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Medical Autism and Autistic Spectrum Disorders

  1. Jul 27, 2008 #1
    This is a link to a different thread. I hope that's ok.
    As the parent of an autistic child, I have a few differences of opinion with Mr. Savage. While it is true that his comments were taken somewhat out of context, they are still wrong even when that context is supplied. Note that he spoke at length about autism, but in his later explanation he claimed that he was speaking about ASD, (Autistic Spectrum Disorder). Autism is a neurological disorder, not a psychological or psychiatric one. My son was diagnosed with ASD by a neurologist when he was 3. This is a typical age for such a diagnosis. The diagnosis was confirmed by the same neurologist when he was older, I forget what age. More recently at the age of 13 he was diagnosed by a psychologist as being autistic. Although a strong case was made for autism, the fact that the doctor was not a neurologist makes it somewhat suspect. My son can be described by the nebulous term "high functioning". He requires no supervision in the daily routine of his life, but he does require special education and a shadow at school. A shadow is like a babysitter who keeps him focused on the work before him. He has no extraordinary skills like those portrayed in the movie Rainman. In many ways he is easier to raise than his older sister who has no symptoms of autism.

    The diagnosis for autism consists of a Chinese menu of symptoms. If you have 2 from column A, 3 from column B, etc, then the diagnosis is made. You can read the diagnosis in the book DSM-IV. The question arises, what if you have many of the symptoms, but not enough for the diagnosis. This is where the spectrum comes into play. I don't know the diagnosis for ASD, but it is only correctly applied to those who are not autistic, and there is where Mr. Savage comes closest to having a point. A diagnosis of ASD means not autistic, so what is the word autistic doing in the name? In my opinion the answer is Rainman put it there. More money is available for children with ASD than would be if it were called Pervasive Developmental Delay, the old name for ASD. Indeed, an early diagnosis my son got was PDD. This was by a teacher of autistic children and not by a doctor of any kind. He also got Sensory Disintigrative DIsorder by another teacher. These are synonyms for ASD.

    In Mr. Savage's weak explanation of his ridiculous earlier remarks concerning autism, he claimed that a diagnosis of ASD was often incorrect, sometimes being made in cases where the child was merely more intelligent than average. I have no statistics on how often misdiagnosis is made. I do think that it is being made in the case of Einstein, Newton, Dirac, Gates, and other famous intelligent people. In my son's case, there is no issue of misdiagnosis. You may prefer the name PDD over ASD, but that is nothing more than an issue of semantics and money. To imply that my son was misdiagnosed or that I need to tell him to stop acting like a girl is to take yourself out of a serious discussion.
     
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  3. Jul 27, 2008 #2

    tgt

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    What are some things that your child do to make the psychologist think he has autism?
     
  4. Jul 27, 2008 #3
    To understand the answer, you must first read the DSM IV (not the whole book, just the page on autism). You can find it in book stores. What you will want to keep in mind is that while some symptoms are clearly delineated, others are subjective. You could make a case for him having or not having some symptoms. This psychologist favored including more symptoms than the neurologist did. I'm sure if the two got together it would make for an interesting conversation.

    Edit: Here is the diagnosis from DSM-IV. DSM-IV Autism
    I don't remember which symtoms were added by the psychologist, I only remember that after the diagnosis we discussed them point by point. I agreed that he had those symptoms, but not that he had them to a pathological degree. For instance, 3-d "persistent preoccupation with parts of objects". We all do from time to time see the world in a grain of sand, but is it a symptom of autism, or just a normal moment of poetic musing?
     
    Last edited: Jul 27, 2008
  5. Jul 27, 2008 #4

    Moonbear

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    Thank you for that excellent post, jimmy. Apparently, I've been misusing the term Autism Spectrum Disorder myself. I had misunderstood it and thought it referred to all the varied types of autism (i.e., from high functioning to the most severe cases). For example, one of my coworkers has two daughters who are both autistic. One is somewhat high functioning; needs someone with her at all times, but can leave the house, attend special education classes, and can handle limited travel experiences. The other one is quite low functioning; completely shuts down if she leaves the house (they can't even take her to visit relatives, because she can't function in any "strange" environment), and can't care for herself at all (as a teenager, she requires full-time caretakers and has to wear diapers).

    jimmy, in that DSM IV criteria, when you see something phrased like "persistent preoccupation with parts of objects," I think the keyword there is "persistent." If EVERY time, or most times a person picks up an object and gets lost focusing in details, that would be persistent. If every once in a while a particular object fascinates someone and they get lost studying the details, that's pretty normal.

    But, of course this highlights why a diagnosis MUST be made by a professional who can distinguish between "persistent" (i.e., pathological) and occasional (i.e., normal), since obviously, there will be somewhat of a gray area in between.
     
  6. Jul 27, 2008 #5
    I agree. I would never put complete faith in a diagnosis of autism from anyone but a neurologist. Unfortunately, the only thing they bring to the table is experience. They presumably have seen many cases and have a better perspective from which to judge. In the end though, it remains subjective. Two neurologists with different experiences may give differing diagnoses.

    My son was delayed in all measurable developmental milestones. He spoke a single word at the age of 1 and a half and never uttered another until he was 4. What's worse, he rarely communicated by any other means either such as pointing or leading. Just before his third birthday, the first diagnosis came in and we got him into early intervention. At that point, he finally began leading. That means he would take me by the hand and lead me to the thing that he wanted. Scariest of all was delay in toilet training. That came at three and a half. There is a window of opportunity on that one and once it shuts, there is no hope. He was trained to use a picture exchange system whereby he had a collection of pictures of things to exchange for the thing itself. We were told to give him small amounts of things like food and water in order to force him to ask for them over and over. This did not work and he never exchanged a picture at home for anything. Today he speaks poor English with a wide variety of grammatical errors. For example "What is _____ is?" to ask the meaning of a word he doesn't know. Yesterday he said "Please borrow me the trash can" so he could throw something away. This is most likely due to the closing of some important window in his past. He asks many questions to which he already knows the answer. This is his way of making conversation. When he was younger, he would grow very frustrated when we didn't know the answer and he would throw tantrums at that point. For that reason, I tried with no success to discourage him from asking this type of question. Now he no longer gets frustrated, and since it is a large part of his conversation, I rather encourage it. It took me years to get over my insistance that he communicate normally and get down to listening to what he had to say on his terms.
     
