Autism Blog - Bye bye Aspergers? « Left Brain/Right Brain

04 Nov 2009

Author: Kev
Comments: 89

Bye bye Aspergers?

The recent article in the New York Times concerning the possibility of the ‘vanishing’ of Aspergers Syndrome from the next version of the DSM (due in 2012) only asks two people (Temple Grandin and Ari Ne’eman) for their opinions. Nothing wrong with that as such but I’d like to hear what the AS community at large thinks.

Temple thinks that the AS community is too large and too vocal to simply disappear but I think she’s missing the point somewhat. The point is (in my opinion) neatly encapsulated by Ari. He points out that AS isn’t disappearing, its simply formally becoming ‘part’ of autism. Something the vast majority of the autism and autistic community have always known it is. To answer Temple directly, the AS community isn’t disappearing, its just finally taking its rightful place alongside the others in the autism community.

NB: this post first erroneously stated Temple Grandin had an AS diagnosis. This is now corrected.

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Comments

89 Responses to “Bye bye Aspergers?”

RAJ
November 4th, 2009
12:53:27

Does Asperger Syndrome exist? Here’s one answer:

http://www.ncbi.nlm.nih.gov/pubmed/11411788?

Asperger Syndrome may be indistinguishable
from Schizoid Personality Disorder as follows

ICD-10 Definition of Schizoid Personality Disorder:

Diagnostic criteria (ICD-10)
According to the World Health Organization’s ICD-10, schizoid personality disorder is characterized by at least three of the following criteria:

Emotional coldness, detachment or reduced affection.
Limited capacity to express either positive or negative emotions towards others.
Consistent preference for solitary activities.
Very few, if any, close friends or relationships, and a lack of desire for such.
Indifference to either praise or criticism.
Taking pleasure in few, if any, activities.
Indifference to social norms and conventions.
Preoccupation with fantasy and introspection.
Lack of desire for sexual experiences with another person.

Asperger Syndrome is a more fashionable label than the negative label of ‘Schizoid Personality Disorder’. Narrowly defined autism, including ‘High functioning autism’ is a neurodevelopmental disorder while Asperger Syndrome and its previous definition ‘Schizoid Personality Disorder’ is better described as a personality disorder.
jypsy
November 4th, 2009
12:59:09

Temple Grandin is not Asperger’s, she has an autism diagnosis.
Laurentius Rex
November 4th, 2009
13:36:39

I don’t regard and have never regarded Temple Grandin as an authority on autism, it isn’t her specialty and she blatantly and deliberately ignores the political aspects.

All she is, is a personality who represents a succesful career trajectory with Autism, who has been given some celebrity in what was at that particular time a relative vacuum of personality’s.

Unfortunately I can’t read the New York Article without signing up, which is something I will not do. However I think asking Temple something techical is the same as asking Jenny McCarthy something technical. Ari is closer to the truth, but projecting into the future, can we even be sure autism will stay?

That depends on a lot else besides science.

As for Gypsy’s comment, Temple Grandin cannot be asperger’s because it won’t exist to be asperger’s and to define people simply by the existing lexicon is never a good way to go because that is to give in to the vagaries of diagnostic fashion, don’t forget we were all psychotic once, because the manuals said so.
Kev
November 4th, 2009
14:00:36

Yeah, that idea really caught fire eh RAJ?
jypsy
November 4th, 2009
14:08:36

Larry, I’m with you re: Dr. Grandin. She’s very opinionated, paints with a very wide brush, and, on some things, is very wrong.

What the NYT said was:
“In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label. Temple Grandin, a Colorado State University animal scientist who is perhaps the best-known autistic American, said Asperger’s was too well established to be thrown overboard. “The Asperger community is a big vocal community,” Dr. Grandin said, “a reason in itself” to leave the diagnosis in place.

“P.D.D.-N.O.S., I’d throw in the garbage can,” she added. “But I’d keep Asperger’s.” “
Laurentius Rex
November 4th, 2009
14:30:11

RAJ always gives the impression of knowing more than he does, because to every diagnosis there is a background and certainly some years ago there was debate mostly initiated by Sula Wolf regarding Schizoid personality disorder.

However the state of knowlege weak though it still is in so many domeains, has moved on to understanding more of the mechanisms at work in autism which is what leads to the current conclusion.

In fact if we had time to devote to it beyond our own fixation with this small section of the DSM that deals with autism we can expect many debates around other conditions and I know that the nosology of “personality disorders” is much disputed, particularly as they are behavioral stereotypes (I will not call them phenotypes, that is to dignify them too much) which do not at all indicate any commonality of causation, they are as wooly and wild as the fashion blows.

It may well be the other way round and I rather suspect it is, from the various evidence of re-evaluating patients in mental hospitals for autistic traits, that these vague and less than useful personality diagnoses hide a great deal which is being easily dismissed and ignored.

I would warrant that almost anyone at some stage in there life would merit a personality disorder diagnosis simply by virtue of having sought professional clinical advice, because this is the way the mindset works, when you look through clinical spectacles at the normal, but fail to engage your own “pathology” as it were.

I wish there were some gift out there that could be given to collectors of pubmed citations and listers of disorders of a faculty of understanding them all critically in aggregate and full historical context.

Again what ICD10 and DSM are, are not statements of fact, they are not the cutting edge of research opinion, they are coding systems whose validity has more to do with meeting there own set of subjectice criteria than any reflection of the real world. They are in effect a rather poor model which everyso often needs revising to reflect how far out of step it is with the current state of knowlege, this is what this current process is about, it is not about defining the conditions, that is always a work in progress, it is about labling and cataloguing them.

Hey Pluto ceased to be a planet recently, does that mean that Pluto has changed it’s orbit, it’s size or shape, and does that mean it is no longer a heavenly body at all. Of course not, it just means that it has been recategorised to suit more current observations.
Arthur Golden
November 4th, 2009
14:36:42

Kev,

1. Concerning Temple Grandin, the article now states (already quoted in comment with time of 14:08, so I won’t repeat).

2. The article now has a note that “Correction: An earlier version of this article incorrectly said Temple Grandin was a professor at the University of Colorado.”

3. The article was somewhat ambiguous when it started with “In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label.” In the next sentence when it then mentions Temple Grandin it states “who is perhaps the best-known autistic American” and does not state she is AS. I think you should correct your blog entry that states “two people with the AS diagnosis (Temple Grandin and Ari Ne’eman).” However, the article is still misleading when it uses the term “mild autism” in the sentence before mentioning Temple Grandin. Of course, the focus of the article is Asperger’s Syndrome and not severity of autism, but I would avoid the use of the term “mild autism” in referring to Temple Grandin.

Arthur Golden
farmwifetwo
November 4th, 2009
14:56:03

I have high hopes it gets rid of those that are self-dx’d aspies and think that Asperger’s is some cutsie club that makes them look like they are genius’. I would part with my eldest’s dx of NLD if it protected the little one and his dx of Autistic disorder.

I have NO issues of anyone with a current Asperger’s dx getting services.

A diagnosis IMO is SOLELY for getting necessary services, programming and funding for ALL those that require it.

Maybe it’ll shorten the actual diagnostic list if you now actually have to prove that an actual disability exists. Plus, no longer having that “Aspergers = genius” catagory, those that are joining the “club” for those reasons may finally leave and those that need the diagnosis b/c of true disability will remain. One can only hope.
farmwifetwo
November 4th, 2009
15:01:14

Re: Temple Grandin.

If you have never heard her speak, I recommend you do. She does have full autistic disorder, it’s very obvious in her mannerisms and speach patterns but she has taught herself proper social/behavioural coping mechanisms and that too shows. She’s not a young woman, I am going to guess she has to be around 60yrs old since she grew up in the 50’s.

She also admits to having opinions. She admits her opinions may not be the same as yours. She also wonders if some of them have to do with growing up in the 50’s when parent’s taught the word “no” and therapies didn’t exist. She doesn’t appologize for her opinions either.

One thing that is obvious, is that she cares. She cares about those from one end of the spectrum to the other. She may not totally understand the politics, the therapies, the camps, but she tries to, tries to listen atleast.

