Parents and Teachers Should Not Be Misled: Autism, For Now, Includes Those With Intellectual Disability

The author of Autism and Oughtisms has posted a guest comment on the site Teaching the Teachers, Educating an Autistic Child is an Opportunity,  in which, like many other parents and professionals, she includes a commentary which distances autism disorders from intellectual disability:

"There is nothing inherent in autism as a condition, that limits a child’s intelligence or makes them impossible to teach. My own son for example (who has a diagnosis of classic autism) is clearly intelligent and incredibly eager to learn. There are however aspects of autism that will get in the way of learning; it is after all a developmental delay and learning disability."

The author's comment covers a lot of ground.  In the paragraph above I agree with most of what she says. What I disagree with though is the statement that "There is nothing inherent in autism as a condition, that limits a child’s intelligence".  That statement is correct in so far as the definition of autism in the DSM-IV does not require a finding of intellectual disability in order to determine that a child has an autism disorder.  It is true also in the sense that 100% of children with autism do not have an intellectual disability.  But it is misleading in  so far as there is a very clear association between classic autism, or DSM-IV Autistic Disorder and Intellectual Disability.  Parents and teachers should know at the outset that as many as 80%, or the vast majority,  of those with an Autistic Disorder diagnosis will also have an Intellectual Disability.  My sources for that assertion are set out in italics following this comment.   

While it is no longer acceptable to use the term "mentally retarded' to refer to those with intellectual disabilities or to openly mock them, it is still politically correct to exclude the intellectually disabled from consideration for inclusion in many discussions and contexts.  It has happened with the DSM-5 and the New Autism Spectrum Disorder, which will exclude from an autism diagnosis those with an Intellectual Disability, and should more accurately be called Asperger's Spectrum Disorder. It is also true with parents who want the world to know that although their child has an autism spectrum disorder they are not one of those with ... an intellectual disability. 

For the record my son has a diagnosis of Autistic Disorder and he is assessed as having "profound developmental delay".  He has an intellectual disability.   He too, like many autistic children, with or without intellectual disability, is also incredibly eager to learn notwithstanding his autistic disorder and his .... intellectual disability.   


Autism and Intellectual Disability Sources:

1) Canadian Psychological Association Autism Brief to the Standing Senate Committee on Social Affairs, Science and Technology November 9, 2006:


""Definition: Autism is a pervasive developmental disorder, first identified by Kanner in 1943. Decades later, Autism came to be viewed as the more severe of the Autism Spectrum Disorders (ASD) which also include Asperger’s Disorder. ASD is a heterogeneous disorder that includes a range of developmental impairments in the areas of social skills, verbal and non-verbal communication as well as restricted or repetitive interests or behaviours.


Symptoms and Impairments:


• Cognitive impairment is present in about 80% of persons diagnosed with Autism and
general intellectual functioning is most often below average. Persons diagnosed with
Asperger’s Disorder have average to above average intellectual functioning.""


2)Department of Health & Human Services - Center for Disease Control Counting Autism NOTE: The CDC surveys indicate the percentages of persons with Intellectual Disability and any Autism Spectrum Disorder including Aspergers.


""CDC’s most recent data show that between one in 80 and one in 240 children with an average of one in 110 have an ASD. This is a prevalence of about one percent of children. These results reflect data collected by CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network in multiple communities throughout the U.S. in 2006.


Estimates are based on health and education records from participating communities, which includes eight percent of the U.S. population of eight year olds. All children in the studies were eight years old because previous research has shown that most children with an ASD have been identified by this age for services.


...


Cognitive Functioning (from the pdf version)


2004


From 37.9% (Arizona) to 63% (Alabama) (overall average: 43.8 %) of the children identified with an ASD also had an intellectual disability (an IQ ≤70, at the sites that had test results on intellectual ability for at least 75% of the children identified).


