9:27am November 14, 2014

“

The diagnosis of Autism is based on behaviour.  Interpreting the significance of deviant, absent or delayed behaviour depends on a sound background of clinical knowledge.  Since Autism is a rare disorder, there are relatively few experts who have the experience of a large number of cases.  But experience matters.  Experience allowed diagnosticians to sense quickly that elusive feature, autistic aloneness.  At that stage, however, they will consider Autism only as an hypothesis to be checked out systematically.  They will listen at length to the family and carefully observe the patient.  They will administer psychological tests and construct a history of the course of the disorder from the beginning.  In this way, Autism can be diagnosed reliably.

In order to evaluate autistic symptoms it is necessary to take into account the age of the child and, even more importantly, its mental age.   There are behaviours which children cannot show below a certain mental age.  For instance, before two years the average child cannot be expected to talk in grammatical sentences.   All this should be obvious to an expert, but the well-meaning amateur often does not realize what a difference mental age makes.

Diagnosticians often differ when it comes to borderline cases.  Therefore it is possible that a child may be labeled autistic at one cenre and something else at another.   This worries lay people who may wrongly jump to the conclusion that it is imposssible to diagnose Autism, and that different authorities are talking about different conditions when they talk about autistic children.  The conclusion is unwarranted.  In fact there is strong consensus among experienced clinicians.

If a young child is referred on the basis of queries regarding social and intellectual development, the possibility of Autism needs to be considered.  However, many other possibilities must be considered as well.  Questions to be asked include:  Is this a developmentally delayed child who will catch up eventually?  Is there a serious neurological or sensory defect that impedes normal development?  A glance at a textbook of child psychaitry will show that there are a great number of developmental abnormalities.   In addition, there are some borderline or unclassifiable disorders.  Often they are designated as such to avoid the risk of inappropriate classification.  In this respect Autism is no exception.

”

Uta Frith, Autism: Explaining the Enigma

If it seems as if the doctors who diagnosed me with infantile psychosis were reading ideas word for word from Frances Tustin’s 1972 book Autism and Childhood Psychosis, it looks as if the people who initially (before the infantile psychosis people got hold of me) diagnosed me were reading Autism: Explaining the Enigma by Uta Frith (1989).

At least, her description of the diagnostic process was precision-accurate. I was admitted to a psychiatric institution for suicidal behavior, the doctor (who by that time had decades of experience as a child psychiatrist, and plenty of experience with autistic children) saw that I seemed autistic, but then wrote that down as a “working hypothesis” only, then he interviewed my mother, observed me at length, gave me a huge number of tests, and then and only then committed a diagnosis to paper. And then of course he used the vaguest diagnosis possible to avoid labeling me with something that could do me harm down the road, and only used autistic disorder four years later when that harm was not possible anymore and diagnostic practices had changed anyway.

It’s really weird reading these old books on autism, not because the books were necessarily right about anything (although they have their moments of “WTF they already knew this back then and nobody is saying it again until now?!”), but because they shed light on the thinking of doctors I knew at various times, where I could not work out why they did things the way they did.

In the “WTF they knew this already?” department, Bryna Siegel’s The World of the Autistic Child actually mentions that autism and PDDNOS are basically the same thing. Which, however much I dislike the author and her books (some of it’s personal, I knew a kid whose life she really screwed up), is more accurate than most of what you heard in the time since she wrote that book. (Which gives no more insight into the world of an autistic child than Frith’s book explains any enigmas.)

12 notes