The problem I have with DSM-5-TR's diagnostic criteria for ASD

[Oz67]

Don't pay any attention to DSM-5. In my opinion, it was politically corrected, woked, de-offensivized, and overly simplified to the point of near uselessness. I suspect they anticipated the quality of graduates that will be coming out in the next few years, and wrote accordingly.

ICD-11 has a similar writings as DSM-5-TR, but it's much better than in DSM-5-TR.

 

[Oz67]

Something that’s bothered me about the DSM-V is how the differences between ASD in males and females are not taken into account, and how separate healthcare needs for each are not specifically recommended, thereby lumping all autistic patients together in healthcare settings.

E.g. I’ve known of unwell ASD1 women being placed onto wards with ASD2 & 3 men or ASD3 children, and emerging with little to no treatment and more traumatised than they were to start with. This kind of thing shouldn’t be happening.

It's sad, tbh

 

[Oz67]

To examine demography and how it is socially-engineered I think is a critical point. Because:

1. Autistic people are not, even in this slowly destigmatising age, a sociopolitically welcome nor desirable demographic, at least not to those in power;
2. The birth rate and also the productivity rate in the West is dropping off a cliff, and governments are anxious to dissuade people from declining the governmentally-approved NT-friendly mortgage-and-two-kids lifestyle, and;
3. If everyday people could find out in vitro or at birth whether or not their child has autism, they may be motivated to abort or disown said child to prevent strain on their lives.

So for there to be a cheap, easy and convenient, quick and painless and relatively accurate genetic test isn’t in the business interests of anyone who has the means to provide it, I.e. politicians, big pharma and private healthcare providers, insurance providers, other corporations. The only powerful entity who could stand to benefit is a national not-for-profit social welfare, care or health service, who would be put under less strain to handle ASD people in their system.

That's interesting

 

[Oz67]

The DSM is written in something resembling legal writing mixed with the worst medical writing.

My understanding of what C. means is something like:

We think ASD is a neurological disorder. People are born with it. But it changes over time and it may not be noticeable until it is noticeable. For some, the symptoms will be obvious at early ages. For others, it will only become clear (i.e., it will "manifest") later --say, when a kid starts having problems socializing after going to school. For others, it could be as late as teen years, college, or even after many failed relationships or work-related problems.

Every person has autistic traits to some degree and at some point. The diagnosis is fitting the cluster of traits over a long time even if problems arrived later.

But what if a person is carrying genes that can cause ASD and environmental factors as well, did not show symptoms in childhood, but became mentally ill, due to environmental factors, due to so many social rules, and then that gene became activated and he or she started to show symptoms of ASD? Then he or she might have ASD, it should not have appeared in childhood if it is mild or atypical presentation or late-onset threshold of PDD-NOS, from DSM-IV-TR, for example.


Info about Autism Spectrum and Other PPDs

Another info about ASD an other PDDs

 

[Oz67]

Something that’s bothered me about the DSM-V is how the differences between ASD in males and females are not taken into account, and how separate healthcare needs for each are not specifically recommended, thereby lumping all autistic patients together in healthcare settings.

E.g. I’ve known of unwell ASD1 women being placed onto wards with ASD2 & 3 men or ASD3 children, and emerging with little to no treatment and more traumatised than they were to start with. This kind of thing shouldn’t be happening.

ICD-11 has some issues as DSM-5-TR, but ICD-11 is a bit better and they still make kind of different versions of ASD based on severity levels and what a person with ASD needs or does not need, however, the various versions of ASD in ICD are not distinct disorders, it is still ASD, similarly to DSM-5-TR but a bit better and much more advanced than in DSM-5-TR.

Source:

icd.who.int/browse/2024-01/mms/en#437815624

 

[Oz67]

https://icd.who.int/browse/2024-01/mms/en#437815624

 

[Oz67]

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.

 

[Oz67]

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).