2006


From 29.3% (Colorado) to 51.2% (South Carolina) (overall average: 41.0 %) of the children identified with an ASD also had an intellectual disability (an IQ ≤70, at the sites that had test reults on intellectual ability for at least 75% of the children identified)""


3) CDC Autism Expert Dr. Yeargin-Allsop noted that in the 60's and 70's ... before the DSM changes that added Aspergers (which excludes persons with Intellectual Disabilities) the "vast majority of persons with autism had intellectual disabilities. Not a simple majority ... the vast majority:


CDC Medical Epidemiologist Dr. Marshalynn Yeargin-Allsopp - CMAJ (Canadian Medical Association Journal)Interview


"But the autism umbrella has since widened to include milder forms, says Dr. Marshalyn Yeargin-Allsopp, a medical epidemiologist at the CDC. For example, it now includes Asperger syndrome, where the sufferer is socially impaired, but experiences typical language development.


Another difference between past and present autism diagnosis involves the presence of intellectual disabilities, adds Yeargin-Allsopp. During the 1960s and 1970s, the vast majority of those diagnosed with autism had an intellectual disability but today, only about 40% have one."


4) The ICD-10 Classification of Mental and Behavioural DisordersWorld Health Organization, Geneva, 1992


F84.0 Childhood Autism


A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder occurs in boys three to four times more often than in girls.


...


All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases.




F84.1 Atypical Autism


A pervasive developmental disorder that differs from autism in terms either of age of onset or of failure to fulfil all three sets of diagnostic criteria. Thus, abnormal and/or impaired development becomes manifest for the first time only after age 3 years; and/or there are insufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restrictive, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals whose very low level of functioning provides little scope for exhibition of the specific deviant behaviours required for the diagnosis of autism; it also occurs in individuals with a severe specific developmental disorder of receptive language. Atypical autism thus constitutes a meaningfully separate condition from autism.


Includes:
* atypical childhood psychosis
* mental retardation with autistic features


5) Autism and intellectual disability: a study of prevalence on a sample of the Italian population.


La Malfa G, Lassi S, Bertelli M, Salvini R, Placidi GF.
Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Hospital of Careggi, Florence, Italy. gplamalfa@videosoft.it
Abstract




BACKGROUND: In 1994, the American Association on Mental Retardation with the DSM-IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD-10. Prevalence of PDD in the general population is 0.1-0.15% according to the DSM-IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments.


METHOD: Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) seems to be a very good instrument for classifying and diagnosing PDD.


RESULTS: The application of the PDD-MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%.


CONCLUSIONS: The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID.""

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Autism Disorders and the DSM-5 Storm - Will Intellectual Disability Realities Be Thrown Overboard?

The DSM-5 storm currently raging amongst psychiatric professionals should not be too shocking to most parents of autistic children.  Autism parents are used to the wars that rage over vaccines and autism and  whether it is right to try and treat or cure our own children. In the complex and controversial world of autism discussions  referring to  the well established fact that the "vast majority" of those with Autistic Disorder diagnoses  also have Intellectual Disabilities will invite outrage.  Even referring to Autistic Disorder as a Disorder will provoke controversy.  Some of these controversies are reflected in professional discussions so we are used to seeing controversy in any mention of autism. While not shocking the latest roar in the DSM-5 storm, this time, again, by Dr. Allen Francis, does shed some light on one aspect of the DSM-5 process that has puzzled me ... the failure to post severity criteria for public consumption on the official DSM-5 site of the American Psychiatric Association even after the start of the clinical field trial phase has been announced.

Dr. Allen Francis has been a persistent and candid critic of the DSM-5 process questioning many conceptual issues pertaining to the diagnostic definition changes of some disorders and the addition of new disorders to the Diagnoatic and Statistical Manual of Mental Disorders of the American Psychiatric Association.  In his latest critique of the DSM-5 process, DSM 5 Field Trials--Missed Deadlines Have Troubling Consequences,  Dr. Francis critiques the sloppiness of the process including missed deadlines for completion of different phases in the process. Dr. Francis focuses on the field trail phase of the DSM revision process and states:


