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Symptoms, Diagnostic Criteria, Co-morbid conditions etc

I'm done with Christmas Cards

Many months ago I had some thoughts along the lines that I haven't seen anywhere a full list of the impacts of autism together with the proportion of autistic people experiencing each one. I was interested for instance that many people mention trouble with fluorescent lights where I have no issues, but I share with many the difficulty with processing spoken words in the presence of background noise and/or other conversations. Neither of these (lights, voices) features explicitly in diagnostic criteria for ASD ("sensory differences" do) and this got me wondering about diagnostic criteria versus experience of ASD.

As usual, I have an urge to classify things in life that I come across that capture my interest!

This may be linked to some of the tense debates that sometimes arise along the lines of "You can't be autistic because you're not like my child (or aunt, uncle etc.)" which results from the fact that autism produces so many different sets of symptoms or "profiles", and, naturally, a system of processes that is concerned only with *diagnosis* of "autism vs something else" is very concerned to develop highly sensitive and specific *diagnostic criteria* and far less interested in common experiences as a result of autism (which a system concerned with care *would*, but I have no experience or knowledge of this).

These are fresh thoughts and I've just learned by reading the first few paragraphs of this paper on rheumatism that *classification* of conditions *is* more concerned with identifying relatively homogeneous groups of people within a larger group sharing a common diagnosis; this appears to be why we have both DSM (for diagnosis) and ICD (for classification).

Despite all of that, even the ICD doesn't address the level of detail exemplified by the fluorescent lights / voices in a crowded pub example, and neither talks about the different ways that aspects of executive function are changed. Thinking about it now, the executive function topic is what brought this back to my mind as I was discussing with my wife how we are each affected in different ways in regard to EF (she's on the waiting list for ASD diagnosis so we're still having the conversations about "could this be part of it?"). 

Fascinating stuff (to me at least).

Parents

  • I guess that the diagnostic criteria in both the ICD and DSM need to be relatively broad criteria so as to encompass people who have the same symptom but expressed in different ways, such as someone who has sensory sensitivities with sounds but not smells and someone else who has the reverse. The diagnostic criteria also need to be quite short and concise, otherwise the diagnostic manuals would be HUGE! However, the diagnostic criteria does only cover the 'tip of the iceberg' and there is much much more information about each symptom and how that symptom is experienced by different individuals. It would indeed be interesting to see data/diagrams/charts detailing what percentage/number/proportion of autistic people suffer from each sub section of each symptom and to what severity. I'm sure such things must exist somewhere.

    I have a need to classify anything brain related, but sadly categories have an annoying tendency to overlap! 

    I've had an OT and a Physio say to me last year that my youngest daughter can't be autistic because she doesn't have the classic facial dysmorphology of autism. Yet she has just had her 3 assessments for Autism at the age of 2 years and 5 months, which is 'very' young to be put through the assessments. I may be proved wrong but I strongly suspect that she will be diagnosed at her MDT meeting. So clearly she could be autistic despite the fact that she isn't like person X. 

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  • I guess that the diagnostic criteria in both the ICD and DSM need to be relatively broad criteria so as to encompass people who have the same symptom but expressed in different ways, such as someone who has sensory sensitivities with sounds but not smells and someone else who has the reverse. The diagnostic criteria also need to be quite short and concise, otherwise the diagnostic manuals would be HUGE! However, the diagnostic criteria does only cover the 'tip of the iceberg' and there is much much more information about each symptom and how that symptom is experienced by different individuals. It would indeed be interesting to see data/diagrams/charts detailing what percentage/number/proportion of autistic people suffer from each sub section of each symptom and to what severity. I'm sure such things must exist somewhere.

    I have a need to classify anything brain related, but sadly categories have an annoying tendency to overlap! 

    I've had an OT and a Physio say to me last year that my youngest daughter can't be autistic because she doesn't have the classic facial dysmorphology of autism. Yet she has just had her 3 assessments for Autism at the age of 2 years and 5 months, which is 'very' young to be put through the assessments. I may be proved wrong but I strongly suspect that she will be diagnosed at her MDT meeting. So clearly she could be autistic despite the fact that she isn't like person X. 

Children