Does anyone feel like the current DSM needs urgent updating?

[Anonymous]

Anonymous wrote:Anyone with long-term ASD knowledge know if/how the new DSM created this phenomenon of boy autism vs girl autism? Where’s this information coming from?

https://www.thetestingpsychologist.com/268-masterclass-autistic-adolescent-girl-w-dr-donna-henderson/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

Not sure why you can't stand this idea, considering it's a thing.

DP. Because it creates the notion that autism can be hidden and it over-medicalizes girls. Sure the presentation may be different for some girls, but the ADOS was tested on both genders.

Pp here, and exactly.

Girls just do not have as severe a presentation as boys. Period.

Wrong. Girls struggle less than boys at younger ages but more than boys during adolescence.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

Not sure why you can't stand this idea, considering it's a thing.

DP. Because it creates the notion that autism can be hidden and it over-medicalizes girls. Sure the presentation may be different for some girls, but the ADOS was tested on both genders.

Usually, the girls receiving late diagnoses have already been medicalized: with anxiety, depression, BPD, etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

Not sure why you can't stand this idea, considering it's a thing.

DP. Because it creates the notion that autism can be hidden and it over-medicalizes girls. Sure the presentation may be different for some girls, but the ADOS was tested on both genders.

Pp here, and exactly.

Girls just do not have as severe a presentation as boys. Period.

Wrong. Girls struggle less than boys at younger ages but more than boys during adolescence.

That has been our experience.

My autistic daughter went to K-2 with many autistic boys. She had an "easier" time than them because she had more school readiness behavior, in terms of being able to follow directions and sit still and listen to the teacher. Now in high school, she is struggling much more than those same boys: anxiety and depression have hit her harder and girl friendships are so much harder to navigate.

Fwiw, the boys were all diagnosed at 2-3 years old and she wasn't diagnosed until 5. They all lined up toys, etc. but those behaviors were seen as more appropriate for girls, so didn't raise any red flags until her social skills didn't make the jump away from parallel play.

[Anonymous]

Anonymous wrote:

That has been our experience.

My autistic daughter went to K-2 with many autistic boys. She had an "easier" time than them because she had more school readiness behavior, in terms of being able to follow directions and sit still and listen to the teacher. Now in high school, she is struggling much more than those same boys: anxiety and depression have hit her harder and girl friendships are so much harder to navigate.

Fwiw, the boys were all diagnosed at 2-3 years old and she wasn't diagnosed until 5. They all lined up toys, etc. but those behaviors were seen as more appropriate for girls, so didn't raise any red flags until her social skills didn't make the jump away from parallel play.

Sure, but there's a difference between your situation - a girl who had clear symptoms of autism that were overlooked because her early signs conformed more to expected girl behavior - and the idea that girls can be diagnosed with "milder" symptoms or that there's a different presentation in girls.

[Anonymous]

(Also, PP, I'm sorry your daughter is having a rough time right now.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

That has been our experience.

My autistic daughter went to K-2 with many autistic boys. She had an "easier" time than them because she had more school readiness behavior, in terms of being able to follow directions and sit still and listen to the teacher. Now in high school, she is struggling much more than those same boys: anxiety and depression have hit her harder and girl friendships are so much harder to navigate.

Fwiw, the boys were all diagnosed at 2-3 years old and she wasn't diagnosed until 5. They all lined up toys, etc. but those behaviors were seen as more appropriate for girls, so didn't raise any red flags until her social skills didn't make the jump away from parallel play.

Sure, but there's a difference between your situation - a girl who had clear symptoms of autism that were overlooked because her early signs conformed more to expected girl behavior - and the idea that girls can be diagnosed with "milder" symptoms or that there's a different presentation in girls.

DP
When people say there's a different presentation in girls, they mean many girls meet the criteria for diagnosing but don't get tested for autism because it looks different than in boys.

For example, an autistic person can have social motivation. At young ages autistic girls are more likely to have more social motivation than autistic boys. But they still struggle with perspective taking and reciprocity just like the boys. They might play "with" other kids but are really just following them around.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

That has been our experience.

My autistic daughter went to K-2 with many autistic boys. She had an "easier" time than them because she had more school readiness behavior, in terms of being able to follow directions and sit still and listen to the teacher. Now in high school, she is struggling much more than those same boys: anxiety and depression have hit her harder and girl friendships are so much harder to navigate.

Fwiw, the boys were all diagnosed at 2-3 years old and she wasn't diagnosed until 5. They all lined up toys, etc. but those behaviors were seen as more appropriate for girls, so didn't raise any red flags until her social skills didn't make the jump away from parallel play.

Sure, but there's a difference between your situation - a girl who had clear symptoms of autism that were overlooked because her early signs conformed more to expected girl behavior - and the idea that girls can be diagnosed with "milder" symptoms or that there's a different presentation in girls.

DP
When people say there's a different presentation in girls, they mean many girls meet the criteria for diagnosing but don't get tested for autism because it looks different than in boys.

For example, an autistic person can have social motivation. At young ages autistic girls are more likely to have more social motivation than autistic boys. But they still struggle with perspective taking and reciprocity just like the boys. They might play "with" other kids but are really just following them around.

or neither. ds played 'with' other kids at the same time as others his age. he just didn't play with them very 'smoothly' - ie he could initiate or participate in playground games, but when it came to collaborative endeavors (lets build a block building togther nicely) he struggled.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

That has been our experience.

My autistic daughter went to K-2 with many autistic boys. She had an "easier" time than them because she had more school readiness behavior, in terms of being able to follow directions and sit still and listen to the teacher. Now in high school, she is struggling much more than those same boys: anxiety and depression have hit her harder and girl friendships are so much harder to navigate.

Fwiw, the boys were all diagnosed at 2-3 years old and she wasn't diagnosed until 5. They all lined up toys, etc. but those behaviors were seen as more appropriate for girls, so didn't raise any red flags until her social skills didn't make the jump away from parallel play.

Sure, but there's a difference between your situation - a girl who had clear symptoms of autism that were overlooked because her early signs conformed more to expected girl behavior - and the idea that girls can be diagnosed with "milder" symptoms or that there's a different presentation in girls.

I agree, but I was responding to a PP who made the blanket statement that a "girl presentation" was less severe than a "boy presentation." While that may be true among kids with "high functioning autism" in preschool, it is not true when they get older.

[Anonymous]

Anonymous wrote:
I agree, but I was responding to a PP who made the blanket statement that a "girl presentation" was less severe than a "boy presentation." While that may be true among kids with "high functioning autism" in preschool, it is not true when they get older.

Oh, I apologize - I totally missed your point! That makes sense.