Does anyone else ever have skepticism over too many dx?

[Anonymous]

NP with a highly socially challenged kid who even with that doesn’t officially meet the ASD diagnosis.

I don’t understand how a kid who supposedly has a disorder which is primarily marked by an inability to read social cues can by age six adopt a sufficient number of social behaviors to fly under the radar. Makes no sense to me. And so many posters on here who announce that a diagnostician finally figured out that their MS or Hs kid has ASD. Again, as the parent of a kid who is highly compromised socially, this doesn’t make sense to me.

[Anonymous]

Anonymous wrote:NP with a highly socially challenged kid who even with that doesn’t officially meet the ASD diagnosis.

I don’t understand how a kid who supposedly has a disorder which is primarily marked by an inability to read social cues can by age six adopt a sufficient number of social behaviors to fly under the radar. Makes no sense to me. And so many posters on here who announce that a diagnostician finally figured out that their MS or Hs kid has ASD. Again, as the parent of a kid who is highly compromised socially, this doesn’t make sense to me.

My kid was diagnosed at age 5. At the time she was diagnosed, it was obvious to the evaluator but not to a casual observer, including her nursery school teachers (when she was 3-4). It's not that she was so adept at masking or had adopted sufficient behavior -- it's that the social expectations for 3, 4, 5 year olds are sufficiently low and social dynamics simple enough that differences/difficulties aren't immediately obvious.

My kid is a teenager now and in some ways she has learned more about expected social behavior (she no longer throws herself on the floor crying in public, she's memorized how to make small talk with adults). But in other ways, the social gap between herself and her peers has grown larger. So I can see that some kids' social differences wouldn't be obvious until they got older.

[Anonymous]

Anonymous wrote:NP with a highly socially challenged kid who even with that doesn’t officially meet the ASD diagnosis.

I don’t understand how a kid who supposedly has a disorder which is primarily marked by an inability to read social cues can by age six adopt a sufficient number of social behaviors to fly under the radar. Makes no sense to me. And so many posters on here who announce that a diagnostician finally figured out that their MS or Hs kid has ASD. Again, as the parent of a kid who is highly compromised socially, this doesn’t make sense to me.

Do you think your child has ASD?

Kids can be socially challenged for reasons other than ASD. Knowing that ASD is a factor can help to identify appropriate interventions.

If the diagnosis of a bunch of kids you've never met "makes no sense" to you, maybe do some research into subtle presentations of ASD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP with a highly socially challenged kid who even with that doesn’t officially meet the ASD diagnosis.

I don’t understand how a kid who supposedly has a disorder which is primarily marked by an inability to read social cues can by age six adopt a sufficient number of social behaviors to fly under the radar. Makes no sense to me. And so many posters on here who announce that a diagnostician finally figured out that their MS or Hs kid has ASD. Again, as the parent of a kid who is highly compromised socially, this doesn’t make sense to me.

Do you think your child has ASD?

Kids can be socially challenged for reasons other than ASD. Knowing that ASD is a factor can help to identify appropriate interventions.

If the diagnosis of a bunch of kids you've never met "makes no sense" to you, maybe do some research into subtle presentations of ASD.

But when did “subtle presentations of asd” even become a thing? Shouldn’t something that is diagnosed through significant challenges not be subtle? Fifteen years ago, there were no “subtle presentations of asd”.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP with a highly socially challenged kid who even with that doesn’t officially meet the ASD diagnosis.

I don’t understand how a kid who supposedly has a disorder which is primarily marked by an inability to read social cues can by age six adopt a sufficient number of social behaviors to fly under the radar. Makes no sense to me. And so many posters on here who announce that a diagnostician finally figured out that their MS or Hs kid has ASD. Again, as the parent of a kid who is highly compromised socially, this doesn’t make sense to me.

Do you think your child has ASD?

Kids can be socially challenged for reasons other than ASD. Knowing that ASD is a factor can help to identify appropriate interventions.

If the diagnosis of a bunch of kids you've never met "makes no sense" to you, maybe do some research into subtle presentations of ASD.

But when did “subtle presentations of asd” even become a thing? Shouldn’t something that is diagnosed through significant challenges not be subtle? Fifteen years ago, there were no “subtle presentations of asd”.

