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Can a child have ASD and be "very social"?
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Anonymous
Actually what the poster said is true. Language disorder is being removed as an indicator from autism, because so many people are confusing the two. Recent field trials have indicated that far fewer children will qualify as autistic....instead, the new DSM adds several levels of language disorders. The idea is to get a more pinpointed Dx of what a child is truly dealing with. The APA recently came out and said that far too many children were being Dxed with PDD-NOS, and that was never the intent of the Dx. In one field study, only two children out of almost 70 with PDD-NOS under the DSM IV still qualified as ASD under the DSM 5. |
Anonymous
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I would never refer to any ASD as mild. I am only saying that some kids with ASDs want social interaction, they just pursue it in atypical ways. Go look at the "severity" tab for the new DSM V definition. (And, you will also see that not all ASDs are SEVERE. The point of the new diagnosis is that the full spectrum will have the same diagnosis, but with levels of impairment.) This is laid out in the "lowest" level of severity.
It is absolutely not a "bar" to diagnosis that a child wants interaction. Its how they go about it that matters. PDD-NOS has always been a poor fit. I have to say that every child I've met with PDD-NOS has been more impaired than my DS with AS. They just don't meet the full diagnostic criteria for autism. But the criteria they do meet they meet significantly. Not always, just the kids I've met. |
Anonymous
And now we've moved on from the "they say all kids have ADHD," to "they say all kids have an ASD." I don't buy it. I think there is such a massive stigma associated with an ASD diagnosis that you have kids running around with a bogus SPD diagnosis, event hough it isn't a medical diagnosis. I see parents in denial. I can't say that I've ever seen a parent claiming an NT kid had an ASD -- maybe they exist, but I've never met one. I've also seen plenty of kids who should have an autism diagnosis but their parents say its Aspergers, but thats another story. Please tell me where in this world autism is not seen as "an extremely disabling condition." Because I would like to move to this place with my child. |
Anonymous
Aspergers IS Autism. |
Anonymous
I disagree. Do you have elementary school-age children? Because if/when you do, or if you do now and you look more closely at the school, you'll see that 6, 7, 8, 10 years olds need these two diagnoses in their folders to get all the services they want. er, need. Schools know how to deal with these two Dx, sort of, and so that's what parents want at least as a starting point. Also ... can we talk insurance companies? The kids with the yet-to-be-determined, amorphous conditions don't fare as well with insurance coverage OR public school accommodations. Both entities like to see bright lines. I am convinced that these two entities -- insurance companies and public school systems dealing with IEPs -- are two of the biggest drivers of over-inclusiveness in diagnoses. Even the most ethical medical providers with "help you out there" on the coding if it means the difference in coverage of $30,000 in therapy bills, or not. I know first hand. |
Anonymous
| ^^^ WILL help you there |
Anonymous
19:08 here: I agree- after reading earlier posts I decided to look at the new criteria under DSM V-- based on the severity tab, my son is Level 1 which states under "Social Communication": "Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions." Clearly, this is how most parents with high-functioning or some say "mild" ASD, especially with Asperger's describe their children. I also looked at the DSM V section for Social Communication Disorders which seems to address language disorders that PPs mentioned. However, it clearly says to rule out the presence of "restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum". The only other developmental condition that comes close to my son's behavior/symptoms is Hyperlexia (http://www.hyperlexia.net/hyperlexia-facts.html) which many people have never heard of (and some professionals argue that Hyperlexia falls under ASDs). But as a PP has mentioned, getting medical coverage under insurance or an IEP under this diagnosis is impossible. Are there parents with children that were diagnosed with Asperger's or HFA and their children didn't exhibit restricted interests or repetitive behavior? Is the PDD-NOS and Asperger's categories the reason why some argue that there has been an over diagnosis of ASD? |
Anonymous
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I like the late Dr. Stanley Greenspan's explanation of what's going with diagnosing. He devoted several radio shows to it. The Misdiagnosis of Autism Spectrum Disorders http://www.icdl.com/distance/webRadio/documents/10-8-08b.pdf http://www.icdl.com/distance/webRadio/documents/10-10-2008.pdf In these he clearly spells out how people are too quick to label because of secondary characteristics instead of the core social communication deficits. Arm flapping, toe walking, pointing....none of these are the true indicators of autism. |
Anonymous
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I have two kids on the spectrum. Both are considered high-functioning, but as one of the PPs said, that should not be confused with "mild". One kid had the classic regression with everything you would expect in infantile autism, the other was a little more atypical, but the more I thought back to her early infancy years, the more it is now clear to me that she too was autistic all along, just like I thought. It is very hard to explain what makes us so sure that the diagnosis is accurate, but after so many years of living with these two ASD kids I know that it is. We have adjusted to their diagnosis and accomodated what was necessary.