  7. Jul 27, 2008 #6
    As for Mr. Savage's remarks, although he has not said so himself, the reaction of many people is that he seems to have confused autism with ADD (attention deficit disorder). I have not heard of any drug treatments for autism, but he speaks of such. A teacher (who probably should have been repremanded for doing so) recommended that we give our son Ritalin. However, as far as I know, RItalin is not prescribed for autism, but rather for ADD. Mr. Savage's remarks are ill-informed even for ADD, but they make more sense in that light. As i said, he has not claimed that he was making such a mistake.
     
  8. Jul 27, 2008 #7

    Monique

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    Until we have no clear indication what is causing these disorders it will remain difficult to give a clear diagnosis. The good thing is that autism is currently recognized as a neurological disorder, 20-30 years ago this was not the case and many children were taken out of the parents' care by child-protection services because of suspected neglect. I hope that in the coming years more will become clear about the biology of autism and possible treatments.
     
  9. Jul 28, 2008 #8

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    But have you heard the behaviours of Newton and Dirac? They were extremely odd in the socialising department.

    Einstein was more socialising but only spoke at age 5 and when he was in year 6, the principal said he would be up to no good. At uni, the professors didn't want to give him a research job after his Phd. The reasons could be because he behaved from unsocially.
     
  10. Jul 28, 2008 #9

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    How about a neural psychologist? Is there a difference?
     
  11. Jul 28, 2008 #10
    I don't believe that Einstein was 5 before he started to speak, I believe he was speaking by the age of 3. I don't know whether his principal said such a thing, but if he did, it would not be a symptom of autism. While it true that a lack of social skills can be a symptom of autism, it is not the case that social awkwardness is sufficient to bring a diagnosis of autism. Here again are the diagnostic criteria for autism. Use this to make your case for Einstein.
    DSM IV
     
  12. Jul 28, 2008 #11
    I don't know. Is there?
     
  13. Jul 29, 2008 #12

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    it does - you were not mistaken. ASD includes Aspergers (the "high functioning" autism) PDD and PDD NOS which are some other acronyms that sometimes get diagnosed (I wonder if the reason is that it is more palatable and has less stigma than the autism diagnosis.
     
  14. Jul 29, 2008 #13

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    You are much too generous. Savage is a boor and an idiot
     
  15. Jul 30, 2008 #14
    This thread is something of a disappointment to me as I had hoped to open a discussion on what he had said. Is autism overdiagnosed as he suggests? The figure he gave was 99%, but he has backed off on that number without provided another one. Can autism be 'cured' by telling the person to shape up, stop acting like an idiot, stop acting like a girl? Did he mean ADD when he said autism? Is ADD overdiagnosed?
     
  16. Jul 30, 2008 #15

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    But most of those questions are so stupid as to not deserve any serious consideration. I have an autistic child as well and the thought of Michael Savage telling him to "shape up and stop acting like an idiot" makes me just want to kick his ***, not discuss issues with him.

    There is some discussion over the entity known as autism which is simply a set of neurological symptoms with little known about the specific causes within the brain. So given that the diagnosis matches the symptoms it is not overdiagnosed but begs the question on what exactly is autism - is it one disorder or a blanket term for a potentially large number of specific brain issues. While autism has an extremely strong genetic component, there is not a single gene identifiable with it such as is the case with Downs or two disorders that present identically to autism - Rhetts and Fragile X. There is also something like 30% of autistic persons who also have some sort of epilieptic disorder. Some research has identified overlaps in the complexes of genes for the two disorders.
     
  17. Jul 30, 2008 #16

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    I have a feeling he is trying to take advantage of the fact that autism and related things are still new and not fully understood so many speculations can be made at this stage. It's like before a detailed study of Mars was made by sending a probe there, people wade many speculations about the planet. We just need time before the scientists study it more.

    One question I have is 'If a person appears to act out the manifestations of autism (very accurately) then does this person have autism (without out any other considerations)?'
     
  18. Jul 30, 2008 #17

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    In the absence of a more specific diagnosis where there are genetic tests like Rhetts and Fragile X then yes. The diagnosis is based upon the behaviors
     
  19. Jul 31, 2008 #18
    The diagnostic for autism can be found here.
    DSM IV
     
  20. Jul 31, 2008 #19

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    Also some basic facts that are commonly misunderstood:

    - there is no conclusive evidence that either MMR vaccines (which have no mercury) or mercury in other vaccines (which was eliminated in the US in 2001) have any relation to autism. Indeed, known cases of neurological damage from mercury poisoning has symptoms that are significantly different than autism.

    - There is no real evidence for an "autism epidemic" autism rates have increased due to a broadening of the DSM diagnostic criteria. The milder forms of ASD would not have been diagnosed 10 or 20 years ago. More classically autistic children would have been labeled "retarded" or "schitzophrenic" in the past.
     
  21. Dec 20, 2009 #20

    Astronuc

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    Autism seen as asset, not liability, in some jobs
    http://www.msnbc.msn.com/id/34047713/ns/health-mental_health/

    A new movement helps hone unique traits of disorder into valuable skills

     
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