I like her. She calls it as she sees it… you have to respect that.
Joseph
November 4th, 2009
15:09:30

RAJ’s link is not working for me right now, but I’m willing to bet that’s not a case-control study, right? You’d have to compare an Apserger’s and a Schizoid personality disorder group, matched for IQ, and see if there aren’t any differences of note.

If there aren’t any differences, that would argue for discarding Schizoid personality disorder, which is a not a label in common use. That is, Schizoid personality disorder should get merged into ASD along with Asperger’s.
Joseph
November 4th, 2009
15:26:50

A diagnosis IMO is SOLELY for getting necessary services, programming and funding for ALL those that require it.

@FW2: So in your view, Temple Grandin should not have a diagnosis, is that right? I’m not sure she requires services. She takes medication for anxiety, but I don’t believe an ASD diagnosis would be necessary for that.
Laurentius Rex
November 4th, 2009
15:28:39

I have met Temple Grandin, and I have heard her speak, and she has met me and heard me speak, (We even had a photograph taken together and published if you want the proof) indeed she has seen one of my videos which I was showing on that occasion.

I base my opinion on her lack of politics on having discussed it with her.

Her speciality is animal science and you can’t dispute that, mine is currently in autism and I don’t think you can dispute that either. She is close enough to me in age for there to be resonances in background there even though we grew up in different cultures the mores of the times were similar.
Tom
November 4th, 2009
15:52:44

Old RAJ playing the bait and switch again. The article he links evaluated 157 children with autism or Aspergers. All had “impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both),which are DSM-IV criteria for autism.” No where in this paper is schizoid personality disorder mentioned. As a metter of fact, the article is making the claim that Aspergers is really just autism.

I strenuously object to this dishonesty. It’s an insult no different than Bensmyson’s agenda of insulting those on the higher end of the spectrum.
NightStorm
November 4th, 2009
16:15:20

I kinda hope they get rid AS, I am sick of it being use to separate from the other autistic community, being used as divider. I want to say, “I am autistic” no if ands or buts.
Leila
November 4th, 2009
16:17:38

I think Asperger’s Syndrome is distinct from autism mainly in the criteria of “no language delay in childhood”. You may find HFA adults that are indistinguishable from their Asperger’s peers, but this is not the majority of cases. If a study proves it otherwise, then go ahead and eliminate the label, but I doubt it will happen. I think Asperger’s should remain as a distinct diagnosis, within the autism spectrum, just as it is today.

PDD-NOS is trickier to diagnose, but it’s valid when the child doesn’t meet all DSM criteria for autism but still presents some autistic traits. I see PDD-NOS kids and compare them to my kid (diagnosed ASD) and the difference is obvious. They are more verbal and more social.
daedalus2u
November 4th, 2009
16:33:10

I agree with Tom. Comparing Asperger’s/autism with Schizophrenia is disingenuous/dishonest. The physical symptoms are very different (pretty much opposite).

http://www.sfu.ca/biology/facu.....ck2008.pdf

The only similarity that I see is that some NTs think that both are “weird” and should be considered pathological. I see this as an attempt to justify the feelings that some NTs have toward both by blaming the individuals that NTs have feelings about rather than forcing NTs to examine themselves and understand why they have those specific feelings about other people.

The feelings that NTs have (or that anyone has) are about the person having the feelings. To project those feelings onto someone else is pathology, the pathology of borderline personality disorder and the other psychotic spectrum disorders. A pathology that is rare to non-existent in people with autism.
Joseph
November 4th, 2009
16:38:42

If a study proves it otherwise, then go ahead and eliminate the label, but I doubt it will happen.

It pretty much has already happened. Briefly, when they compare groups of people diagnosed with autistic disorder vs. people diagnosed with Asperger’s, matched for IQ, they typically find few differences of note. There are some studies that say otherwise, however.

Additionally, there are several studies where they strictly re-diagnose ASD children based on DSM-IV criteria. They find that the proper diagnosis for all or nearly all Asperger children is actually autistic disorder. Basically what this means is that DSM-IV Asperger’s is poorly defined.
Kate
November 4th, 2009
16:55:05

I am torn on this. My son was dx’d with Asperger’s (late dx in middle school) due to the fact that he had no language delay in childhood. When we first started to search out what was going on with him, autism never entered our minds since we were only familiar with the “Kanners” autism. I am now, much more familiar with the wide spectrum that can occurr with an autism dx but I worry that other parents may miss a dx or get mis-diagnosed, as we did. So due to the fact that those “cute aspies” (sarcasm) are so vocal, we found the answers to our questions.
My son (16) has stopped using Aspergers when the odd question comes up about him. He has been teased about Ass Burgers enough and now just uses autism. And if using autism instead of Asperger’s stops farmwife from slandering my guy (and others), I would be okay with that.
Kate
Anne
November 4th, 2009
16:56:00

The study that RAJ links to is one of the studies that suppports the proposal of the DSM-V’s Neurodevelopmental to fold Autistic Disorder, Asperger’s, and PDD-NOS into one classification. The study found that subjects with an Asperger’s diagnosis also fit the diagnostic criteria for Autistic Disorder.

The fact that some parents of kids with AS diagnoses are reportedly objecting to this proposal suggests to me that autism is considered a more stigmatizing diagnosis.
Joseph
November 4th, 2009
17:08:05

Yep, I can access the link now, and Tom is absolutely correct. RAJ’s behavior is unbelievable. The bait is the title of paper: “Does DSM-IV Asperger’s disorder exist?” It has nothing to do with Schizoid personality disorder. The paper is also not about what RAJ would like it to be about. It’s exactly about what I said above:

Additionally, there are several studies where they strictly re-diagnose ASD children based on DSM-IV criteria. They find that the proper diagnosis for all or nearly all Asperger children is actually autistic disorder. Basically what this means is that DSM-IV Asperger’s is poorly defined.
Sullivan
November 4th, 2009
17:30:44

She cares about those from one end of the spectrum to the other

I have high hopes it gets rid of those that are self-dx’d aspies and think that Asperger’s is some cutsie club that makes them look like they are genius’.

Do you even see the contradictions in your comments? My guess is that you do because you don’t usually use “self-diagnosed” when using the disrespectful and uncaring “cutesie club” statements you often use.
Kate
November 4th, 2009
17:49:30

One more thing and this is direct to fw2. Getting a dx of Asperger’s can be detrimental as in some areas it actually EXCLUDES services. Sadly the meme, that it is milder or self diagnosed or whatever, that you farmwife are determined to spread far and wide, undermines the ability of accessing those services.

I am sure that if a lot people just up and decided that NLD was due to a bunch a people getting together to form a “cutsie club” and it was time to get rid of them, you would be okay with that? Right?
Leila
November 4th, 2009
17:58:50

Joseph, please clarify – were they comparing AS and HFA adults with similar IQ’s? In that case, it won’t show the difference between an Asperger’s adult and an autistic adult with lower IQs.
Tom
November 4th, 2009
18:09:27

Farmwifetwo,

Are you aware that AS and NLD share many very common features? Some think they are identical entities. Could it be that your child is part of this “cutsie club” you so despise? Maybe you shouldn’t be throwing stones. You might hit your son.
Joseph
November 4th, 2009
18:25:39

Joseph, please clarify – were they comparing AS and HFA adults with similar IQ’s? In that case, it won’t show the difference between an Asperger’s adult and an autistic adult with lower IQs.

Well, yes, but that’s the point. If there are no differences of note between an HFA adult and an AS adult with the same IQ, why should the HFA adult be called HFA and not AS, and vice versa?

You could argue that every ASD person with an IQ above X should be called AS and everyone below X should be called autistic. However, there’s already a research classification for this cognitive dimension: HFA vs. LFA. No need for Asperger’s.

Also, what would you do with an untestable child? You’re not going to call the child “possible Asperger’s,” right?

The DSM-V spectrum won’t be divided along cognitive lines, btw. The “severity” dimension there will be based on something else, I understand.
David N. Brown
November 4th, 2009
18:50:08

Classifying AS relative to autism is an important technical question, but I have never considered it necessary or particularly useful for services. In presenting, I have introduces the issue with a joke I came up with about paleontology: “We don’t know what it is, but we can name it!”
Sullivan
November 4th, 2009
18:51:39

Temple Grandin is not Asperger’s, she has an autism diagnosis.

