APA's new diagnostic manual: Asperger's Disorder to be Dropped

[maatTheViking]

Being introverted or extroverted doesn't have anything to do with autism or how you handle social situations, IMO.

I am introverted (defined as: drawing energy from being alone, having energy drained by being with people), but I am pretty good in social situations. I have a former co worker who was extremely awkward in social situations, but is quite extroverted and outgoing.


In general, I find that all these mental disabilities from ADHD to autism are problematic when they are defined by a set of 'traits' to layperson. It leads to 'diagnosis' of people without understanding the true disorder. It is like when people over-organize and say 'oh, my OCDness got ahold of me' - but they are very far from having OCD, they have just heard one trait.

Leave diagnosis to th professionals (who has thei own issues and debates as this thread originally shows).

[Angelskates]

In general, I find that all these mental disabilities from ADHD to autism are problematic when they are defined by a set of 'traits' to layperson. It leads to 'diagnosis' of people without understanding the true disorder. It is like when people over-organize and say 'oh, my OCDness got ahold of me' - but they are very far from having OCD, they have just heard one trait.

Leave diagnosis to th professionals (who has thei own issues and debates as this thread originally shows).

I agree, though I have found it necessary to explain autism to kids using traits of commonality. I ask the group of kids if they have a specific trait, and some will always raise their hands, and so I tell them that they have something in common with the person I am introducing (who usually has autism). I scatter in things like "Do you like computers?" and "Do you like chocolate?" as well, just to show them that just because this child has autism, doesn't mean he "weird" - we all have things in common. That doesn't mean we're all a little bit autistic, but it's a good way of introduce children with special needs to those without because they can see some of themselves in him or her. If only it was as easy with adults. Kids always ask the most awesome questions, and are, IME, really interested in the answers. IME adults need labels more than children.

[MacMadame]

It is like when people over-organize and say 'oh, my OCDness got ahold of me' - but they are very far from having OCD, they have just heard one trait.

That has got to be one of my biggest pet peeves. That, saying "my ADD has kicked in" when you get disorganized, and claiming to be "addicted" to something just because you like it a lot. It's the trifecta of mental illness as a personality trait.

There are a lot of addicts in my family and one of my sisters had OCD and these are serious and horrible things to have. People act like it's fun or the latest fad to have OCD. They should try living in my sister's shoes. She actually spend a couple of years in mental institutions over the years because something would push her over the edge and she couldn't cope with real life. She's only out now because they found the right medicine for her but she's basically doped to the gills to keep her from washing her hands so much her skin bleeds 24/7. It's not a pretty way to live.

I think TV has a lot to answer for with this one as a recent trend seems to be to glorify the mentally ill as somehow more astute than the rest of us as if their mental illness somehow opens their mind to secret creativity the rest of us are too conventional to tap into. We have Monk who is supposedly OCD but it's presented as this cute quirk and it really doesn't prevent him from having a full life (I've never seen his skin bleed from too much washing). Then there's that new show that I couldn't bare to watch after one episode where a schizophrenic decides to go off his meds so he can be a better crime fighter.

[Angelskates]

I think TV has a lot to answer for with this one as a recent trend seems to be to glorify the mentally ill as somehow more astute than the rest of us as if their mental illness somehow opens their mind to secret creativity the rest of us are too conventional to tap into. We have Monk who is supposedly OCD but it's presented as this cute quirk and it really doesn't prevent him from having a full life (I've never seen his skin bleed from too much washing). Then there's that new show that I couldn't bare to watch after one episode where a schizophrenic decides to go off his meds so he can be a better crime fighter.

TV is both a blessing and a curse when it comes to these things. It does show some with difficulties, both not a whole range. Some do have OCD and live a relatively full life, so they're not misrepresenting the illness, just not representing it from all possibilities. I think there's also a problem with the one with the mental illness being represented as a criminal far too often; I'd rather see them as portrayed as being able to live a full life. It's a challenging issue when it comes to the media, because mental illness and special needs come in many forms, in many extremes, from mild to severe. Just like those without mental health problems or special needs, the media doesn't portray them all, but that doesn't mean what that are portraying isn't accurate, it likely is for some people.