This podcast featuring Donna Henderson may help answer your questions.

https://www.thetestingpsychologist.com/ttp-119-autism-in-girls-women-w-dr-donna-henderson/

[Anonymous]

The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

[Anonymous]

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

There are specific criteria to qualify for an autism diagnosis. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

[Anonymous]

Anonymous wrote:

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

There are specific criteria to qualify for an autism diagnosis. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

NP. I have two kids with diagnoses of autism, one meets all the criteria and is a classic Aspire. He's good-natured and willing to go with the flow, even when he doesn't understand exactly what or why. The other has severe ADHD and anxiety also and I sort of think the psychologist fudged with meeting the criteria for autism, and in day-to-day life the ADHD and anxiety are much more significant, for him and the impact on others.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

There are specific criteria to qualify for an autism diagnosis. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

NP. I have two kids with diagnoses of autism, one meets all the criteria and is a classic Aspire. He's good-natured and willing to go with the flow, even when he doesn't understand exactly what or why. The other has severe ADHD and anxiety also and I sort of think the psychologist fudged with meeting the criteria for autism, and in day-to-day life the ADHD and anxiety are much more significant, for him and the impact on others.

^ classic Aspie (autocorrect error)

[Anonymous]

Our doc simply said psychologist err on the side of over DX - and yes there is borderline readings even with the ADOS and other exams they use to make the DX - but they err on the side to DX because of insurance and all the growing literature of early intervention...but presentations of ASD will change overtime, some more subtle than others...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

Eyeroll. You think wrong.

would you like to support that with evidence? behavior does change with environment but the “masking” discourse suggests that kids are deliberately hiding their condition at school. that’s not really believable. of course kids behave differently at school v home, but the stressors are different. my kid is generally much better at home than school but he’s not “masking” at home - he has many fewer stressors at home that trigger him.

most of the DSM diagnoses require the symptoms to be apparent across multiple domains. if your kid is only having behavioral issues at home - yes that it due to something happening at home, likely including parenting style - not because your kid is somehow fooling everyone else.

(For clarification, I am the eyeroll PP but not the original PP who said "maybe we're just lousy parents" - although I feel similarly.)

Anecdotes don't equal data and I have only personal experience as I haven't had time to go looking for data, but in my experience, this is exactly what is happening - yes, my kid would deliberately hide his condition, or more specifically his distress, at school. I have watched him tell a counselor - one he knows and trusts - that he's fine now and would take their advice and go back to the classroom, even with me sitting right next to him pointing out that's not what he told me a minute ago, and then the instant the counselor left, he burst into tears and saying "no actually I can't do this! please don't make me go back!" He could hide a full-blown panic attack in the middle of the lunchroom with no one the wiser, until he was in a safe space. He would spend every ounce of energy he had to bottle up his distress and just get through the school day without crying, because he could not stand for people to see him cry. (Never mind that its not physically possible to learn under that level of stress.) And then as soon as he got home, the dam would break and alllllll that distress would come spilling out.

"Behavior issues" are not the only symptoms. Behavior is communication, and behavior issues are signals to the outside world that something is wrong. But the absence of obvious signals doesn't necessarily equal an absence of problems. It just means you may need to look harder to find them. Especially in a typical large classroom environment, one can absolutely have symptoms that fly under the radar because they aren't obvious as "issues" in that environment.

"Deficits in social-emotional reciprocity" can look like talking too much / dominating the conversation, or it can look like not talking at all. "Deficits in nonverbal communicative behaviors" can look like refusal to make eye contact and making strange hand gestures, or it can look like staring straight at you and not moving (and likely not actually absorbing anything you say). "Restricted, repetitive patterns of behavior, interests, or activities" can be less than obvious when the interest itself is not that abnormal, but the intensity or focus is - like the 13yo boy who will talk about Minecraft for 4 hours but who can't hold a typical conversation about anything else.

