Jul 2024, 11:16 am

This is great!! I’d love to see the word “deficits” be replaced by “differences.” I’d also like to see something added to the criteria to guide professionals more clearly in the area of masking and how it can cause some criteria to appear as though they aren’t being met during an assessment. Really, it’d be great if all professionals knew how to ask the right questions that can more effectively rule in or out each criteria.



FranzOren
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04 Jul 2024, 12:30 pm

AutisticBarbie wrote:
This is great!! I’d love to see the word “deficits” be replaced by “differences.” I’d also like to see something added to the criteria to guide professionals more clearly in the area of masking and how it can cause some criteria to appear as though they aren’t being met during an assessment. Really, it’d be great if all professionals knew how to ask the right questions that can more effectively rule in or out each criteria.



Thank you for correcting me, I was being too clinical about it, I am sorry :(



AutisticBarbie
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04 Jul 2024, 12:41 pm

Oh no, I love the clinical! I completely agree and I think it is great that you have spelled it out with such detail! Now if we could just propose that to the APA. It’s interesting, I was just speaking with a nearly retired psychologist who was talking about how confusing it can be to clinicians between the differences between autism & pragmatic communication disorder, so I was excited to see somebody bring it up and incorporate it like you did, that was awesome!! :D



FranzOren
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04 Jul 2024, 12:55 pm

AutisticBarbie wrote:
Oh no, I love the clinical! I completely agree and I think it is great that you have spelled it out with such detail! Now if we could just propose that to the APA. It’s interesting, I was just speaking with a nearly retired psychologist who was talking about how confusing it can be to clinicians between the differences between autism & pragmatic communication disorder, so I was excited to see somebody bring it up and incorporate it like you did, that was awesome!! :D


Thank you so much

To be honest with you the disorders that includes communication delay, even without restricted interests or repetitive behaviors, they were known as Pervasive Developmental Disorders before 2013 in DSM and 2022 in ICD.



FranzOren
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11 Jul 2024, 3:41 pm

AutisticBarbie wrote:
Oh no, I love the clinical! I completely agree and I think it is great that you have spelled it out with such detail! Now if we could just propose that to the APA. It’s interesting, I was just speaking with a nearly retired psychologist who was talking about how confusing it can be to clinicians between the differences between autism & pragmatic communication disorder, so I was excited to see somebody bring it up and incorporate it like you did, that was awesome!! :D


I told the chaGPT that there should be non-clinical diagnostic criteria for Autism Spectrum Disorder, such as:


* Sensory sensitivities: Extreme sensitivity to light, sound, touch, clothing, or temperature

* Repetitive behaviors: Hand-flapping, rocking, jumping, twirling, or lining up toys

* Unusual interests: Fixations on certain objects or activities, or overly focused interests

* Routines and rituals: Getting upset by small changes to routines or having difficulty with transitions

* Sleep problems: Sleepiness or disrupted sleep

* Social communication: Poor eye contact, lack of facial expression, or difficulty starting or maintaining conversations

* Gastrointestinal issues: Constipation or other gastrointestinal issues

* Delayed language, movement, or learning skills

* Unusual eating and sleeping habits

* Unusual mood or emotional reactions

* Anxiety, stress, or excessive worry

* Lack of fear or more fear than expected

* Impulsive behavior

* Aggressive behavior

* Short attention span



AutisticBarbie
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11 Jul 2024, 9:16 pm

Was that what you inputted or what it spit out?



JamesW
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12 Jul 2024, 2:30 am

Quote:
(Italics mine)
2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.


I'd like to see the word 'rules' here replaced with 'conventions'. As it stands, it reads like 'Following ND rules is not OK; not following NT rules is also not OK.'

There are no 'rules' for conversation. What has become 'conventional' is merely what the majority of people tends to find relatable and comfortable. This varies markedly from culture to culture, nation to nation, age group to age group, etc. ND people converse differently because we think differently.

One thing that has always puzzled me: if NTs know when it is their turn to speak, how come they're always all talking at once?



