Saturday, March 24, 2012

The DSM-V and autism: Mary-Minn's Stim Page, 3-2012

The DSM-V and autism

In May 2013, the American Psychiatric Association will be publishing the DSM-V, an updated version of their Diagnostic Standard Manual (DSM). The DSM describes the criteria that medical professionals use to make a diagnosis. I think there exist additional criteria that are known to everybody else in the autism field––teachers, case managers, care providers, and autists themselves.

I have no formal education in psychology, let alone diagnostics. I embarked on this project only because I was alarmed by what I was reading in the media about the drastic impact the new DSM would have on autists and our community, especially when it comes to getting necessary services.

Fully armed with a mission to alert the autism community and to flout the psychiatric "experts" while I’m at it, I compared the DSM-IV TR (the previous DSM) with the proposed DSM-V, item by item. My findings were reassuringly anti-climactic—maybe just a tad disappointing for this former newspaper reporter, who knows all too well that bad news sells papers.

I read arguments on websites and blogs, and in magazines, trade journals and newspapers about the ramifications of the new DSM on the autism community. I read an opposing argument about the facile intention to write away the "autism epidemic", a creepy locution. Whose facile intention this was, the article did not specify, but my knee-jerk self attributed it to the APA.

I then read an argument by an APA author in favor of eliminating Aspergers, which was that it’s difficult to distinguish between an autist with early speech delays (such as myself) and someone who had no early speech delays. This made sense to me. It seems like an arbitrary distinction, once a person can talk.

When making comparisons, I need to physically check things off, so I printed out the DSM V for Autism, and the DSM-IV TR pages for Autism and for Aspergers. What upset me at first glance was that the physical length of the verbiage in Autism plus Aspergers in the DSM-IV added up to quite a bit more than Autism in the DSM-V, which pointed toward a collapsing of the criteria. Furthermore, diagnosis by the DSM-V required meeting more criteria, hence it appeared to be more restrictive.
Upon reading the criteria more closely, though, I noticed that they were more concretely described and less vague, and that each criterion included more traits, including some that hadn’t even been mentioned in the earlier DSM-IV TR. So the inclusiveness of each criterion made up for the requirement that the patient meet a greater number of the criteria. This spectrum approach brought Aspergers back into the fold.

The DSM-IV TR read more as though it was describing children than adults; whereas, the DSM-V sounded more age-inclusive. The more technical and ever so slightly more archaic style of the earlier DSM had a more sepulchral ring to it, at least to my ears.

What struck me most was that only the DSM-V included sensory processing difficulties, something that is common knowledge in the autism community.

I was also surprised to see no mention of coordination difficulties in either version. Nor did they include difficulties with executive function, which, in my opinion, is the root cause of most of the other difficulties, such as sorting out and tolerating distracting stimuli, self-regulating, tolerating interruptions, making transitions, taking turns, recognizing faces and multi-tasking.

I was pleased to see no mention in either version of the lack of imagination, sense of humor or empathy that I’ve read about in so many other places.

Since the DSM was written with the intention of helping people get treatment for problems ailing them, I was not surprised to find no mention of the positive attributes, such as the Aspergian single-minded focus and prodigious memory for interesting facts, the facility in classifying objects and concepts, the logic-based thinking and inductive reasoning style, the extreme empathy for non-human creatures or people in another age group, the photographic visual memory. No one autist possesses all these gifts but they are a part of our autistic makeup.

Perhaps these super-skills illustrate different types of autism; perhaps, though, these differences have more to do with individual temperament than subtypes of anything. Autism is a mixed bag, coming with deficits and challenges, behavioral traits, and strengths. There are more variations, though, than with other developmental "disorders" in the DSM, leading me to believe that autism is more complex and difficult to define. Describing autism is more like describing a culture than a geographical location.

Mary-Minn Sirag

Tuesday, March 13, 2012

Ryan Crain as Dean Martin

Ryan: i like old movies that have frank sinatra and dean martin in them and james cargey too.

Melissa: Do you want to write some more about which movies you like, and why they're your favorites?

Ryan: ocean'11 and love me or leave me with james cargey. here is a photo of dean martin:

Here's a video of Ryan:
ryan crain as dean martin

Thursday, March 1, 2012


Subject: New Definition of Autism Will Exclude Many, Study Suggests

New Definition of Autism Will Exclude Many, Study Suggests
Single Page Version

Published: January 19, 2012

 Proposed changes in the definition of autism would sharply reduce the
skyrocketing rate at which the disorder is diagnosed and might make it
harder for many people who would no longer meet the criteria to get health,
educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the
American Psychiatric Association, which is completing work on the fifth
edition of its Diagnostic and Statistical Manual of Mental Disorders, the
first major revision in 17 years. The D.S.M., as the manual is known, is
the standard reference for mental disorders, driving research, treatment
and insurance decisions. Most experts expect that the new manual will
narrow the criteria for autism; the question is how sharply.

 The results of the new analysis are preliminary, but they offer the most
drastic estimate of how tightening the criteria for autism could affect the
rate of diagnosis. For years, many experts have privately contended that
the vagueness of the current criteria for autism and related disorders like
Asperger syndrome was contributing to the increase in the rate of diagnoses
- which has ballooned to one child in 100, according to some estimates.

