As a Psychologist, I’ve Seen Many Children Misdiagnosed as Autistic—It’s a Clinical Catastrophe

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Editor’s Note: This blog is also being published on our affiliate site, Mad in the UK.

The one-size-fits-all autism spectrum disorder (ASD) diagnosis, as configured in the Revised Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5-TR), is a clinical catastrophe.

Well-meaning child practitioners who take the current DSM autism criteria at face value likely assume that the widely-used ASD diagnosis provides them with understanding of and insight into children’s developmental difficulties and a reliable basis for making educational placement and treatment recommendations. Nothing could be further from the truth.

Young boy looking through the window

During my extensive career, I have encountered literally thousands of young children whose developmental challenges had been misdiagnosed in other clinics as autistic or, more currently, “on the spectrum.” Victims of what I consider the promiscuous use of the autism diagnosis, actualization of their developmental potential was compromised when treatment decisions were based on the current clinically ill-conceived autism diagnosis, which most often proved to be a misdiagnosis.

As I discuss below, a small minority of the many autism-suspected children I saw did fit the original criteria for autism. However, it is far too easy for a child to get an autism diagnosis these days. Why? A careful reading of the DSM-5-TR autism criteria immediately exposes the core problem. In the autism criteria section “Deficits in Social Communication,” we notice that the first three criteria refer to a range of symptoms, from the mild and superficial to the profound and entrenched. A range of symptoms to establish a diagnosis? This would be amusing, if the implications were not so serious.

Evidently, in 2013 the autism criteria in the DSM-5 were intentionally expanded so that more children could qualify for the therapeutic services they required. Unfortunately, by fusing together several already indistinct diagnoses—pervasive developmental disorder (PDD), Asperger’s and autism—and by loosening the autism diagnostic criteria to enable the autism “catchment area” to expand to a range of symptoms and several levels of severity, a diagnostic monster was created. Like the Blob of the old horror films, this diagnosis oozes into all the crevices, providing a handy diagnostic label for almost any developmental challenge that affects social communication.

There is a further difficulty in the section that concerns “stereotypical and repetitive behaviors.” The DSM-5 (and now the DSM-5-TR) correctly introduced as a criterion the issue of sensory hypo- and hyper-reactivity. It is, in fact, critical to note a child’s degree of sensory reactivity when autism is suspected, because we can expect genuinely autistic children to experience some degree of sensory hypo- or hyper-reactivity. However, this manifestation does not work in reverse. In other words, not all children with sensory issues are necessarily autistic. Unfortunately, with the doors of the autism diagnosis flung open so widely, I continue to encounter young children with sensory reactivity problems who have been misdiagnosed by practitioners as ASD.

The conceptualization of a range of symptoms, from light to severe, leads only too readily to the current prevalent, unquestioning use of the term “autistic spectrum.” The concept of a spectrum cannot even begin to provide a differential diagnosis. Consider the following. If your doctor diagnosed your headaches as “headache spectrum disorder,” would you accept such a facile, superficial understanding of your pain? I doubt it. You would want to know what underlies your headaches. Are they attributable to visual strain? Stress and tension? Poor sleep? A vitamin deficiency? A reaction to medication? A brain tumor?

Using the term “autism spectrum disorder” does enormous disservice to children, because it glosses over the many developmental specifics that might underlie a child’s challenges related to social communication. In the field today, there appears to be an astonishing degree of practitioners’ overlooking the fundamental clinical reality that symptoms have roots! The same symptom, observed behaviorally, can stem from myriad developmental and contextual factors. Take, for example, the DSM-5-TR autism criterion “failure to initiate or respond to social interactions.” If we allow ourselves to think clinically, analytically, and creatively, we immediately see that this social difficulty visible on the surface could be attributed to any of numerous possible underlying causes: under-confidence and social shyness; an undiagnosed hearing impairment; giftedness, with the child’s interests lying in other than social realms; a problem affecting speech, such as a word-processing difficulty, a stutter or stammer, a word retrieval challenge, or oral dyspraxia. In addition, children who have witnessed domestic violence, who have been physically or sexually abused, who suffer from depression, or who have experienced trauma will also check that symptom box of “failure to initiate or respond to social interactions.”