My 2nd ASD kid is a very social kid. Much too social for other kids or adults, because she knows no boundaries, is always in people's personal space and typically cannot hold a conversation beyond 2 talking points, which throws people off, as her pronunciation, her grammar use and her overall persona seems well put-together. She also looks much older than she is, so people expect her to act like a 6-7 year old. My son is a little more reserved and generally withdraws easily if the social expectations exceed what he can grasp. Both clearly have the restrictive and repetitive patterns of behavior, play and speech. But because my daughter has girl specific special interests people easily overlook the fact that she can brush a doll's hair for hours without ever changing anything. For days. She also happens to have an obsession for shoes, which is also not unusual per se, but the level to which she takes it definitely is. I don't know any ASD kids what I would say are misdiagnosed. I know PDD-NOS kids that in my opinion are ASD kids, however. |
Anonymous
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One Michigan autism center says out of the kids referred to them, either by pediatricians, schools, etc., 75 percent do NOT have autism or an ASD, even though the child exhibited some autistic behaviors. 75 percent. That's a lot of misdiagnosing going on. |
Anonymous
No, what they are saying is that out of the 100% referred for possible ASD, 75% end up not fitting the diagnosis and thus do NOT get diagnosed. The Kennedy Krieger Institute in Baltimore is very conservative when it comes to the ASD diagnosis, so when a child gets diagnosed by them, it's likely that the child truly has ASD. When my kids were diagnosed I definitely sought out 2nd and 3rd opinions and we evaluate their development on a regular basis. If anyone had expressed doubt over the accuracy of the diagnosis I would have definitely requested a new autism evaluation. (which should be done in a very comprehensive manner and not just during an hour or two). |
Anonymous
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But these were kids who had often gotten an initial flag of autism from somebody, often the schools. These were the second evaluations these kids were getting...and I agree, evaluations should be hours long, even though I've spoken to plenty of parents where the dev ped spent less than an hour with their kids. Sometimes 15 minutes! http://www.associatedcontent.com/article/2941632/detroit_experts_say_autism_is_overdiagnosed.html?cat=5 Detroit experts say autism is overdiagnosed Autism is often misdiagnosed, according to Henry Ford specialists. A proper diagnosis of autism spectrum disorder should be made by a team of specialists, said Dr. Colleen Allen, program director of the Henry Ford Center for Autism and Developmental Disabilities (CADD), with locations in Detroit and West Bloomfield. "Autism is such a complex disorder. It is easily misdiagnosed," said Allen, a speech and language pathologist with Henry Ford Health System. ince Henry Ford's CADD program opened in July 2008, only about 25 percent of 300 children evaluated have met the criteria for an autistic spectrum disorder, Allen said. The two- to three-hour evaluation includes a speech-language pathologist, a geneticist and a developmental pediatrician, as well as a child neurologist and a child psychiatrist if necessary. Most of it is often covered by health insurance, and the Ethel and James Flinn Foundation in Detroit has provided a $50,000 grant to support the mental health portion of the diagnostic evaluation, Allen said. The CADD diagnoses of autism are much lower than what would be expected based on CDC estimates that one in 110 children in the United States has an autistic spectrum disorder, Allen said. Other conditions have similar symptoms Symptoms that could make a parent or health care professional suspect autism may actually be the result of a speech or language delay; a behavioral, emotional or psychiatric diagnosis; a cognitive impairment; a nutritional or sleep deficit; or a medical diagnosis, she said. "When I started 30 years ago, autistic behaviors were very extreme and autism was rare," said Dr. Barry Wolf, a geneticist, pediatrician and member of the CADD team. "Now, you can hardly find a family that doesn't have someone who has been diagnosed with autism. I don't think the incidence has increased so much. The labeling has increased dramatically." |
Anonymous
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1. Stanley Greenspan was notoriously skeptical of all HFA and AS diagnoses. he felt they would lead parents to lower expectations for their children, and was loath to recognize an ASD in many situations. The man was a visionary but he treated parents like they were children and I would never take his word for anything on this subject.