That is my understanding as well. The article was not really specific on Dr. Grandin, but I believe they are implying she is a person being “mild” autistic as a counterpoint to Ari Ne’eman as someone with an Aperger diagnosis.
Socrates (Dead)
November 4th, 2009
18:53:12

RAJ - Finally I get the proof I’ve been looking for, for years – You are a capital-see-you-en-tea.
jypsy
November 4th, 2009
18:56:19

Sullivan,
That is what I was saying (or trying to). It was Kev who said she’s Aspergers.
Laurentius Rex
November 4th, 2009
19:14:51

Socrates there is a worse four letter word than the one you spell out, it is Tee Arr Oh Ell Ell, whoops five letters, I’ll get me coat.

To serious matters, (as if trolling were not a heinous abuse of netiquette)

Semiotics tells us that a name, or a lable exists for a reason, that is it has some use as a signifier, however if the thing that it signifies turns out to be less “significant” to the culture then that sign either adapts and points to something else or drops out of use.

The reasons that Lorna Wing siezed upon eponymity to posit an expanded version of what was then just autism is because the epidemiology indicated it, indeed the whole concept of an epidemic is predicated upon the statistics in the USA catching up with those early estimates, to honour Dr Aspergers largely overlooked contribution, and because alas for those un PC times it was considered to be more acceptable to folk with a regular IQ.

It was not really intended as a clinical diagnosis at all, just a research position, however as I said before, Klin and Volkmar, amongst others took the ball and ran. The early years were chaotic ones with conflicting sets of criteria Szatmari(sp) Gillberg and what ended up in DSM with more than a nod toward ICD 9 I think it was.

Those are the facts, if you don’t believe me ask Lorna Wing. When I was writing “Whichever way” I ran it past Lorna Wing first and she did not find anything to disagree over other than that I had been a bit cheeky toward Christopher Gillberg.
Arthur Golden
November 4th, 2009
19:21:51

Although I am generally familiar with the biography of Temple Grandin, it seems some posters here are not and did not try to Google for factual information, so I took the following from Wikipedia, hoping future posts will be based on actual facts:

Temple Grandin was born August 29, 1947 in Boston, Massachusetts. She was diagnosed as autistic in 1950. Having been labeled and diagnosed with brain damage at age two, she was placed in a structured nursery school with what she considers to have been good teachers. Grandin’s mother spoke to a doctor who suggested speech therapy, and she hired a nanny who spent hours playing turn-based games with Grandin and her sister. At age four, Grandin began talking, and she began making progress.

She considers herself lucky to have had supportive mentors from primary school onwards. However, Grandin has said that middle school and high school were the worst parts of her life. She was the “nerdy kid,” the one whom everyone teased and picked on. She would be walking down the street and people would say “tape recorder,” because she would repeat things over and over again. Grandin states that “I could laugh about it now, but back then it really hurt.”

After graduating from Hampshire Country School, a boarding school for gifted children in Rindge, New Hampshire in the 1960s, Grandin went on to college. She received her bachelor’s degree in psychology from Franklin Pierce College (also located in Rindge) in 1970, her master’s degree in animal science from Arizona State University in 1975, and her Ph.D. in animal science from the University of Illinois at Urbana-Champaign in 1989.

Based on personal experience, Grandin advocates early intervention to address autism, and supportive teachers who can direct fixations of the autistic child in fruitful directions. She has described her hypersensitivity to noise and other sensory stimuli. She claims she is a primarily visual thinker and has said that language is her second language.
Leila
November 4th, 2009
19:22:34

I’m still not convinced that High Functioning Autism is so similar to Asperger’s Syndrome. The cognitive aspect is critical in my opinion. HFA people can still have limited speech or conversational skills and a lot of trouble following a basic academic curriculum – savant abilities not withstanding.

There are many different presentations of autism, and even though they have to be under the same umbrella, it doesn’t help to eliminate the “subcategories” if you want a better understanding of this condition.
Laurentius Rex
November 4th, 2009
19:43:17

Speculation about Temple Grandins diagnosis is a bit moot, I don’t know whether she has had a seperate adult dx or not, and in any case a diagnosis ought to be date stamped as the diagnosis of autism in the 50’s and 60’s is not the same as the current diagnosis in DSM IV Tr, which gives rise to a lot of confusion and really confounds a lot of the studies.

There are many people who had autism diagnoses in childhood(of varying rigour given that Autism itself did not hit the DSM until 1980, who either lost them or mislaid them and subsequently gained an Asperger’s dx in adulthood.

There is also another big problem an elephant in the room as it were in that not all speech delay is autism, language and speech being frequently confused. Autism and Asperger’s both essentially contains a language disorder whether that manifests as significantly late speech or in other ways. It is an absolute myth even to associate speech delay with Kanners original variety of autism, a number of his patients were by contrast hyperlexic with early speech.

To use the date of the onset of speech as a marker to seperate two conditions is really not practical, it doesn’t work other than at a simplistic level (for example who has blue eyes and who brown) it says nothing of what is really going on.

The markers for the “true” autistic seem to fluctuate not just over time but according to who is speaking, for instant the mercury militia would probably include lack of toilet training as the marker, or something equally arbitrary, being that Temple Grandin is almost always in because she makes no waves, but Donna Williams is out because she is a “fruit salad” – that was too tempting an analogy not to make, sorry Donna your analogy not mine :)
Laurentius Rex
November 4th, 2009
19:56:21

Indeed Arthur, the point is that her middle and high school experiences were mainstream and not unlike mine at all, or many other people I am familiar with.

It was very extraordinary to get an Autism diagnosis in 1950, that meant one had to be in contact with one of the few people that believed enough in it, to grant a diagnosis other than some unspecified brain disorder, or childhood psychosis. Back in the 50’s and 60’s even Mike Rutter was going with Childhood psychosis.

Although Asperger gave us the term in German of Psychopathy, he meant something very different and was putting it more in the domain of personality ‘disorders’ in his opinion. Pyscophathy not having aquired the popular connotations of cold blooded axe murderer it has today.

When I was born in 1955 which puts me not that far apart generationally from Temple in the immediate post war era, there was a lot of cultural difference between the US and UK approaches to psychiatry and pediatrics, each side of the atlantic having there own terms and sticking to them. However terms such as “minimal brain damage” “clumsy child syndrome” and “hyperkinesia” were in vogue to describe children who just did not fit the pattern, I aquired the lable of hyperkinesia because I was very volatile, hardly slept, was a climber and a runner but for most of my early childhood and right up through my teens I was considered to be the psychodynamic product of a difficult marriage relationship of my parents, thus it goes. Temple was damn lucky, I was just working class.
Tera
November 4th, 2009
20:01:48

farmwifetwo said:

I would part with my eldest’s dx of NLD if it protected the little one and his dx of Autistic disorder.

You’re arguing apples and oranges here. While Asperger’s is on the autistic spectrum, NLD is not, in any official way.

Lorna Wing has said she thinks NLD is on the autistic spectrum, and although in the 1980s, Dr. Byron Rourke tried to fit “early infantile autism” under what he called the “NLD umbrella.” He no longer says that anymore, and hasn’t for years. But it is merely a learning style that some autistic people have (people with diagnoses of HFA and AS) and some non-autistic people have.

The committee trying to sort this stuff out for the upcoming DSM-V (so far) refer to NLD as a “co-morbidity”—as much as I hate that phrase—of autistic spectrum conditions, along with AD(H)D and intellectual disability.
laurentius rex
November 4th, 2009
20:04:22

Leila, it helps to have the right subcategories under the umbrella, Asperger’s was never the right one, it was abused and did not in the end work at all, which is why it is likely going.

Given that the spectrum is multi dimensional, cognitive impairments if you will, in more than one domain, the permutations are vast, even if you cluster, just look at the mathematical picture if you can. That is why individual assesment is necessary not judgement en masse by diagnosis alone.

