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I am totally curious to what they will be. I figure I'd start a thread since we're getting close to release date. Does anyone here have any collateral contact with the DSM committee and know?
Definitely curious. Wildly awaiting. I heard they were going to be more stringent. As a clinician, I don't love that.I am totally curious to what they will be. I figure I'd start a thread since we're getting close to release date. Does anyone here have any collateral contact with the DSM committee and know?
Definitely curious. Wildly awaiting. I heard they were going to be more stringent. As a clinician, I don't love that.
Anecdotally, it seems a lot of adults are wanting this diagnosis. Not sure the effect of the criteria changes but it is easy enough to self-diagnose or find some hacky therapist to agree with a self-diagnosis. It is a late and I maybe a bit snarky, so I do not mean to offend. But, again anecdotally, this may be becoming a problem.Anecdotally, I am seeing the diagnosis A LOT more often in chart reviews. So, I'm wondering if a more stringent criteria set would be a good thing. Anyone have a good source for epidemiology of the diagnosis since the change in DSM-V?
Anecdotally, I am seeing the diagnosis A LOT more often in chart reviews. So, I'm wondering if a more stringent criteria set would be a good thing. Anyone have a good source for epidemiology of the diagnosis since the change in DSM-V?
One in 57, up from one in 63 five years prior. It's completely over diagnosed, with parents and adults fetishizing the disorder so that any quirky behaviors or flapping when excited means ASD, not to mention the myth of masking in high functioning females being the reason for lower rates in females (hint: it's got something to with boys single x chromosome). Honestly, I hope they make it way more stringent. I do about hundo ASD evals a year. There is a trend, if I see them before age 4, there's a high probability it's actually autism or another serious neurodevelopmental disorder. However, if I see them after seven, it's like duh - clearly not autism - parents just want a tidy story. Mostly ADHD with a slice of good ole anxiety and parental accommodation. I will say that my threshold for diagnosis under age 6 is a lot lower. In may state I can do a provisional diagnosis that will get the kid in ABA/hab until age six. I often tell parents to hold off on getting a puzzle piece tattoo until then. As a field, we are dangerously close to the label actually meaning anything.Anecdotally, I am seeing the diagnosis A LOT more often in chart reviews. So, I'm wondering if a more stringent criteria set would be a good thing. Anyone have a good source for epidemiology of the diagnosis since the change in DSM-V?
I'd settle for some clarification on what a standardized measure of intellegence even MEANS in a toddler. Bayley-4 cognitive contains items related to pretend and imaginative play, as well as those that require age-level receptive language. ASD kids can kill it on the the visual-spatial stuff (puzzles, pegboards, matching tasks), but get gigged on (or even hit a ceiling because of) the social and language stuff. I see a lot kids who get an SS of 65-75, but have no problem with higher-aged tasks after the ceiling has been hit. Don't get me started on measuring IQ in a 12-15 month old!I wish they would clarify diagnosing ASD in kids with ID. The current language is vague. But some literature is looking at the difference between "primary ASD" and a "secondary ASD" that is the result of ID/etc. I also wish that they would provide more stringent examples of the negative symptoms of ASD.
Edit: gasp - 1 in 48. Autism and Developmental Disabilities Monitoring (ADDM) Network | CDC
You could interpret their findings as an improvement in the accuracy/reliability of ASD diagnosis during the measured time period, thus the convergence of teh ASD (rising) and ID (falling) dx trends represents an improvement in diagnostic sensitivity, versus a confound. It's also important to recognized that the authors used IDEA classification as the operational definition of diagnosis. It's widely avaialble data, but somewhat suspect as to reliablility (they even point out that this didn't always adhere to DSM criteria). Still, interesting stuff. I find Table 1 pretty interesting, in that there are what appear to be significant differences in rates between urban/rurarl, north/south, red/blue states, which suggest that there's something else going on.Polyak, A., et al. (2015). "Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis." Am J Med Genet B Neuropsychiatr Genet 168(7): 600-608.
Anecdotally, it seems a lot of adults are wanting this diagnosis. Not sure the effect of the criteria changes but it is easy enough to self-diagnose or find some hacky therapist to agree with a self-diagnosis. It is a late and I maybe a bit snarky, so I do not mean to offend. But, again anecdotally, this may be becoming a problem.
