DSM IV criteria question

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Registered: 03-28-2003
DSM IV criteria question
7
Sat, 08-16-2003 - 3:39pm
My dh and I were discussing this, and I just don't know. So I thought some of you are so knowlegeable, you could help me.

There are the catigories A,B,C,D,E,and F. Do you have to meet A and B, and does C pertain to both? For example, my son would meet criteria for A. (2)Failure to develop peer relationships appropriate to developmental level and it does cause clinicaly signifigant impairement to his social functioning (C). But the PhD has already told me none of the other things on A apply. So he actually doesn't meet criteria for A.

On B. (3) He will flap his hands, say if an airplane flys over, after pointing it out. But just for a second. Clearly that doesn't cause any clinical signifigant impairment to his social functioning. So no C for B.

A zillion Thanks

Sio

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Registered: 03-25-2003
Sun, 08-17-2003 - 2:16am
This is my reading of it, and I am referring to the criteria listed at the Childbrain site: http://www.childbrain.com/pddq3.shtml -- note that the AS criteria are listed AFTER the autism criteria -- 2 from A, 1 from B, and C, D, E and F all have to be met.

So my reading of it is, if he doesn't meet 2 from A, technically speaking, he doesn't get the diagnosis. STILL some of these are awfully subjective. Be SURE he doesn't meet them; that would be my advice.

Under A, I would look hard at items 1 and 4 and make sure he doesn't meet those. I view C, D, E and F as pertaining to the WHOLE disorder and not to a part of it -- for example, if he flaps at all, I would give him an item for B, even if it causes no impairment.

It sounds as if your son has some but perhaps not all features of Aspergers. That might put him "on the spectrum" but maybe not give him the official diagnosis. It's so subjective, though. If getting the diagnosis gets you services, I always say, take the diagnosis!



Tigs

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Registered: 07-11-2003
Sun, 08-17-2003 - 4:28am
Tigs had a lot of good points. I guess my question to you would be how many times did the PhD see your ds and for how long each time? When working with spectrum kids I've often found that the Aspies seem rather normal for the first 3-4 sessions (each session being 30-90 minutes long, depending). There is always going to be one trait that sticks out like a sore thumb, but most stay burried until the child begins to see me as one of his/her 'safe people'. It's always been disturbing to me that some professionals assume the child will be themselves with them or that they are so well trained (the dr that is) that they will simply see something that is being 'leashed'. Our family specialst insists on seeing a person 5 times before ruling out AS or ATA because it is so natural for the person to try to act 'normal'.

For instance, most of my Aspie students, when new to me and my partner, similate rather appropriate eye-to-eye gaze by simply staring at us. Now, that should be a red flag to us, right? After all, we both have the big A in our families and live with it every day. But the problem is, ALL of our new students just stare at us, even those who are NT. I find 1 and 4 to be the sneakiest traits in part A, especially 4. It has been my expirience that if you have an Aspie come visit you in you home for a month it will take about 1 week for them to relax enough to 'just be themselves' (even though they think they already ARE). And the kicker is, it doesn't really matter if they've been there before and already know you really well. I've seen this very thing with my niece, who comes every Spring Break. Just on the last day she will finally start to 'ignore' us, it takes her that long to get comfortable. And I've seen it in my own 12yo dd. Her father and I share custody and she is always more attentive, mannered, young lady for the first week with either of us. But after a week she starts doing things like going to bed without telling anyone, forgets to hug back, will not return a kiss on the cheek like all the other kids, gets the 'limp hand shake' going, etc. Just tonight I had to remind her to do all of those things, to which she replied every time "Oh yeah".

Now, on the hand flapping thing....who told you that hand flapping had to be done to such a degree that it caused social impairment? All it has to be is sterio-typical, restictive, or repetitive. Also, most people, even some drs, aren't aware that the action of touching one's forehead with thumb and forefinger repetitively is sterio-typical of Autism. They keep looking for touching of the forehead with with the back or side of hand (like Rainman). Heck, I have this trait myself but most people don't notice, not even my own mother....until my forehead breaks out in a rash from being rubbed raw.

Of course, it may be that your ds doesn't actually have AS. Remember, if he doesn't actually meet all of the dx criteria for for any specific PDDs or the other three things listed then he will be given a dx of PDD-NOS if he meets sections C, D, and E (F being the illiminating of the above mentioned. This doesn't make him any less an Aspie persay, it just means the his specific PDD is not AS....and that your NOT crazy for recognizing something different in your ds.

Peace,

Candes

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Registered: 03-28-2003
Sun, 08-17-2003 - 9:38am
Candes

Thanks, I was hoping you'd answer this one. Thanks Tigs as well.

The PhD has been meeting with Liam for the summer. We've gone so many times I've lost count. (But my wallet knows!) I think it is safe to say we are well on our way to a lasting relationship. She is working on a lot of things at once. She's even been to his school. Most visits last an hour, but the testing ones can last up to two hours. He likes her a lot, so I'd say he is definitely being himself by now. One test really frustrated him to the point I went in to calm him down. It was the one where they have to draw this very abstract picture, then draw the parts they remember. It looked kind of like a space ship on it's side to me.

All she will tell me about the evaluation is that he is very smart and she doesn't see him "thinking" like an autistic person. Or rather, the data doesn't show him using his brain in a manner typical of a person on the spectrum. But I have no idea what that means! During this time he has gotten a Dx for CAPD and he already has SID Dx, and she's confirmed his ADD Dx. Poor guy!