Just like your pet peeve, I hate it when people say the have the flu, when it's just a cold, or are depressed when they've just had a bad day. Language has changed to make some words "less" that what they actually mean. The flu and depression are also pretty severe, and are thrown around when people don't understand the terms, but have the terms been used (incorrectly) so much it's impossible for them to mean what they're supposed to mean now?

[Gil-Galad]

And this is a shame, that you need that casual label. Not just you, but so many people feel the need to throw labels around in order to help understand others, when really lay labels mean absolutely nothing except make the labeller feel better and supposedly give them a way of trying to understand that is, sadly, more socially acceptable than saying "different". It does nothing for the person being labelled, except put them in a box. How is the label a starting point to helping you understand? You really don't know that he has Asperger's, but you've told yourself he does. Can you explain how that helps you understand why he might be the way he is? I am really curious...

As a therapist, as a (mental) health professional and as a teacher it is hugely problematic if label your patients or charges too quickly or at all. Because this relationship should be primarily about the charges, about their needs, their progress. While it is also important to maintain one's own health in these relationships, therapists etc. are especially trained (or should be) to deal with difficult behaviour, unusual reactions and infuriating situations that come up while being responsible for another person's health / education - without having to resort to labels / unfounded diagnosis (what the heck is the plural here?).

Anita on the other hand is none of the above. You emphasise over and over again that Anita is a layperson, and - in my opinion - as a layperson, it is not her job to find out what her cousin needs, or how she can most of help to him. You basically accuse her of being selfish by labelling her cousin - so I just have to ask - what exactly is wrong with trying to feel better by labelling people?

Anita is not her cousin's therapist, his babysitter or what not. That means the emphasis in this relationship should be on her, how can she maintain a good relationship with her cousin, how can she make sure that she feels comfortable in this relationship, how can she make sure that his reactions in a discussion / situation don't upset her. I tell that to relatives of severely ill people (mentally or physically); they should find out what works best for them in these difficult situations. And if reading a big old book of Freudian theories does the trick - they are welcome to it. If they want use the ICD-10 and label every single behaviour the affected family member / friend exhibits, they are welcome to it, too.

A very close relative of mine regularly exhibits behaviour that could be classified as bipolar. She is not diagnosed as bipolar - and I am not really a layperson, so I definitely shouldn't be running around putting random labels on people. But from time to time, when I am back on that rollercoaster that is being close to someone with bipolar tendencies - I just need to make the "she is bipolar, she is bipolar - by next week this fad will be over"-dance. Because otherwise it would be too maddening. This label is mostly for me, I need this label for the Ohmmmmmm-moment during our talks on the phone or person to person. I need this label, this ugly-disorder-box I put her in, in order to keep myself sane, to keep my calm and to be the best me I can possibly be in her life.

[Angelskates]

Anita on the other hand is none of the above. You emphasise over and over again that Anita is a layperson, and - in my opinion - as a layperson, it is not her job to find out what her cousin needs, or how she can most of help to him. You basically accuse her of being selfish by labelling her cousin - so I just have to ask - what exactly is wrong with trying to feel better by labelling people?

She's said that she is labelling to find out what her cousin needs - I think this can be done without the label, by getting to know her cousin. Laypeople using mental health labels makes the labels mean nothing. If awkward and quirky means a kid has Aspergers, it's taking away from the actual disorder, which is far more than that. Why should the emphasis in the relationship be on Anita18 and not both Anita18 and her cousin?

I disagree with your labelling your relative as bipolar as well - and I don't understand why you need it to keep sane, can't you just say to yourself, "she's a little different, she thinks differently - by next week this fad will be over"? Again, bipolar tendencies doesn't mean someone is bipolar, and I think throwing these labels around makes them easily misunderstood. Labels are not there to make the person giving the label feel better, that isn't their purpose. Aspergers, autism and all the other labels in this thread have been thrown around so much that society now doesn't understand what they really mean. I don't think labels are in the "ugly-disorder-box", I don't think they're ugly at all; correctly given, they can serve a purpose that actually helps.