You could interpret their findings as an improvement in the accuracy/reliability of ASD diagnosis during the measured time period, thus the convergence of teh ASD (rising) and ID (falling) dx trends represents an improvement in diagnostic sensitivity...
The bigger concern is the general disregard for using validated methods of assessment, especially with adults and especially in non-academic medicine settings.adult autism dx's rely pretty heavily on the clinical interview and collaborative evidence and not much else. Also, I'm not aware of a psychometrically decent clinical interview for adults with high functioning autism (two examples of attempts here and here), which obviously leads to variability in the integrity of the interview.
The bigger concern is the general disregard for using validated methods of assessment, especially with adults and especially in non-academic medicine settings.
Very true, I can't tell you how many times I've been annoyed with some clinician who thinks they can just do what they feel because the science isn't 100% settled on x assessment practice.
Can you expand on this a little more for me?I'm sick of being told to do just this by supervisors who trained a few decades ago and have declined to read any of the current literature or stay up to date on changes in how we're trained in graduate programs. If I wanted to do whatever I wanted I could have saved a lot of time and money by just becoming a life coach and claiming expertise based on 'because I said so.'
One for adults, those who just have a weird/quirky that has some overlap with autistic features. I propose calling "pseudoautistic personality disorder" and a person needs X of the following criteria based on self-report only:
- feels odd/weird socially
- gets sad about not fitting in
- reports they are "just different"
- frequently nerds out about a narrow subject and then feels bad about liking the things they like
- reports that it is hard for them to make eye contact (even though their joint attention skills are fine)
- Is like socializing about little things around the water cooler like physically painful for you, especially on a monday or before you've had coffee?
- has a college degree, romantic partner, or job, but sometimes gets into trouble with them bc of their oddness
- does not like loud sounds or busy places
- Despite being in gifted programs as a kid and frequently told how smart they are, is the person now considered an "underachiever" and feels bad about that and an autism diagnosis would "explain everything."
- owns a weighted blanket/fidgets/pop its
- hates jeans
- has a relatively low tolerance for uncomfortable things and has big emotions
- physical exercise as a coping mechanism: what's that?
- gets personal gratification from going against the grain/does "not understand" why people like watching sports/playing sports
- had a pretty typical language development, had tons of friends in early childhood, maybe was even a little verbally precocious,
- Nerdy parents
- has ANY hobbies or collections
- is the person white or white identifying?
- person would get social credit/clout/avoid white guilt from having an autism identity
Personal theory about the neurodiversity movement: it's for privileged people because only they can afford to cover up severe adaptive impairment with money and ignore behaviors like fecal smearing.I think there's also an interesting phenomenon where autism has become a more accepted/less stigmatized identity/diagnosis, so people seek out to "replace" a diagnosis that's seen as worse (e.g., ID, BPD).
I also think there's a lot of cognitive dissonance stuff that goes along with some of the "neurodiversity" movement. For example, I have a friend (physician) who has an autistic son and is big into neurodiversity, so he believes that autism shouldn't be treated. Okay, cool. But my friend also has ADHD, which he believes is neurodiversity but SHOULD be treated but is not a disability and is not a mental illness, despite being treated by a psychiatrist. But we also shouldn't stigmatize mental illness and we should treat mental illness but not neurodiversity, but he doesn't have a mental illness and is neurodiverse and is being treated, but not as neurodiverse as his kid, who shouldn't be treated. It's just... there's so many layers of logical hoop jumping there.
Also, here's an interesting interview. At around 14:30 Dr. Fist talks about the updated ASD criteria:
Btw, I think Dr. Fist kinda hits it on the head: there has a been a huge explosion in autism over-diagnosis, whereby anyone who is a little weird or awkward is now "on the spectrum" in the zeitgeist/lexicon.
Here's a .pdf from APA in 2015 that discusses this for ASD: (https://dsm.psychiatryonline.org/pb-assets/dsm/update/DSM5Update2016.pdf#page=7)
If those are the changes, I don't expect the new updates will do anything to reduce autism over-diagnosis. Also, there is a scary amount of online autism advocacy from people who beleive they have autism (and they probably don't - likely because they're just odd/rigid/poorly socialized/etc.,).
