DSM IV Autism

[MinnieVanMom]

I was wondering about the criteria for autism vs. aspergars. Just about the one area of language on the criteria.

I was told that if a child didn't have language or lost it for a period by 3 then the DSM is autism. What happens if the child did loose all language skills but then became verbal? Does the original DSM stay as autism or can it be changed to Aspies?

 

[bookwormde]

To the finest point of the criteria for verbal deficits (past or present) excludes a child from an apsergers diagnosis. This is one of the great problems with the antiquated nature of DSM-iv and Autism. This would technically give a diagnosis of Autism- High Functioning.

Most highly experience clinicians will adjust the diagnosis to the most useful and descriptive diagnosis for the child to get the most effective therapies and supports, even though technically it is slightly “off label”

bookwormde

 

[MinnieVanMom]

Thank you so much. We are going to a different Dr. today for an evaluation and just wondered. I thought was almost certain that if there was a total language loss by age three that the DSM criteria would stay with Autism which although terrible is good for the reasons you stated, better services and therapy. Off label or not, our State is looking for reasons to take children off services and waivers so they ordered a new evaluation.

 

[BeckyScott]

DS's last evaluation, he was switched from HFA to PDD-NOS.

I was told then (mind you, by one psych at one hospital, YMMV) that he could never have an Aspergers diagnosis. History of speech delays. They said that his speech was no longer delayed enough to be considered "significant" which booted him out of autism, but he couldn't be Asperger's because the history was there. So nothing left but PDD-NOS. I think that's where you'd move to if the speech wasn't delayed.

Mind you, DS didn't regress, he was always delayed. But I'd think the issue is the same.

 

[jodifla]

This is also what our son's evaluator said: speech delay means no Asperger's Dx. And in our case, that anyone who suggested it didn't really know what they were talking about.

One of the reasons scientists like specific definitions is for research purposes. It's hard to do accurate clinical trials that can lead to helpful therapies without discrete definitions.

 

[holeceks]

My DS12 has an Aspergers diagnosis. B/4 he was "labeled" with that, they spent over a month verifying with his past doctors that there was no delay or regress in his language.

One of the things that they consider a "symptom" when diagnosing Aspergers is that they ARE very verbal from the time they were young. Our DS was talking like an adult very early on, and was what they considered a mini-Einstein about certain subjects before he was 2YO.

HTH

 

[bookwormde]

Most renowned clinicians in the field have found that there is virtually no difference in therapies from an Aspergers diagnosed child and an equivalents HFA child who’s speech has “caught up”. Just because an HFA diagnosed child has “caught up” does not mean that the diagnosis changes, just that the therapies or natural adaptive abilities have been effective.

This is a good example of just how “poor” the diagnostic criteria is in light of today’s understanding of autism.

One thing to remember is that it is broadly accepted that the speech delay must be clinically significant to be considered, typically in the outer 5-10% of the bell curve.

bookwormde

 

[iluvdiscruises]

well, my son was evaluated by a top pefiatric neurologist and after about 4 yrs of regular evals has both Apraxia (intense speech delays...no cognitive problems) AND Aspergers diagnoses...so go figure.

I just went to a great talk by Michael John Carley (he has Aspergers and was diagnosed as an adult when his son was - he runs grasp.org) Every story he told, every thing he related from his experience, he may as well have been talking about my son. It was the first time I ever heard him described so clearly.

 

[MinnieVanMom]

It took us seeing a new Psy but we really do like her a lot and felt she listened to what we said about our DS. We are going back next Wednesday and she will have the report and her suggestions. We are going to do everything we can to stay with her for behavior and social training.

She was very surprised that his DX had been changed from autsim to aspies but said that in fact lack of any language by age 3 is why DS is considered HFA even though he is verbal now.

It is not a time to be celebrating over a DX of autism but it allows us to get the services necessary to keep changing DS outcome for the better.

 

[PrincessMom4]

Our kids are "Science experiements". We went from an ODD and ADHD label to limbo right now but she shows all the signs of Aspergers, but when we did the DSM it showed that she didn't. All of her behaviours, lack of social skills and obession with one topic (animals) is a fairly clear indication that she has aspergers. According to all the research that I've done it shows that. PDD-NOS is the label they give you when they can't place you as either Autistic or Aspergers.

