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Clear as mud; does confusion reign in the field of autism spectrum disorder diagnosis? (And yes! – we prefer ‘condition’ too!) But here’s why ‘disorder’ is often used, for autistic individuals… (ICD 10 / DCM-5)

Clear as mud; does confusion reign in the field of autism spectrum disorder diagnosis? (And yes! – we prefer ‘condition’ too!) But here’s why ‘disorder’ is often used, for autistic individuals… (ICD 10 / DCM-5)

Autism may be the most confusingly diagnosed and labelled condition across the entire world…”

Whilst we aim to be positive here at Spectra.blog, there’s so much that’s frustrating about the state of autism diagnosis, currently! Or rather, there are inconsistencies and misunderstandings, as well as disparities, in terms of different clinicians, authorities, countries and territories, and their protocols. It’s no wonder that people new to the world of autism information are left feeling confused.

ICD-10 – UK

For example – a national (UK) training body offering a nationally-recognised autism qualification confidently maintains in 2018 that the three main autism diagnoses are ‘severe’, ‘high functioning,’ and ‘Asperger’s Syndrome’.

Meanwhile (and CONVERSELY), the ICD-10, the most commonly-used diagnostic manual in the UK, lists Childhood Autism, Autistic Disorder, Atypical Autism and Asperger Syndrome, as well as the still-clumsy ‘Pervasive developmental disorder, not otherwise specified’, as the categories.

DCM-5 – USA

Meanwhile in America, within the DCM-5 diagnostic manual, clinicians use the broad term Autism Spectrum Disorder, but with a numerical note of severity, and / or the additions of ‘With or without accompanying intellectual / language impairment,’ dividing the ‘severities’ from 3 to 1. (e.g ‘Autism Spectrum Disorder level 1’ is seemingly akin to an Asperger’s-type diagnosis, under the ‘older’ system).

To further confuse things, in real terms, there’s seemingly very little diagnostic difference between High Functioning Autism (HFA) and Asperger Syndrome. The differentiating factor is whether or not developmental and language delays were seen in infancy, but in all honestly, that’s surely often subjective, based on familial memories?

In any case, someone already diagnosed with HFA doesn’t necessarily accept that they are similar in diagnosis to Asperger’s, and vice versa.

Functioning labels

Another point is the functioning labels, (mild, severe, high functioning, low functioning), which DCM-5-using clinicians now tend to omit, but that many people still use conversationally (as do, as discussed, some training providers of autism courses / qualifications).

Furthermore – what about the situation we alluded to at the start – that many people aren’t happy with the reference to ‘disorder’ in autism spectrum disorder, preferring ‘condition’? A great, valid point, but with BOTH diagnostic tools using ‘disorder’, how else is an individual to find out info and information, without searching for the correct diagnostic term?!

All in all, it is an extremely confusing situation – but perhaps with the UK’s imminent arrival of ICD-11, everything will become clearer? Forgive us for what is essentially a blog in the style of a rant – but so many people, ourselves included, are frustrated and a little confused! Autism may be the most confusingly diagnosed and labelled condition across the entire world!

A little disclaimer – here at Spectra.blog we don’t claim to be experts about Autism Spectrum Conditions / Disorders; the information we post here is based purely on our own exposure and experiences.

If you fancy some more ‘ranty content, you may also like –
Is Autism’s Triad Of Impairments outdated? (ASC / ASD / Asperger’s) – and  ‘Them V Us – disparity in the autism spectrum condition ranks (ASD/ASC/Asperger’s).’

 

Is Autism’s Triad Of Impairments outdated? (ASC / ASD / Asperger’s)

Is Autism’s Triad Of Impairments outdated? (ASC / ASD / Asperger’s)

Autism is often defined by the famous ‘triad of impairments’, a concept introduced in the late 1970s. (Wing and Gould.) Undertake any course of further learning about autism or read a reference book, and you will come across it as the gold standard of diagnosis regarding autism spectrum conditions (ASCs).

Our question is – Is Autism’s Triad Of Impairments now dated?

The Triad of Impairments is a tool describing ASC limitations – it’s sometimes described as including the three elements of Communication, Social Interaction and Flexible Imaginative Functions (which can also mean repetitive or obsessive behaviours; sometimes, the third element of the triad simply refers to ‘flexibility’ and / or ‘imagination’.)

The triad has also been described as impairments in theory of mind and executive dysfunction, and a propensity to ‘detail-focused’ behaviour.

However, with the revisions to America’s DSM-IV, e.g. as the various sub-types of autism have been amalgamated into autism spectrum disorders (ASDs) / ASCs, the triad as a concept is more frequently being condensed further, as just two elements: (1) impaired social communication and social interaction (as one), and (2) restricted behaviour/flexibility.

Our question relates to whether (1) the triad is retained at all. And (2) whether ‘impairments’ is necessary as a term, being a description with such negative implications?

A 2009 Study states: “Exceptional pioneering work in the late 1970s gave rise to the concept of the triad of impairments: impaired communication, impaired social skills and a restricted and repetitive way of being-in-the-world. This allowed a new way for professionals and families to understand autism; this was a transitional idea.”

Some experts are moving away from the triad, which is seen as a single explanation for the symptoms of autism – as found in the articleTime to give up on a single explanation for autism’.

The authors state: “Despite half a century’s research into ASD, there is little evidence regarding the unity of the three core areas of impairment [as described in the triad]. The triad of impairments can be fractionated, and should be studied separately.”