I actually have some quite severe cognitive impairments, that is a matter of record, that it does not show is a matter of adaptation. My immediate diagnosis prior to Aspergers (and I am not going into earlier ones tentative or otherwise) was specific learning and cognitive difficulties.

Aspergers was always too clumsy and ill specified a diagnosis, often a diagnosis of default for an adult.
RAJ
November 4th, 2009
21:41:50

Joseph wrote:
“Yep, I can access the link now, and Tom is absolutely correct. RAJ’s behavior is unbelievable. The bait is the title of paper: “Does DSM-IV Asperger’s disorder exist?” It has nothing to do with Schizoid personality disorder. The paper is also not about what RAJ would like it to be about. It’s exactly about what I said above”

Sorry Joseph, but on your own website you claim to be ‘on the spectrum’ yourself. Were you diagnosed as a child with autistic disorder?

As far as the relationship between and the overlap of Asperger Syndrome with schizoid personality disorder you might want to read Schopler’s commentary on the relationship:

http://books.google.com/books?.....38;f=false

Schizoid Personality Disorder does carry a negative impression in the ND group but how would you seperate these two overlapping conditions?
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Patrick
November 4th, 2009
22:35:23

The diagnosis mess can be confusing. Not sure if I really care about the disappearance of Asperger’s as long as the needs of the diagnosis holder(s) are getting addressed.

I used to hold a personality disorder diagnosis, in fact it was given in 1995, and then Major Depression and an Asperger’s diagnosis in about 2005. The trail goes all the way back to teenage years, but problems were manifest well before then, and unrecognized by the medical/education community of the day.

Yes, there are overlaps, but what the Personality Disorder folks aren’t bringing to the table are MRI scans of grey vs white matters to characterize the clients brain development. (Or perhaps they have and I am underinformed.) There are likely socio-environmental factors that play into some PD diagnoses, like strict or abusive parenting, or being in a neighborhood filled with criminal activity. But their have been researchers looking into the organic basis for some of these too.

There are researchers that claim to be able to differentiate between certain Autism Spectrum disorders based on the distribution of grey matter, but again, the people who need help indeed need help, and at least some probably don’t care what the label placed on them is.

I wouldn’t mind being MRI scanned for one of these studies to see where I fall, but my impression at this time is that they will call me functional even if my executive function doesn’t exist, for all practical purposes.
Socrates (deceased)
November 4th, 2009
22:42:36

Chaps, I don’t feel given RAJ’s entrée, that any further engagement of him would serve any useful purpose.

While wallowing in this ocean of corruption, let us at least try and keep our eyes on the horizon, in the expectation of a brighter dawn.
Anne
November 4th, 2009
22:44:24

RAJ, Schopler distinguishes AS from SPD in finding that AS is like autism, but SPD is not. In fact, in the book you linked to, Schopler says that the AS/Autism distinction is not meaningful, which is the same thing that the Neurodevelopmental Workgroup for the DSM-V is saying. On page 23 of the book you linked to, Schopler says that, in his opinion, AS and HFA are not distinct conditions, and that the most useful method of grouping is to use one classification of ASD, and then subgroup according to “quality of social interaction and level of ability in verbal and nonverbal skills.”

I understand that you’re just trolling, but your link to this 1998 book by Schopler, Mesibov and Kunce does show that there have been advocates for abolishing the AS/Autism distinction for quite some time, and it appears that this view is going to win the day.
Mike Stanton
November 4th, 2009
23:32:14

Raj

The reference you cite in your opening comment does not support your contention that Asperger syndrome is a personality disorder equivalent to Schizoid Personality Disorder and distinct from neurodevelopmental disorders like autism. It does in fact support Joseph’s point that many if not all Asperger children meet the criteria for DSM IV autistic disorder. I fail to see how Joseph’s diagnostic status has any bearing on this.

You also wrongly describe the chapter that you link to as a commentary by Eric Schopler

As far as the relationship between and the overlap of Asperger Syndrome with schizoid personality disorder you might want to read Schopler’s commentary on the relationship:
http://books.google.com/books?.....38;f=false
Schizoid Personality Disorder does carry a negative impression in the ND group but how would you seperate these two overlapping conditions?

It is in fact a chapter by Sula Wollf in which she explores the differences and the similarities between Asperger Syndrome and Schizoid Personality Disorder. Her observation that she found an excess of schizoid personality traits in the parents of autistic children suggests to me that the distinction between personlity disorders and developmental disorders is not as clear cut as you suggest. Wolff is quite clear that for Schizoid children their difficulties arise from inherent features of their personality. It is part of who they are and not the result of life experiences.

I am not convinced that Schizoid Personality Disorder is viewed negatively by those of us who favour neurodiversity. There is a case to be made for including it in the autistic spectrum. At the very least the relationship is more complex than the either/or scenario you suggest.
Corina Becker
November 4th, 2009
23:35:05

I support merging Asperger’s with the rest of the ASD, as it simplifies classification and eliminates confusion and potential discrimination.

One of the concerns that has been brought to my attention about this issue is that if Asperger Syndrome is no longer in the DSM, that all the hard work of raising awareness will be wasted, and that people with the diagnosis of Asperger’s will fall through the cracks again.

However, I think because of the awareness that has been made about Asperger Syndrome can be shifted to be about ASD. Also, the wider range of diagnostic criteria means that people previously diagnosed as Asperger Syndrome will be recognized as being ASD, and thus will not fall into the cracks as before. Of course, this is under the impression that appropriate services for all ranges of the spectrum and all ages, from childhood to adult, are available. If those services aren’t available and implemented properly, then yes, people will fall through the cracks.

Also, I recently discussed this issue with my mother. She’s a high school teacher, and while she understands my concerns and agrees that Asperger is Autism, she has explained that as a teacher, the label has been a useful tool for her to figure out what can and can’t a student do, and what accommodations to make in the classroom. I suggested to her that perhaps then more descriptive IEPs may be in order, so that the knowledge behind the label will not be lost in the (highly likely, yet unconfirmed) merge.
Laurentius Rex
November 4th, 2009
23:58:15

Mike you are altogether too soft on the opposition and your suggestion regarding schizoid is a non runner.

To begin with Sula Wolf is another of these mavericks like Elizabeth Newsome who can write the odd popular book or two based on clinical experiences for sure (as can Digby Tantum) but have an odd agenda to create new classes of nosology. Sula is really out in the wilderness.

The problem is with personality disorders themselves, they just do not work, they are probably one of the biggest messes in the DSM altogether because they do not seperate out into clearly distinct patterns or entities at all, they overlap and interweave and indeed can contain within the diagnostic descriptors several classes of quite unlike behavioral symptomologies.

It’s an area best left well alone unless you are a new broom determined to sweep clean.

It just gets beyond my understanding how someone in order to advance a position they want to believe will pull old literature out of context, without the history, and without the revisions since, it is like trying to diagnose a problem in your fuel injected ecu controlled car using a pre war model T ford manual, some of it is the same for sure, but a lot has changed, including our understanding of what goes on in the combustion chamber itself.
Mike Stanton
November 5th, 2009
00:30:46

hi Larry

you may well be right about personality disorders. I have not read widely inthis area but I do find Wolff’s work intriguing. I am not fully persuaded by her argument that there is a distinct difference between Aspergers and Schizoid personality disorder. My suggestion was that rather than taking Aspergers out of the spectrum we should consider whether the schizoid children she described belong on the spectrum instead.

I agree completely about taking sources out of context. Bending the facts to suit your agenda is never a good idea.
Laurentius Rex
November 5th, 2009
00:32:42

What we do not see with RAJ is a serious attempt to examine personality disorders alongside autism and I have no intention of putting further fuel on his fire by giving him a few more to chew on that have confused the issue with autism before, other than to say that he is playing a mean trick in order to associate a whole class of people he does not like, namely rebellious young ‘aspies’ who he feels are poisoning his clear cut notions of a pure autism that never was.

Schizoid is by far not the worst PD you want to be labled with and fairly neutral if you consider that being a loner is not such a bad thing at all.