I think it's terrible that you encourage people to "use the ICD-10 and label every single behaviour the affected family member / friend exhibits" if they want. What about just saying that these behaviour are part of that person's uniqueness? Throwing around labels casually is NOT the best way to help someone, and I feel sorry for anyone who needs it in order to try and build a relationship. Quirks and differences are what make people unique. To label those behaviours as mental health issues rather than individual personality traits takes away from that person actually being a PERSON instead of a group of labels. I'm really disappointed that a therapist would encourage that. If there is a diagnosis, by all means give it, but to casually label demeans actual diagnoses. It's like people saying they have the flu when it's a cold, the flu is serious, and so when someone does have the flu, they see it as not as serious, because to them it's a cold. Same goes with depression, or when someone casually uses ADD/ADHD or OCD.

[jlai]

I wouldn't throw the labels around. OTOH, the names of the diagnosis are useful and need to be unstigmatized.

I have someone in my family that really needed a diagnosis. The diagnosis is helpful because you can start looking things up on the internet, go to discussion groups about the topic, and learn how to deal with issues associated with the diagnosis. I have no problem with using the diagnosis to get help. But other family members react negatively to the "label" to the point of pretending that person needing the diagnosis is just an ordinary person who is a little introverted. Errrr, no, she is not just a little introverted, she has trouble understanding basic language. She needs a diagnosis to get help.

But the diagnosis brings so much stigma some people in denial just pretend their loved ones are just a little "introverted".

I also see some parents with normal kids (not all thankfully) with the attiude of "I don't want my kid hang around that kid". And then the parents with a kid with a mild form of disorder not wanting their kids hang around with THAT kid with a severe form of disorder.
Anyway, this year, parents around my area were opting out of resource classrooms to get their kids with diagnosis into regular classrooms with a para hanging around him/her. And some resource classrooms are down to a teacher student ratio of 1 to 2 or 4, in a high school!

[RFOS]

Here's an interesting article:
http://www.guardian.co.uk/lifeandsty...y-social-rules

As I mentioned in the Kill Bill thread a month or so ago, I was recently diagnosed with Asperger's as an adult. I was and still am conflicted about the "label" and so far have chosen not to share it with many people (not even my sisters). I definitely don't want to use it as an "excuse" or have others treat me differently because of the label, but it did help me make some sense of why I have extreme difficulty in certain areas despite working on them a lot and why I just feel "different" in a variety of ways. I'm awkward and awkward-seeming in general but can manage in most situations, but connecting with women in "that way" is something I feel like I just don't "get" and haven't had the confidence to really try. The one person I met from an online dating site left very abruptly because she could tell I was so uncomfortable, even though I felt like it was going better than I expected, so that definitely didn't help my confidence. I've been trying again but so far haven't had any luck even getting a response to my messages. I always use proper spelling and grammar and try to mention at least one thing from her profile that is interesting or funny or that I can relate to as a jumping off point, and compliment her on that, and mention in a low-pressure way that I'd be interested in chatting. A couple of times I mentioned looks briefly in a friendly hopefully non-creepy way, but most of the time I haven't mentioned it because I don't want to come across as shallow and figure that I would want people to be more interested in the content of my character (as represented honestly in my profile) than looks. I have a lot of good qualities and could be a great boyfriend if given the chance, and one thing I'm most proud of is that I am extremely honest and would never represent myself as something I'm not. Therefore, advice like "be yourself" doesn't help at all. I'm working on trying to become a more socially skilled version of myself, but progress can be agonizingly slow. Sometimes if I'm in the right situation with the right people I can feel very confident and have a lot of fun and others clearly enjoy being around me but other times for a variety of reasons I don't feel as confident and it really shows.

