ASD Diagram

I designed the (hopefully) simple graphic below to help people understand the family of Autism Spectrum Disorders — as outlined in the DSM-IV — and how they relate to one another (click on the image to see a larger version). I did not include Rett's Disorder or Childhood Disintegrative Disorder, as they usually receive their own diagnoses apart from an ASD.

As you can see, much of the confusion comes from the duplicative use of terms like PDD and ASD at both the category and sub-category levels.

It's important to note that the just-approved DSM-V subsumes both PDD-NOS and Aspergers into one category called, quite simply, Autism. In addition, a new category called Social Communication Disorder has been created to hopefully account for children who don't meet the new ASD criteria but still have deficits in the key areas of communication and social skills.

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Let me know what you think on Twitter: @1asddad

October 2012 Links

I'd hoped to post these before October was over, but Hurricane Sandy slowed me down a bit. Nonetheless, here are some interesting links I've run across in the past month.

In other news, we've received final legal approval for our autism app designed to help parents understand signs and symptoms. Hopefully it will be available in the iTunes store later this month (for free, of course).

Concerns About the DSM-V

dsm As always, Emily Willingham does a great job illuminating concerns about proposed changes to the DSM's criteria for diagnosing autism. With the goal of reducing false positives (people diagnosed with autism who don't actually have autism), the new criteria might actually exclude a not-insignificant number of people who actually do have autism. This begs the question, which is worse: false positives or false negatives?

I've read conflicting accounts as to the potential impact the new criteria might have on diagnosing autism, but one thing is clear: there's a lot of confusion. And where there is confusion, there are bound to be problems.

Wouldn't it be better to treat someone who has issues that may or may not add up to autism, rather than deny treatment to someone simply because the new criteria are vague and open to broad interpretation?

In her conclusion, Willingham makes a fascinating proposition: perhaps the goal of trying to affix a label or specific diagnosis is in itself problematic.

In her words, "We all have gaps that need mitigating. If we addressed specific gaps instead of wholesale labels, we’d all overlap with each other in some way, for anxiety, attention deficits, compulsive or obsessive or impulsive behaviors, depression, mania, intellectual disability or learning differences in specific areas, or addiction–and it would be a lot harder to stigmatize what we have in common, regardless of our overall neurobiology. Furthermore, we wouldn’t have to worry about applying lists of criteria that result in the wrong labels or therapies for the wrong people, or–worse in my mind–overlooking entirely the people who need help and support."

Well put. Read her full post here.

Debunking the Theory du Jour

Trichuris Suis Above: a cure for autism?

You may have heard or read last Saturday's NY Times article by Moises Velasquez-Manoff correlating autism with immunity and influenza, and going further to suggest an, ahem, unorthodox means of preventing autism (spoiler: parasitic worms!).

I'll admit, on first read the article seemed credible. Upon subsequent readings, however, I got an uneasy feeling. Something about it didn't seem…right.

I'm not a scientist, obviously, so I couldn't put my finger on what, specifically, was bothering me. I did note that the author made several giant leaps of logic, and made some causal connections that seemed tenuous at best. Then there were some statements that just seemed…off (e.g., if medical care in third-world countries is so poor that they live with widespread parasitic infections, how can we trust their stated rates of autism? And mice may show signs of autistic behavior, but neurologically they do not have autism.).

Since I'd noted a bit of a splash (if that's the right word) around the Web after the article was published, I thought I'd try to write about my qualms. Then I came across a post by biologist, writer, and editor Emily Willingham that did a far better job expressing my concerns than I ever could. Her rebuttal to the article is excellent; if you have time, read it here.

At the end of her detailed and thoughtful post is this closing statement, which pretty much sums it up:

"What we have here is an argument that relies on shaky and shifting hypotheses of autism and autoimmune epidemics and hygiene, built using sparse data and scientific hints, a poor understanding of basic evolution and ecology, and a paradox of calling for a return to a more infectious past to 'cure' autism while blaming immune-dysregulated, occasionally infected mothers of the present for...autism. In his closing, Velasquez-Manoff argues that evolution provided us with a roadmap of the original microbial and parasitic ecosystems we once were, one that, presumably, if we follow it, will guide us out of the 'insanity' and 'affliction' that is autism. If it's possible, that's where he's most wrong. Evolution isn't something that happens with a plan. To describe it in those terms is to have a profound failure of understanding of what evolution is. Where we're going, evolutionarily speaking, there are no roads. And it would be better for most of us if there weren't any parasitic worms, either."

Let me state it here and now: I'm unequivocally pro-science. Real science. Science that is rigorous, replicable, peer-reviewed, and proven. Anything less is speculation, and while there's nothing inherently wrong with speculation (it's where science often begins, after all), speculation should never be passed off as fact.

Velasquez-Manoff's piece was published in the Op-Ed section but positioned itself as a matter fact. It's not. There's simply too much speculation, circular thinking, reliance on tenuous causality, and hyperbole. Is it an interesting theory, one worthy of further research? Perhaps. But is it science? Not yet anyway.

Autism Science News

A lot is happening in autism science at the moment, especially in the areas of etiology and diagnosis. Here are some interesting articles I've come across in the past few months: