Thursday, February 11, 2010

Nothing new under the sun DSMV

So at long last the deliberations on DSMV are out. Well it has been what some of us have been predicting and campaigning for, for some time, a little logic in the equation, a little nod to where the research is actually pointing.

Indeed there is nothing new under the sun and it does not behove me to write anything new either, this is what I am on record as having said in 2005. (from whichever way you look at it, it's still autism)

"Kanner vs. Asperger

One particular persistent “Urban Legend” viewed over the autistic horizon is that Kanner's syndrome is the paradigm of classic autism and that all other forms are variants or dilutions of this.

The later appearance of Asperger’s syndrome as a diagnosis, the arguments as to whether it justifies the same levels of intervention or services as what was formerly considered to be autism and it’s the way it reads in DSMIV as “autism lite” seems to suggest to those desire to keep autistic purity at the “severe” end of a notional linear spectrum that the manual gives substance to their argument.

However analysis does not bear this out. The debate has raged and continues to rage over as to where it fits ever since Lorna Wing mooted a wider spectrum and drew attention to Asperger’s work,. The practical suggestion of a possible syndrome named after him was not so much drawn from his work as much as to remember his hitherto forgotten contribution to the literature of autism, However that remembrance has in a sense called it into being as a separate syndrome.

The way it is described in DSMIV is a social construct borne of committee decisions and a desire to leave open the debates at the time as to whether Asperger's Syndrome exists on a Schizoid, Schizotypal axis or as a continuum and broader phenotype of autism.

Leaving aside the cultural reasons why Kanner has hitherto received more prominence and become the Grand old Man of Autism as the more senior of the two in the urban legend we have to consider certain facts.

Kanner’s and Asperger's samples were both small in consideration to the population we now know of.

Notwithstanding their common middle European heritage, subsequent geographical separation of where they ended up in practice meant that there were cultural differences which affected the way their papers were written up, and cultural factors determining both the interpretation of the behaviours described and the way those behaviours manifested themselves given the different social milieu.

If anything, what is remarkable about both of their observations, despite the two men’s later trajectories and beliefs, is that given these differences there is a remarkable degree of correlation between these two seminal research papers, enough to indicate that they were dealing with small samples of a much larger and disperse population. Indeed the global and cultural separation of the two in the 1930’s and 40’s would tend to suggest that the phenomenon they observed and described was a real and global one.

The categorisation of DSMIV and the creation of Asperger’s syndrome as a separate clinical category has merely confused matters. Gillberg is on record as stating his opinion that none of Asperger’s patients would satisfy a current diagnosis of Asperger’s Disorder (DSM version) and all would come into the description of Autistic Disorder. Likewise Atwood an erstwhile populariser of Asperger’s syndrome has declared that the only difference between it and High Functioning Autism is the spelling.

Similarly a longitudinal study of Kanner’s patients would indicate they more readily describe a broader phenotype of functioning ability than those who seek to confine autism to within a strictly low functioning, non verbal paradigm for what appear to be largely political and social reasons I will elaborate later.

Finally in the descriptions in DSMIV itself Asperger’s Disorder is identical to Autistic Disorder except in that Autistic Disorder includes additional criteria for communication.

These criteria appear to have nothing to do with cognitive development, and are broad enough in my opinion to include practically everyone who currently bears the separate diagnosis of Asperger’s Disorder.

The relationship of Cognitive Capacity (a term I prefer to IQ as being accurately descriptive of what IQ attempts but fails to comprehensively map) to Autism or AS is another red herring.

The criteria of Asperger’s syndrome seem specifically to have been written to exclude very low IQ, and without reference to any real knowledge of what is being described.

It is merely a sleight of hand or as Film maker Alfred Hitchcock would describe it a “McGuffin”

It is arbitrary. Asperger’s syndrome as “high IQ autism” is not borne out when one considers measured IQ’s of 70 as the starting point. I do not know a figure for my own IQ, perhaps Professor Simon Baron Cohen has that somewhere but I think it is irrelevant to understanding of what is at the core of autism in that the possession of greater or lesser cognitive capacity is not determined by the autistic traits per se, and that the existence of greater of lesser cognitive capacity does not determine anything about the autistic traits either other than ones eventual ability to mitigate their effect. Glenys Jones, from Birmingham University, for example is on record as having stated something of this sort."


Clay said...

Can't find anything wrong with that. Indeed, there is nothing new under the sun.

Autism and 14-Monkey Experiment said...

Nothing new or different at all in this arena.