[Jun Y]

I know a little bit about the DSM-5 drafting process, so I can say with some confidence that the reason why Asperger's was dropped was that it is now widely recognized as a mild form of ASD (autism spectrum disorder). People who were appropriately diagnosed with Asperger's before will simply be diagnosed with mild ASD instead. They will not be ignored. BTW, ASD is a long recognized diagnosis in DSM-IV-TR so it is nothing new.

A while ago, This American Life did a story on living with Asperger's syndrome. I highly recommend it. You can listen to the stream audio below (part 3):
http://www.thisamericanlife.org/radi.../play-the-part

In fact, in DSM-5, the authors intended to classify disorders in a more organized and medically logical system. For example, substance use disorder used to be further classified into abuse and dependence, even though both have the same etiology and neurological basis. The only difference is really severity. Last I heard but unconfirmed, DSM-5 will consolidate them into one class of disorders of addiction and differentiate by severity, just like ASD. (Of course within the addiction diagnosis there are various types of addiction to alcohol, stimulants, behaviors, etc.).

[VIETgrlTerifa]

Thank you for the insight.

[Angelskates]

I know a little bit about the DSM-5 drafting process, so I can say with some confidence that the reason why Asperger's was dropped was that it is now widely recognized as a mild form of ASD (autism spectrum disorder).

This, IME, is not true of the general public. Most people don't see Asperger's as a type of autism - parents, for example, want the different label because they see it as not as bad as "actual" autism, just like some like to call their child's form of autism "high-functioning", which doesn't actually exist as a diagnosis. AS and HFA have always been preferred IME, and HFA is used quite a lot in the general population, despite not existing as a diagnosis. Within the professional community, Asperger's has always been recognised as a type ASD - I don't think this has changed; TPTB have been umm-ing and ahh-ing about making these changes for at least three years. I don't think that anything has changed "now" as far as general or professional recognition for Asperger's. I think the DSM-V is right to join them, but I do wonder what that will mean for those with the diagnosis. Will they require a new assessment to diagnose them with ASD (mild or otherwise)? Can they be reassessed and come out without a diagnosis, or will they automatically have mild ASD? I hope they work these things out and make it public knowledge, and schools, insurance companies and anyone one else, make the changes needed by May, so that anyone who does need services, doesn't have to wait to receive them.

RFOS - thanks for the article and sjaring your own story. I think two years old is REALLY young for an Asperger's diagnosis, and think that part of the issue with the public (and maybe psychologists) over-diagnosising is explained in this article. The mum said that knowing her two year old has Asperger's was a "no brainer" after seeing "the lining up of toys and so on" - everyone that comes to me with kids having lined toys up asks if I think their child has ASD. Lining up of toys is not unusual for any child, it is not solely a characteristic of autism, but it seems to be the one thing that worries parents most.

[UGG]

Interesting. I am having my 21 month old son screened for autism in two weeks. It is not because I "want a label" or because "I want an explanation for his behavior". I want to help him and make his life better if he does have it by getting the help he needs as early as possible. we are already in early intervention which I have to say has been really awesome!!

Angelskates-I am pushing to have him tested so young because he has never pointed (like literally never pointed to show us something in a book, airplane, flower,, body part etc...), never clapped, never "showed" us toys, books, etc...does not pretend play, did not associate words with objects until about two months ago after we began Early Intervention. His gesturing is very very minimal-he did not gesture at all until about a month ago. He did not wave until last month, he (since he has been a baby) is obsessed with anything round or with wheels. He prefers "spin" those types of objects over and over again as opposed to playing with cars, balls etc... Since EI, he will now play with those types of toys if we initiate, but he will not on his own. he also has recently started flapping his arms when he wants to show emotion. he also does not say any words not even mama or dada.

The skills that he has that throw everyone off are that he is SUPER affectionate-always giving hugs and he smiles all the time. He has good eye contact-it was very poor before EI but has improved drastically. Since EI he can now follow simple direction-"give mommy the ball" "get me your shoes" etc... and he can appropriately play (when I initiate ) with his toys. Since August, his therapist has been working on appropriate toy play, gesturing, and associating words with objects.