 

RETAINING the triad (and considering it imperative for our learning) could do two NEGATIVE THINGS:

(1)Inhibit the development of research into strategies to help autists. The same article states: “If different features of autism are caused by different genes, associated with different brain regions and related to different core cognitive impairments, it seems likely they will respond to different types of treatment.” This is why the authors recommend studying the three ‘triad’ elements separately, rather than looking for SOMETHING that causes all the three ‘triad’ elements.

(2)Support the notion that autism requires a cure. Again the article, which supports the idea of focusing on each element of the triad, instead of clubbing together the three traits, states: “Abandoning the search for a single cause [for] autism may also mean abandoning the search for a single ‘cure’ or intervention.”

The link with genes

An interesting 2008 study asked whether GENES affect the triad – e.g. whether the triad of autistic-like traits is mirrored at the genetic level; with separate genes contributing to each so-called impairment? The authors found that: ‘Each aspect of the triad is highly heritable.’

The authors stated that the ASC triad could have multiple causes, at genetic, neurological and cognitive levels, meaning that autism can result when a number of independent ‘impairments’ co-occur. The authors suggested that: “Some avenues of (ASC) research may be best pursued WITHIN, rather than across triad domains,” e.g. focussing on each element of the triad, rather than looking at the triad itself, as a non-negotiable platform.

There are other issues with the triad too. Does it take into account age and gender? Not really. A 2014 study hinted at ambiguity, and stated: “Findings regarding gender differences in the core triad of impairments seen in ASD remain ambiguous.”

Also, should the triad somehow incorporate sensory issues in autists, e.g. their over-or under-sensitivity to sounds, touch, light, temperatures etc? As this is surely a major element or factor for people with autism.

Impairment or the autie advantage?

Let’s move onto the term impairment – an objective term. A ‘New Scientist’ article states: “Auties, as some people with autism call themselves, don’t merely think differently: in certain ways they think better. Call it the autie advantage.”

A blog on SEN Assist sums our question of ‘impairment’ up well, with author Adele Divine stating – “The ‘triad’ is a helpful tool in that it highlights difficulties, which are common to those with a diagnosis of autism, but I have an issue with the word ‘impairment’. The dictionary definition of impairment is: ‘The result of being impaired; a deterioration or weakening; a disability… ‘The Triad of Differences’ would be less harsh. Differences may lead to difficulties, but with the right structures and supports differences can also lead to great discoveries. Many of the difficulties represented in the triad can also be positive character traits. The word ‘impairment’ does not suggest this.”

Focussing on autism’s positives

The existing triad does focus on impairments where an autistic person is concerned, but as we touched upon in our blog: ‘Tony Atwood’s theory of ‘discovering’ the strengths of Asperger’s instead of diagnosing traits and disorders’, perhaps we (as a group of interested parties) should focus more on positive autism traits, described by Professor Atwood as including aspects like consideration of details, a determination to seek the truth, and an original, often unique perspective in problem solving? (For interest, see Professor Atwood’s books HERE.)

As described on a blog for workshop provider, Autism Awareness Centre, autist John Simpson has created his own, more positive triad for the autism spectrum, which is:

*The need for predictability

*The need for motivation

*An uneven cognitive profile (splinter skills)

To conclude this rather lengthy musing, we’d love our followers’ feedback on the triad of impairments within autism – how valuable is it in today’s more enlightened culture and #actuallyautistic mindset, whereby autists promote acceptance?

A little disclaimer – here at Spectra.blog we don’t claim to be experts about Autism Spectrum Conditions / Disorders; the information we post here is based purely on our own exposure and experiences.

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Data protection & privacy policy – Spectra.blog

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Tuesday, 15th May: Judy Eaton of Help 4 Psychology tells BBC Radio 5 Live why awareness of PDA (pathological demand avoidance, an autism profile) must increase

Tuesday, 15th May: Judy Eaton of Help 4 Psychology tells BBC Radio 5 Live why awareness of PDA (pathological demand avoidance, an autism profile) must increase

NEWS FLASH!

This Tuesday, 15th May, at 6.30am, Judy Eaton of Help 4 Psychology has been invited to the studio of BBC Radio 5 Live (UK) to discuss PDA (pathological demand avoidance), and help raise awareness of this autistic profile.

According to the PDA Society, an organisation that provides information and support for parents, families and teachers, PDA is currently recognised as an autistic profile. Key areas of concern for the individual are: ‘An anxiety driven need to be in control and avoid other people’s demands’, and ‘An Intolerance of Uncertainty.’

Read our blog ‘A short introduction to PDA /pathological demand avoidance’ HERE.

(The interview should be available on the BBC i-player afterwards as part of 5 Live’s programming.)

 

Steve O’Connor’s song: “Just Me (Sam’s Song)” – a beautiful song helping autists find their voice (ASD/ASC)

Steve O’Connor’s song: “Just Me (Sam’s Song)” – a beautiful song helping autists find their voice (ASD/ASC)

Steve O’Connor, a talented singer, songwriter, recording artist and poet from Liverpool in the UK (pictured above), has recorded a beautiful song he wrote about a very inspirational young lady by the name of Sam, who has Autism.

“The song is called ‘Just Me (Sam’s Song)’ and by its nature is designed to raise awareness on such an enigmatic subject – I hope this song may help in this way, for those who sometimes cannot speak for them selves, this is their song, their voice,” Steve tells us.

Click HERE to listen to the song!