Schizoid only sounds bad because of that slight onomatopea with Schizophrenia, which also gets a worse press than it deserves.

I could go on about that in detail as well concerning the way research is lumping that with bipolar on a spectrum, perhaps those lables will be going too, eventually and not before time.

Anyway to get back to the chase, some autism researchers are onto the PD thing, here is one example, Blair, R J (2007)Fine Cuts of Empathy and the Amygdala: Neurocognitive Approaches to Developmental Disorders: A Festschrift for Uta Frith: A Special Issue of the Quarterly Journal of Experimental Psychology, Psychology Press. Very interesting I was there to here the lecture.

Does RAJ ever bother read the somewhat squiffy citations he gives? Or does he just conjure a word cloud out of google?
Laurentius Rex
November 5th, 2009
00:48:56

Mike I think you are misunderstanding the whole process, nobody is suggesting that Aspergers is going, simply that it is being absorbed within the class that currently contains classes as being of no practical use.

I personally am not worried by carrying a lable that is no longer valid because that does not mean my autism will have changed or gone away, any more than I was changed when I first recieved the lable. In terms of the work that the NAS is doing that’s not going to make any difference, in the UK at least where things are already going this way, it will make it clearer, it is only in the US with the private insurance system and the bizarre way in which departments of developmental disorders work that it might mean something if a corresponding code of severity comes out, which is the other suggestion.

I am dyslexic in this country, widely recognised, but in the US, in DSM it does not exist so this really is to some extent a semantic argument not a real one, dyslexia was lost to the US lexicon a long time ago in favour of learning disability which in the UK and I believe Australia carries an entirely different connotation as you are aware. DSM is crazy, it seperates developmental reading disorder from developmental writing disorder and a whole bunch of other stuff which educationally in the UK (because none of this belongs in the medical and psychiatric domains) is lumped under specific learning disability and often uses dyslexia as a fallback “nom du guerre”

As I keep on saying there is a lot of sociology behind all this, none of it can be understood from the perspective of psychiatry alone.

I believe squarely that autism belongs in the educational domain, and needs no medical professional for diagnosis. (any more than a broken bone or head cold really does)

The only fall out from this is Dr Asperger’s memory, he was a remarkable man by all accounts and a very humane one who believed in the inherent ability of disabled children, that is to say all disabled children, as I learned from a former patient of his how he intervened to get him into a mainstream school and a proper education.
Mike Stanton
November 5th, 2009
01:03:43

Larry,
I take your point entirely that Aspergers is not being removed. It is being relocated. I was making the point that RAJ’s citations actually pointed in the opposite direction to the one he was arguing for vis a vis Aspergers.
Laurentius Rex
November 5th, 2009
02:45:28

Whoops just posted this to the wrong slot, it was meant for here

That is the problem isn’t it Mike, that whilst the internet has undoubtedly democratised access to a lot of material and allowed the lay person to trawl databases for citations, it has also allowed for a lot of sloppy practice and outright cheating.

Whilst it is legitimate to search by key words it still means you ought to read the abstract itself and then if you have decided it is of relevance to attempt the whole paper itself. That is where most people fall down, they will post a list of citations supposedly in support of the argument, having failed to consider counter citations (which any good rhetorician needs to look at as well in order to prepare ones own counter arguments as to why they are not felt to support the data one is defending.

One of the things you are taught as a post grad is how to read papers properly and to consider that abstracts are not the be all and end all, as there are good abstracts and bad abstracts, and mostly they tell you nothing about the methodology or not enough to be able to mount a proper critique.

Of course we all get sloppy, opinionated and biased, to the extent that we will prejudge that if a paper is coming from such and such a name, who has little reputation preceding of well argued papers then we are more likely to pass it over, especially when it is coming from the bad science brigade.

The new flim flammery though is to make it appear that those more respected authors who we trust are saying the opposite of what we expect them too, witness the way the Geiers jumped on the semi-legitimate science of the double barrelled one to support there unsustainable quackery.

Well this is what RAJ and those other Trolls who cut there teeth on the ASA newsgroup do, because all they have to do is misdirect and fool enough people to look authoratative in whatever they are saying, it’s trickery worthy of Derren Brown the charlatans charlatan isn’t it? Absolutely classic.

You will notice I am doing it myself by my own magisterial pronouncement seen in the phrase “semi-legitimate science of the double barreled one” therein lies my own bias, but I have to say that not in a long time have I found him convincing in the least, and won’t until he takes off those monotropic spectacles of his and starts being objective again.

At least I can take the piss out of myself eh, this pot is shining himself with brillo :)
Joseph
November 5th, 2009
04:44:01

Were you diagnosed as a child with autistic disorder?

I’ll let you figure that one out. Let’s see. The diagnosis of ‘autistic disorder’ first appeared in the DSM-III-R, in 1987. At the time I had already graduated high school, so what do you think?

What is the point of this diversion, anyway? Another random attempt at trying to offend and discredit people?
David N. Brown
November 5th, 2009
05:53:13

I have posted an article of the overlap between ASD and schizophrenia at the page below:
http://evilpossum.weebly.com/info.html
It includes a theoretical proposal for the psychiatric classification of “delusional aspie” distinct from classic schizophrenia.
Also, taking a second look, RAJ’s description of “Schizoid Personality Disorder” is very different from schizophrenia.
I’ve commented on this issue before. It seems to me that, in my own discussions and even more on this thread, the people bringing this up don’t seem that interested in discussing the core characteristics of classic schizophrenia. Unfortunate, as this is a complex, subtle and potentially very important issue.
dr treg
November 5th, 2009
09:54:50

As usual psychiatric nosology is causing problems again i.e. creating a box and trying to fit people into the box who do not fit thus labelling them incorrectly and often for life.
It is best to keep psychiatric symptoms descriptive and simple i.e.
1. What are the main symptoms in simple terms i.e. excessive fear, self-pity, resentment, dishonesty?
2. Is there altered sensitivity i.e. hypo/hypersensitivity to these thoughts/feelings?
3. Is there reduced connectivity?
4. Is there obsession-compulsion?
to get a feel for how inflamed the patient`s brain is and where most of the inflammation is likely to be.
i.e. auditory hallucinations suggest schizophrenia and may be associated with inflammation causing reduced density of dendritic spines in the auditory cortex.
http://www.ncbi.nlm.nih.gov/pubmed/18463626
There seem to be increasing numbers of people who are in a state of deficiency in understanding, processing, or describing emotions (alexithymia) who have recognisable abnormalities of the immune system. Many of them are probably being labelled personality disorders/ borderline psychiatric disease when all they need is some insight.
http://www.associatedcontent.c.....html?cat=5
What does it matter if someone is borderline Aspie or borderline schizo-affective personality disorder? It probably only matters because the labels stigmatise the patient in society making their situation even worse.
Laurentius Rex
November 5th, 2009
11:39:20

To be honest I see delusion as more of a mainstream thing, a product of the very adaptation the human brain has to seeing pattern, in that it is very easily in the case of insufficient evidence to hypothosise to far into delusion.

I see an awful lot of it in the blogosphere amongst those stubborn types who will not see the evidence even when it is pointed out to them.

Possibly that is something lacking in there education, statistics is not the easiest subject to appreciate if you are weak in maths (as I admit to being) possibly there is something sub-pathological, in that there are alternate “survival” drives urging one towards conclusions that support the world view that makes them comfortable, or good old fashioned cognitive dissonance.

The thing that will not work is back room amateur psychiatry cobbling together new disorders or combinations out of the existing descriptions, because the descriptions are only the surface phenomenon, the ripples on the pond as it were.

You really have to understand where the descriptions are coming from to make sense of it, and that requires a little more understanding and study alas, it doesn’t come overnight. I only wish it did.
Stephanie
November 5th, 2009
16:39:45

Leila said: “PDD-NOS is trickier to diagnose, but it’s valid when the child doesn’t meet all DSM criteria for autism but still presents some autistic traits. I see PDD-NOS kids and compare them to my kid (diagnosed ASD) and the difference is obvious. They are more verbal and more social.”