What is going on here? Tallying surface symptoms—without considering key developmental influences, as well as the child’s social-emotional context and certain physiological variables, such as food sensitivities, hearing loss, sensory overload and so on—too easily leads to a falsely positive autism diagnosis.

We see then that a close reading and thoughtful consideration of the DSM-5-TR autism criteria expose a number of weaknesses in logic and in developmental assumptions, making this diagnosis a truly elastic, one-size-fits-all concept. What is the result of such accommodating diagnostic criteria? A huge incidence of false positives, not commonly acknowledged in the field. It is no wonder that the statistical incidence of autism appears to be soaring, triggering concerns about an autism epidemic. I estimate that of the thousands of autism-diagnosed children whom I have reassessed using qualitative (that is, descriptive, functional, interactive, developmentally sensitive) means, at least 90% of them had been misdiagnosed as autistic when the DSM had been used previously at other clinics.

Diagnostic Promiscuity

The overly flexible configuration of diagnostic criteria fuels what I call the promiscuous diagnosing of autism today. The result, a recurring theme in this article, is the rampant misdiagnosis of autism. In over 30 years of clinical experience in this field, I have found the following childhood developmental difficulties to have frequently been misdiagnosed as autism by practitioners who applied DSM-IV, DSM-5 or DSM-5-TR criteria:

  • mild to moderate emotional difficulties.
  • more serious emotional difficulties which appeared to be related to psychosis, as later confirmed by a specialist.
  • oral dyspraxia, a condition in which the hard-wiring between the brain and oral musculature is disconnected, leaving the child able to understand language but unable to produce it.
  • moderate to profound hearing impairments which had gone undiagnosed, or, if already diagnosed, whose impact had been misinterpreted as autism.
  • selective mutism.
  • brain abnormalities; genetic syndromes; Rett’s Disorder—all later confirmed by medical specialists. Alternatively, a child’s brain or genetic abnormality may have already been identified, but the impact of that abnormality had been misconstrued as autism, because the child’s resulting communication problems mimicked the broadly configured symptoms of autism.
  • miscellaneous developmental difficulties, despite normative medical test results.
  • developmental delays in children who evidenced normative potential, but who simply needed more time, patience and understanding to reach their potential. Some needed targeted therapies for speech, motricity, learning skills, or emotional well-being to close minor developmental gaps.

Unfortunately, prematurely and erroneously misconstruing as autism virtually any delay in anticipated age-level social/verbal communication is an all-too-common phenomenon, with the autism misdiagnosis then negatively impacting on the entire trajectory of a child’s developmental path.

The Aftermath of an Autism Misdiagnosis

The ramifications of an autism misdiagnosis are far-reaching. First of all, in conventional symptom-focused assessment the child’s strengths are often disregarded. Then when autistic-like symptoms and the all-too-persuasive autism diagnosis are brought into high-relief and emphasized in a child’s profile, that child’s evident and latent strengths and normative capacities are further overlooked. Because the child’s profile has been seen through a distorted diagnostic lens, the understanding of a child’s entire personality and functional potential becomes subsumed under the ASD diagnosis.

Secondly, it is not just the child’s strengths that may be overlooked during conventional assessment. Equally worryingly, the underlying weaknesses, the specific roots and causes that trigger or contribute to the autistic-like symptoms evident on the surface often do not receive the treatment attention they require.  If, for example, a child’s sensory issues, hearing loss, oral dyspraxia or emotional challenges are not recognized and then treated effectively, that child will likely continue to present with autistic-like behaviors–a situation that could be remedied with effective attention to these underlying contributors to the child’s difficulties.

A third factor concerns the well-meaning but essentially misguided recommendations regarding treatment interventions and educational placements that often result when professionals rely on the elastic DSM autism criteria as a basis for their recommendations. Unfortunately, an autism diagnosis or misdiagnosis possesses the power to cast an enduring shadow over a child’s entire future, depending on the recommendations and interventions that result.