Which of these is likely to get overlooked in a middle school classroom with 40 kids? Does that mean those symptoms don't "count"? Middle schoolers can be CRUEL - do you blame the kid for learning their peers will make fun of them if they flap their arms or walk on their toes and learn to only do that at home? Do you blame the kid with crippling anxiety for not drawing *any* attention to themselves? Do you blame the kid for trusting their mom enough to say "I hate school so much I wish I could die", but not being able to say that to a school counselor?

But pp I think you are talking more about hiding anxiety and depression, not hiding who you are fundamentally as a person.
Anxiety and depression yes are symptoms of an environment causing stress. But the masking discourse centers around the idea that some kids can appear so neurotypical that their autism - a diagnosis defined by social deficits - is not apparent to anyone else. I think that what you’re saying is that kids can completely hide their behaviors but it causes them stress. I think others are disputing that it’s possible to completely conceal them so they are 100% not evident. I don’t think anyone is disputing that kids are trying (and we all wish they did not have to try). I think people are disputing that they are in any way succeeding.

I think the ASD is evident in subtle cases but it doesn't look like what people think it does. For example a person with ASD may be able to use eye contact, but they are acutely aware of it and it makes them uncomfortable. Some symptoms may not be apparent to others but they are apparent to the person experiencing them.

This is the whole argument.
If someone has asd that is imperceptible to others for the 8-9h a day they are at school - for many years - is that truly autism? I don’t know the answer I’m just clarifying that the masking skepticism is NOT based on skepticism about the desire or the effort to conceal ‘behaviors’, it’s skepticism that any human being would actually be able to successfully pretend all day every day that they don’t have autism to the degree that it is undetected by teachers and classmates.

Just one example: The quiet, socially awkward kid, who is being generally ignored by other kids except for a few nice kids who also are not popular, and who is not a behavior 'problem' for the teacher and gets decent grades may have autism and no one the room would necessarily know it or know what is going on in that kid's world.

[Anonymous]

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

You are talking about two different things.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

There are specific criteria to qualify for an autism diagnosis. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

NP. I have two kids with diagnoses of autism, one meets all the criteria and is a classic Aspire. He's good-natured and willing to go with the flow, even when he doesn't understand exactly what or why. The other has severe ADHD and anxiety also and I sort of think the psychologist fudged with meeting the criteria for autism, and in day-to-day life the ADHD and anxiety are much more significant, for him and the impact on others.

It doesn't sound like the problem is the definition then.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

Eyeroll. You think wrong.

would you like to support that with evidence? behavior does change with environment but the “masking” discourse suggests that kids are deliberately hiding their condition at school. that’s not really believable. of course kids behave differently at school v home, but the stressors are different. my kid is generally much better at home than school but he’s not “masking” at home - he has many fewer stressors at home that trigger him.

most of the DSM diagnoses require the symptoms to be apparent across multiple domains. if your kid is only having behavioral issues at home - yes that it due to something happening at home, likely including parenting style - not because your kid is somehow fooling everyone else.

(For clarification, I am the eyeroll PP but not the original PP who said "maybe we're just lousy parents" - although I feel similarly.)

Anecdotes don't equal data and I have only personal experience as I haven't had time to go looking for data, but in my experience, this is exactly what is happening - yes, my kid would deliberately hide his condition, or more specifically his distress, at school. I have watched him tell a counselor - one he knows and trusts - that he's fine now and would take their advice and go back to the classroom, even with me sitting right next to him pointing out that's not what he told me a minute ago, and then the instant the counselor left, he burst into tears and saying "no actually I can't do this! please don't make me go back!" He could hide a full-blown panic attack in the middle of the lunchroom with no one the wiser, until he was in a safe space. He would spend every ounce of energy he had to bottle up his distress and just get through the school day without crying, because he could not stand for people to see him cry. (Never mind that its not physically possible to learn under that level of stress.) And then as soon as he got home, the dam would break and alllllll that distress would come spilling out.

"Behavior issues" are not the only symptoms. Behavior is communication, and behavior issues are signals to the outside world that something is wrong. But the absence of obvious signals doesn't necessarily equal an absence of problems. It just means you may need to look harder to find them. Especially in a typical large classroom environment, one can absolutely have symptoms that fly under the radar because they aren't obvious as "issues" in that environment.