 

[jodifla]

Most renowned clinicians in the field have found that there is virtually no difference in therapies from an Aspergers diagnosed child and an equivalents HFA child who’s speech has “caught up”. Just because an HFA diagnosed child has “caught up” does not mean that the diagnosis changes, just that the therapies or natural adaptive abilities have been effective.

This is a good example of just how “poor” the diagnostic criteria is in light of today’s understanding of autism.

One thing to remember is that it is broadly accepted that the speech delay must be clinically significant to be considered, typically in the outer 5-10% of the bell curve.

bookwormde

And is this the renowned clinician Tony Attwood??

Why would a child with Asperger's need the same type of speech therapy that a child without language needs. Doesn't make any sense to me.

 

[jodifla]

Our kids are "Science experiements". We went from an ODD and ADHD label to limbo right now but she shows all the signs of Aspergers, but when we did the DSM it showed that she didn't. All of her behaviours, lack of social skills and obession with one topic (animals) is a fairly clear indication that she has aspergers. According to all the research that I've done it shows that. PDD-NOS is the label they give you when they can't place you as either Autistic or Aspergers.

Boy, isn't this the truth!

Have you seen the book The Mislabeled Child? It's written by pediatric neurologists, but they do through many of the different Dxs and explain why kids get mislabeled with each, chapter by chapter.

Maybe see if it's in your library. The one at my library was always checked out, so I got my own copy!

 

[bookwormde]

Jodifa,

No this is most of the leading clinicians in the field including Attwood.

My reference was to an HFA child who had gained equivalency to an aspergers child (which is relatively common with the new support) in the speech area that we were talking about as a disqualifying criteria for Aspergers.

bookwormde

 

[BeckyScott]

Are we having some confusion with the wording? "Speech" vs "language"? I don't want to nit-pick, I used "speech" in my first post when I meant both speech and language. I just wanted to make sure we're all talking about the same thing.

If it's a language issue, and has more to do with the social norms of using language, I could see that it would be much the same with HFA and Aspergers. Just the social appropriateness, or whatever you'd want to call it. Or for example, oldest DS tends to pronounce words exactly the way they're spelled, even if he's told differently, his brain sees it the way it's spelled and doesn't really "get" the gray area of odd pronunciations.

If it's speech, the enunciation, does that happen with Asperger's? I'm not sure. Youngest DS had both speech and language delays. And he still has both, only to a lesser extent. Around here, they tend to lump speech and language together when the child is young, and then seperate them as the child gets older.

qualitative impairments in communication as manifested by at least one of the following:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Just for reference. It *looks like* what it is saying (and I'm no doctor) is that the Speech Issues (specific pronunciation) isn't determinate one way or the other. It's Language. And while I'm thinking that most of our kids do have speech issues, that isn't part of the criteria. The criteria 2 and 3 read like they could be applied to Aspergers just the same as Autism, so bookwormde's suggestion that they use the same therapies seems reasonable, so long as the child is HFA and can "use his words".

The DSM for Aspergers reads as:

IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

and that's all it says about language at all.

 

[carrie6466]

My DD also fell into the PDD-NOS due to severe speech delays. She never lost speech, she didn't speak at all except for mama and dada until she was 3.

I don't even normally involve myself in these topics because I don't feel that I am knowledgeable enough to discuss much about it, but having had DD's IEP meeting today I've learned this.

Speech is the sounds, letters or words she doesn't articulate well...or at all.

Language is the fact that you take turns listening and speaking, you look at each other when doing so, and every conversation does not have to be on the same subject

At least that is what I took away from what the speech pathologist said in the meeting.

From the neurologist I learned the Asperger's diagnosis would never be a consideration (even though I have 2 nephews who have been dx'd with it)because of the speech delays.

 

[DisDreaminMom]

Would like to say that my DS had speech delay until age 3 and was initially diagnosed with PDD-NOS because of this. After extensive psych evals, his diagnosis was changed to Aspergers due to his extreme display of the characteristics. I was told that it was "outdated" to deny diagnosis based solely on Speech delay when other behaviors are in line. In addition, I did not talk until I was 3 and this was taken into account. Oh, and DS went from no speech to complete sentences in a period of a few weeks. Still pedantic speech pattern, though, even with extensive therapy.

Just my $.02.