That is not true of all with the PDD-NOS label. My son who has the most “severe” symptoms has a PDD-NOS diagnosis, compared to his brothers with classic autism. He is less verbal and less social (after a variety of therapies) than his brothers are. PDD-NOS means, in his case, that he has a pervasive developemental disorder with autistic traits that does not align with a regular diagnosis of autism. It does not indicate social skills, verbal skills, or how pronounced those traits may be.
Joseph
November 5th, 2009
17:43:57

It is best to keep psychiatric symptoms descriptive and simple i.e. 1. What are the main symptoms in simple terms i.e. excessive fear, self-pity, resentment, dishonesty? 2. Is there altered sensitivity i.e. hypo/hypersensitivity to these thoughts/feelings? 3. Is there reduced connectivity? 4. Is there obsession-compulsion?

Are you describing a psychiatric diagnosis there, or AoA?

to get a feel for how inflamed the patient`s brain is and where most of the inflammation is likely to be.

Right, because you’d be able to tell from that information. All chiropractors can, of course. Them and astrologers, and homeopaths too.
daedalus2u
November 5th, 2009
17:53:16

Larry, I think you are exactly right. People who are NT are more susceptible to “drinking the Kool-Aid” and to “groupthink”, that is to delusional world-views adopted because someone told them. The communication difficulties that people on the spectrum have provides a degree of “protection”. I talk about this in my blog post on “theory of mind vs theory of reality”.

http://daedalus2u.blogspot.com.....ality.html
Laurentius Rex
November 5th, 2009
18:25:21

Deadalus, interestingly enough Digby Tantum picked me up on a very similar point, when he used me for a quotation in his latest book.

“Can the world afford autism” His latest pet thery being that the NT mind is connected to a sort of Interbrain, the minds equivalent of the Internet, by reference to SF writer Olaf Stapledon’s Hive Mind and said by contrast that the autistic brain lacking the ability to link into the “hive mind” (via body language etc etc..) is able to think independantly and see new insights.

Not familiar with the phrase “drinking the Kool-aid” here, we don’t have Kool-aid on this side of the pond.
Socrates (deceased)
November 5th, 2009
18:39:56

Oh, I’m quite capable of resolving the DNS of the Hive mind and surfin’ the 17,000 channels of shit on my TV.

I just don’t want to.

It’s not a lack of connectivity, it’s repulsion.
daedalus2u
November 5th, 2009
19:02:24

The expression “drinking the Kool-Aid” relates to a US religious cult where some hundreds of followers committed suicide by drinking a drink made from powder and laced with cyanide. It was actually Flavor-Aid and not Kool-Aid, but a politician used the “Kool-Aid” expression in a book and that is the expression that stuck. Adopting the world-views of people like “birthers”, and the anti-vaxers would be appropriately described as “drinking the Kool-Aid”.
Emily L. Williams
November 5th, 2009
20:02:55

My main concern with shrinking ASC into a single category (which, scientifically, I don’t disagree with) is whether the higher-functioning of the aspies are going to be ousted from autism altogether. If they are going to paint the entire spectrum with a single brush, and Catherine Lord, one of the creators of the ADOS-G (a Gold Standard diagnostic tool which I consider to be FAR too exclusionary) is on the APA committee, then I have a bad feeling the breadth of the Spectrum may shrink.

I agree that the terms, as far as their functionality, ARE confusing and sometimes create more problems than they’re worth. Plus, how many times have I had the conversation on forums of “Why don’t we just call Asperger’s something like HFA Type II?” But my concern is with the realistic application of the new criteria and whether the criteria will become stricter, thereby failing to identify lighter variants of the phenotypes and also thereby ignoring the difficulties these people may have and could use some help with.

Autism doesn’t need to leave you on Disability to cause day-to-day problems.
Socrates (deceased)
November 5th, 2009
20:08:14

Emily,

culled from a previous comment I made:

The DSM V PDD committee suggested having a single spectrum from Kanner’s all the way to Broader Autistic Phenotype, and mopping up the stragglers with Autistic Spectrum Disorder – Residual Features…

We are all autistic now.
Laurentius Rex
November 5th, 2009
20:26:23

At this point Laurentius gets onto his social model hobbyhorse.

The point about disability for high funtioning (if I dare use that term) folks is that it is the misfit between the phenotypes characteristics and what is required in education and employment behaviourally and socially, all this call for team players and that “hive mind mentality” the failure to grasp what we don’t grasp which leads to the high unemployment, the exclusions from schools etc.

The NAS is not up to scratch on the DSM changes yet, too busy combatting the French Faux pas at the moment.

Anyway if the US could get out of the mentality that opposes Obama’s health reforms there might be more social model oriented welfare out there rather than diagnosis and lable driven insurance codes, which is a major part of the problem.

If services are social model driven rather than symptom driven then the lable is not so much of the problem.

I can see the bigger danger is not the dropping of Aspergers as a name, but the adoption of a kind of non service attracting lifestyle top notch nobel prize winners BAP for those whose manifestations are more subtle.

I personally blame the Aspie Supremacists a great deal for this, they have not done us a lot of good in many respects with all this we are not disabled stuff. The social model needs to attract more transatlantic support because it allows one to be disabled without the stigma if you see what I mean.
dr treg
November 5th, 2009
20:27:29

“Right, because you’d be able to tell from that information. All chiropractors can, of course. Them and astrologers, and homeopaths too.”
.... and Health Professionals with an interest in Neuroscience.
Autism is mainly a history based rather than an examination or investigation based diagnosis at present, but maybe CSF TNF measurements may be useful in the future.
When higher-functioning A.D. spectrum patients were interviewed the core symptoms appeared to be:
1.Unusual perceptions.
2.Unusual information processing.
3.Impairment of emotional regulation.
These are not mentioned in the D.S.M.-IV definition.
http://www.ncbi.nlm.nih.gov/pu.....d_RVDocSum
“If you listen to the patient they will tell you the diagnosis” – Sir William Osler.
David N. Brown
November 5th, 2009
21:45:16

Dr. Treg,
“auditory hallucinations suggest schizophrenia”
Actually, I think the most diagnostically significant feature of schizophrenia is disordered thinking, and actions that may not make much sense even in light of their warped perceptions of reality. In situations where violence occurs, I would consider actions that show planning and deliberation (following a floor plan, conserving ammunition, etc.) to be evidence against schizophrenia, at least in the “classic” sense.
Socrates (Dead)
November 5th, 2009
22:56:49

Larry,

Is there any reason for Auntie NAS not getting in a huff about the Mayor of London, Boris Johnson’s remarks about Bankers?

“How can they pretend the world hasn’t changed? What blindness, what deafness, what Asperger’s afflicts them? The banking sector now stands in a completely different relation to the wider public.”
Laurentius Rex
November 5th, 2009
23:22:20

Hey there do your own Boris bashing, in fact I was not even aware of this comment by Boris, the French comment seems to have overshadowed it, and my impression was this morning that the NAS was being besieged to do something, apparantly they got a result (of sorts)
Laurentius Rex
November 5th, 2009
23:24:37

And I was going to add before this comment box took a life of its own, that Boris’ comment probably escaped under the Radar. Have LARM done anything about it yet? they are on the ground too.
dr treg
November 5th, 2009
23:34:43

Thats right. The characterisic symptoms described by DSM for schizophrenia are
delusions
hallucinations
disorganized speech (e.g., frequent derailment or incoherence)
grossly disorganized or catatonic behavior
negative symptoms, i.e., affective flattening, alogia, or avolition.
It is interesting that delusional perceptions can also occur in autism. Patients with autism may also have auditory hallucinations aswell but then their diagnosis shifts to the dual-diagnosis of autism and psychosis.
However, it is probably just the same inflammatory process affecting dendritic spines in different parts of the brain to a lesser or more severe extent.
I wouldnt put money on distinguishing if a patient had schizophrenia or not based on premeditated or impulsive violence.
Laurentius Rex
November 6th, 2009
00:06:27

Dr Treg you would seem to be the living embodiment of delusion and disordered thinking, in your failure to grasp what Schizophrenia either is or isn’t and what Autism is or isn’t conceptually.

