Is ASD a useful label or is it we don’t know we will lump it under an umbrella term?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes it makes sense. It is a very broad spectrum. There are two things to know:
1) All ASD involves social communication deficits. Usually this involves limited or no ability to pick up social cues. A lot of the variability in ASD is from this issue because it's like someone visiting a foreign country where they don't know the language. The visitor will act strangely, but it will look different depending on the customs of their own country.
2) All ASD involves restricted, repetitive behaviors. Narrow interests is classic, but this group includes sensory issues, as they try to confine themselves to seeking or avoiding certain sensations. For example, my kid eats only about 10 things, often refusing foods based on texture alone.

We don't know why those two items go together so often, but we see them together so often, we created the ASD syndrome. A syndrome is an set of symptoms that frequently occur together without an obvious connection.

The third thing to know is that ASD is often comorbid with other disorders. We don't know why this is either. But it accounts for a lot of the variability too. Many have ADHD, itself something of a spectrum. Many have communication disorders, adding a layer of complexity to understanding your AS kid..

I hope this helps.

It actually doesn't make sense, because the DSM is very arbitrary. The standards for ASD (such as repetitive behavior) have changed. You used to not be able to diagnose ASD with anything comorbid, and now you say "ASD is often comorbid." It really is a moving target. ASD is a collection of symptoms, and the DSM criteria are so broad, that there's not really any unifying principal.

The "moving target" has a lot to do with the history of what the DSM is and the personalities of early Autism researchers. The ASD diagnostic criteria are pretty specific even if how individuals express those criteria seem broad. We see similar variance in expression of symptoms across other diagnoses where we know more about the underlying neurology.

No, the ASD criteria are not specific. They are very broad, and in many potential combinations, that there is a lot of possible variety. The "moving target" is due to the inherently subjective nature of all DSM diagnoses -- they're decided by committee based on a collection of symptoms; not through actual differential, physically-based processes (or even treatment approaches.)

Sure, psychiatric diagnosis is both an art and a science. But if somebody is.crying their eyes and talks about suicide, we've got absolutely no trouble figuring out they have depression. Then take a five-year old can give a university-level lecture on beetles but doesn't know why the rest of the world is not interested and suddenly people think we don't know what the problem is.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes it makes sense. It is a very broad spectrum. There are two things to know:
1) All ASD involves social communication deficits. Usually this involves limited or no ability to pick up social cues. A lot of the variability in ASD is from this issue because it's like someone visiting a foreign country where they don't know the language. The visitor will act strangely, but it will look different depending on the customs of their own country.
2) All ASD involves restricted, repetitive behaviors. Narrow interests is classic, but this group includes sensory issues, as they try to confine themselves to seeking or avoiding certain sensations. For example, my kid eats only about 10 things, often refusing foods based on texture alone.

We don't know why those two items go together so often, but we see them together so often, we created the ASD syndrome. A syndrome is an set of symptoms that frequently occur together without an obvious connection.

The third thing to know is that ASD is often comorbid with other disorders. We don't know why this is either. But it accounts for a lot of the variability too. Many have ADHD, itself something of a spectrum. Many have communication disorders, adding a layer of complexity to understanding your AS kid..

I hope this helps.

It actually doesn't make sense, because the DSM is very arbitrary. The standards for ASD (such as repetitive behavior) have changed. You used to not be able to diagnose ASD with anything comorbid, and now you say "ASD is often comorbid." It really is a moving target. ASD is a collection of symptoms, and the DSM criteria are so broad, that there's not really any unifying principal.

The "moving target" has a lot to do with the history of what the DSM is and the personalities of early Autism researchers. The ASD diagnostic criteria are pretty specific even if how individuals express those criteria seem broad. We see similar variance in expression of symptoms across other diagnoses where we know more about the underlying neurology.

No, the ASD criteria are not specific. They are very broad, and in many potential combinations, that there is a lot of possible variety. The "moving target" is due to the inherently subjective nature of all DSM diagnoses -- they're decided by committee based on a collection of symptoms; not through actual differential, physically-based processes (or even treatment approaches.)

Sure, psychiatric diagnosis is both an art and a science. But if somebody is.crying their eyes and talks about suicide, we've got absolutely no trouble figuring out they have depression. Then take a five-year old can give a university-level lecture on beetles but doesn't know why the rest of the world is not interested and suddenly people think we don't know what the problem is.

Neither example is even remotely related to many of our kids. You can have a brilliant 5 year old who is not ASD and that is part of the point of the concern with the term.

[Anonymous]

Anonymous wrote:How old is your child, OP?

When my child was first diagnosed with "high functioning autism" when he was 5, I felt the same as you. I didn't feel comfortable lumping my highly verbal, academically capable child with the picture of autism I had in my head.

Now that my child is older, I can see that he is, indeed autistic. His social communication deficits and his desire to engage in repetitive activities are more obviously restrictive. Yes, he's still very verbal and (sometimes) academically capable, but I can see how it's a difference in degree, not a different thing, from people who are classically autistic.

Can you tell us more PP? How old is your child and when did you start seeing the differences more clearly?
DS12 has trouble with emotional regulation, and sometimes talks too much or too loudly and tends to be in other people's space more than other children his age. He's also very clumsy. On the other hand, he has a wide range of interests from sporty to academic, has a lot of friends and is very social and has good grades.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes it makes sense. It is a very broad spectrum. There are two things to know:
1) All ASD involves social communication deficits. Usually this involves limited or no ability to pick up social cues. A lot of the variability in ASD is from this issue because it's like someone visiting a foreign country where they don't know the language. The visitor will act strangely, but it will look different depending on the customs of their own country.
2) All ASD involves restricted, repetitive behaviors. Narrow interests is classic, but this group includes sensory issues, as they try to confine themselves to seeking or avoiding certain sensations. For example, my kid eats only about 10 things, often refusing foods based on texture alone.

We don't know why those two items go together so often, but we see them together so often, we created the ASD syndrome. A syndrome is an set of symptoms that frequently occur together without an obvious connection.

The third thing to know is that ASD is often comorbid with other disorders. We don't know why this is either. But it accounts for a lot of the variability too. Many have ADHD, itself something of a spectrum. Many have communication disorders, adding a layer of complexity to understanding your AS kid..

I hope this helps.

It actually doesn't make sense, because the DSM is very arbitrary. The standards for ASD (such as repetitive behavior) have changed. You used to not be able to diagnose ASD with anything comorbid, and now you say "ASD is often comorbid." It really is a moving target. ASD is a collection of symptoms, and the DSM criteria are so broad, that there's not really any unifying principal.

The "moving target" has a lot to do with the history of what the DSM is and the personalities of early Autism researchers. The ASD diagnostic criteria are pretty specific even if how individuals express those criteria seem broad. We see similar variance in expression of symptoms across other diagnoses where we know more about the underlying neurology.

No, the ASD criteria are not specific. They are very broad, and in many potential combinations, that there is a lot of possible variety. The "moving target" is due to the inherently subjective nature of all DSM diagnoses -- they're decided by committee based on a collection of symptoms; not through actual differential, physically-based processes (or even treatment approaches.)

Sure, psychiatric diagnosis is both an art and a science. But if somebody is.crying their eyes and talks about suicide, we've got absolutely no trouble figuring out they have depression. Then take a five-year old can give a university-level lecture on beetles but doesn't know why the rest of the world is not interested and suddenly people think we don't know what the problem is.

Neither example is even remotely related to many of our kids. You can have a brilliant 5 year old who is not ASD and that is part of the point of the concern with the term.

Both are real world examples of actual.people with their respective diagnoses. The child is a real child who was not that brilliant but knew an awful lot about insects: restricted interest, and couldn't tell when people were bored or disgusted by his mini-lectures: missed social cues.

Sometimes it's really not that difficult to diagnose these things, lack of blood tests notwithstanding. If you don't recognize classic depression or ASD, then maybe you are not as knowledgeable about how these diagnoses are made as you think.

[Anonymous]

NP. We get your argument but you don't seem to be getting PP's argument. That child could also easily have been a brilliant NT child without ASD.

You are awfully confident you can arm chair diagnose anyone.

[Anonymous]

Anonymous wrote:NP. We get your argument but you don't seem to be getting PP's argument. That child could also easily have been a brilliant NT child without ASD.

You are awfully confident you can arm chair diagnose anyone.

Like I said, it's a real example for someone who already was diagnosed, I have seen more than once, and also know his mother. I did not do an armchair diagnosis, but it was pretty easy to see, non-professional that I am.

My point though is that psychiatric diagnoses are real things even if we don't understand all the neurology behind them yet amd our diagnostic tools are not perfect. There's a common thread running through each diagnosis and the symptom lists are based on that.