Honestly, at this point, I think we do need to capture these people with other diagnostic labels in order to preserve ASD, one that differentiates them from people with real autism. Personally, I kind of see who categories of people who would benefit from a new label being created:
And finally a non-joking diagnosis the delineates primary a autism spectrum disorder from a secondary autism like condition that is really just due to severe/profound brain injuries/intellectual disability/etc,
- One for adults, those who just have a weird/quirky that has some overlap with autistic features. I propose calling "pseudoautistic personality disorder" and a person needs X of the following criteria based on self-report only:
- feels odd/weird socially
- gets sad about not fitting in
- reports they are "just different"
- frequently nerds out about a narrow subject and then feels bad about liking the things they like
- reports that it is hard for them to make eye contact (even though their joint attention skills are fine)
- Is like socializing about little things around the water cooler like physically painful for you, especially on a monday or before you've had coffee?
- has a college degree, romantic partner, or job, but sometimes gets into trouble with them bc of their oddness
- does not like loud sounds or busy places
- Despite being in gifted programs as a kid and frequently told how smart they are, is the person now considered an "underachiever" and feels bad about that and an autism diagnosis would "explain everything."
- owns a weighted blanket/fidgets/pop its
- hates jeans
- has a relatively low tolerance for uncomfortable things and has big emotions
- physical exercise as a coping mechanism: what's that?
- gets personal gratification from going against the grain/does "not understand" why people like watching sports/playing sports
- had a pretty typical language development, had tons of friends in early childhood, maybe was even a little verbally precocious,
- Nerdy parents
- has ANY hobbies or collections
- is the person white or white identifying?
- person would get social credit/clout/avoid white guilt from having an autism identity.
- Then there are those for kids that we will call "pseudoautism spectrum disorder due to too much coddling in childhood":
- Did a parent over rescue the kid and never let them feel bad/force them to do anything effortful/unconfortable/transition from pleasant to unpleasant activities/talk to new people.
- was time out viewed as abuse in the house?
- how many special diets have you tried and is your kid sensitive to gluten?
- Does the kid do weird things for attention.
- is the kid really rigid and has a restrictive diet because they were never forced to eat anything.
- is the kid a "picky eater" but really likes ice cream, french fries, hamburgers, pizza, chicken nuggets from multiple restaurants? (E.g., does the kid eat BK and McDonalds chicken nuggets equally?)
- are they allowed as much screen time as possible and play more than one hour of videogames per day.
- does the kid do pretty well behaviorally at school, but has most problems at home (based on rating scales)
- is dad pretty uninvolved? you know, he's there, but not really.
- is mom a stay at home mom.
- is anger inherently pathological in the culture of the house?
- do vaccines cause autism?
- does the parent actively desire their child to have an autism diagnosis for other reasons than it's diagnostic and treatment utility?
- Is the kid a major distraction from issues in the marriage/family?
Personally, I think it comes from internalized ableism/internalized stigma--like "disability is bad, so we're not disabled--we're just better." It seems similar to the disability separatism that has long been present from the Deaf community, though at least in my experience, the autistic self-advocate/ND community is at least willing to recognize themselves as part of the broader disability community, unlike the Deaf community that bristles at being called disabled but totally wants protection under the ADA and 504. Kind of like with ADHD being "neurodiverse" rather than "psychiatric"--"oh, I have these psychiatric symptoms that cause major life impairment and are treated by a psychiatrist, but my brain is just better/special/magical--not like those mentally ill folks."Personal theory about the neurodiversity movement: it's for privileged people because only they can afford to cover up severe adaptive impairment with money and ignore behaviors like fecal smearing.
I also find it funny that the neurodiverse crowd really really likes a formal diagnosis.
"Here, take this checklist of extremely common and non-specific characteristics indicative of normal development and experiences. You too can have a trendy diagnosis!"
