The question if diagnostic criteria for Autism Spectrum Disorder should change a little to be more accurate

[Oz67]

I wonder if there should be a much more clear childhood history to determine if a person has Autism Spectrum Disorder, I am not saying that Autism Spectrum Disorder cannot be diagnosed later in life, rather that there should be clear childhood history.

The problem with diagnostic criteria C for Autism Spectrum Disorder in DSM-5-TR:

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).

That is a problem because if we look at it chronologically by age, it can manifest at different ages

For example:

1) What is normal to do in early childhood may be abnormal to do in late childhood

2) What is normal to do in late childhood might be abnormal to do in early adolescence

3) What is normal to do in early adolescence might be abnormal to do in late adolescents

4) What is normal to do in late adolescents might be abnormal to do in young adulthood

5) What is normal to do in young adulthood might be abnormal to do in adulthood, chronologically.

If Autism Spectrum Disorder doesn't fully manifest until social rules become more complex or by making learned strategies later in life, it might be harder to document childhood history.

 

[Shamar]

While I was diagnosed at age 60, I can state specifically and distinctly that in early childhood (age 3), I was non social, I could not figure out people (neither peers nor adults), I had no friends, and I preferred to be by myself. My behavior remained the same through late childhood, early adolescence, late adolescence, young adulthood, through to today. I am still wondering why nobody noticed in childhood. I can't document it (everyone who would know is deceased), but that is what I clearly remember.

"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)." In other words, symptoms may be present, or may not be present, but one or the other must apply. This was conceived by experts in the field.

 

[scleod]

That is an interesting topic.

Many of the markers for autism are "hard wired" in us at a young age. As a child they present in our so call "play". Lining up toys, not responding to others, repetetive behaviors, swaying stimming, echolalia (advanced verbal) etc.

As someone who slipped through the cracks of society. I did not benefit from help till years later when I was diagnosed at 30. Due to the misconception that autism was "wrong" or something needed to be "corrected". I was forced to develope a mask VERY young. It was more finely tuned mask to "protect" myself. Allowing me to "fool" the assessor to believe I was not on the spectrum, simply by being a "master" masker. This assessment would have been in grade one. By this time I had already formed a mask that completely transformed who I was on the outside.

I believe the tolerance that has grown in the last X amount of years has been a huge factor. But the assessment itself was very well put together. When I was recently tested my mother had to answer assessment questions based on the childhood assessment, since I have no recorded information from my childhood.

A huge factor is the psychologist you have. Their knowledge, openness and unbiased views on the situation at hand.

 

[Outdated]

I had no friends, and I preferred to be by myself. My behavior remained the same through late childhood, early adolescence, late adolescence, young adulthood, through to today.

My childhood sounds the same as yours, but when I was 16 and 17 I turned that around and ended up going to the other extreme, I became a social butterfly until it burnt me out later in life.

 

[TheBooFace]

I wonder if there should be a much more clear childhood history to determine if a person has Autism Spectrum Disorder, I am not saying that Autism Spectrum Disorder cannot be diagnosed later in life, rather that there should be clear childhood history.

The problem with diagnostic criteria C for Autism Spectrum Disorder in DSM-5-TR:

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).

That is a problem because if we look at it chronologically by age, it can manifest at different ages

For example:

1) What is normal to do in early childhood may be abnormal to do in late childhood

2) What is normal to do in late childhood might be abnormal to do in early adolescence

3) What is normal to do in early adolescence might be abnormal to do in late adolescents

4) What is normal to do in late adolescents might be abnormal to do in young adulthood

5) What is normal to do in young adulthood might be abnormal to do in adulthood, chronologically.

If Autism Spectrum Disorder doesn't fully manifest until social rules become more complex or by making learned strategies later in life, it might be harder to document childhood history.

As long there's no genetic/organic diagnosis for Autism, it will remain subject to subjective interpretation and observed behaviors.

 

[JayLapointe]

I wonder if there should be a much more clear childhood history to determine if a person has Autism Spectrum Disorder, I am not saying that Autism Spectrum Disorder cannot be diagnosed later in life, rather that there should be clear childhood history.

The problem with diagnostic criteria C for Autism Spectrum Disorder in DSM-5-TR:

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).

That is a problem because if we look at it chronologically by age, it can manifest at different ages

For example:

1) What is normal to do in early childhood may be abnormal to do in late childhood

2) What is normal to do in late childhood might be abnormal to do in early adolescence

3) What is normal to do in early adolescence might be abnormal to do in late adolescents

4) What is normal to do in late adolescents might be abnormal to do in young adulthood

5) What is normal to do in young adulthood might be abnormal to do in adulthood, chronologically.

If Autism Spectrum Disorder doesn't fully manifest until social rules become more complex or by making learned strategies later in life, it might be harder to document childhood history.

Considering the lost generations IE Boomers/Gen X/early Millenials there are a ton of us that just slipped through the cracks as Autism wasn't well known or broadly diagnosed when we were young. Most of us had our issues explained away by other things. that is why you do hear so many late diagnosed folks and I would imagine the late diagnosed numbers are very poorly misrepresented. It can be hard for some to provide that information about early childhood. I'm only in my 40's but I can honestly say I do not remember much of my childhood pre teens. My own boomer mother still does not acknowledge my autism, so I couldn't even get my parents to help in filling that history honestly. And there would be many others that would be my age or older that wouldn't be able to provide a clear history of childhood. Does that mean we then can't be autistic anymore? Are we back to something else, adultbergers maybe?

Personally I think that criteria of "Must present" in early childhood should be stripped completely. There will always be those of us on the margins who won't really show up on the charts till much later in life when things start to fall apart.

 

[Mary Terry]

Many parents do not realize or want to acknowledge that their children are "different". They can even become angry if someone (who is more observant) suggests that they have their child evaluated.

 

[JayLapointe]

Many parents do not realize or want to acknowledge that their children are "different". They can even become angry if someone (who is more observant) suggests that they have their child evaluated.

Case in point Mary, my own mother argued with the school professionals that I wasn't "special" only left handed. Caveat here is that she was herself a teacher in the district, so she had more sway than most. If it hadn't been for her intervention I would have been put through testing prior to grade 1. The flip side though is that the "Special" education stream of the 80's/early 90's wasn't the best, a place to go but not to grow, so ultimately I probably was done a favor being kept out of it then.

 

[scleod]

The alternate side is that parents who had a child on the spectrum don't recognize they have a child on the spectrum. Since autism is genetic parents often exhibit spectrum traits. Either one or both may be on the spectrum themselves. This may cause them to be unaware that their child is exhibiting characteristics/ traits that are different from other children, that fit the criteria of being on the spectrum.

This was my parents. My dad recently passed. Seeing my momma without my dad I am realizing, my momma is on the spectrum. I was unable to see it before. But it is very clear now.

 

[Neonatal RRT]

I wonder if there should be a much more clear childhood history to determine if a person has Autism Spectrum Disorder, I am not saying that Autism Spectrum Disorder cannot be diagnosed later in life, rather that there should be clear childhood history.

The problem with diagnostic criteria C for Autism Spectrum Disorder in DSM-5-TR:

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).

That is a problem because if we look at it chronologically by age, it can manifest at different ages

For example:

1) What is normal to do in early childhood may be abnormal to do in late childhood

2) What is normal to do in late childhood might be abnormal to do in early adolescence

3) What is normal to do in early adolescence might be abnormal to do in late adolescents

4) What is normal to do in late adolescents might be abnormal to do in young adulthood

5) What is normal to do in young adulthood might be abnormal to do in adulthood, chronologically.

If Autism Spectrum Disorder doesn't fully manifest until social rules become more complex or by making learned strategies later in life, it might be harder to document childhood history.

You make some good points here... and so do others with regards to those older adults who do not have a documented childhood history. My parents were not involved, at all, with my diagnostic testing or interviews... my wife was... but frankly, it wasn't needed after all the hours of comprehensive testing... it was pretty obvious. I think the broader issue is WHO is doing the diagnosis and HOW it is being done... I think this is where the questions lie. I don't think the average general practitioner, psychologist, nor psychiatrist is qualified... unless they have made it their specialty... adult autism. The DSM is a good general guide, as is, but as we all know, everyone's autism presents a bit differently... and certainly there are differences between us as young children and as adults. It really comes down to how skilled the practitioner is at testing and recognizing all the signs and symptoms... in adults...knowing the differences between males and females. There are specific types of neuro-imaging, blood tests, and genetic testing that can be done to add to the information... but unless you are at a university-based autism research center, it's highly unlikely this will be done.

 

[velociraptor]

I was diagnosed with high-functioning Asperger's and I was perfectly happy with that. I do not like the new ASD1 label and the people who hung that on me are welcome to take it back and cram it sideways into the most uncomfortable place possible.

 

[Judge]

Personally I came to the conclusion a long time ago that behind closed doors, that the DSM-V rationale amounts little more than for them to lament, "We just don't really know at this point in time".

But that they had to create such an ambiguity as a "veil" to such a conclusion, not to cause a panic.

One can only wonder what the DSM-VI may be all about.

Probably akin to awaiting the next incarnation of Microslop Windows.

 

[velociraptor]

One can only wonder what the DSM-VI may be all about.

Fine-tuning billing practices in a way that gets fewer CEOs of large health insurance companies shot in public.

 

[Judge]

Fine-tuning billing practices in a way that gets fewer CEOs of large health insurance companies shot in public.

That's about the only dynamic that makes any sense under the circumstances.

By bu$iness, for bu$iness.

Our autism is not the point, but rather that they just want to better serve us as "return customers".

 

[Mary Terry]

That's about the only dynamic that makes any sense under the circumstances.

By bu$iness, for bu$iness.

Our autism is not the point, but rather that they just want to better serve us as "return customers".

There are front page stories in the Wall Street Journal and New York Times this week about the massive fraud in Medicare and Medicaid programs for autistic children. There's a big financial incentive to have children designated as autistic and subjected to most likely utterly useless "therapies", treatments, behavior modification, etc. paid for by our taxpayer dollars, and the parents want the government benefits they can obtain for having an autistic child.

It's a mess.