Defining what autism is

Now that the APA will be publishing the latest version of DSM (DSM-V) in 2012 how might they define Diagnostic Criteria for 'Autism'.

Current diagnostic tools use cutoff scores, for example DSM-IV contains 12 isolated symptoms of equal weight (none are specific to 'autism'). If a clinician checks off four items, you have autism, if the clinician checks off three items you don't.

Many researchers have argued that cutoff points are abitrary especially in ASD screening tools.

The Wisconsin Twin study has examined whether Chinese menu checklists(one from column, 1 from column b) are arbitrary. The answer apears to be yes.

Using cutoff scores from different diagnostic tools, concordance rates in identical twin pairs compared to fraternal twin pairs varied from a high of 'ADOS-spectrum cut-off = MZ 77% (17/22), DZ 31% (9/29)' to a low of 'A combined criterion of ADOS-spectrum cut-off and SCQ led to a MZ pairwise concordance of 50% (10/20) and a DZ pairwise concordance of 15% (3/21)'

If you can't define a problem how is it possible to solve it?

http://imfar.confex.com/imfar/2009/webprogram/Paper4692.html

Very interesting, RAJ.

I wanted to share with you and our readers that you can take a look at the draft proposals for DSM-V definitions. At the moment, they are considering getting rid of all the various sub-categories (like Asperger's and PDD-NOS) and having a single Autism Spectrum Disorder diagnosis. The idea is that, until they find a biological difference to define various subtypes of autism, all ASDs be considered more or less the same thing, varying by severity but not type.

See: http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSM-V-Work-Group-Reports/Neurodevelopmental-Disorders-Work-Group-Report.aspx

DSM is an acronym for "The Diagnostic and Statistical Manual of Mental Disorders".

Since when did Normal Variation manage to work its way into possible inclusion as a mental disorder in the next version of DSM. This is described as 'Socially isolated or ?awkward" with some ritualized behaviors and preoccupations but these are NORMAL for developmental stage and cause NO interference" but the proposal, if implemented would place common and normal variations of human characteristics under the umbrella of a 'Mental Disorder'.

What they also are describing is normal behavioral variations of adult stroke patients. Where is the relevance?

If implemented it looks like prevelance rates are headed towards 1/10 and Autism Spectrum Disorder would become an indiscrimantly applied meaningless label.

Here is Simon Baron-Cohen's take on the proposal in an Op-Ed published in the NY Times:

http://www.nytimes.com/2009/11/10/opinion/10baron-cohen.html?_r=1