It was patently obvious from the moment of its announcements that the new DSM-5 field test timetable was also a product of fantasy that would not be met in the real world. First off, it should have been clear that the field trials could not possibly start on time 2 months after their announcement. Recruiting the sites, training the personnel, gaining human rights approvals, and pilot testing always take at least 6 months. Predictably, we are already in mid November 2010 and it is still not at all clear when the DSM-5 field tests will actually begin to enroll patients at all its sites.Then there is the design. Forget for the moment that it asks the wrong questions and will produce largely irrelevant answers. Forget that it is testing poorly written criteria sets that are in much too rough a form to be ready for testing. Again, our focus here is only on timetables and missed deadlines. The DSM-5 field trials are a masterpiece of cumbersome complexity-- an administrative nightmare. They were originally scheduled to last 9 months starting July 2010 and ending in March 2011. Instead, the project will probably not start in full force until December 2010 or January 2011 (or later). By my reckoning (based on the experience with the DSM-IV field trials), it will take at least a year to complete from the date of first patient entry. And this assumes a maximum possible efficiency that is not at all likely given all the past laggard DSM-5 performances.
...
Because we are reaching a point of no return, these accumulating delays spell future disaster for DSM-5. The future schedule provides little room for error or forgivingness. The DSM-5 publication date of May 2013 is fixed in stone --both because the new ICD-10-CM codes will become official in October 2013 and because the APA budget depends on DSM-5 publishing profits. But the work to be done is enormous, not really do-able in the remaining time allotted. The result will be a rushed and jumbled DSM-5 that will create huge problems for our field and for our patients.

Dr. Francis's comments do not instill confidence in the DSM-5 to this humble autism dad.  But they do reflect some of the concerns I have felt over the failure by the DSM-5 revision teams to post the severity criteria for the New Autism Spectrum Disorder which will combine Aspergers and PDD-NOS with the existing category of Autistic Disorder. The most important distinction between Autistic Disorder and Aspergers has always been the exclusion from Aspergers Disorder diagnosis of anyone with Intellectual Disability.  Credible authorities have indicated that as many as 75-80% of persons with Autistic Disorder also have intellectual disabilities.  This aspect of Autistic Disorder reality is rarely mentioned or taken into account by anyone  discussing autism including the major  mainstream media or even researchers who now routinely announce "autism" study results based exclusively on research participants with high functioning Autistic Disorder or Aspergers.

When the proposed combination of the various PDD categories into the existing Autistic Disorder  was made public he major mainstream media focused exclusively on the reaction of persons with Aspergers or well known parents of children with Aspergers like anthropologist  Roy Richard Grinker.  The fear of some with Aspergers of being grouped with Autistic Disorder was assuaged by the assurances of Grinker and others who have gushed about how autism no longer carries a stigma. What was being unsaid in such statements was that the fear of stigma was the stigma of being associated  with a category that included so many persons with Mental Retardation now referred to euphemistically as Intellectual Disability.

As the father of a son with Autistic Disorder and Intellectual Disability who is not ashamed to speak openly about the Intellectual Disability aspect of my son's condition my concern is the exact opposite of those who fear association with Intellectual Disability.  My concern is that the severely debilitating challenges facing those with currently defined Autistic Disorder and Intellectual Disability will be further obscured and hidden in  the New Autism Spectrum Disorder. During the DSM-IV era "autism" has become increasingly defined in the public mind, and more and more in the minds of professionals and researchers,  by very high functioning persons with no obvious deficits or challenges. Meanwhile public, media and researchers alike simply ignore those low functioning persons with Autistic Disorder particularly those with Intellectual Disabilities.

Concerned about the persistent attempt to disassociate Intellectual Disability from Autistic Disorder I have visited the official DSM-5 site several times to see if the severity criteria would at least refer to intellectual disabilities or cognitive challenges in the severity criteria category. Despite the site's message to check back frequently there is today still no posting of the severity criteria for the proposed New Autism Spectrum Disorder. Dr. Francis, the lead professional in the DSM revision process that led to the DSM-IV, is obviously  much, much better informed about the likely reasons for this delay than this humble parent.  If he says it is a matter of sloppy work by the current DSM-5 revision teams  than it probably is or at least it is a major factor.

I  have to wonder though whether the persistent stigmatization arising from association of autism with intellectual disability ... with mental retardation ... is also a major factor in the failure of the DSM-5 review team to post severity criteria for the New Autism Spectrum Disorder.  I remain concerned that the challenges facing those most severely affected by autism will continue to be obscured and ignored, even hidden,  by medical professionals and researchers.

If Dr. Allen Francis, captain of the DSM-IV, does not have confidence in the good ship DSM-5, then why should I, a mere passenger,  have confidence that the ship will  weather the storm and arrive at a safe harbor? And why should I have confidence that some of the ship's baggage, including the Intellectual Disability reality faced by the vast majority of persons with the currently defined Autistic Disorder, will not be thrown overboard before the DSM-5 arrives in port?

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Synaptic Disorder Instead Of Autism Spectrum Disorder?

The word "Autism" has become romanticized, occasionally glorified, in public discussions of the neurological disorder. It is literally being stripped of its meaning as a diagnostic label of a mental disorder and is being turned into a different way of thinking, a way of life, a culture. Maybe it is time to start thinking about dropping the use of the term autism in the DSM, abandon the Autism Spectrum Disorder concept and replace it with a more informative, less romanticized, less politicized  name ... Synaptic Disorder.

At its most extreme the glorification of autism spectrum disorders has seen historical talents and geniuses from Mozart to Einstein "diagnosed" long after their deaths as  having been "autistics". One of the silliest of such fantasies is the speculation that Jesus Christ was autistic. At the other end of the stigma spectrum are those aided by the American Psychiatric Association, and its dilution of the concept of autism disorders in the DSM-IV,  who want the world to believe that autism and intellectual disability are unrelated conditions that are "coincidentally" present in 75-80% of those with Autistic Disorder and between 40 and 50% of all persons with autism spectrum disorders. 

Maybe it is time to consider abandoning use of the term "autism" altogether and replace it with a new, more informative, and less politicized term .... synaptic disorder.  In his December 2009  Simons Initiative on Autism and the Brain Lecture at MIT, "Autism, What Do We Know? What Do We Need?",  Dr. Thomas Insel, Director of the National Institute of Mental Health (NIMH) acknowledged that autism is not fully explained by genetics. It is also necessary to consider environmental factors ( a point made 10 years earlier by Teresa Binstock and emphasized by many autism authorities including Dr. Irva Hertz-Picciotto).  Dr. Insel also discussed the matter of how we describe autism disorders and whether we are talking about these disorders in ways that are helpful to understanding them biologically as summarized on the MIT World review of his lecture:

"The formal definition of autism includes three main components: deficits in social behavior, abnormal language, and repetitive or restricted (motor) behaviors (hand flapping, for instance). But it can also include a host of other associated features like seizures, mental retardation, GI disorders, dysmorphic appearance, and regression.

Insel compares talking about autism as a single disorder to talking about epilepsy or fever or chest pain as a single disorder. Discussions must include understanding details at many levels—genetic, environmental, cellular, behavioral, systems. While researchers may now increasingly refer to autisms (plural) or think of the disorder along a spectrum, these categories may cause more problems in getting to the underlying biology of the disorder. Current research suggests that autism is a developmental brain disorder, specifically a disorder of synapses." (Bold emphasis added-HLD)

Given Dr. Insel's view, as Director of the NIHM, speaking at MIT, that autism is a synaptic  disorder  would  it not be prudent for the DSM-5 team to hold off on  another transformation of the pervasive developmental disorders, already spoken of as autism spectrum disorders, until the research confirms (or refutes) the view that autism is a disorder of synapses?  Dr. Insel has indicated that describing autism as a disorder of synapses, synaptic disorder, may be more helpful in getting to the underlying biology of the disorder.

Synaptic Disorder instead of Autism Spectrum Disorder? Surely it should at least be considered by the American Psychiatric Association  as it once again revises the DSM. 

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Evidence of Common Genes Linking Autism Spectrum Disorders and Intellectual Disability

"Apparently an intact postsynaptic structure is especially important for the development of cognitive functions, language, and social competence"

- Professor Gudrun Rappold

In Newly Discovered Gene Variants Lead To Autism And Mental Retardation  Medical News Today reports on a Study by Researchers working with Professor Gudrun Rappold, Director of the Department of Molecular Human Genetics at Heidelberg University Hospital who purportedly have found genetic mutations in the SHANK2 gene, partially responsible for linking nerve cells,  and variants in the number of gene copies that were common to patients with autism and patients with mental retardation. The mutations and variants were not found in control patients in the study.

Professor Rappold stated that "the same mutation can be present in an autistic patient with normal intelligence and in a mentally impaired patient".