So maybe i am a crazy parent i have no idea. But I just want to get him help if he does have it. It is very scary.

So...I know he seems young but I think he as many red flags. he does not line up his toys though. No idea if I am doing the right thing-I am flying by the seat of my pants.

[maatTheViking]

UGG, you re not crazy ( or more crazy than any parent).

I don't think anyone was advocating against early diagnosis and interventions, but more against lay persons labeling their cousins or co workers or what ever based on one trait or behavior.

I think we as parents always are cautionous when it comes to our children, if you suspect something is wrong it is better to get it confirmed/not confirmed than wait (this applies to physical stuff as well, this is why we did a hearing test right when our son was born)

[UGG]

Thank you mattTheViking. LOL-I did not mean to sound defensive. I just know it is somewhat "controversial" (for lack of a better word) to get your kid tested before two. I am just very very scared it sucks.

[PDilemma]

Thank you mattTheViking. LOL-I did not mean to sound defensive. I just know it is somewhat "controversial" (for lack of a better word) to get your kid tested before two. I am just very very scared it sucks.

UGG--Those are legitimate developmental concerns. And that is not what I was talking about when I wrote about crazy parents wanting a diagnosis. I taught high school. That right there should tell you that it was a different matter. The parents I dealt with (and was referring to) were the ones who decided that instead of getting their 15 year old to not drink two Red Bulls every morning for breakfast, they should try to get him diagnosed ADHD and medicate him so he could pay attention in class. Or the ones who decided their eleventh grader had an undiagnosed reading disability when he failed a literature test. I could easily diagnose the disability that led to his failure in that case: he never opened the book. Those are crazy parents looking for a diagnosis to explain something away. (And I could tell more stories than those two).

You are a smart parent recognizing legitimate developmental concerns and addressing them appropriately.

[Clytie]

[quote]There is nothing wrong with being an introvert. We live in a society that prefers extraversion, so people who are introverts are seen as the lesser species, but it's just a different personality type.[quote]

I hear you. I remember being in teachers college ten years ago with my facility adviser. She said teaching was an extroverts field which was a shame because honestly not that many students we would teach would be extroverts. But it was all about selling yourself. And I speak as an introvert like her. And she honestly was fantastic. She also said sometimes you should just read a book to the class to enjoy a book which rarely happens now. Its all about breaking down the process.

And as for the teacher saying it would ruin her lesson plans wtf? The last five-ten years has been all been heavily about differential instruction. Meaning you plans your lessons and assessments for different learning strategies. As for gifted students - some are truly gifted but apparently teachers are careful to give this label because often it leads to more problems. These are students who tend to learn material more quickly in elementary/high school but by university most of their classmates have 'caught up' and suddenly they are no longer that far ahead. And it leads to self-esteem issues. Not to say there are not gifted students but its rarer than people want to believe.

As figure skating viewers we should have an idea how few the truly gifted are in any field. Do we want to lead people to believe they are above the norm when honestly they just may be above the norm barely? My brother bombed out of high school and now is an electrician who makes more than I do as a teacher. I think our education system needs a rethink but what a job that would be. I think overall its kind of telling that people look to Norway as a teaching ideology. They are really particular about who can teach and they spend plenty of money on support in the classroom. . Would that really float in North America?

I feel for all the parents who want the best for their children. It seems we are a society fond of labels- often to the point where it means it is the only way for us to get the help we need. Of course no one really wants to pay taxes to make sure this help happens. Because it does not affect their kid. They way it does in Norway. The guiding beacon of excellent test scores. And yes sorry I have gotten off course for the Aspergers topic. But sadly I think it ties in, in away.

[maatTheViking]

Clytie I find you comments interesting.

About being Gifted - following a discussion at a work email list about gifted children, I read a bunch of online resources. I saw that I had some of the gifted traits when I was a kid. However, just as you said: in primary school I was the best, the smartest in my class. In high school I was in the top 2%, and got the best exam scores of my class. At university I was top 30% maybe? If I'm generous? Suddenly you are surrounded with a lot of smart people, are they all gifted? Then I went to work at Microsoft, and I found myself to be average .