There has been a 40-year push to make psychiatric diagnoses more standardized and evidence-based. This push has largely been successful and we continue to improve. There is much less subjectivity and better treatments than there used to be. It's not anywhere near the rigor we can achieve with physical illnesses, but that is no reason to blow off the entire field, which has helped millions of people and saved lives.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP. We get your argument but you don't seem to be getting PP's argument. That child could also easily have been a brilliant NT child without ASD.

You are awfully confident you can arm chair diagnose anyone.

Like I said, it's a real example for someone who already was diagnosed, I have seen more than once, and also know his mother. I did not do an armchair diagnosis, but it was pretty easy to see, non-professional that I am.

My point though is that psychiatric diagnoses are real things even if we don't understand all the neurology behind them yet amd our diagnostic tools are not perfect. There's a common thread running through each diagnosis and the symptom lists are based on that.

There has been a 40-year push to make psychiatric diagnoses more standardized and evidence-based. This push has largely been successful and we continue to improve. There is much less subjectivity and better treatments than there used to be. It's not anywhere near the rigor we can achieve with physical illnesses, but that is no reason to blow off the entire field, which has helped millions of people and saved lives.

Very much an arm-chair diagnosis and you may not know all the facts as it is not your child. The tools are basically check lists and are very subjective. They do not have any true tests or really is even have clarity on what ASD is. ADHD years ago was used as the every kid has diagnosis, and now ASD is. Some kids are just off the wall smart. Many of our kids it is something else and rarely do the evaluators take the time to understand each diagnosis beyond what they read or see and just slap on a label and be done with it to collect their check. Many kids get misdiagnosed early on.

[Anonymous]

I've never heard of a child diagnosed with autism who turned out to be NT. I have heard the opposite many times.

[Anonymous]

OP here. Kiddo is 3.5. Child Find used ASD category. Ped sa

[Anonymous]

Anonymous wrote:

Anonymous wrote:How old is your child, OP?

When my child was first diagnosed with "high functioning autism" when he was 5, I felt the same as you. I didn't feel comfortable lumping my highly verbal, academically capable child with the picture of autism I had in my head.

Now that my child is older, I can see that he is, indeed autistic. His social communication deficits and his desire to engage in repetitive activities are more obviously restrictive. Yes, he's still very verbal and (sometimes) academically capable, but I can see how it's a difference in degree, not a different thing, from people who are classically autistic.

Can you tell us more PP? How old is your child and when did you start seeing the differences more clearly?
DS12 has trouble with emotional regulation, and sometimes talks too much or too loudly and tends to be in other people's space more than other children his age. He's also very clumsy. On the other hand, he has a wide range of interests from sporty to academic, has a lot of friends and is very social and has good grades.

your child is not autistic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP. We get your argument but you don't seem to be getting PP's argument. That child could also easily have been a brilliant NT child without ASD.

You are awfully confident you can arm chair diagnose anyone.

Like I said, it's a real example for someone who already was diagnosed, I have seen more than once, and also know his mother. I did not do an armchair diagnosis, but it was pretty easy to see, non-professional that I am.

My point though is that psychiatric diagnoses are real things even if we don't understand all the neurology behind them yet amd our diagnostic tools are not perfect. There's a common thread running through each diagnosis and the symptom lists are based on that.

There has been a 40-year push to make psychiatric diagnoses more standardized and evidence-based. This push has largely been successful and we continue to improve. There is much less subjectivity and better treatments than there used to be. It's not anywhere near the rigor we can achieve with physical illnesses, but that is no reason to blow off the entire field, which has helped millions of people and saved lives.

No. Psychiatric conditions are real things. Pyschiatric diagnoses are not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes it makes sense. It is a very broad spectrum. There are two things to know:
1) All ASD involves social communication deficits. Usually this involves limited or no ability to pick up social cues. A lot of the variability in ASD is from this issue because it's like someone visiting a foreign country where they don't know the language. The visitor will act strangely, but it will look different depending on the customs of their own country.
2) All ASD involves restricted, repetitive behaviors. Narrow interests is classic, but this group includes sensory issues, as they try to confine themselves to seeking or avoiding certain sensations. For example, my kid eats only about 10 things, often refusing foods based on texture alone.

We don't know why those two items go together so often, but we see them together so often, we created the ASD syndrome. A syndrome is an set of symptoms that frequently occur together without an obvious connection.