The study to which the article refers is Mutations detected in the SHANK2 synaptic scaffolding gene in autism spectrum disorder and mental retardation. S Berkel, CR Marshall, B Weiss, J Howe, R Roeth, U Moog, V Endris, W Roberts, P Szatmari, D Pinto, M Bonin, A Riess, H Engels, R Sprengel, SW Scherer, GA Rappold, Nature Genetics, 2010 in press (tracking number NG-LE27550R1; manuscript ID 589) Doi:10.1038/ng.589

In a  Brief Communication published in the same issue of Nature Genetics the authors state that:

Using microarrays, we identified de novo copy number variations in the SHANK2 synaptic scaffolding gene in two unrelated individuals with autism-spectrum disorder (ASD) and mental retardation. DNA sequencing of SHANK2 in 396 individuals with ASD, 184 individuals with mental retardation and 659 unaffected individuals (controls) revealed additional variants that were specific to ASD and mental retardation cases, including a de novo nonsense mutation and seven rare inherited changes. Our findings further link common genes between ASD and intellectual disability.

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Autism Taboo: Shhhh! Don't Mention THEM!

It is now politically incorrect to refer to anyone as mentally retarded. The polite and proper term to use now is intellectually disabled. Either way there is very little mention of the fact that many persons with Autism Spectrum Disorder diagnoses are severely intellectually challenged. In the world's autism communities there are many who perceive it as an insult to mention the existence of the intellectually disabled autistic population.

It is obvious that some persons with High Functioning Autism and Aspergers are very intelligent, even brilliant. Some very intelligent persons with ASD diagnoses are capable of running organizations and conducting very influential media campaigns. They show no obvious behavior, social or communication deficits; to the point that parents of more challenged autistic children are left wondering how these media superstars ever received an Autism Spectrum Disorder diagnosis in the first place. At the same time some well known autism researchers work hard at showing the world how intelligent autistic persons really are, even those who cannot demonstrate that intelligence with any obvious ability to communicate or function in the real world.

The mere mention of the existence of low functioning autistic persons with serious intellectual challenges is forbidden. Neurodiversity ideologues and ASAN "self" advocates routinely insist upon a positive only, a "posautive", view of autism. A posautive view does not include mention of the intellectually disabled autistic persons, those who do not run an organization with a Washington DC address, work as researchers in Montreal autism research facilities, attend university or colleges for gifted youths, or conduct numerous high profile media campaigns.

The exclusion by autism self advocates of the intellectually disabled autistic population occurs despite the fact that many persons with Autistic Disorder are intellectually disabled. The ICD-10 mentions this fact expressly in its description of Autistic Disorder:

Autistic Disorder

...

In addition to these specific diagnostic features, it is frequent for children with autism to show a range of other nonspecific problems such as fear/phobias, sleeping and eating disturbances, temper tantrums, and aggression. Self-injury (e.g. by wrist-biting) is fairly common, especially when there is associated severe mental retardation. Most individuals with autism lack spontaneity, initiative, and creativity in the organization of their leisure time and have difficulty applying conceptualizations in decision-making in work (even when the tasks themselves are well within their capacity). The specific manifestation of deficits characteristic of autism change as the children grow older, but the deficits continue into and through adult life with a broadly similar pattern of problems in socialization, communication, and interest patterns. Developmental abnormalities must have been present in the first 3 years for the diagnosis to be made, but the syndrome can be diagnosed in all age groups.

All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases.

Includes:
* autistic disorder
* infantile autism
* infantile psychosis
* Kanner's syndrome

Settlement.org a web site of the 2009 Ontario Council of Agencies Serving Immigrants speaks about intellectual disabilities with express reference to autism:

What is an intellectual disability?

Intellectual disability is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of him or herself, and social skills. These cause a person to learn and develop more slowly than a typical person. Individuals with an intellectual disability may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating. A person with an intellectual disability will require some level of support for his or her entire life. Intellectual disabilities are sometimes called "developmental disabilities."

There are more than 200 known causes of intellectual disability. Some common examples of intellectual disability are:

• Down syndrome
• Autism

The attempt by higher functioning persons with ASD's and Aspergers to disassociate "autism" from intellectual disability helps stigmatize persons with intellectual disabilities including the many persons with autistic disorder and intellectual disabilities. While intellectual disability in itself may not be a diagnostic criteria for autism spectrum disorders, and is expressly excluded from Aspergers, the fact is that ID is oftent associated with Autistic Disorder. That surely is more than coincidence.

