Do all autistic people meet the DSM 1V criteria??

[Suki]

Hello

 

This is my first post. We're in the process of trying to find out what's going on with our 7 year old son. So far, his school have just had him observed by a member of the ASD team and our GP has referred us to our local Child Development Centre. The CDC asked his school and myself to complete a bunch of forms, including the Connors ADHD questionnaire and detailed questionnaires regarding communication and social interaction. The forms have been sent back so now we're just waiting for an appointment. While I've been waiting I've spent a lot of time googling, speculating, worrying...... Inevitably, I stumbled across the DSM 1V criteria for diagnosing autism. I have to say that I am struggling to apply even a couple of the criteria to my son, let alone 6!! My question is, do they always use this criteria to diagnose autism, even the mildest, highest functioning cases? My son definitely has a lot of autistic type traits but not, it appears, the core deficits of problems with communication and social interaction. So, does that mean he cannot possibly be autistic??

 

I would not be at all be surprised if my son has ADHD and/or Sensory Processing Disorder, he ticks nearly every box on the Connors questionnaire, the term "motor driven" describes him perfectly! He has always been like this but it has become a lot more noticeable over the last year as most of his peers have matured and he now sticks out like a sore thumb! I had never heard of SPD until the school assessment concluded that he had "major issues with sensory integration" and recommended he be assessed by an OT. I googled it and, again, he ticks a lot of boxes. It was a revelation as previously the only explanation I could think of for his behaviour was autism. He definitely has issues with noise, light/dark, and sometimes touch eg. hates having his hair cut, goes mad when I try to tuck his shirt in etc. However, if his desire to do something is greater than his fear of the noise etc he will overcome it and go into the noisiest soft play centre or swimming pool! Apparently, this isn't unusual though. When pressed, the lady from the ASD team said there was a lot to suggest my son isn't autistic eg. he presents as very happy and sociable and interacts well with his peers, but obviously she wouldn't commit herself!

 

However, aside from the sensory stuff and the ADHD-like behaviour which is causing him to be very behind with his school work, particularly literacy & numeracy, the school and myself are worried about the following:

 

he has poor fine motor skills which means his handwriting is appalling.

 

he hums, makes car and other silly noises most of the time and seems unaware he is doing it.

 

He never joins in with large group activities such as football or games at parties. Not only does he not join in at all, he behaves very strangely by humming and playing with a car (or imaginary car). He tells me he doesn't join in as he can't stand the noise and is scared of getting hurt, so presumably this is a sensory issue rather than not wanting to interact with the other children?

 

He sometimes comes inside at playtime as he can't stand the noise.

 

At school I've been told he seeks out some repetitive routines that he is reluctant to break such as placing his water bottle away from the other children's and sitting on the carpet with his coat & bags at the end of the day when the teacher always tells them to leave them on the table. I'm not aware of him having any rituals like this at home.

 

He mainly plays with girls. The teacher thinks this is a problem but presumably its because the girls play the more gentle, role play type games he enjoys.

 

He is totally obsessed with cars & anything mechanical. Insists on taking a car to play with wherever he goes "in case its boring". This can include walking down the street and waiting while I drop his sister off at ballet which takes about 5 minutes!!

 

Very fussy with food.

 

Trouble sleeping. Will often play noisily in his room till 11pm.

 

Diarreah since he was a baby which we've never found a reason for.

 

On the plus side:

 

He comes across as a friendly, happy child. Although he has trouble with big group activities as explained above, he interacts well one on one and in small groups and will join in enthusiastically with activities he enjoys such as art, cookery, making things.

 

He has several close long standing friendships, although they are mainly with girls.

 

He has great imaginative play which he normally plays with his sister. I'm actually thinking of selling their ideas to Disney Pixar! Play often involves cars, but can also be things as varied as putting on a show or camping using my clothes airers and blankets!

 

He is very interested in the world around him, asks lots of questions,loves going on holiday and seeing new things.

 

Extremely articulate and interesting to talk to. No problems with speech at all. Shows good understanding, gets sarcasm, humour etc.