I don't think labeling me as gifted would have helped me in any way, but differentiated teaching would have - I definely didn't get challenged and think I could have benefitted being asked to work harder. In the end, I'm not really gifted at all.


And the money issue and back to Aspergers/autism: I read an article somewhere about early diagnosis, and some pediatrician s said their biggest concern was that a lot of areas don't have early intervention programs, or parents/state/who ever can't afford it. So what help is an early diagnosis? I think that argument doesn't work, but it highlights the monetary issues in treatment, along with the ones in education.

[Angelskates]

I just know it is somewhat "controversial" (for lack of a better word) to get your kid tested before two. I am just very very scared it sucks.

UGG - I don't think you're crazy, either. I do have concerns with ASD being diagnosed at such a young age. If you already have services, why is there a need for diagnosis at this age? Does it make a difference to the services you receive? All of the developmental things you listed are traits of ASD, or PDD, or global delay and some other things as well. Some children don't do these things at 21 months, and then develop normally, though late. To me, I would say the developmental issues are traits, but it's the flapping in combination with them that would make me think ASD. I think it's great that your son is in EI, and it's fabulous that he's improving already Many of the ASD kids I work with are affectionate - some too much so, and some because they want the tactile, sensory response, some because that's who they are. All of the ASD kids I work with smile a lot Sometimes, while getting told off

My issue is with the article posted is not just the age, it's that the one thing the mum says made her think it was Aspergers (or at least the one thing chosen to be published) was lining up of toys. This means absolutely nothing by itself, but it is the thing most know about and the thing I am most asked about. It's things like this that make the public have such a skewed view of what ASD is.

[UGG]

UGG - I don't think you're crazy, either. I do have concerns with ASD being diagnosed at such a young age. If you already have services, why is there a need for diagnosis at this age? Does it make a difference to the services you receive? All of the developmental things you listed are traits of ASD, or PDD, or global delay and some other things as well. Some children don't do these things at 21 months, and then develop normally, though late. To me, I would say the developmental issues are traits, but it's the flapping in combination with them that would make me think ASD. I think it's great that your son is in EI, and it's fabulous that he's improving already Many of the ASD kids I work with are affectionate - some too much so, and some because they want the tactile, sensory response, some because that's who they are. All of the ASD kids I work with smile a lot Sometimes, while getting told off

My issue is with the article posted is not just the age, it's that the one thing the mum says made her think it was Aspergers (or at least the one thing chosen to be published) was lining up of toys. This means absolutely nothing by itself, but it is the thing most know about and the thing I am most asked about. It's things like this that make the public have such a skewed view of what ASD is.

Yes-it will make a difference regarding the services available to us-and also...I cannot live another year with this on my mind. I need to know so I can move on with my life-if he doesn't get a diagnosis, I can sleep at night and this mental torture will hopefully go away. Of course we will continue with early intervention and I will keep my eye on things. If he does have it, I want to be at peace with a diagnosis and move forward full speed ahead and use any resource I can get my hands on to help him. Maybe it is selfish-I don't know. But I cannot live in limbo like this. I don't mean to sound dramatic-I know that I do. I just do not want him to struggle.

I appreciate your insight and anything anyone else has to say.

When he had just turned one, his delays were not as obvious but the older he gets, the more obvious it becomes. And I never realized how much kids point! I (not on purpose) am always checking out to see if and how often other kids point and clap-and it seems like even many young children do these skills and it is very often. We had a play date with a friend who is 4 months younger than my son and I swear he clapped and pointed the whole time. He does not talk yet either but he could gesture so well and we knew exactly what he wanted.

[maatTheViking]

UGG, one of the things being a pedant has taught me is thy you have to be 'selfish' to be unselfish. I can definely understand your need for a diagnosis, and if it brings you peace, it is one less thing on your mind, which will make you have more energy to other things (such as being a parent ).