"Deficits in social-emotional reciprocity" can look like talking too much / dominating the conversation, or it can look like not talking at all. "Deficits in nonverbal communicative behaviors" can look like refusal to make eye contact and making strange hand gestures, or it can look like staring straight at you and not moving (and likely not actually absorbing anything you say). "Restricted, repetitive patterns of behavior, interests, or activities" can be less than obvious when the interest itself is not that abnormal, but the intensity or focus is - like the 13yo boy who will talk about Minecraft for 4 hours but who can't hold a typical conversation about anything else.

Which of these is likely to get overlooked in a middle school classroom with 40 kids? Does that mean those symptoms don't "count"? Middle schoolers can be CRUEL - do you blame the kid for learning their peers will make fun of them if they flap their arms or walk on their toes and learn to only do that at home? Do you blame the kid with crippling anxiety for not drawing *any* attention to themselves? Do you blame the kid for trusting their mom enough to say "I hate school so much I wish I could die", but not being able to say that to a school counselor?

But pp I think you are talking more about hiding anxiety and depression, not hiding who you are fundamentally as a person.
Anxiety and depression yes are symptoms of an environment causing stress. But the masking discourse centers around the idea that some kids can appear so neurotypical that their autism - a diagnosis defined by social deficits - is not apparent to anyone else. I think that what you’re saying is that kids can completely hide their behaviors but it causes them stress. I think others are disputing that it’s possible to completely conceal them so they are 100% not evident. I don’t think anyone is disputing that kids are trying (and we all wish they did not have to try). I think people are disputing that they are in any way succeeding.

I think the ASD is evident in subtle cases but it doesn't look like what people think it does. For example a person with ASD may be able to use eye contact, but they are acutely aware of it and it makes them uncomfortable. Some symptoms may not be apparent to others but they are apparent to the person experiencing them.

This is the whole argument.
If someone has asd that is imperceptible to others for the 8-9h a day they are at school - for many years - is that truly autism? I don’t know the answer I’m just clarifying that the masking skepticism is NOT based on skepticism about the desire or the effort to conceal ‘behaviors’, it’s skepticism that any human being would actually be able to successfully pretend all day every day that they don’t have autism to the degree that it is undetected by teachers and classmates.

Just one example: The quiet, socially awkward kid, who is being generally ignored by other kids except for a few nice kids who also are not popular, and who is not a behavior 'problem' for the teacher and gets decent grades may have autism and no one the room would necessarily know it or know what is going on in that kid's world.

But on what basis would that kid have autism? He feels awkward in his heart ?

[Anonymous]

Anonymous wrote:The problem with the asd masking discourse is the poor definition to begin with of asd.
Many many ppl are unusual or struggle with intuition or social rules. It is the basis for all 80s tween television and much of 90s tween television and movies.
When does that become ‘autism’. If you are trying to ‘fit in’ at school and yet are clearly not a ‘typical’ kid - does that equal autism? If trying to be ‘like other kids’ makes you exhausted and cranky when you get home - is that it?
We don’t have good answers yet and I am undecided personally if the expansion of the criteria into a lot of ‘normal’ gray areas is good or bad.

I agree with you, and I hope research helps answer some of these questions. I have a brother who is old-school autistic--intellectual disability, stimming behavior, etc. He is obviously disabled to anyone who meets him and can not live on his own. My nephew also has an autism diagnosis (along with ADHD), he has always been mainstreamed (didn't get the autism diagnosis until MS). They could not be more different and especially to older people like my mom, it is hard to wrap your head around their similar diagnosis, and you wonder if it is even useful to have such a broad spectrum.

My other nephew has ADHD, Anxiety, and ODD and when young, was way more difficult to manage at school and home than his brother, but, is improving on all fronts through therapy, medication, and A LOT of hard parenting work by my SIL and brother. As they get older (they are high schoolers), my nephew with the autism diagnosis seems to be the one "falling behind" due to rigidity and social deficits, while his brother (who my SIL thought would never be able to manage on his own) is really blooming in HS. She thinks getting his extreme anxiety under control (along with maturity) has been the key. Watching the two of them mature, I do see the autistic piece in my nephew and how that is likely a correct diagnosis that may have lifelong impacts that can not be medicated away.