 

Loves haring his enjoyment of things with me. Keeps showing me what he's playing, and telling me the latest "hillarious" thing to happen in Mr Bean or Scooby Doo etc.

 

No gross motor skill problems, good swimmer and cyclist.

 

Not routine driven (apart from the things noticed by his teacher).

 

Sorry for my ramblings,but if you've managed to get this far I would be grateful for your views and experiences!

 

 

Suki

[Tally]

Hello, and welcome to the forum.

 

There are a few different diagnostic criteria, but they are all quite similar. If your son does not seem to even come close to the DSM criteria, it's umlikely he would meet any other criteria either.

 

There is a condition called Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) that basically means the person has autistic traits, but does not meet the full diagnostic criteria. But if your son does not have deficits in communication or interaction, he might not have enough traits for this diagnosis either.

 

It sounds like your son's social difficulties may be the result of other difficulties, rather than a symptom in themselves.

 

Your son clearly does have difficulties though. You are definitely right to be seeking clarification of them and support for your son.

 

Have you looked into Dyspraxia at all? There is some overlap with this and ASD, and many people with dyspraxia have some social difficulties.

[baddad]

Hi Suki -

 

It is not necessary for a child to tick all of the boxes of the DSM criteria, but it is necessary for them to 'meet the criteria' - that is, to display at least six of the 'core features' (at least 2 from 'A', one each from 'B' and 'C' - the remaining '2' being from any of the three areas, whether they all be from a, or b, or c, or 2 from any one thereof. There are a couple of other factors too - i.e. age of onset/observation of symptoms. No child should be diagnosed who does not meet that criteria, but my own feeling is that these days many (inappropriately) are. I also believe many are diagnosed on the basis of anecdotal evidence or 'subjective' application of terms like:

encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

 

Where 'abnormal' is effectively 'in the eyes of the beholder'.

 

His use /liking for imaginative play and his desire and ability to be involved in group play are very strong indicators against a dx of autism of any kind, as are his SOH, love of 'new' experiences and many other items you mention. The fact that his choices about group play are usually when the group play involves things he enjoys are perfectly normal kids behaviour!

 

I'm wondering whether your concerns were actually more highlighted by school, and if so whether by one particular teacher? IMO this is a real issue these days, with anyone from teachers through to dinner ladies feeling more than qualified to 'identify' autism on the basis that their friend's sister's boyfriend has a brother who has 'it' and they've seen 'rainman' three times......

 

Some of the things you've highlighted do sound like aspects of autism - the noise sensitivity, for example - but could easily by indicative of other things or even just a 'dislike' of certain activities / situations.

 

His poor sleeping, fussy eating etc are shared by thousands of 'NT' children and autistic children, and IMO more often than not this is usually indicative of poor routines and/or inconsistently applied (if applied at all) sanctions or management. (There were two programmes on recently about 'fussy eating' - one of them including a girl supposedly identified as being 'somewhere on the autistic spectrum' - in all cases, the 'problems' identified had more to do with the parents than the children, who all responded well to professional input despite the parent's assertions that they had 'tried everything' and that their children would prove to be the exceptions to the usual rules). Please understand I'm not 'having a pop' at you or anyone else - there are some autistic children (and NT come to that!) for whom it is not so simple and I wouldn't dream of making assumptions - but having said that I think the number for whom exceptions are claimed are grossly exaggerated, and the evidence of TV programmes like the ones above tend to back that up. The same applies, of course, to behavioural management of aggressive or destructive behaviours (it was good to see a 'Super Nanny' show recently involving a child dxd with ADHD responding well to 'the naughty step' once it was being properly enforced!), though that seems to be a non-issue in your son's case Further, I am the first to put my hand up and say that I made many errors regarding (i.e.) consistency myself during my son's early years, so I know just how easy it is to think you're doing all the right things when you're actually not.

 

Reading your list of positives it would seem, IMO, extremely unlikely that if the DSM IV criteria were appropriately applied to your son he would be diagnosed with an autistic spectrum disorder. I suspect there's a very good chance, though, that he will be, for all of the reasons stated above. I hope you'll let us know the results, and that whatever they are you son gets any support he does need, while not being disabled by damaging assumptions about things he does not.