2. I am totally confused as to how the fact that an evaluation center only finds a diagnosis in some of the kids referred to them means it is being over diagnosed. It means the opposite, that clinicians can tell the difference. Who cares what teachers and folks who make the referrals think, thats not a diagnosis. if my gynecologist finds a lump in my breast and refers me to a surgeon who finds, as in most cases, that it is benign, that doesn't mean that breast cancer is being overdiagnosed. 3. getting back to the original point, there is no definition of an ASD anywhere, including both the DSM IV and the DSM V, that requires NO interest in social interaction. |
Anonymous
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NP. My DS is 2.5 and we've seen ASD characteristics in him for quite a while. He is quite "social". Whatever the label ends up being, we've chosen to evaluate and get therapies. I am very glad we did not wait. He has been in speech therapy since 18 months and he had his first full developmental ped evaluation at that age as well (scheduled since he was 15 months, it takes a while to get in). So far the dev ped has said he does not think he is ASD but we can't rule out HFA until later. He does, though, display some behaviors (for instance, perserverative behavior with doors, which has turned into other limited interests).
Although we like our regular ped practice, I wouldn't rely on them for developmental issues, to be honest. I'm really glad we see a dev ped (Dr. Shapiro, who is wonderful). At each screening from 9 months on, they took a wait and see approach. I called my county's early intervention group by 12 months. If you have not done this, OP, please do. At the very least you'll get a full eval and a sense of where he is overall. We did county speech for quite a while but also immediately added private. If you can do private, do it (in addition or instead, whatever). Once I did go to the dev ped, our regular ped said she thought it was great and the right thing to do. As I've now learned, just making eye contact and engaging socially is good but it doesn't rule out HFA. There are more subtle cues that come into play and become much more obvious as babies/toddlers get older and social expectations increase. Many ASD babies can engage with adults, especially caregivers, but the most important question is how they interact with peers and that's something that will only become apparent when older. Anyway, my biggest point to you, OP, is I strongly encourage you NOT to wait any further to intervene. Yes, early intervention is critical. I think it's made a huge difference. You have enough yellow flags in different areas that therapy really seems warranted, ASAP. |
Anonymous
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1. Stanley Greenspan is just the tip of the iceberg, though. He's hardly an outlier saying doctors, psychologists, EI are overdiagnosing and misdiagnosing. Heck, even the chairman of the DSM-IV is saying this. In fact, the APA has now come out and said as much. 2. The article doesn't make it clear, but I suspect it's because all those kids were initially labeled as autistic and ASD by somebody else. When a school psych labels a child with ASD, parents walk away thinking that's what the child has. These people present themselves as clinicians who are able to make that Dx. Likewise, dev peds label, then tend to refer parents to this autism center, which does all the treatments. So this is no general population, most of these kids came labeled. What's important to note is that this is the center's view of this, not just mine or the reporter's. (The problem with your gyn example is that you actually don't have to have any training to label a child with autism in a setting like EI.) 3. The DSM III actually did say that children with autism had no interest in people. That was the standard until the 1994 DSM-IV changed it. However, the wording a severe is absolutely in the DSM iV: PDD NOS This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" ? presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these. |