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12 Jul 2024, 2:49 am

MatchboxVagabond wrote:
FranzOren wrote:
Does the Broad Autism Phenotype blur the differences between people with ASD and normal persons with autistic traits? To what extent does the Broad Autism Phenotype manifest into ASD and should get diagnosed as a young or older adult?


The problem I have with the DSM-5-TR diagnostic criteria for ASD is this “C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).”

You need someway of dealing with the problem that there is a line and people just slightly on opposite sides of the line may not be really that different. Even being spectrum adjacent, as in not quite having enough of the autistic pokemon collected to get a diagnosis does not imply that any of the traits are any less severe, they may be more severe, just fewer areas affected. It's part of why Social Pragmatic Communication Disorder and Sensory Processing Disorders were created. It's far from perfect as the DSM 5 introduced some pretty significant holes that the folks that wrote the criteria prefer not to talk about.

And I don't necessarily disagree that C. is a problem. It's not a particularly well defined line between what constitutes early development, especially when you've got folks with higher IQs and more ability to mask that may not actually show obvious signs until many years later. Or at lower IQ levels where proper participation in the evaluation process may be hindered and a different condition or disorder may be a more appropriate explanation.


Well put



FranzOren
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12 Jul 2024, 12:10 pm

JamesW wrote:
Quote:
(Italics mine)
2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.





I'd like to see the word 'rules' here replaced with 'conventions'. As it stands, it reads like 'Following ND rules is not OK; not following NT rules is also not OK.'

There are no 'rules' for conversation. What has become 'conventional' is merely what the majority of people tends to find relatable and comfortable. This varies markedly from culture to culture, nation to nation, age group to age group, etc. ND people converse differently because we think differently.

One thing that has always puzzled me: if NTs know when it is their turn to speak, how come they're always all talking at once?




Rather if a person has ASD Level 1 or has a Broad Autism Phenotype is a bit arbitrary, because it is hard to spot symptoms of masked symptoms of ASD in a few seconds, it may take to a few minutes or days to find out that someone has ASD Level 1. Also what is not normal to do in the USA might be normal to do in some countries, as an example, and it essentially means that the diagnostic criteria for Autism Spectrum Disorder are not the same in some parts of the world and it is a cultural or sub-cultural bound syndrome.

What might be considered symptoms of ASD in most parts of the world, might be nomral part of life in some parts of the world for people with ASD level 1



Last edited by FranzOren on 12 Jul 2024, 12:21 pm, edited 1 time in total.

FranzOren
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12 Jul 2024, 12:17 pm

AutisticBarbie wrote:
Was that what you inputted or what it spit out?


Can you explain your question a little bit more?



FranzOren
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12 Jul 2024, 12:18 pm

JamesW wrote:
Quote:
(Italics mine)
2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.


I'd like to see the word 'rules' here replaced with 'conventions'. As it stands, it reads like 'Following ND rules is not OK; not following NT rules is also not OK.'

There are no 'rules' for conversation. What has become 'conventional' is merely what the majority of people tends to find relatable and comfortable. This varies markedly from culture to culture, nation to nation, age group to age group, etc. ND people converse differently because we think differently.

One thing that has always puzzled me: if NTs know when it is their turn to speak, how come they're always all talking at once?



What do you suggest a better diagnostic criteria for Autism Spectrum Disorder be?



JamesW
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13 Jul 2024, 2:32 am

FranzOren wrote:
JamesW wrote:
Quote:
(Italics mine)
2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.


I'd like to see the word 'rules' here replaced with 'conventions'. As it stands, it reads like 'Following ND rules is not OK; not following NT rules is also not OK.'

There are no 'rules' for conversation. What has become 'conventional' is merely what the majority of people tends to find relatable and comfortable. This varies markedly from culture to culture, nation to nation, age group to age group, etc. ND people converse differently because we think differently.

One thing that has always puzzled me: if NTs know when it is their turn to speak, how come they're always all talking at once?



What do you suggest a better diagnostic criteria for Autism Spectrum Disorder be?


I don't. I'd just like the word 'rules' changed.



FranzOren
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13 Jul 2024, 9:07 am

That makes sense.