The third thing to know is that ASD is often comorbid with other disorders. We don't know why this is either. But it accounts for a lot of the variability too. Many have ADHD, itself something of a spectrum. Many have communication disorders, adding a layer of complexity to understanding your AS kid..

I hope this helps.

It actually doesn't make sense, because the DSM is very arbitrary. The standards for ASD (such as repetitive behavior) have changed. You used to not be able to diagnose ASD with anything comorbid, and now you say "ASD is often comorbid." It really is a moving target. ASD is a collection of symptoms, and the DSM criteria are so broad, that there's not really any unifying principal.

The "moving target" has a lot to do with the history of what the DSM is and the personalities of early Autism researchers. The ASD diagnostic criteria are pretty specific even if how individuals express those criteria seem broad. We see similar variance in expression of symptoms across other diagnoses where we know more about the underlying neurology.

No, the ASD criteria are not specific. They are very broad, and in many potential combinations, that there is a lot of possible variety. The "moving target" is due to the inherently subjective nature of all DSM diagnoses -- they're decided by committee based on a collection of symptoms; not through actual differential, physically-based processes (or even treatment approaches.)

Sure, psychiatric diagnosis is both an art and a science. But if somebody is.crying their eyes and talks about suicide, we've got absolutely no trouble figuring out they have depression. Then take a five-year old can give a university-level lecture on beetles but doesn't know why the rest of the world is not interested and suddenly people think we don't know what the problem is.

Neither example is even remotely related to many of our kids. You can have a brilliant 5 year old who is not ASD and that is part of the point of the concern with the term.

Both are real world examples of actual.people with their respective diagnoses. The child is a real child who was not that brilliant but knew an awful lot about insects: restricted interest, and couldn't tell when people were bored or disgusted by his mini-lectures: missed social cues.

Sometimes it's really not that difficult to diagnose these things, lack of blood tests notwithstanding. If you don't recognize classic depression or ASD, then maybe you are not as knowledgeable about how these diagnoses are made as you think.

Yeah, but how do you reconcile a child with poor expressive language, who shuns social interaction and appears aloof and disinterested, with a child who is "socially motivated" (in that he communicates and actively seeks interaction even if odd/awkward), has advanced expressive language skills? Both are labeled ASD, and it doesn't make a ton of sense. All you can really say is "they both react in a non-NT way to social cues." that's not really satisfying.

[Anonymous]

Anonymous wrote:OP here. Kiddo is 3.5. Child Find used ASD category. Ped sa

Sorry sent before I was done. Ped said “nah”, neurologist said “nah”, speech therapist said “maybe”. Child find said “ASD”. Taking him to KK in the next month but I don’t know what difference it makes since so far none of the experts seem to agree. I see some flags but these also seem to fit other possible issues MERLD or ADHD or Audio processing disorder or just being 3. I want specific information on what the deficits are, why they are happening and how to address them. ASD just seems so damn broad it doesn’t help me know what to do with it (other than getting insurance and school to cover things).

[Anonymous]

Anonymous wrote:I've never heard of a child diagnosed with autism who turned out to be NT. I have heard the opposite many times.

This is about whether ASD is a useful label; not whether NT kids are being mislabled. Research shows up to 37% of kids lose ASD diagnoses. https://www.contemporarypediatrics.com/modern-medicine-feature-articles/lost-asd-diagnosis-now-what A lot of those kids do get ADHD dxs, but this still begs the question of whether we're pathologizing normal variants of personality or not. IMO it really has to do with life outcomes -- if these dx'd kids get jobs, get married, etc, then I think that will be a good argument for over-diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. Kiddo is 3.5. Child Find used ASD category. Ped sa

Sorry sent before I was done. Ped said “nah”, neurologist said “nah”, speech therapist said “maybe”. Child find said “ASD”. Taking him to KK in the next month but I don’t know what difference it makes since so far none of the experts seem to agree. I see some flags but these also seem to fit other possible issues MERLD or ADHD or Audio processing disorder or just being 3. I want specific information on what the deficits are, why they are happening and how to address them. ASD just seems so damn broad it doesn’t help me know what to do with it (other than getting insurance and school to cover things).

I think pediatricians and neurologists are tuned into huge differences, not subtle ones. Child Find may just be perceiving that your kid has differences that impact schooling. I've heard that KKI is pretty rigorous, so should be good information for you.