You like your pseudo scientific medical talk of dendrites and inflammation all like the beauty products sales pitch of active liposomes and what have you.

It sounds to me like sales flim flammery.

Schizophrenia as a concept is far from universally agreed upon, much in the same way as the characteristics of autism are debated, yet you talk as if it were a reality. To make a reality out of descriptions of appearance to admit no doubt, that smacks to me of delusion, so tell me what is abnormal about it then?

You are a surface person you don’t look at the etymology of those words you use, and the history of how they have come to be used, or the way in which research has either depended upon or challenged them, you are no philosopher that is for sure and not much of a medic either, just another quack with a fixed idea in a sea of so many.

Hey there I have persistant visual ‘hallucinations’ what do you make of that, I don’t think anyone knows what they are yet, could even be inflammation, but not in the dendrites, or the dardanelles or even the rhododendrons. Its called migraine aura BTW but it is wise never to mention that to a shrink, sets them off in an axonometric projection of reified stereotypy which I would not call at all holistic, if you pardon all the puns there, someone must have massaged my cranium into a flux of logorhea :)

Google has found out thy bed of crimson joy.
David N. Brown
November 6th, 2009
00:57:35

Dr. Treg,
From everything I have read, I have doubts about attributing any “premeditated” act of violence to a diagnosable schizophrenic. I am convinced that at least a small percentage of autistics have hallucinations and possible delusions akin to classic schizophrenia. I would consider this more likely when well-planned violence based on a delusion occurs.
dr treg
November 6th, 2009
10:16:25

Schizophrenia and autism are DSM diagnoses. However at stated above patients with autism seem to be saying that the core symptoms are not in the DSM diagnostic criteria.
http://www.ncbi.nlm.nih.gov/pu.....d_RVDocSum
Both diseases are associated with
Immune abnormalities
Genetic abnormalities
Reduction of dendritic spines in the frontal lobes. Schizophrenia is associated with reduction in dendritic spines in the auditory cortex.
Predominantly negative or bad feelings – resentment, fear, self-pity and dishonesty.
Obsessive-compulsive behaviour
n.b. dendritic spines are reduced in migraine attacks possibly secondary to hypoxia. Perhaps this is why oxygen treatment is used for migraine attacks.
http://www.ninds.nih.gov/news_.....ypoxia.htm
Hope your visual spectra improve. Perhaps some oxygen during attacks to increase your dendritic spines may be useful.
Stephanie
November 6th, 2009
16:47:32

Laurentius,

“Anyway if the US could get out of the mentality that opposes Obama’s health reforms there might be more social model oriented welfare out there rather than diagnosis and lable driven insurance codes, which is a major part of the problem.”

How does moving towards socialized medicine increase the likelihood of the social model being used? Most of the Dems that “represent” me and my family are willing to ally themselves with Autism Speaks whenever the topic of autism comes up. I really don’t want them in control of the medical care my children receive!

Aside from that political quibble, I would say that as long as the autism diagnosis is becoming more inclusive instead of more exclusive, then there may also be a chance that services will become more need/benefit based instead of normalcy-based. I’m still learning about what all the social model entails, so I’m not sure whether or not that’s what you’re suggesting.
Joseph
November 6th, 2009
17:30:45

Immune abnormalities
Genetic abnormalities
Reduction of dendritic spines in the frontal lobes.

This is probably the case of all neurodevelopmental disorders and differences. You might as well say “autism is just like Down Syndrome.”

Predominantly negative or bad feelings – resentment, fear, self-pity and dishonesty.

Let’s see evidence of this. Dishonesty is associated with autism? Are you sure?

I will speculate that chiropractic is associated with dishonesty.
David N. Brown
November 6th, 2009
20:36:47

Hope your visual spectra improve. Perhaps some oxygen during attacks to increase your dendritic spines may be useful.

Not sure if this is meant as a comment to me. I believe, in hindsight, that I had a kind of recurring “dissociation” in my mid-teens, but it involved a sense of thought beyond my control rather than sensory hallucinations. I believe, in my own case, the problem was a result of stress and a particular experience of social rejection. After a year or two, the problems just stopped.
dr treg
November 6th, 2009
22:32:00

You are quite right – most neuro-developmental diseases are associated with an immuno-genetic dendritis.
Certainly Downs syndrome is associated with autistic clinical features.
http://www.riverbendds.org/ind.....leman.html.
Fear (anxiety), self-pity (depression) and resentment (anger/hatred) are all associated with autism.
Perhaps some of the more open-minded bloggers may describe an association between autism and dishonesty as well as honesty. Or are all children with autism completely honest?
dr treg
November 6th, 2009
23:18:25

Here are quotes from some references which suggests that dishonesty may be associated with autism.

“I have an autistic brother and let me tell you they can lie just like any other human. They tell their reality not necessarily the truth. They usually tell it how they see it (if they can talk). They are still human. My brother is actually facing jail time because of lieing. Of course they will most likely put him in a home but he did do some bad things and then lied about them but he is very autistic, but he can talk. I have taken care of many autisitic children over the last few years (about 15 years almost) and have known many of them to lie or say half truths.”

“Oh, yeah, they lie. Lie like a rug. My son is 15, and is high functional austic, and lies at every opportunity. Even though he is punished very seldom, he will lie about everything from what time did he get up, did he brush his teeth, did he break something and on and on.
In fact he lies so often that we dont know when to believe him or not. It is very frustrating but the answer is YES, the can and do lie.”
http://www.steadyhealth.com/Do.....96420.html

“Humor is one thing. . But it is NOT good for our kids to learn to tell lies. Outside of that they don’t know how to get out of them, once they do lie, it becomes something they get obsessed with. Eventually no one trusts them, and when they tell the truth they can’t understand why they aren’t believed.
Trust me, I’ve worked with enough of these kids to know.”
http://autism.about.com/b/2009.....uccess.htm

However Professor Baron-Cohen notes that children with autism make very poor liars.
http://www.incharacter.org/article.php?article=101
Dedj
November 7th, 2009
00:41:35

The issue is not whether people with autism lie (even Atwood mentions this in his guides) but whether the pattern and occurance of lying amongst people with autism is significant enough to make lying and dishonesty (in increased or decreased amounts) significant features of autism.

Differences in motivation and skill in lying may also be interesting. Most of what I’ve seen in autism publications indicates that lying in autism is an avoidance technique, or ‘rigid’ application of the concept of dishonesty.

This is in contrast to PaD’s where lying can be used as a deliberate but non-insightful defence of the persons own image, or typical behaviour where lying can be used to achieve humour, increased benefit, or deliberate harm to another individual.
Joseph
November 7th, 2009
01:44:50

Here are quotes from some references which suggests that dishonesty may be associated with autism.

A couple testimonials of autistic people who have been known to (gasp) lie is your evidence of an association of dishonesty with autism?

You’re a grade-A quack, Dr. Treg.
dr treg
November 7th, 2009
08:43:27

Here are some more anecdotes of patients with autism confessing their lying from WrongPlanet.net.
http://www.wrongplanet.net/postt15464.html
http://www.wrongplanet.net/postt63066.html
http://www.wrongplanet.net/pos.....8e37e27a53
http://www.wrongplanet.net/pos.....art15.html
http://www.wrongplanet.net/postt48021.html
Although there do not appear to be statistically significant double-blind controlled clinical trials of lying in autism it does seem that such a trial could be worthwhile to answer the question: do children with autism lie more or are more dishonest than normal children?
“If you listen to the patient they will tell you the diagnosis” – Sir William Osler.

You seem to be a grade-A statistician Joseph.
“Lies, damned lies, and statistics” is part of a phrase attributed to the 19th Century British Prime Minister Benjamin Disraeli, among others, and later popularized in the United States by, among others, Mark Twain: “There are three kinds of lies: lies, damned lies, and statistics.” The statement refers to the persuasive power of numbers, the use of statistics to bolster weak arguments, and the tendency of people to disparage statistics that do not support their positions.
http://en.wikipedia.org/wiki/L.....statistics

Do you lie Joseph?
Sullivan
November 7th, 2009
09:06:25

Dr. Treg,

I seriously am trying to figure out if you add anything to the discussion. I don’t mind opposing points of view. But, in general, your statements are devoid of real content and very troll-like in nature.