About the criteria, she's only really talked to me about A., and she just said his only issue there was (2). Or rather what I think would be (2) based on our conversations. And she's doubtful he'd meet the others. Also, that (2) may be a result of his CAPD due to his issues with not being able to just concentrate on the voice he finds important and tuning out the others. He has to focus on all the conversations going on around him, and it hurts his head while causing a sort of sensory overload. (One person on an adult CAPD board likened it to when Pecachu shuts down after using too much energy. Liam agreed with that assessment). So at recess, he plays well with others in the beginning, but then ends up playing alone or with one other kid. Wanting to go inside for quiet. Thus he is very capable of doing (1), (3), and (4) before he goes off alone. Or, if while alone, another kid comes up to play with him. After researching CAPD, this does make sense to me. But I'm not the one with the degree, so it isn't up to me.

I have a great deal of confidence in her because she is the person our TEACCH center sends people to who they just aren't sure about for what ever reason after an evaluation there. After TEACCH wouldn't evaluate him, they recommended I take him to her. She's done both her undergrad and graduate work at Harvard to include a stint at the Harvard Aspie clinic. TEACCH will evaluate him if she thinks they should.

Although I have confidence in her, I just want to make sure I understand her and I agree! Either way we go here, so, as usual, I'm just trying to find out as much as I can. What ever you call it, he has social issues when in a large group of people. Sure, his whole life doesn't have to be led in a crowd, like it is in elementary school, but it is right now and he is very uncomfortable. So I just want what is best for him.

Sio

BTW, when are you going to post that article on HFA, AS, and ASD?

iVillage Member
Registered: 03-28-2003
Sun, 08-17-2003 - 10:19am
So, Candes, What my PhD may be trying to tell me is that by saying she thinks his social issues can be explained by his CAPD, that could mean he doesn't meet F? Is that how it could work? Not that you would know for sure, as you've never met my son. That's why I say "could".

Thanks,

The obnoxious, anal parent,

Sio

iVillage Member
Registered: 07-11-2003
Sun, 08-17-2003 - 4:22pm
Sio, it sounds like your Phd has excellent credentials and has spent ample time with your ds to make a propper dx. You're very lucky to have found her so don't let go.

It sounds to me as if your Phd is trying to explain to you that your son has dx's in comorbity causing his autism-like behaviors. This is actually pretty common. Yes, CAPD combind with ADD and a few other things can look an aweful lot like an HF-PDD of some kind, including AS.

WARNING:Abstract analogy approching....

However, one thing I would like to note is that CAPD is not one of the illimination crieria for section F. Now, here's where it gets frustraiting and confusing. CAPD is technically a Nuero-LD, not schizophrenia or the the like. However, when it is combind with other dx's you can still rule out autism and other PDDs(at least that's the way it was explained to me in school). It's like having all the right ingredients to make a cake from scratch when you thought you were going to use a mix. What you end up with is still a cake, and it will taste slightly different, but you used raw ingredients instead of a pre-packaged-all-in-one-just-add-oil-and-eggs box from the store. But a cake is still a cake, no matter if it is double dutch chocolate, angel food, or carrot cake. The nuitrients are all relatively the same, you eat them in mostly similar ways(depending on whether you use toppings), and it all digests pretty much the same. It is the same when dealing with the philisophical diciplines, including psychology dxing and treaments. Section F is a list of pre-fab cake mixes, but you can still make a cake from scratch. Also, when getting treatment you still have a PDD-flavored cake to eat, even though it didn't use 'all natural' PDD.

Your PhD will help you with choosing the right treatments according to your ds' dx's. You will notice that a lot of these treatments are the same or seemingly similar to treatments used for HF-PDDs. Like Tigs said, you look at the whole picture. While you DO approach each trait individually as it arises, how you end up dealing with them in the long run depends upon what other traits he has. But that's a whole nother analogy, LOL.

Sigh, I wanted to get into what your your PhD meant by 'how the autistic brain works' but we're having a B-Day party for Jade this afternoon and I still have to decorate the house, so I have to go for now. I'll try to add to this later tonight if the kids give me an hour to myself.

Peace,

Candes (who encourages parents to be obnoxious and anal when it comes to stuff like this)

P.S. Yes, I will be getting the article out soon. We've had some family emergencies this last week (custody issues) that have prevented me from working. Can't get into it now, but I will explain after the court date this week. Sigh.....I need more coffee.

iVillage Member
Registered: 03-28-2003
Sun, 08-17-2003 - 4:56pm
Candes,

I send you a peace sign, as my son says it also means kindness. You give a lot of that! Thanks a zillion times. I also send you thoughts of chocolate!

BTW, Liam would be a chocolate layer cake with chocolate pudding in the middle and chocolate frosting with a lot of Hershey kisses on top! And maybe a picture of Spider man playing with Harry Potter and Sponge-bob in Bikini Bottom.

Have a great party.

Of course, I'd love to know what you think she meant about how people who are autistic think! But maybe another day.

Good luck and I hope for a great outcome with your custody issues!

Sio

iVillage Member
Registered: 03-28-2003
Sun, 08-17-2003 - 5:04pm
Candes,

In talking (and thinking) about chocolate, I forgot to say my main thought in reading your post. I think what you said about him looking like he is autistic, yet not being so is what she is preparing me for. She just keeps bringing up how his CAPD and ADD being co morbid are causing him very big problems. She says he has severe ADD and moderate to severe CAPD. Poor little guy! However, I'll have to wait until September to know for sure!

Sio