Refusal by anyone, including the alleged Autism self advocacy organizations, to recognize the ID Autistic population is just another form of bigotry, discrimination and intolerance. Such exclusion contributes to the stigmatization of those with MR/ID generally and autistic persons with MR/ID specifically.

autism

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Ari's Omission : Autistic Disorder and Aspergers Disorder are Critically Different Disorders

Why do some persons with Aspergers Disorder insist on the right to speak for persons with Autistic Disorder, to tell the world that persons with Autistic Disorder do not want to be cured, and why does the media let them get away with it?

Newsweek has now become the latest stop for Ari Ne'eman, a very intelligent, highly articulate gentleman with Aspergers who persistently purports to speak on behalf of all people with "autism". Ne'eman, with Aspergers Disorder, expresses his opinion, as a person with "autism", about what is good for children with Autistic Disorder a related but distinct Disorder in the Pervasive Developmental Disorder category of the DSM-IV. One of his central themes which he delivers on behalf of persons with autism is "we don't want to be cured". Good for the intelligent, articulate Ari Ne'eman but does he have the right to make that claim on behalf of persons with Autistic Disorder with communication deficits and in many cases cognitive impairment people, including children with whom he has little in common?

Many children and adults with Autistic Disorder suffer from cognitive and communication deficits which seriously impair their ability to understand and function in the real world. Those with Aspergers Disorder like Ari Ne'eman do not have cognitive impairment or serious language impairment ... by definition.

DSM-IV Diagnostic Criteria for Aspergers Disorder and Autistic Disorder

The DSM (Diagnostic and Statistical Manual, American Psychiatric Association) diagnosis criteria for Aspergers Disorder expressly exclude impairments in cognitive AND communication development:

(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)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

The reality for many people with Autistic Disorder is much different when it comes to delays, some permanent, in cognitive development and language:

(B) 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

4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

The DSM does not expressly state that cognitive development is a diagnostic criteria for autistic disorder but it is clearly implicit in the list of developmental deficits that cognitive deficits or mental retardation would be associated with these serious deficits in many cases.

ICD-10 Diagnostic Criteria for Aspergers Disorder and Autistic Disorder

The European equivalent of the DSM, the ICD-10 Classification of Mental and Behavioural Disorders states this obvious point expressly in distinguishing between Autistic Disorder and Aspergers Syndrome. Under the ICD-10 an Asperger's Syndrome diagnosis expressly excludes

Autistic Disorder

...

In addition to these specific diagnostic features, it is frequent for children with autism to show a range of other nonspecific problems such as fear/phobias, sleeping and eating disturbances, temper tantrums, and aggression. Self-injury (e.g. by wrist-biting) is fairly common, especially when there is associated severe mental retardation. Most individuals with autism lack spontaneity, initiative, and creativity in the organization of their leisure time and have difficulty applying conceptualizations in decision-making in work (even when the tasks themselves are well within their capacity). The specific manifestation of deficits characteristic of autism change as the children grow older, but the deficits continue into and through adult life with a broadly similar pattern of problems in socialization, communication, and interest patterns. Developmental abnormalities must have been present in the first 3 years for the diagnosis to be made, but the syndrome can be diagnosed in all age groups.

All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases.

Includes:
* autistic disorder
* infantile autism
* infantile psychosis
* Kanner's syndrome

Asperger's Syndrome

A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. The disorder differs from autism primarily in that there is no general delay or retardation in language or in cognitive development. Most individuals are of normal general intelligence but it is common for them to be markedly clumsy; the condition occurs predominately in boys (in a ratio of about eight boys to one girl). It seems highly likely that at least some cases represent mild varieties of autism, but it is uncertain whether or not that is so for all. There is a strong tendency for the abnormalities to persist into adolescence and adult life and it seems that they represent individual characteristics that are not greatly affected by environmental influences. Psychotic episodes occasionally occur in early adult life.

Diagnostic Guidelines

Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behaviour, interests, and activities. There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis.

Includes:

* autistic psychopathy
* schizoid disorder of childhood

In both the DSM and the ICD manuals Aspergers and Autistic disorders are distinct with Aspergers expressly excluding general delay in cognitive and communication development. These distinctions should be made clearer in the DSM V revision and separated from the same "spectrum" that has caused so much misunderstanding.

