Published on 12, July, 2020
Some concerns with diagnostic criteria C for Autism Spectrum Disorder and Social (Pragmatic) and other Commutation Disorders
Diagnostic criteria for Autism Spectrum Disorder:
A. Persistent deficits in social communication and socialinteraction across multiple contexts, as manifested by all ofthe following, currently or by history (examples are illustrative,not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, forexample, from abnormal social approach and failure ofnormal back-and-forth conversation; to reduced sharing ofinterests, emotions, or affect; to failure to initiate orrespond to social interactions.
2. Deficits in nonverbal communicative behaviors used forsocial interaction, ranging, for example, from poorlyintegrated verbal and nonverbal communication; toabnormalities in eye contact and body language or deficitsin understanding and use of gestures; to a total lack offacial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understandingrelationships, ranging, for example, from difficultiesadjusting behavior to suit various social contexts; todifficulties in sharing imaginative play or in making friends;to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, oractivities, as manifested by at least two of the following,currently or by history (examples are illustrative, notexhaustive; see text):
1. Stereotyped or repetitive motor movements, use ofobjects, or speech (e.g., simple motor stereotypies, liningup toys or flipping objects, echolalia, idiosyncraticphrases).
2. Insistence on sameness, inflexible adherence to routines,or ritualized patterns of verbal or nonverbal behavior (e.g.,extreme distress at small changes, difficulties withtransitions, rigid thinking patterns, greeting rituals, need totake same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal inintensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessivelycircumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusualinterest in sensory aspects of the environment (e.g.,apparent indifference to pain/temperature, adverseresponse to specific sounds or textures, excessivesmelling or touching of objects, visual fascination withlights or movement).
C. Symptoms must be present in the early developmental period(but may not become fully manifest until social demandsexceed limited capacities, or may be masked by learnedstrategies in later life).
D. Symptoms cause clinically significant impairment in social,occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectualdevelopmental disorder (intellectual disability) or globaldevelopmental delay. Intellectual developmental disorder andautism spectrum disorder frequently co-occur; to makecomorbid diagnoses of autism spectrum disorder andintellectual developmental disorder, social communicationshould be below that expected for general developmentallevel.
Diagnostic criteria for Social (Pragmatic) and other Communication Disorders:
A. Persistent difficulties in the social use of verbal and nonverbalcommunication as manifested by all of the following:
1. Deficits in using communication for social purposes, suchas greeting and sharing information, in a manner that isappropriate for the social context.
2. Impairment of the ability to change communication tomatch context or the needs of the listener, such asspeaking differently in a classroom than on a playground,talking differently to a child than to an adult, and avoidinguse of overly formal language.
3. Difficulties following rules for conversation and storytelling,such as taking turns in conversation, rephrasing whenmisunderstood, and knowing how to use verbal andnonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g.,making inferences) and nonliteral or ambiguous meaningsof language (e.g., idioms, humor, metaphors, multiplemeanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effectivecommunication, social participation, social relationships,academic achievement, or occupational performance,individually or in combination.
C. The onset of the symptoms is in the early developmentalperiod (but deficits may not become fully manifest until socialcommunication demands exceed limited capacities).
D. The symptoms are not attributable to another medical orneurological condition or to low abilities in the domains ofword structure and grammar, and are not better explained byautism spectrum disorder, intellectual developmental disorder(intellectual disability), global developmental delay, or anothermental disorder.
Concerning about diagnostic C for Autism Spectrum Disorder
Although Autism Spectrum Disorder is a neurodevelopmental disorder, but if the symptoms of Autism Spectrum Disorder do not become fully manifested until social demands exceed limited capacity or masked by learned strategies later in life, how are family members and mental health professionals supposed to know about childhood history? What if your family members stopped having good memories about your childhood?
What if you have Autism Spectrum Disorder, but the symptoms did not manifest until older adolescents or adulthood? How are family members and mental health professionals supposed to spot those symptoms behaverly from childhood, if it didn't manifest until later in life?
The problem is that Autism Spectrum Disorder is diagnosed based on behavioral symptoms. The question is if you can have the same brain patterns of Autism Spectrum Disorder without showing obvious symptoms of Autism Spectrum Disorder.
To diagnose Autism Spectrum Disorder that did not manifest until later in life, even if without enough childhood history, is to rule out other neurological disorders that has similar symptoms, and if those neurological disorders are ruled out, then ask a patent what is going on with their mind, the patent without obvious behaviors of Autism Spectrum Disorder will tell you that social rules became too complicated for him or her to follow and that he or she masked diagnostic criteria B for Autism Spectrum Disorder, and that it causes them clinically significant impairment in social, occupational, or other important areas of current functioning.
Concerned about diagnostic criteria C for Social (Pragmatic) and other Commutation Disorders
I have similar concerns about diagnostic criteria C for Social (Pragmatic) Communication Disorder. Although Social (Pragmatic) and other Communication Disorders are neurodevelopmental disorders, what if the symptom of Social (Pragmatic) and other Communication Disorders did not fully manifest until social communication exceed limited capacities? How are family members and mental health professionals supposed to know about childhood history? What if the symptoms of Social (Pragmatic) and other Communication Disorders did not manifest until older adolescents or adulthood? How are family members and mental health professionals supposed to know about childhood history?
To know if a person has Social (Pragmatic) and Other Communication Disorders that did not manifest until later in life, even without enough childhood history, is to rule out neurological disorders that causes similar symptoms, and of those neurological disorders are ruled out, the patent can say that thay meet diagnostic criteria for Social (Pragmatic) or other Communication Disorders that did not manifest until later in life and it causes him or her deficits that result in functional limitations in effectivecommunication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
My other concern is that diagnostic criteria for Autism Spectrum Disorder and Social (Pragmatic) and other Communication Disorders has some gender bias. I did a research from DSM-5-TR that most women are four more times less likely to be diagnosed with Autism Spectrum Disorder than men, and that most woman with Autism Spectrum Disorder have fewer obvious symptoms or mask better and tend to socialize better.
yeah thats why they often focus on children and not adults.thats also why the referal forms have a bit on that requires your parents to fill in about how you was like when you was growing up... but i didnt do that bit as i refuse to allow my parents to know about it anyway. oh and as for the gender bit... the thing is with men we dont grow up as fast mentally so we always retain that childhood mentality for a long time which likely attributes to higher diagnosis. women mature mentally faster, so this can perhaps make women seem more grown up, and less child like and more mature. and in this grown up maturity it makes it harder to diagnose compared to a boy as a boy is less mature and more childlike for longer apparently... or so i read.
That makes sense.