As a long-time witness to the aftermath of autism misdiagnoses, I have found this particularly troubling, as the following examples illustrate. Five-year-old Joe had a word-processing problem. Intimidated by the assessor during a DSM symptom-focused assessment, he had refused to speak or to cooperate. He left the hospital assessment clinic with an autism misdiagnosis and a recommendation for placement in an autism kindergarten. Similarly, the practitioner who relied on Matt’s DSM-derived diagnosis of autism advised his parents: “Don’t bother talking to him.  He is autistic.  He doesn’t understand language.” My speech therapist colleague strongly advised the parents to do precisely the opposite—speak to him generously!

Finally, there is the significant, usually negative, emotional impact on parents whose child has received an autism diagnosis—or misdiagnosis. The emotional impact of a child’s autism diagnosis can prompt parents to suffer emotions that range from discouragement and sadness to depression and even a sense of mourning. Too often, along with the autism diagnosis, parents receive from practitioners a negative and pessimistic prognosis about their child’s future. The result may be that parents find that they are not available emotionally to their child, at precisely the developmental stage that the challenged child needs parents most. Are parents to blame for such a situation? Not in the least, because parents are simply responding to the information they received from specialists they trusted.

I invested much time with parents, doggedly educating them about the meaninglessness of the elastic autism spectrum diagnosis, trying to neutralize their despair, and helping them reset their child’s developmental and educational goals in a way that attended to underlying causes while nurturing the child’s strengths and abilities. Even when, by using dynamic, interactive, descriptive means of assessment, I ascertained that the child was indeed autistic, the work with parents proceeded in the same strength-focused direction, affirming to parents that autism is a state, not a trait, and that the ability to grow and change is intrinsic to all human beings.

Fortunately, I have had the good fortune to have been mentored by courageous, brilliant psychologists whose models of intervention provided a creative and efficacious way of assessing and treating suspected autism without using the DSM criteria. As a result, my colleagues and I were able to change positively the developmental trajectories of many hundreds of young children who had been diagnosed elsewhere, whether correctly or incorrectly, as autistic.

An Accurate Autism Diagnosis?

Are all diagnoses of autism essentially misdiagnoses? No, not all. I estimate that well over 90% of the autism-diagnosed children I saw had been misdiagnosed elsewhere by practitioners using the DSM. However, there were a few children who met the more intense, focused original criteria dating back to 1943.

In this article, I have occasionally used the term “genuinely autistic.” By this, I mean children who evidence extreme emotional cutoff-ness along with entrenched perseverative behaviors. That is, their presentation typifies the two primary diagnostic criteria originally formulated by Leo Kanner. Recognizing that the elastic DSM-5 and DSM-5-TR autism criteria do not even begin to provide a basis for a reliable differential diagnosis, I have found it helpful when assessing autism-suspected children to keep the focused criteria of Kanner as a mental benchmark for a genuinely autistic condition. Most of the other autism-suspected children proved to have autistiform (autistic-like) behaviors, but not actual autism. The vast majority of the children I have encountered required sensitive clinical work to decipher the root causes of their autistiform, although not autistic, developmental symptoms.

Hope

And if, by using the strict criteria of Kanner, the autism diagnosis proves accurate, is there still hope for the genuinely autistic child? Yes! In my office, positive changes begin, first of all, by casting aside the symptom-focused diagnosis and mindset and then by searching for evidence of the child behind the symptoms.  This means searching for sparks of developmental ability which can be fanned into a warm developmental bonfire.

The next step requires painstaking attention to emotional, sensory, physiological and contextual influences on development. What factors might be impeding normative social communication development?

I have found that adapting the interactive, developmental play strategies of the brilliantly conceived DIRFloortime model of Drs. Serena Wieder and Stanley Greenspan has proved to offer a much more reliable way of assessing children’s developmental strengths and weaknesses than tallying surface symptoms as per the DSM. DIR play-based interactions with a child provide a dynamic, descriptive profile in real time. The question that then motivates the work is not “What does this child have?” but rather “What can this child become?

The exceptional philosophy and methods of the late, courageous educational psychologist Reuven Feuerstein have provided inspiration, vision, alternative methodology and terminology. Feuerstein’s life’s work was rooted in an ironclad belief in the potential for modifiability as an intrinsic feature of being human. His optimistic, non-conventional strength-focused methods of working with children and adults with special needs provided the fertile ground for creative, out-of-the-box thinking about autism, unfettered by the conventional need for a diagnosis. Feuerstein’s strength-focused notion of searching for “islets of normalcy” and growing these islets into veritable continents dovetailed beautifully with the DIRFloortime notion of circles of communication. Instead of using the DSM symptom checklist, I look for islets of normalcy. What to do with them?  Create ever longer chains of circles of communication. The result has very often been developmental magic, as children grow in strength and gradually shed their autistiform symptoms.