 

L&P

 

BD

[bid]

Hi Suki,

 

It is perfectly possible that your son may have, for example, ADHD and Dyspraxia, without also being on the autistic spectrum.

 

Bid

[Mumble]

It sounds like you and others are considering a range of possibilities rather than being tied to (and therefore having the possibility of falling into the trap of looking for) one explanation. There are many possibilities you've raised, and Dyspraxia, which Tally raised also came to mind. I'd just urge you to keep an open-mind, explain/record the issues rather than trying to see things/fit them to anything for now, and see where the assessments go. Whatever the outcome, and awareness of his specific issues will be the most beneficial thing in helping him develop as you know what to work on specifically with him, rather than what a particular diagnosis tells you to work on.

[Suki]

Thank you all for your replies.

 

I did have a brief look at Dyspraxia but, correct me if I'm wrong, isn't motor skills a big problem with this? My son has very good motor skills (apart from his pencil grip issues), has no problems with PE and rides a bike & scooter really well. He can also kick a ball really well with his dad, just a shame he feels unable to join in proper football games.

 

Baddad, I know what you mean about the criteria being subjective. The 2 criteria I half ticked were the one you mentioned about restricted patterns of interest due to his car obsession and the inflexible adherence to routines based on what his teacher said about the water bottle etc. However, although he is very obsessed with cars, I wouldn't call it restrictive as the interest is very broad. In fact, he loves all vehicles and plays imaginative games with them. The interest extends to anything mechanical, electrical, science based, techy, computers etc. Not surprising as his dad is an engineer and has similar interests! The thing with the water bottle etc is certainly a bit strange but I haven't really noticed him doing anything like this at home,although he can get a bit funny if I disturb things in his room, but most kids would wouldn't they? He is generally very flexible in where we go and what we do and not routine driven. In fact, I know a mildly autistic boy who insists on being home at a certain time to what a certain TV prog a la Rainman. My son would never do anything like that. There is no way I could tick anything in A & B no matter how hard I tried to find *something*. I have to say I do know quite a few autistic children, most of them mild, which shows how common it is to get an ASD diagnosis. I do struggle to see how some of them would meet all that criteria although, to be fair, I don't know them like I know my son so there could well be things I don't see. After reading your replies, if my son does get an ASD diagnosis based on this criteria I will definitely be disputing it!

 

I see the point about the fussy eating and sleeping etc. My daughter is also a fussy eater (probably worse than my son) but because I have no concerns about her I don't analyse everything little thing she does like I do with him.

 

Having said all that, he definitely does have significant problems and his differences between him and his peers are getting more obvious the older he gets. Its just a case of finding out what it is and getting him proper help.

 

I will keep you posted but I have a horrible feeling it will take a very long time to get to the bottom of this.

 

Oh, as we speak I have a "summer fair" set up in my lounge complete with bouncy castle and some "cool cars on display on stands", actually they're DVD boxes but who cares lol, the kid has a great imagination!!

[baddad]

In fact, I know a mildly autistic boy who insists on being home at a certain time to what a certain TV prog a la Rainman. My son would never do anything like that.

 

 

Little boys who can 'insist' and have their wishes met will do so. That has nothing to do with autism, 'Mild' or otherwise!

I'm sure his Mum (and dad) would protest that their little boys 'insistance' was very different to a neurotypical child's 'insistance', but IMO the Lady (and gent) probably doth protest too much... As you've acknowledged with 'fussy eating' and your DD, if you're looking for something and expecting to see it and have a preconceived explanation for why you will see it when you do so it you will find the answer you are looking for.

 

As already said, I really hope you can find some strategies and support to help your son, and it really is great (and refreshing, if I'm honest) to hear that you haven't already identified autism as the 'answer' and are just looking for a consultant who will confirm it for you. Have a lovely day at the summer fair, and win a coconut for me!

 

L&P

 

BD

Edited May 14, 2011 by baddad