Post by Phil W LeePost by Aquarian MonkeyPost by Bob BadourI think a pretense of distinction when folks really have no idea what's
going on is counter-factual. Thus, removing the distinction and
acknowledging that all folks really understand is a cluster of symptoms
does strike me as progress; albeit a small progress.
I would agree with what you are saying insofar as superficial distinctions with no underlying validity are pointless. Where I differ is that I don't think anyone is saying "since we are unable to discriminate between subtypes, let's just lump them together until we can." What I have heard them say is that they aren't really that different, so why not lump them together. They are different. Even if we don't understand how or why.
I see it is a step back because I think nearly *everything* related to research is being held up because they lump unlike groups together and treat them as if they are homogenous. Maybe ABA does help some subtypes of autism, but harms a few. Wouldn't it be good to tease out those few so that we know not to go that route? Maybe environment plays a primary role in some subtypes of autism, but not all. Wouldn't it be good to identify those subtypes and learn how to reliably detect them so that environmental modifications can be made, and conversely prevent "the rest" from throwing their money down the drain by buying supplements and exerting unnecessary effort in managing the environment? What if vaccines *do* cause autism in....I don't know, pick a number...say...4.5% of autistics? Shouldn't we figure out how to identify people in that group so they avoid vaccinations? And then clearly communicate to the rest of the population that if you do not have this specific issue, you are safe
to have vaccines?
It's not a step forward. It's a step back.
At any rate, at this point I think D would be moved to Social Communication Disorder if I brought her to a brand new professional for a diagnosis today. It's stupid. She has mild autism. I know it. The only reason I am not freaking out is because her school district is giving her support without any proof of her diagnosis to begin with. Remember we moved? I asked for an evaluation and they said it was unnecessary...what services did I want...and they gave them to her. I asked them if they wanted a report from her doctor and they said it wasn't necessary. But I can't help but think of all the kids just like D who are probably going to either not get services or have to fight for them. I will tell you what, if she didn't have the support she has now, she wouldn't be doing as well.
I think the change could be good or bad - we just don't know yet.
I don't think the existing subtypes were accurate or useful, and by
eliminating them, they give the chance (which may or may not be
followed up) to replace them with more accurate subdivisions.
In particular, I'm not at all sure that the distinction between low
and high functioning was either consistently applied or necessarily
useful - does it measure the extent of the autism, or the underlying
IQ? It is entirely possible that a person with fairly extreme autism
but high IQ may be able to cope with adopting strategies to cope which
would not be within the capability of someone with low underlying IQ.
I like the example of Temple Grandin, and the metaphor of neurological
wiring. I would describe TG as being strongly autistic in wiring --
both for good and for bad. Excellent visualization and memory.
Enormous distractibility and indifference to people. Hearing disorder
that was not diagnosed until many decades later. She is still subject
to panic attacks than meds do not completely control. I think she
would never be call aspie though she might be call "high-functioning."
She was four or five when doctors told her parents to resign
themselves to her life-time institutionalization. But her mother
took over. Yes, wiring can be modified, or otherwise compensated
for. Activities stimulate brain areas; much-stimulated areas grow.
That is one basis of treatment in schizophrenia today, with change in
activity and *size* of brain areas now documented by brain scans.
TG earned a PhD and, as a now-acknowledged expert, eventually
designed most of the catttle slaughterhouses in the country. She
has written books, been the subject of a Golden Globe-winning TV
movie.
I would describe her as someone with severe differences and
some deficits, who has compensated and adjusted pretty well.
- I think that the physical/wiring *differences* should be assessed,
and then the compensations and adjustments that have already been
adapted.
That includes, for example, excellent visualization and memory; also,
problems in stable perception, by any modality. Then you can start
classify behaviors. Some are (a) the direct result of the wiring,
like wincing at noises. Others are the indirect result of wiring,
including "compensation" that may have been intentionally taught.
Distinguish adaptations that may help the autistic immediately, as
to whether they are functional or dysfunctional in social
environments.
"Not fitting in" is a very general experience, not at all limited to
autistics. Since autistics are prone to having less constant
sensory processing, I expect that social snubs -- when they do
notice them -- can lead to "avoidance" as seen in Post-traumatic
distress syndrome.
Post by Phil W LeeOr it may be some aspect of IQ or specific autistic trait which makes
the difference - who knows?
More to the point, who could find out with the old categories?
If this paves the way for a re-categorisation, it could be a very good
thing.
As long as the previous categories were being used
--
Rich Ulrich