 The psychiatrists' association is wrestling with one of the most
agonizing questions in mental health - where to draw the line between
unusual and abnormal - and its decisions are sure to be wrenching for some
families. At a time when school budgets for special education are
stretched, the new diagnosis could herald more pitched battles. Tens of
thousands of people receive state-backed services to help offset the
disorders' disabling effects, which include sometimes severe learning and
social problems, and the diagnosis is in many ways central to their lives.
Close networks of parents have bonded over common experiences with
children; and the children, too, may grow to find a sense of their own
identity in their struggle with the disorder.

 The proposed changes would probably exclude people with a diagnosis who
were higher functioning. "I'm very concerned about the change in diagnosis,
because I wonder if my daughter would even qualify," said Mary Meyer of
Ramsey, N.J. A diagnosis of Asperger syndrome was crucial to helping her
daughter, who is 37, gain access to services that have helped tremendously.
"She's on disability, which is partly based on the Asperger's; and I'm
hoping to get her into supportive housing, which also depends on her

 The new analysis, presented Thursday at a meeting of the Icelandic
Medical Association, opens a debate about just how many people the proposed
diagnosis would affect.

 The changes would narrow the diagnosis so much that it could effectively
end the autism surge, said Dr. Fred R. Volkmar, director of the Child Study
Center at the Yale School of Medicine and an author of the new analysis of
the proposal. "We would nip it in the bud."

 Experts working for the Psychiatric Association on the manual's new
definition - a group from which Dr. Volkmar resigned early on - strongly
disagree about the proposed changes' impact. "I don't know how they're
getting those numbers," Catherine Lord, a member of the task force working
on the diagnosis, said about Dr. Volkmar's report.

 Previous projections have concluded that far fewer people would be
excluded under the change, said Dr. Lord, director of the Institute for
Brain Development, a joint project of NewYork-Presbyterian Hospital, Weill
Medical College of Cornell University, Columbia University Medical Center
and the New York Center for Autism.

 Disagreement about the effect of the new definition will almost certainly
increase scrutiny of the finer points of the psychiatric association's
changes to the manual. The revisions are about 90 percent complete and will
be final by December, according to Dr. David J. Kupfer, a professor of
psychiatry at the University of Pittsburgh and chairman of the task force
making the revisions.

 At least a million children and adults have a diagnosis of autism or a
related disorder, like Asperger syndrome or "pervasive developmental
disorder, not otherwise specified," also known as P.D.D.-N.O.S. People with
Asperger's or P.D.D.-N.O.S. endure some of the same social struggles as
those with autism but do not meet the definition for the full-blown
version. The proposed change would consolidate all three diagnoses under
one category, autism spectrum disorder, eliminating Asperger syndrome and
P.D.D.-N.O.S. from the manual. Under the current criteria, a person can
qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under
the proposed definition, the person would have to exhibit 3 deficits in
social interaction and communication and at least 2 repetitive behaviors, a
much narrower menu.

 Dr. Kupfer said the changes were an attempt to clarify these variations
and put them under one name. Some advocates have been concerned about the
proposed changes.

 "Our fear is that we are going to take a big step backward," said Lori
Shery, president of the Asperger Syndrome Education Network. "If clinicians
say, 'These kids don't fit the criteria for an autism spectrum diagnosis,'
they are not going to get the supports and services they need, and they're
going to experience failure."

 Mark Roithmayr, president of the advocacy organization Autism Speaks,
said that the proposed diagnosis should bring needed clarity but that the
effect it would have on services was not yet clear. "We need to carefully
monitor the impact of these diagnostic changes on access to services and
ensure that no one is being denied the services they need," Mr. Roithmayr
said by e-mail. "Some treatments and services are driven solely by a
person's diagnosis, while other services may depend on other criteria such
as age, I.Q. level or medical history."

 In the new analysis, Dr. Volkmar, along with Brian Reichow and James
McPartland, both at Yale, used data from a large 1993 study that served as
the basis for the current criteria. They focused on 372 children and adults
who were among the highest functioning and found that overall, only 45
percent of them would qualify for the proposed autism spectrum diagnosis
now under review.

 The focus on a high-functioning group may have slightly exaggerated that
percentage, the authors acknowledge. The likelihood of being left out under
the new definition depended on the original diagnosis: about a quarter of
those identified with classic autism in 1993 would not be so identified
under the proposed criteria; about three-quarters of those with Asperger
syndrome would not qualify; and 85 percent of those with P.D.D.-N.O.S.
would not.

 Dr. Volkmar presented the preliminary findings on Thursday. The
researchers will publish a broader analysis, based on a larger and more
representative sample of 1,000 cases, later this year. Dr. Volkmar said
that although the proposed diagnosis would be for disorders on a spectrum
and implies a broader net, it focuses tightly on "classically autistic"
children on the more severe end of the scale. "The major impact here is on
the more cognitively able," he said.

 Dr. Lord said that the study numbers are probably exaggerated because the
research team relied on old data, collected by doctors who were not aware
of what kinds of behaviors the proposed definition requires. "It's not that
the behaviors didn't exist, but that they weren't even asking about them -
they wouldn't show up at all in the data," Dr. Lord said.

 Dr. Volkmar acknowledged as much but said that problems transferring the
data could not account for the large differences in rates.