Diagnosis, Determinism and the DSM V

Filed Under (Autism and Learning, Autism Spectrum and Diagnosis) by Estee on 09-11-2009

I was sitting in a waiting room recently when I picked up this from the April 2009 issue of Today’s Parent magazine’s article, Is It A Learning Disability by Marcia Kaye. I turned the pages reading about “conceptual and motor problems,” and in the middle of the page was a photo of a drawing.

“They don’t draw, they scribble,” said the caption.

Who are they? I thought. Does she really know who she is referring to?

The they, is the Adam who when he made is first intentional scribble on the page, I jumped happily. Whose “motor problems,” and indeed they are challenges, in holding a pencil or a crayon seemed to be surpassed. At least the first step had been made. You see, I’ve kept every one of Adam’s “scribbles,” his effort rewarding by his marking that later turned to a happy face, a letter, a sun and a tree and one day, a happy face with long hair which he named “mommy,” at the age of six. The theyare people. They are Adam. They are individuals who are challenged but not unintelligent, who continue to progress at their own rate on the exterior, while on the inside, have many ideas and things to share.

And then there is the category of Non-Verbal Learning Disabilities, which I read with great interest. For the Today’s Parent article stated that “this category encompasses non-verbal learning disabilities (NLD’s), which is a controversial area, with possible overlap into Asperger’s syndrome and mental health issues. But the LDAC [Learning Disabilities Association of Canada] considers NLD to be a bona fide learning disability. A child with an NLD may have a great vocabulary, a good memory and an excellent grasp of detail, but miss the bigger picture. He may be a good reader, but a poor comprehender…if you say ‘Oh great, I have to get a root canal!’ they may take you seriously.” It goes on to describe the social awkwardness and anxiety issues that we so often talk about with regards to autism.”

And to to muddy the waters even a little bit more, we have the discussions over DSM V [Diagnostic Statistical Manual] and removing Aspergers or what differentiates individuals along the autism spectrum:

The Neurodevelopmental Disorders (ND) work group’s discussions have focused on three areas:

1) Possible modification of ADHD criteria to allow for co-morbidity of autism and ADHD (currently excluded). The ADHD & Disruptive Behavior Disorders Work Group has agreed to consider this possibility.

2) Discussion of the validity of Rett’s disorder as a separate disorder and inclusion of a new modifier within the Autism Spectrum Disorders (ASD), which might include genetic and medical disorders and other biologically-definable conditions.

3) How to address Pervasive Developmental Disorders – Not Otherwise Specified (PDD-NOS). The individuals currently diagnosed with PDD-NOS may still be described in DSM-V, but the work group will discuss whether they can redefine ASD in such a way that the PDD-NOS diagnosis isn’t necessary, as this diagnosis currently captures a very heterogeneous group of individuals.

The ND Work Group will be seeking additional feedback from advisors and other experts prior to “finalizing” any recommendations.

Questions still under active discussion for ASD include:

1) How to describe the “spectrum” of disorders now known as ASD (e.g., how many domains will define the disorder);

2) What is the specificity of repetitive behaviors in ASD and how might they be better defined;

3) Whether Childhood Disintegrative Disorder (CDD) is a unique and separate disorder, and if so, what are its defining characteristics;

4) Whether autism is a life-long diagnosis or whether it is possible to recover/remit to the point where the diagnosis is no longer applicable;

5) Whether Asperger’s disorder is the same as “high-functioning autism”;

6) How the DSM-V can alert clinicians to common medical comorbidities (including genetic disorders, epilepsy/EEG abnormalities and sleep, or GI problems) and potential biomarkers;

7) How to include consideration of severity and impairment in diagnosis (currently defined as “qualitative impairments”) and how to integrate these with the overall structure of DSM-V; and

8) How/where to discuss cultural influences on diagnosis (e.g., Korean use of reactive attachment disorder rather than ASD to avoid family stigmatization).

What is most poignant to me is the purpose of both the differentiation and the suggestion that the atypicalities are abnormal rather than a way of being in the world. If Adam’s way of obtaining and processing information about his environment and the people around him are respected (as they are in his household and school), then he continues to grow, mature and learn. And while there continues to be little research that truly helps us understand how “severity” has often to do more with outward “functioning” rather than intelligence, I struggle with articles that fail to discuss how society tends to want to categorize and differentiate individuals based on the severity of their learning disability rather than discussing how people with different or atypical learning needs learn and how we can better support them.

When I read the suggestions for broadening autism to emcompass Aspergers and other characteristics in the DSM V, the issue as I see it is not the damaging effects that calling Asperger’s or PDD-NOS or NLD to autism is to the person or family. For I view it as the families’ discomfort in perhaps being associated with autism. I see the issue is a continued determinism about autism and herein lies the problem. Until autism and many issues are no longer viewed as problems to be solved, but rather atypicalities that require our understanding and providing for, we will forever find ourselves spinning on the hamster’s wheel.

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About Me


ESTÉE KLAR

I’m a PhD candidate at York University, Critical Disability Studies, with a multi-disciplinary background in the arts as a curator and writer. I am the Founder of The Autism Acceptance Project (www.taaproject.com), and an enamoured mother of my only son who lives with the autism label. I like to write about our journey, critical issues regarding autism in the area of human rights, law, and social justice, as well as reflexive practices in (auto)ethnographic writing about autism.