What’s in an autism diagnosis, Part 2

by Benison O'Reilly on Wednesday, March 17th, 2010

I love Seana’s latest blog about the iPhone Apps. She is such a tech-head, unlike her co-author, who learns just enough about technology to function in this modern world, but no more.

However, the next generation of my household may turn out to be quite different. I mentioned that Joe has a computer obsession last time. His latest irritating habits are to download random bits of software from the Internet and to try and reprogram our computers using MS-DOS. He is just nine years old, too!

I came in this afternoon to discover a blue screen on my laptop – never a promising sign. My budding computer technician (aka Joe) looked decidedly guilty, but couldn’t help proclaiming, ‘It’s the blue screen of death!’ Where does he learn these things?

Our long-suffering professional computer technician, who we have to call periodically to undo the worst of Joe’s handiwork, has suggested we give Joe his own, old computer that he can trash to his heart’s content. I’m not so keen, however, as we would be giving in completely to his autistic obsession, never a wise thing in my opinion.

Anyway, speaking of obsessions, I thought I’d continue on where I Ieft off last time, discussing the proposed DSM-5 for autism spectrum disorder. We mentioned last time the elimination of Asperger’s syndrome and PDD-NOS as separate diagnostic categories, but there are other changes afoot too.

In the DSM-IV there were three domains of deficits for autistic disorder: qualitative impairment in social interaction; qualitative impairments in communication; and restricted, repetitive, and stereotyped patterns of behaviour, interests, and activities. In the DSM-5 these three domains become two:

1) Social/communication deficits

2) Fixated interests and repetitive behaviours

The reasons for this decision, were as the American Psychiatric Association explains:

• Deficits in communication and social behaviors are inseparable and more accurately considered as a single set of symptoms with contextual and environmental specificities

• Delays in language are not unique nor universal in ASD and are more accurately considered as a factor that influences the clinical symptoms of ASD, rather than defining the ASD diagnosis

• Requiring both criteria to be completely fulfilled improves specificity of diagnosis without impairing sensitivity

Another proposed change, which is overdue, is the inclusion of ‘unusual sensory behaviours’ as a component of the diagnostic criteria for ASD. In the DSM-IV no mention is made of sensory behaviours, even though, as many parents of children on the spectrum can testify, some of these behaviours can be the most challenging of all to manage.

The last important change proposed in the DSM-5 is the recognition that, whilst ASD is a neurodevelopmental disorder and therefore must be present from infancy or early childhood, it may not be recognised in some individuals (notably, those with a current diagnosis of Asperger’s) until later childhood, when life starts throwing up new social challenges.

Despite his remarkable progress, Joe is not a ‘recovered’ child and remains somewhere on the autism spectrum. I think we can safely categorise his computer obsession as a fixated interest, although on the bright side it may also provide him with a career down the track. Fingers crossed….

Tags: autism, diagnosis