A PARENT'S TAKE ON DIAGNOSIS AND THE DSM-IV

When most of think of diagnosis by a doctor we usually think of stethoscopes, blood tests, x-rays, or other less pleasant and more intrusive probings and proddings. However, to be diagnosed with Autism, Asperger's syndrome or other developmental disorder, you will probably get to keep your clothes on during the examination and you won’t find the doctor’s surgery full of high tech machinery. The doctor will mainly want to talk to you, and perhaps your family and gain an understanding through observing and listening to you.

Looking for a cluster of symptoms

The reason for this rather primitive form of medical examination is that the Doctor will be seeking to ascertain the extent to which you fit in with certain diagnostic criteria for a disorder of the mind, in this case Autism Spectrum Disorder, and this the tricky bit, he or she is not just looking for one symptom or characteristic, but a group of them. And to make matters even more tricky, the cluster of characteristics are, individually, what you would find in literally hundreds of millions of people around the world.

For example, how many people do you know who display “apparently compulsive adherence to nonfunctional routines or rituals” or “marked impairment in the ability to initiate or sustain a conversation”? So rather than go through the laborious process of diagnosing everyone's ritualistic, self-centered, and tactless family members with Autism Spectrum Disorders, a group of psychiatrists came up with what is affectionately known as DSM-IV, or the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.

To diagnose or not to diagnose

Okay, no one starts off with a 4th edition; they start with the first and revise it several times. The purpose of this document is to attempt to create consistency of diagnosis, so that a person who is considered rude and obnoxious in one culture is less likely to be diagnosed as having a major mental disorder in another culture. So what happens with Autism Spectrum Disorders, as it does with other disorders of the mind, is the diagnosing professional is seeking to ascertain whether a person has certain characteristics, and has sufficient numbers of them and intensity of them to qualify for a diagnosis. So someone who has serious difficulty holding a conversation, one of the criteria for autistic disorder, but has no other of the characteristics, would not qualify for the diagnosis.

Muddled complexity

The diagnostic criteria for High Functioning Autism and Asperger’s Syndrome are very similar in the DSM-IV, and this is why many people, including qualified psychiatrists, treat the disorders as if they are the same condition. Then the DSM-IV has no reference to Autism Spectrum Disorders, but speaks only of Pervasive Developmental Disorders. Autism and Asperger’s syndrome are covered by both, but Autism may be called Autistic Disorder or AS instead, while Asperger’s syndrome may be called, Asperger syndrome, Aspergers syndrome, Asperger or just AS.

It can be a very emotional experience having your daughter diagnosed with Asperger’s syndrome and having to try to assimilate all these terms, and come to terms with very nebulous diagnostic criteria, was not a lot of fun.

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