By Sullivan | LeftBrainRightBrain
Did the child have autism?
It’s a pretty serious question, and not as simple as many think. Many think autism is defined merely as “a collection of symptoms”.
The question “what is autism” has been discussed a lot in the last year, both directly and indirectly. This was prompted in large part by the Hannah Poling concession, and often centered around the phrase “features of autism”.
Lisa Rudy at autism.about.com recently addressed this issue in a blog post: If It Looks Like Autism and It Acts Like Autism…
In her post she states:
But according to the diagnostic manual, unless the symptoms can be better explained by Retts disorder, Childhood Disintegrative Disorder or Schizophrenia – people with autism-like symptoms have an Autism Spectrum Disorder.
Well, yes and no. I’ll go into it because this bugs me somewhat, so indulge me while I explore this. There are three important facts that many leave out from the DSM-IV’s diagnostic criteria for autism.
First—the DSM-IV is a set of “diagnostic criteria”, not a definition of the disorders.
Second, consider this phrase in the diagnostic criteria:
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.(Emphasis added.)
The criteria of “before age 3” is very important. I’ll discuss this more below. The third “fact” that people tend to ignore is related to the age 3 criterion:
The closest thing to a definition of Autism in the DSM-IV is as a “Pervasive Developmental Disorder”. Again, emphasis added.
Sorry for the sidetrack. But, there is a difference between the diagnostic criteria and the definition of what autism (or any condition) is.
However, this does not mean, as I have have asserted incorrectly in the past, that the fact that autism is a developmental disorder precludes giving an autism diagnosis to someone suffering from an injury. Developmental disorders include, for example, traumatic brain injury.
OK, now that we have given more depth to the “definition” of autism, what about that example I started this post with?
Consider a child who undergoes a traumatic event. This child develops “behavioral symptoms normally associated with the syndrome of infantile autism”. After treatment and time, the symptoms improve.
And, no, I wasn’t referring to Hannah Poling or to anyone you probably were thinking of. This example is from this paper, Acute onset of autistic features following brain damage in a ten-year-old . Here’s the abstract:
Abstract We report the case of a 10-year-old boy who, following a prolonged period of unconsciousness, displayed severe eye-to-eye gaze avoidance, sensory inattention, and some other behavioral symptoms normally associated with the syndrome of infantile autism. The symptoms lasted only a few months and were associated with the more permanent behavioral changes of post-encephalitic psychosis. Serial computerized tomography scans were taken during his illness and recovery. The relevance of this case to the etiology of infantile autism is discussed.
I’ll admit: I wasn’t able to get the paper from the library and I didn’t pay the $34 to download it. I’d really like to read this in full, because it raises some very interesting questions.
One big question arises from the fact that this child isn’t/wasn’t autistic. He had autistic features, but he wasn’t autistic. Why wasn’t he given an autism diagnosis? Well, for one big reason, the symptoms had an onset at age 10.
Now, here is where it gets interesting. Consider this hypothetical situation: What if a two year old had the exact same causes for his autistic behaviors as the 10 year old in this paper? Would the 2 year old be “autistic” while the 10 year old isn’t? It’s worth taking a moment to think that one through. This is a big question.
If symptoms define one as autistic or not, then both the 10 year old and the hypothetical 2-year-old are autistic. But, if we include the criteria that onset of symptoms must occur before age 3, then only the 2 year old is autistic—even though the cause is the same. Obviously this doesn’t make any sense. How do they solve this contradiction? Does the 10 year old get an autism diagnosis? Does the 2 year old not get a diagnosis?
As I noted above, this is a much more difficult question than most people (even self-designated experts) want to make it out to be.