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Redefining Autism

October 5, 2012

            I found an article from The New York Times, entitled, “Report sees less impact in new Autism definition”. This article discusses the proposed changes to the official diagnosis of Autism for the revision of the Diagnostic and Statistical Manuel of Mental Disorders (DSM). Parents and families are concerned that the proposed definition change would jeopardize their current state-financial services. Scientists that posted in The American Journal of Psychiatry  was referenced in the New York Times article, and it concluded that the number of people that would be excluded from state-funding would be about 10%. The article also mentions that the proposed changes to the current definition of Autism allows for more effective identification of Autism across the spectrum for both males and females. Although the results from previous clinical trials show the new definitions of Autism have been effective, they believe moving the new diagnostic criteria out of academic centers and into the real world will show just how effective the definitions really are.

            In this article, I found it interesting how it started out with the main worry/anxiety parents had with the change of definition wasn’t that it was going to make current and future diagnoses more accurate, but that it was going to affect their current state-funding for their children. With a more refined definition of Autism, health care officials should be able to more accurately diagnose children. This will help against the potential misdiagnosis a child may be given, if for instance they exhibit enough “qualifying” symptoms when they’re being analyzed. Another aspect of the diagnosis is that there may not be as many children diagnosed or perceived as having Autism, which may be beneficial to parents who are worried about the cost of health care for their children. In regards to parental concern about the loss of funding, I wonder how much influence the parental community for families with Autistic children will have on the people who are working on the revision for the DSM. I kind of, skeptically, think that parents in large numbers complaining and commenting about the effects it would have on their lives could influence those who are writing the revision.

            Some of the qualifying symptoms for people being evaluated for Autism that are listed in the article I read include: language delays and the absence of social bonding or eye contact. While I understand that there is most likely a biological component to Autism, I wonder how much the child’s socio-environment influences the development or onset of Autism. Additionally, I also wonder how much context is taken into account when diagnosing a child. For instance, it seems totally possible to display a lack of eye contact or the absence of social bonding if the child is in a situation that is discomforting to them. As discussed in the reading for class by Wakefield and Schmitz, there is the potential for a false positive, or a misdiagnosis in the event social context of a child’s behavior isn’t taken into account (Wakefield & Schmitz, 2010). This idea was also discussed in our lecture on Wednesday October 3rd, when we talked about the “Clinician’s Illusion” or more simply, the difference between the behavior seen in the clinician’s office as versus the behavior exhibited in the real world. For this reason, I hope that the changes to the definition does cause more accurate diagnoses and consideration of social context to occur.

            In regards to lecture previously referenced, I am also curious to see how the rate of diagnosis and the overall percentage of the population with Autism changes over the next few years. If the diagnosis really is more accurate, then it seems like there should be a slightly more accurate and representative number of people with Autism in the United States. With Autism becoming more widely understood, and more commonly diagnosed, I think that changing/refining the current definition of Autism is a good move for the DSM, clinicians, and families seeking answers about and treatment for their child’s behavior.

References

http://www.nytimes.com/2012/10/02/health/report-sees-less-impact-in-new-autism-definition.html?ref=health

Wakefield, J., & Schmitz, M. (2010) The Measurement of Mental Disorder. A Handbook for the Study of Mental Health. pp. 37

Tyler Brandt

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2 Comments leave one →
  1. October 9, 2012 6:36 pm

    This was an informative post. I do agree with you that a more “accurate diagnosis and consideration to social context” would be beneficial. It would, as you stated, reduce the incidents of false positives. However, I sympathize with the parents’ concerns about the proposed changes eliminating their child from the diagnosis of Autism. Currently, their child is “morally innocent” (Luhrmann reading) of socially inappropriate behavior. Their biology is damaged through no fault of their own. With the new diagnosis changes, the child could go from someone suffering from Autism to someone who is a victim of poor parenting, refusing to behave, and/or weird. Also, this child could be one that would benefit from an Autistic group inclusion (parental training, therapies, etc) but now may not have the opportunity. You do mention the possible correlation to Autism onset/development due to environmental factors. I do know that children who have been diagnosed with Autism, displayed avoidance behaviors within infancy. This is a good indication that some on the spectrum have a genetic component to their disorder.

    Carrie Fuller

  2. October 12, 2012 1:26 am

    I’m glad to know that they are going to remove avoidance of eye contact as a symptom of Autism because I know in Vietnamese culture, it is respectful to avoid eye contact when talking to a person who is of a higher status or of another gender. When they take this cultural tradition into consideration and not labeling these kids as with Autism, these kids should receive less stigma. Meanwhile, for the kids who do not make the criteria of the new definition of Autism, and still act differently than how people expect them to behavior, they or their family will be criticized as Carrie mentioned.
    It was interesting and very important that you mentioned the cut on funding when Autism is redefined. I wonder how big of a role the health insurance industry plays in the change of this diagnosis.
    Yufei Chen

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