Canada's Globe & Mail is late to the discussion, once again, of major autism issues. This time, Parents of autistic kids fear diagnostic changes will mean reduced services, the Globe is parroting the concerns of the major US corporate media over the possible impact of the DSM-5's New Autism Spectrum Disorder on persons with Asperger's and High Functioning Autism. Like the US corporate media the Globe simply ignores the probable impact, on intellectually disabled autistic persons of the express exclusionary language of Mandatory Criterion A of the New Autism Spectrum Disorder.
Mandatory Criterion A of the New Autism Spectrum Disorder states:
Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.
The highlighted expression will exclude some from an autistm diagnosis where Criterion A can be accounted for by general development delay. General developmental delay is not a separate category in the DSM-5 at least not under that title. It is found under the diagnosis Intellectual Developmental Disorder (IDD):
A 00 Intellectual Developmental Disorder
Updated July 5, 2011
Intellectual Developmental Disorder is a disorder that includes both a current intellectual deficit and a deficit in adaptive functioning with onset during the developmental period. All three of the following criteria must be met.
A. Intellectual Developmental Disorder is characterized by deficits in general mental abilities such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning and learning from experience.Intellectual Developmental Disorder requires a current intellectual deficit of approximately 2 or more standard deviations in Intelligence Quotient (IQ) below the population mean for a person’s age and cultural group, which is typically an IQ score of approximately 70 or below, measured on an individualized, standardized, culturally appropriate, psychometrically sound test.
AND
B. The deficits in general mental abilities impair functioning in comparison to a person’s age and cultural group by limiting and restricting participation and performance in one or more aspects of daily life activities, such as communication, social participation, functioning at school or at work, or personal independence at home or in community settings. The limitations result in the need for ongoing support at school, work, or independent life. Thus, Intellectual Developmental Disorder also requires a significant impairment in adaptive functioning. Typically, adaptive behavior is measured using individualized, standardized, culturally appropriate, psychometrically sound tests.
AND
C. Onset during the developmental period. (Underlined dark bold highlighting added - HLD)
Impairment in communication and social participation will support a diagnosis of
Intellectual Developmental Disorder. A person with Intellectual Developmental
Disorder and deficits in social participation and communication will by definition have those deficits accounted for by his/her IDD and will be excluded from an autism diagnosis by operation of the exclusionary wording in Mandatory Criterion A of the DSM-5 Autism Spectrum Disorder.
None of the spokespersons for the DSM-5 Neurodevelopmental Workgroup Committee have explained how these two provisions can exist in the DSM-5 without excluding intellectually disabled persons from an Autism Spectrum Disorder diagnosis. To the contrary Dr. Catherine Lord has already confessed a clear intent on the committee's part to exclude from an autism diagnosis those with intellectual disabilities.
The Globe & Mail, in fairness, is not a frequent reporting source on autism disorders. It is probably just following the corporate media trend in the US ... ignoring those described by CDC autism expert Dr. Marshalyn Yeargin-Allsopp as the vast majority of those diagnosed with DSM-IV Autistic Disorder (AD) ... those with AD and intellectual disabilities.
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