Closing Thoughts

So often autism is treated like a terminal disease for which improvements may be sought but from which total recovery is not anticipated. How sad and how unwarranted. I have been fortunate to work with inspired colleagues and to have been able to fuse effective, alternative developmental methods for autism assessment and treatment. These methods focused on children’s strengths, not symptoms, and with such encouraging results.

It is important to remember that not every developmental difficulty has a specific label. Nor do all developmental difficulties require diagnostic labels. It is far more important to understand what is happening to a child physiologically, emotionally, and contextually than to label that child. This is a clinical reality that is very difficult for practitioners working in a symptom-focused and diagnosis-based framework to internalize and appreciate. I believe that effective clinical work can only begin when we put the autism diagnosis aside and strive to reach, understand and assist the child behind the symptoms. That is what counts.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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25 COMMENTS

  1. This is Sisyphean. Really.

    First I agree there is “overdiagnosis” of autism and that had a lot to do with turning it into an spectrum, etc.

    Now, there is no accurate or “genuine” diagnosis for which there is no Gold Standard. No biological marker, no way to distinguish normal from abnormal, and no pathological process.

    The DSM in obsfuscated language claims, as poorly I get:

    1.- There is no way to distinguish “pathological symptoms” from?, I guess normal, or normal symptoms.

    2.- There is no “pathological process” for “pathological symptoms” of mental disorders, none. That is, there is no “disease” or “disorder” that explains why symptoms occur, or how they are part of a disease/disorder. Let alone how they evolve or respond to “therapy/treatment”.

    3.- It obfuscates that by using the word incomplete, in a synonim: not complete. Incomplete in the context of the DSM means 1 and 2, above. There is no connection between pathology, symptoms, expression and recognition as part of!, pick one!.

    Then, there can’t be accurate nor genuine diagnoses of Autism, period.

    The DSM is authoritative and collates, I assume ALL research in different areas of mental disorders including autism. Even if it does not appear so…

    This article looks to me, as my opinion, as a big advert for the author. To drive clients to his/her practice.

    It passes as critical, but it does not reflect what I stated above. That is necessary before speaking of diagnoses, treatments, false positives without a Gold Standard!, etc…

    The piece reads to me like an appeal to emotion, using words and concepts, authors, to impress the readership, and as the DSM, to obfuscate 1, 2 and 3, above, among others. And the lack of biomarkers and A gold standard.

    I am not being insensitive to persons or relatives, I am arguing from first principles. I feel for you, I really do, but not for peddlers of pseudoscience.

    Example: the author does not seem to consider after the quick intro that much of that could be normal!. Agreed, the severity of her practice might preclude such personal observation, then again, personal perhaps, when speaking of overdiagnosis in abstract sounds misleading to me…

    I imagine there is no real table of 95% confidence interval, age, culture, family, skin color APPROPIATE for “initiates or accepts social interaction”. Is there?, how was it built?, from MRIs?.

    Going to a guru who thinks has such table in their minds is going to an oracle to be told he/she can predict the future with candle sticks!, that does not work even in the stock market!. As my opinion, skeptic one at that.

    And it recurs to the old gaff of psychiatry: antinomies.

    Author!, prove to me in an argument, you know, 2 premises and one conclusion that hypo, hyper stuff can be deduced logically and consistently from said 2 premises. Cognizant it will take more than 2, but let’s tart with two, candle stuff…

    Otherwise, any bable, any interpretation, any text from THAT, is IRRATIONAL. And therefore cannot be argued, at ALL… except for it’s irrationality…

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  2. This article seems disingenuous. The website of this trade-marked therapy, icdl dot com, itself says it is useful for “especially children on the autism spectrum.” And the author only attacks the diagnosis of autism. What about all the other diagnoses in the DSM? So the author’s real problem is with stigma, and improper treatment choices.

