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So much snow! - Transience Divine
February 10th, 2010
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So much snow!
Everyone is calling it Snowmageddon-- a total of some three feet of snow since Friday, in an city with only one snow plow. We've have reports of friends trapped or displaced without heat and electricity, the metro is stopped, the government (which means everything except for Thai food) is closed. Cars can't drive (though many try), so people have taken over the streets. But we're safe, and from our window, Snowmageddon is absolutely beautiful.

our windowSnowy Street
From out windowSnowy Street


What do you all think of the DSM-V? And in particular, the proposal to classify all MIT students as having "Autism Spectrum Disorder"?

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From:nobody_nowhere
Date:February 10th, 2010 04:24 pm (UTC)
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I think that the DSM has been in need of revision for a while, especially with respect to ASDs.

I would not expect the DSM-V to diagnose any more or less MIT students as ASD than already are, and am curious as to which proposal you think would lead to this.

Merging AS with HFA seems to be under consideration, but undecided upon - it truly is unclear what the major differences in the disorders are. Currently, HFA requires a full spectrum Autism diagnosis, which requires significant language delay and fitting slightly more diagnostic criteria than AS. However, the decision of these dividing lines was originally somewhat arbitrary, and it has been pretty unclear whether there is any long term clinical difference between the two. As an example, the last paper I read on this, "Defining the Behavioral Phenotype of Asperger's Syndrome" (Ghazziudin, 2008), concluded that compared to HFA people with AS were more likely to be "Active but Odd", while those with HFA were more likely to be "Aloof" or "Passive". One has to wonder whether this is more of a personality type difference that was naturally selected for by criteria that splits people who talk early apart from those that talk later or not. In particular, it's not clear that the actual social and otherwise deficits between HFA and AS are that different, aside from people with HFA tending to have slightly more severe deficits on average (they have to fulfill more diagnostic criteria than AS - if they only filled enough to satisfy AS diagnostic criteria by the DSM-IV and had clinically delayed speech, they would be classified as PDD-NOS. Many studies combine AS and HFA (and PDD-NOS) in order to get a sufficiently large ASD group. Studies with enough representatives from each group to do a three-way comparison generally find relatively minor differences (if any) between groups, with perhaps the HFA group having slightly more deficits (see what I said about the diagnostic criteria, though). Basically, as far as the nature of deficits and types of appropriate intervention, it's not clear that there is a major difference between HFA and ASD. And PDD-NOS is such a catch-all right now that there isn't a ton to say about it.

I could talk on this for a while, and would be delighted to discuss more offline (well, given our locations, online but not on the LJ forum), but an amusing (to me) and somewhat relevant quote from the Ghazziudin paper: "In case of disagreement about the diagnosis (AS vs. HFA), a consensus was reached by discussion."

Which is to say that distinguishing HFA from AS is hard - perhaps because the actual differences being used to separate them isn't meaningful?

Um, not sure why I went off on that particular topic relating to ASDs, since it looks like a number of topics are under consideration, and I could talk about any of them.
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From:nobody_nowhere
Date:February 10th, 2010 04:40 pm (UTC)
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Reading through more of the DSM-5 website, are you referencing "The recommended DSM-5 draft criteria for autism spectrum disorders include a new assessment of symptom severity related to the individual’s degree of impairment. The draft criteria also specify deficits in two categories: 1) social interaction and communication (e.g., maintaining eye-to-eye gaze, ability to sustain a conversation and peer-relations) and 2) the presence of repetitive behaviors and fixated interests and behaviors. Additionally, in recognition of the neurodevelopmental nature of the disorder, the criteria require that symptoms begin in early childhood. Clinicians must take into account an individual’s age, stage of development, intellectual abilities and language level in making a diagnosis." when you suggest that it would classify "all MIT students as having (ASD)"?

That's really not such a big or notable change from the preexisting diagnostic criteria, though. In fact, it's not immediately clear how that changes the current diagnostic criteria - that's simply not enough information. I am somewhat disappointed by the failure to include in this description of the diagnostic criteria anything about sensory issues (which was once part of the diagnostic criteria, and was then removed, but has been having renewed research interest in the last couple of years verifying that it is seen pretty much universally in ASD). It is my personal belief that ASD is caused by overgrowth of neurons early on followed by underpruning, leading to unusual strengths at lower level tasks combined with deficits at higher order tasks, and that this underpruning can be best observed at the clinical/diagnostic level through sensory issues. ah well.
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From:jrising
Date:February 10th, 2010 07:13 pm (UTC)
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Fascinating! I don't think I have the background you do to talk about this, but here are my thoughts.

The line the piqued my interest was from a NYTimes article (http://www.nytimes.com/2010/02/10/health/10psych.html?hpw) that Asperger's would be folded into ASD. It's discussed more fully here: http://www.dsm5.org/Newsroom/Documents/Autism%20Release%20FINAL%202.05.pdf

From a technical standpoint, I think that's a good move. For a long time, I've thought that AS was a kind of HFA, and I'm glad to see that that view has official recognition.

Socially, though, I'm not at all sure of the fall-out. Culturally, autism is associated with retardation, and equating it (on a spectrum) to AS could seriously stunt the development of a lot of intelligent children who might otherwise end up at high-end tech schools. On the other hand, it could do the opposite, helping people recognize the intelligence of people all along the autism spectrum. Labels are very powerful, and it took a lot of work and luck for MIT students to be able to own AS proudly.
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From:nobody_nowhere
Date:February 10th, 2010 07:53 pm (UTC)
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I'm at work, so can't make a longer post now. but have you seen this op-ed?

http://www.nytimes.com/2010/02/10/opinion/10grinker.html?ref=opinion
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From:jrising
Date:February 10th, 2010 08:19 pm (UTC)
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Great article. I doubt that the stigma surrounding autism has faded as much as Grinker claims, but I agree with the rest. An in any case, one of autism's greatest strengths is indifference to social opposition.
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From:nobody_nowhere
Date:February 11th, 2010 11:22 pm (UTC)
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Ran across this article today.

http://news.yahoo.com/s/ap/20100211/ap_on_he_me/us_med_asperger_s_diagnosis;_ylt=AiBKHKegt1QufQfZG.RKSWis0NUE;_ylu=X3oDMTJvb3B2bWprBGFzc2V0A2FwLzIwMTAwMjExL3VzX21lZF9hc3Blcmdlcl9zX2RpYWdub3NpcwRwb3MDNwRzZWMDeW5fbW9zdF9wb3B1bGFyBHNsawNwcm9wb3NlZGF1dGk-

Apparently there are a bunch of people with AS that are upset about this. Personally (as indicated in other stuff I've written) I tend to feel that we should be going with the 'technical standpoint' in writing a diagnostic manual and not worry so much about a 'social fallout'.
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From:nobody_nowhere
Date:February 10th, 2010 08:06 pm (UTC)
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For more on people's reactions to the decision (re: what does changing the labeling scheme mean):

http://www.npr.org/templates/story/story.php?storyId=123527833&sc=fb&cc=fp
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