Ari Ne'eman a very intelligent, highly articulate gentleman with Asperger's Disorder has every right to speak on his own behalf and on behalf of those persons with Aspergers who agree with his views. Mr. Ne'eman has no right to suggest that persons with Aspergers and persons with Autistic Disorder are fundamentally similar. They differ by definition in the critically important areas of cognitive and language development. Ari Ne'eman does not have these deficits and can not begin to appreciate the challenges that having those deficits brings to the lives of persons, like my son Conor, who has an Autistic Disorder diagnosis and is assessed with profound developmental delays.

Aspergers includes social impairment. Autistic Disorder includes social impairment but also includes substantial delays and deficits in language impairment and, in many cases, cognitive development. It is hard to imagine any two areas, communication and cognitive functioning, any more important to daily life. And yet, despite these two critically important differences they are not separated clearly enough as disorders in the DSM. The result is widespread public confusion and misguided advocacy.

The impending DSM-V should do everyone a favor and separate more clearly these two disorders with fundamentally different diagnostic criteria in areas central to any human existence - communication and intelligence.

autism

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Tropic Thunder Helps Those With Intellectual Disabilities

I am the father of a 12 year old boy diagnosed with Autistic Disorder and assessed with Profound Developmental Delays. I was invited to attend a showing of Tropic Thunder and yesterday I did so, albeit with serious misgivings. Having seen the movie I believe that Tropic Thunder actually helps those with intellectual disabilities, and others, by focusing our attention on how the motion picture industry exploits, and presents inaccurate, and false, images of people with intellectual disabilities and other challenges, including obesity and addiction.


Tropic Thunder targets Hollywood for a number of sins, including its exploitation and presentation of distorted images of people with intellectual disabilities. The character portrayed in the movie within the movie, "Simple Jack", does not resemble in any way anyone I have ever met with an intellectual disability or developmental delay. The presentation of the character and the use of the word "retard" in some of the relevant scenes was uncomfortable for me as the father of a son with "profound developmental delays". But I did not find it offensive. and the clear targets are the vain and superficial actors who portray such distortions and the industry which greedily exploits them.

I am not trying to tell others how to feel about this issue. Or whether they should see the movie. For me, Tropic Thunder raised serious issues for discussion in the way that satire does - not by a scholarly dissertation - but by actually showing, and mocking, its target - in this case the motion picture industry.

And it is funny.

autism

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Autism Disorder Versus Asperger's Syndrome

The Autism Society of America has published a good overview of Autism Disorder and Asperger's Syndrome on TylerPaper.com. The article contains a basic description of both Autism Disorder and Asperger's Syndrome and helps distinguish between the two similar but distinct disorders:

What distinguishes Asperger's Syndrome from autism is the severity of the symptoms and the absence of language delays. To the untrained observer, a child with Asperger's may seem just like a normal child behaving differently. They may be socially awkward, not understanding of conventional social rules, or show a lack of empathy. They may make limited eye contact, seem to be unengaged in a conversation, and not understand the use of gestures.

One of the major differences between Asperger's Syndrome and autism is that, by definition, there is no speech delay in Asperger's. In fact, children with Asperger's frequently have good language skills; they simply use language in different ways. Speech patterns may be unusual, lack inflection, or have a rhythmic nature or it may be formal, but too loud or high pitched. Children with Asperger's may not understand the subtleties of language, such as irony and humor, or they may not recognize the give-and-take nature of a conversation.

Another distinction between Asperger's Syndrome and autism concerns cognitive ability. While some individuals with autism experience mental retardation, by definition a person with Asperger's cannot possess a "clinically significant" cognitive delay, and most possess average to above-average intelligence.

autism

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Study Details Atomic Structure of Autism Associated Proteins

Autism has been defined largely by behavioral deficits. That is changing though as new research is reported almost daily providing more detail on the neurological basis of autism. NEURON magazine in its incredible December 20 07 issue has published a report of a study showing it is possible to reverse some symptoms of Fragile X and some autism disorders. The same issue reports a study detailing, on an atomic level, the structure of altered proteins associated with autism.