This latest round is worse than usual. You respond to the statement, “A couple testimonials of autistic people who have been known to (gasp) lie is your evidence of an association of dishonesty with autism?” with more testimonials.

I read a lot of lies on the internet. Some I discuss here. Many involve autism parents lying. I do not make a claim that there is an association between autism parents and lying.

I see no point in approving further comments in this discussion.
Laurentius Rex
November 7th, 2009
11:10:19

Oh Dr Teg, if I were so pathologically prone to lying I would be unable to say that you were a quack, intent on slandering a particular population for your own ends, whatever they are (similar to Harold Doherty’s no doubt) I would instead be far more polite about my opinions.

There is some pretty flawed Socrates is a cat logic here (Socrates are you a cat?)

Politicians lie all the time, does that make them autistic?

So do Dr’s particularly when prescribing placebos or other ineffective treatments.

ALL fiction writers, dramatists and story tellers lie. (and that is called culture)

The liars paradox of course forbids you to own up to your own creativity here, otherwise we might have to accept that on occasion you can tell the truth.

I am Santa Claus, there you see I have just told a lie, easy wasn’t it, will you add me to your evidence now?

I do not think you know anything about the semantic and pragmatic problems in autism at all, which underlie the difficulty that autistic people have in carrying off a lie, or of using falsehood as part of normative social activity (false praise, flattery for instance) a lie to be effective has social dimensions beyond simple falsehood itself it involves a considerable degree of social understanding to be effective, simple denial of something obvious (“did you have a bath this morning” – “no”) is not a lie in the same sence at all.

You should be into linguistics perhaps you might begin to grasp the nuances of these things.
Dedj
November 7th, 2009
18:34:12

One would have to question why someone would think double-blind trials of people lying are even possible, given that lying is a deliberate act (stating truly held false beliefs isn’t lying), and the examiner must know its a lie in order to tally it into the statistics.

That children and teenagers lie is not under contention. That lying in children and teenagers with autism would therefore be expected is not under contention. That atypical lying in chidren and teenagers with autism is so frequent and intense as to constitute a clinical feature is under contention.
Joseph
November 7th, 2009
19:22:05

Although there do not appear to be statistically significant double-blind controlled clinical trials of lying in autism it does seem that such a trial could be worthwhile to answer the question:

I echo what Dedj said. I can see a lot of readers wondering where the “Dr.” in “Dr. Treg” comes from in light of the above.

Double-blind trials are appropriate when you want to evaluate treatments. If you want to determine if there are differences between autistics and non-autistics, the appropriate design is a case-control study. In a case-control study you can match groups for certain variables, like IQ, to make sure you’re not studying a separate construct (like intellectual disability) by proxy. There can be blinding in case-control studies, to control for observer bias, but this doesn’t make the case-control study a clinical trial or anything of the sort.

An even better design (prohibitively expensive perhaps) is to do a whole population prevalence study of ASD with good case-finding, and then evaluate the autistics located by the study. This way you don’t have a whole lot of selection bias. The NHS study is an example of this.
Dedj
November 7th, 2009
21:16:55

Blinding would really only apply to the diagnosis of the subject, however, examiners sufficiently trained to extract whether a statement is a truth or a lie may be able to deduce diagnosis during the interview.

One would have to find a way to account for this. In addition, using observation only to determine lying may also be problamatic, as some of the sign of lying (atypical eye-contact, fidgiting, playing with hands, stuttering and stammering, overly-asserting the story, changing the story etc) are also indicators of autism in some people (eye-contact, atypical body language, proprioceptive function and sensory issues, ‘odd’ prosody, verbal memory issues, echo/palilalia)

Institutionalisation is certainly a big factor to account for, if it can be accounted for at all. Someone who has learnt, for example, that saying ‘no’ to a request earns them some form of negative sanction (or that the person goes away) may be motivated to say ‘yes’ to a quesion even when the true answer is otherwise. A simplistic example I know, but hopefully you’ll have got the point.

Rigid application of social schema will have to be accounted for as well. One of the examples Atwood gives is of a boy who learnt to lie. Whereas typical children use lies to see what reaction they get, to avoid punishment, for malice, or for shits and giggles, this boy lied because he thought it was what he should have been doing because everyone else appeared to be doing it.

It’s interesting that we’ve somehow been directed to talk about ‘children with autism’, rather than the entire age-spectrum.
Joseph
November 7th, 2009
21:37:42

Right; that sort of assessment is probably very difficult to blind.

BTW, there are a couple case-control studies on this. Oswald and Ollendick (1989) reported “impaired capacity” for deception. This was replicated by Baron-Cohen (1992).
Laurentius Rex
November 7th, 2009
21:40:42

Really research into the lying question would be nugatory, I doubt if anyone would wish to waste there time with a serious study of this, we are all being led astray by what is effectively a “blood libel”

I doubt if Dr Treg whatever his qualifications and background are could hack it as a serious researcher, and I really doubt if anyone would fund it being as the whole premise is so flawed.

It takes more than googling a few abstracts to put together a research proposal, one needs to be able to argue it coherently and come up with a tentative methodology at least.

So when you come to a fork in the road where on path leads to the village of the liars and the other leads to the village of truth tellers, and you meet a stranger how can you find which village he has come from by asking only one question?
Dedj
November 7th, 2009
22:00:52

Frith (1992) appears to substantiate the concept of impaired capacity for deception further, as does Tidswell et al, (1991), Hughes and Russell (1993) and Solomonica-Levi et al (1996).

Although it must be noted that impaired capacity does not mean reduced intent, these studies and others appear to indicate that people with autism have reduced capacities to understand when another is using deception, reduced skill in using deception, and indicate that the concept that deception can exist is more difficult for people with autism to grasp intellectually and intuitively.
Dwight F
November 9th, 2009
01:09:13

Re: Hallucinations

I was under the impression that the sensory anomolies that have been associated with autism are hypersensitivity, along with hyposensitivity, and synaesthesia rather than standard hallucinations. So they typically are experiencing real sensations on a different scale or via a different sensory association rather than perception of non-existant phenomena delusional perceptions (or does synaesthesia count as the later even when the fact that you are tasting sound is understood?).

On trying to test for lies, yeah I have a hell of a time even with my own son figuring out when he’s intentfully lying and when we are just screwing up our communication, talking about different things. A lot of it is based on a repetoire of assumptions, that are only going hold for him, that we’ve built up over the years. A lot of them are context rather that direct “tells” from him. Even then it’s hit and miss and the assumptions have had to change over the years.

I will say he started lying relatively old. Although being late to talk would have some bearing on that, and relying more heavily on being downright stubborn to get what he wanted could have some bearing, too. :) Logically speaking, when you don’t much care about the other person’s opinion that’s going to significantly lower your motivation for lying. It’s kind of a chicken and egg thing. If you don’t understand that [successfully] lying can change their opinion then you aren’t going to do it, thus you don’t get much practice and experience in lying.

So there is just a whole lot of complexity to try tease anything meaningful out of, especially with limited exposure and history between the tester and the subjects.
Eve
February 5th, 2010
19:44:54

Regarding Asperger’s VS Schizoid Personality Disorder –
While those two share a lot of similar features, I have to disagree when it comes to them being the same or Asperger’s being a personality disorder rather than a developmental disorder.

Here is why – Schizoids and Apserger’s both share a certain disregard for social norms, but people with Asperger’s don’t realise that what they’re doing is odd or wrong, while schizoids just generally don’t care. Also, people with Asperger’s tend to be withdrawn and/or content to be by themselves, but they are generally curious about others and do want to make friends. For some, the inability to do so causes considerable anxiety. Schizoids usually don’t see people by choice, not because they don’t know how to approach them.

As far as Asperger’s disappearing as a diagnosis and being blended with autism, I can’t see much of a problem with that. It has already been established that Asperger’s was part of the Autism spectrum, and quite similar to High-functioning Autism, only without cognitive or language development delays. We could say that people with Asperger’s have High-functioning Autism of the Asperger type or something like that.

Eve