Also, everyone’s ex is a narcissist or has BPD. Oh! And EMDR is the only evidence-based treatment for PTSD (and literally everything else).Yeah, I have this HUGE pet peeve of people posting things like "things you didn't know are symptoms of (ADHD, autism, PTSD)" and just lists everything that person has ever experienced, regardless of it being related to the actual diagnosis.
Also, everyone’s ex is a narcissist or has BPD. Oh! And EMDR is the only evidence-based treatment for PTSD (and literally everything else).
Also, everyone’s ex is a narcissist or has BPD. Oh! And EMDR is the only evidence-based treatment for PTSD (and literally everything else).
I still think the South Park test for ADHD was the best.Wow. That's about as bad as the ADHD self-diagnosis questionnaires that basically start and end with, "do you sometimes procrastinate and have trouble focusing on tedious tasks?"
Wow. That's about as bad as the ADHD self-diagnosis questionnaires that basically start and end with, "do you sometimes procrastinate and have trouble focusing on tedious tasks?"
I still think the South Park test for ADHD was the best.
I have no doubt this exists, but I have to wonder how divorced I am from the youth of today? Is this just "social media" stuff? My youngest (of 3) is 5 now, and in suburbia, I feel like when your kid is weird, your kid is "weird" and is told so by a variety of invested sources. Kind of the like the opposite of what you are talking about. Like, "please fix your kid" kind of stuff. Where is all this "your kid is a weirdo" positivity is real-life?Personally, I think it comes from internalized ableism/internalized stigma--like "disability is bad, so we're not disabled--we're just better." It seems similar to the disability separatism that has long been present from the Deaf community, though at least in my experience, the autistic self-advocate/ND community is at least willing to recognize themselves as part of the broader disability community, unlike the Deaf community that bristles at being called disabled but totally wants protection under the ADA and 504. Kind of like with ADHD being "neurodiverse" rather than "psychiatric"--"oh, I have these psychiatric symptoms that cause major life impairment and are treated by a psychiatrist, but my brain is just better/special/magical--not like those mentally ill folks."
A lot of it is online, yeah.I have no doubt this exists, but I have to wonder how divorced I am from the youth of today? Is this just "social media" stuff? My youngest (of 3) is 5 now, and in suburbia, I feel like when your kid is weird, your kid is "weird" and is told so by a variety of invested sources. Kind of the like the opposite of what you are talking about. Like, "please fix your kid" kind of stuff. Where is all this "your kid is a weirdo" positivity is real-life?
Wow. That's about as bad as the ADHD self-diagnosis questionnaires that basically start and end with, "do you sometimes procrastinate and have trouble focusing on tedious tasks?"
Oh ****, I sometimes procrastinate and have trouble focusing on tedious tasks!
I can actually attest that I failed the CPT when I tried to take it (when learning to administer it as a prac student).
Complex PTSD and in the case of Autism, everything is “Erhmagerd, Masking! Or Erhmagerd, Nonverbal learning Disorder!!!”And everything is complex PTSD. EVERYTHING.
Complex PTSD and in the case of Autism, everything is “Erhmagerd, Masking! Or Erhmagerd, Nonverbal learning Disorder!!!”
That Testing Psychologist Facebook group is equal parts fascinating and horrifying.
I recently saw someone in that group unironically recommend brainspotting for PTSD. Almost everyone else recommended EMDR.
During our ADHD assessments in clinic, I swear 90%+ of CPT administrations came back as invalid. So useless.I can actually attest that I failed the CPT when I tried to take it (when learning to administer it as a prac student).
Come on, the uterus moving around the body is CLEARLY giving women crazy ideas like they should have rights.Counterpoint: Nothing in today's day and age should be labelled as the sexist, completely useless diagnosis of "hysteria"
I recently saw someone in that group unironically recommend brainspotting for PTSD. Almost everyone else recommended EMDR.
I think the hysteria comment was pointing out the comparison to the catch-allness of girls with asd and how hysteria was another catchall for girls who aren't stereotypically typical.Counterpoint: Nothing in today's day and age should be labelled as the sexist, completely useless diagnosis of "hysteria"
I think the hysteria comment was pointing out the comparison to the catch-allness of girls with asd and how hysteria was another catchall for girls who aren't stereotypically typical.