In Structural Analysis of the Synaptic Protein Neuroligin and Its b-Neurexin Complex:
Determinants for Folding and Cell Adhesion Pascale Marchot and Igor P. Fabrichny, Institut Fédératif de Recherche-Jean Roche, Université de la Mediterranée; Philippe Leone, Gerlind Sulzenbacher and Yves Bourne, Universités Aix-Marseille; and Davide Comoletti and Meghan T. Miller, UCSD Department of Pharmacology, Skaggs School of Pharmacy and Pharmaceutical Sciences provide detailed data, charts and description of the structure of the neurologin family of proteins believed to be affected by genetic mutations and believed to be involved with autism and mental retardation.

In Atomic Structure of Proteins Altered in Autism the University of California, San Diego Health Sciences Press Release published on Newswise emphasizes that this study builds on previous studies but provides new detail:

“This goes beyond previous studies to show the individual atoms of these two proteins and how they interact,” said Palmer Taylor, Ph.D., Dean of SSPPS and the Sandra & Monroe Trout Professor of Pharmacology. “We have described the mutations found in some people with autism; and we have identified where the altered amino acids are located in the protein, and how they impact the folding and cell adhesion properties of neuroligin and neurexin.”

The research builds on earlier work that mapped the molecular structure of neuroligins and their partner proteins, neurexins – a protein complex involved in the junctions, or synapses, through which cells of the nervous system signal to one another. The new study, conducted with Pascale Marchot and Yves Bourne and their colleagues in Marseille, France, adds to a clearer understanding of how particular genetic mutations affect formation of this complex and contribute to the developmental abnormalities found in certain individuals with autism.

Normally, individual neuroligins interacting with specific neurexin partners are involved in synaptic adhesions, imparting ‘stickiness’ that enables them to associate and form synapses that have the capacity for neurotransmission. Incorrect partnering in these diverse protein families results when a mutant neuroligin fails to associate properly at synapses, preventing the normal transmission of brain cells.

The change in synaptic function may account for impairments in development, social interaction and communication displayed in individuals with autism spectrum disorders, according to the researchers.

The world is experiencing an Autism Knowledge Revolution. When knowledge grows superstition, prejudice, ideology and personal agendas wane in influence, in this case to the benefit of persons with autism.

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Autism May Result from Wrong Amount of MeCP2 Protein, Wrong Number of Synapses

“MeCP2 has an important role in fine-tuning the amount of synaptic responses, having just the right amount of MeCP2 and the right number of synapses drives healthy brain development"

- Hsiao-Tuan Chao, M.D./Ph.D. graduate student, Baylor College of Medicine

A study published in Neuron reports evidence that problems in synapse formation early in post natal development give rise to mental retardation, Rett syndrome, autism and other developmental disorders. The protein MeCP2 (methyl-CpG binding protein 2) is critical in determining the number of synapses. And the correct number of synapses is necessary for healthy brain development. A mutation of the MeCP2 gene results in too little of the protein which further results in girls developing Rett syndrome. Boys with too much MeCP2 have spasticity and mental retardation with autism-like behavior.

In MeCP2 Controls Excitatory Synaptic Strength by Regulating Glutamatergic Synapse researchers Hsiao-Tuan Chao, Huda Y. Zoghbi, and Christian Rosenmund of the Baylor College of Medicine report conclusions of their study of two groups of mice, one group of mice with too little MeCP2, and another group with too much of the protein, to figure out what is the right number of synapses and how the number is determined. The found that too little of the MeCP2 protein meant that not enough synapses formed. Too much MeCP2 meant too many synapses formed.

As reported on the Baylor College of Medicine web site:

“The beauty of this result is that this critical process in the development of synaptic connectivity in the brain is tightly regulated by the amount of MeCP2,” said Rosenmund. “It is one of the strongest pieces of evidence that mental retardation and autism-like diseases originate with problems in synapse formation.”

Chao said, “It suggests that the pathways in which MeCP2 is involved and the proteins it regulates are probably critical for how the brain can determine how many synapses to make as it’s developing.”

“This determination of how many synapses to make happens early in life,” said Zoghbi. “If it’s not right, then the brain undergoes secondary changes to try to compensate. This is a big important observation and opens up ways to think about adult diseases that involve loss of synaptic function. It is also interesting that patients who lack this protein or have too much have features of autism. More and more, data point to the possibility that autism is a disorder of abnormal function of the synapse.”

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