October 30, 2012

Rediagnosis ‘increases’ autism – most ‘autistic’ children probably have THIS or similar

A change from DSM-III to DSM-IV, and an "updiagnosis" from Asperger's to autism is part of the equation for an alleged "explosion" in cases of autism, Asperger's or both. So, too, is the fact that we don't really have a tight definition of what constitutes autism.

The “this” that's behind the change in diagnosis? Schizoid personality disorder. It’s been a recognized personality disorder diagnosis for decades.

In the DSM-III, the previous version to the current one of the American Psychiatric Organization’s “bible,” you can also see the diagnosis of schizoid disorder of childhood. (PDF of entire DSM-III.) In fact, different websites note this phrase was once used for Asperger’s syndrome.

And, here’s what DSM-III had as diagnostic criteria:
Diagnostic criteria for Schizoid Disorder of Childhood or Adolescence
A. No close friend of similar age other than a relative or a similarly socially isolated child.
B. No apparent interest in making friends.
C. No pleasure from usual peer interactions.
D. General avoidance of nonfamilial social contacts, especially with peers.
E. No interest in activities that involve other children {such as team sports, clubs).
F. Duration of the disturbance of at least three months.
G. Not due to Pervasive Developmental Disorder; Conduct Disorder, Undersocialized, Nonaggressive; or any psychotic disorder, such as Schizophrenia,
H. If 18 or older, does not meet the criteria for Schizoid Personality Disorder.

So, we have a “relabeling” from DSM-III to DSM-IV on Asperger’s, which may easily be misdiagnosed as full-blown autism, and people claim there’s an epidemic, then start blaming vaccines, promoting alternative medicine, etc.

And, maybe sensory processing disorder is one of the things that some people call autism. And, there's debate over whether it is an actual "issue," as proponents try to get it in DSM-V.

It may not be called that, but maybe it is, in its more severe manifestations.

What if sensory processing disorder is one of the things that some people call Asperger's, if not full-spectrum autism. What if a child had sensory overload so bad as to have a seizure? And, had learning delays because of this? And were hypersensitive to certain foods?

At the same time, per a lawyer friend of mine with experience in various special education issues, sometimes, parents need the right "label" to get the right special services for their children. At the same time, she notes school districts resist such labeling, because they lose money on most special education services.

So, to Flavius and others, I am more than willing to see possible new treatments scientifically investigated. Let's stop promoting ones, or defending other people promoting ones, that have been investigated, but disproven. If true liberalism is going to be "reality-based," doesn't that have to apply across the board?

And, on DSM-V, what will be the low end of the "spectrum" in "autism spectrum disorder," anyway?

 Update, Oct. 30, 2012: Asperger's, whether or not it's really autism's diagnostic "cousin," is becoming more and more an in thing, as NY Mag shows in detail. Here's Tyler Cowan, bidding for Jonah Lehrer or Malcolm Gladwell status on the TED circuit:
In his zeal to present autism in a positive light, Cowen flirts with dottiness, writing things like, “Autistics are the culmination of Buddhist thought and indeed Buddhist practice,” and coming very close to diagnosing the entire country of Finland as autistic.
Oy. Vey.

Update, March 2, 2010: Meanwhile, due to fear tactics of people like Andrew Wakefield and Jenny McCarthy, one in four parents are afraid to vaccinate their children.

One good thing? Some doctors are refusing to treat anti-vax parents or their children any more.

Update, Jan. 6, 2011: Well, we know now that the lies of Andrew Wakefield involved deliberate fraud.

Update, Feb. 9, 2010: Per previous speculation on my part, part of the rise in autism diagnosis that is actually an increase in autism cases is linked to older parents.

But, note that it's both parents and not just mothers.
“It’s important we not turn around and blame mothers,” Dr. Dolores Malaspina said. “The evidence is very, very strong that there is a paternal age effect.”
That said, the researchers said the parental age effect does not account for all the increase in diagnosis.

Of course not.

Going by what you can find around the web about adult-manifest SPD, I offer these insights:

Causes? Unknown but likely multivalent. A relative with schizophrenia increases the likelihood for SPD, which indicates some genetic background. Environmental factors are likely involved. The time crunch of modern parenting may be a factor.

I will certainly venture that the increased genetic fragility of more and more women having later-life pregnancies is an issue. There may also be genetic fragility issues, or uterine stress issues, with test-tube conception.

And, without being too Freudian, other parenting and home-life issues may be contributory in many cases.

And, color me skeptical in another way about the uptick in diagnosis, whether of Asperger’s or full-spectrum autism. Who is making such diagnoses? Medical doctors? Or chiropractors, homeopaths, chiropractors and other voodoo practitioners?

Treatment? Talk therapy. Of course, schizoids are loners, so it’s tough to get them to stay in too long in one-on-one therapy. In group therapy, they may simply let others talk more and stay silent.

Medications are not indicated unless other mental health issues are also involved.

Update, March 4:

Per comments, it is true that I don't have exact numbers of schizoid disorders of childhood. But, even a quick Google search led me to find that in Great Britain, a country with about 18 percent the population of the US, multiple research studies of children diagnosed with SCD; I also found one from Denmark. This should indicate the diagnosis was NOT uncommon.

And, for anyone defending the idea of an “autism epidemic,” YOU don’t have numbers. Or, even if you’re defending the idea of anything close to that.

You admit yourself that we don't know what autism is. And I show one likely vehicle for how what “autism” wasn't has become what “autism” is.

The bottom line is this:

Per Carl Sagan, extraordinary claims demand extraordinary evidence. (And, since we’re talking science here, that evidence must be scientifically verifiable.)

Claims of an “autism epidemic” are certainly extraordinary. Such claimants therefore have the burden of proof for producing a scientifically verifiable cause of such an epidemic.

So far, they have failed utterly.

I offer the alternative of how a psychiatric rediagnosis, combined with a possible medical updiagnosis, may be a significant cause of an alleged “autism epidemic,” along with offering a possible empirical cause for any increase that may be real – that empirical cause being more and more late-fertility age births by mothers in the developed world.

And, the fact that Asperger’s is listed as a condition in DSM-IV opens a whole new can of worms. Is it, or “autism,” a physical or a mental disorder?

Update, Feb. 3, 2010: As to what may be causing an increase in actual cases of autism? I do think that, after you subtract out the above, there is such a thing.

Like some other childhood fragile-genes syndromes, it's more older, i.e., post-40, women in the western world having babies. That includes you, Jenny McCarthy. Not to be too harsh about it, but, look in the mirror as part of your blame-casting.

Finally, let's note, as the American Psychological Association now works on DSM-V, that in the non-nutter, but profit-driven, world, though the APA denies it, DSM-V and its process of editing and formulation is connected indeed to the pharmaceutical and the insurance industries.

Update, March 2, 2010: The mainstream media is starting to challenge Jenny McCarthy on this issue.

Update, March 30, 2010: Salon does a great job of showing how she can't even keep her nuttery straight.


C. Marie Byars said...

Actually, the DSM V may roll Aspbergers back up into an Autistic Spectrum disorder. But there are some significant differences between the two, which are what ALLOW people with Aspbergers to generally function at a higher level. From what I last read, maternal factor is an age. But so are possible "in utero" conditions, moreso than outright genetics. But people don't need to blame moms---we get enough guilt, anyway.

Gadfly said...

No, not blame moms... except that warning shot at Ms. McCarthy.

But, over-40 would-be moms need to ask more about the risks, and be more self-honest, perhaps?