    But despite the author’s “30 years of clinical experience in this field”, she offers no scientific evidence that her approach is preferable. A quick search shows there is scant evidence “of its effects on children’s communication and adaptive skills.” (raisingchildren dot net dot au) This makes her preference mere opinion.

    Also what parent of a 5-year-old would tolerate the advice “Don’t bother talking to him. He is autistic. He doesn’t understand language.” unless, even at that age, he responded very little to anyone. So how can the author know that the child was “[i]ntimidated by the assessor during a DSM symptom-focused assessment”? Sounds like projection to me. And how could she know his exact words? Was she there and did she write them down immediately? Or is this a 30 year old memory?

    The author leaves aside the issue of adults who claim their misdiagnosis was that they were NOT considered autistic as children. That they struggled to conceal their challenges and appear “neuronormal”. Always thinking there was something unmentionably wrong with them, never getting any support. They report that the realization the label applied to them was a relief and validating, and they express regret they had not received support as children. Science does show that earlier interventions are more successful.

    The author would be more credible if she attacked the notion that psychology is a full-fledged science. It is merely is proto-scientific at best. But since she does not, we must assume she, like the vast majority in her field, want to retain the cache of science necessary for reimbursed interventions, but without rigorous science to justify it.

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  3. So your solution to a bad psychiatric system (which the DSM is to begin with) is to go 70 years into the past? Please stop diagnosing people with behavioral observations. This is fruitless and dangerous. Tons and tons of medical and biological tests are available to test for neurodiversity, the persons capabilities and brain activity, eye movement, etc etc. I have never seen a child diagnosed with autism using just one symptom. That doesn’t even cover the diagnostic criteria. There are also bucketloads of other symptoms not considered such as having ADHD, autoimmune disorders, being queer, having prosopagnosia, having aphantasia, all statistically correlated with having ASD. When occurring in conjunction with the ASD criteria it is an almost certainty to be ASD. You leave out Aspergers from your paper. Seems like you just don’t think that’s a thing at all? Which would be a mistake. If you’re not neurodivergent yourself or have family who are then I don’t think you really understand what it looks like.

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    • Sort of thinking the same thing “If you’re not neurodivergent yourself or have family who are then I don’t think you really understand what it looks like.” Some of the other things was which version in the DSM manual are we talking about. I myself am 73 years old and got a formal diagnosis of being on the Autism Spectrum in 2019. I went to one of the premier high schools in the Country, Brooklyn Tech. I have multiple areas of study and interests. I went back to school when I was 30 to get a degree in electrical engineering and graduated 1st in my class. Worked at a national laboratory. I am a visual artist and yes I am autistic.

      So what I have found is that autistic people tend to hang around with the same. What I found is that an overwhelming amount of people I knew were misdiagnosed. There is a huge amount of literature that Kira has written about that talks about related symtomology clusters from medical conditions, gender diversity and yes being queer etc. A main goal of the neurodiversity movement is to shine a light on the benefits of this diversity. For example, the creativity that so often goes with learning differences like ADHD and dyslexia, or the hyperfocus and novel perspectives associated with autism.

      “Everybody has strengths and everybody has things that they’re working on,” notes Stephanie Lee, PsyD, a clinical psychologist with extensive experience working with kids with ADHD and on the autism spectrum. “Instead of thinking of people with autism or ADHD as needing to be ‘fixed,’ we put a spotlight on things that they’re good at and help with things that they’re working on.”

      Here is a documentary I made 2 years ago on the general topic https://www.youtube.com/watch?v=uAFuSSJxaaQ

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      • I don’t disagree with valuing positively diversity, neurodiversity included.

        But what you seem to be narrating is not medical nor psychological, sounds political to me. Specially if it involves sexual behaviour, or when it intersects with it.

        Politics can cause suffering, but that does not make political part of health nor well being per se.

        And I haven’t read evidence any neurodiversity labeling schemata can provide a net benefit on the aggregate of the labeled neurodiverse, or that on the aggregate it is the most efficient alternative, if there is any at all. As labeled, not when self identified. Even then, there is room for other considerations, but I am trying to be appreciative, propositive and respectfull*. Even self identifying can be done granularly without using labels…

        In the past: I am a dreamy person, I like to take time to imerse deeply in my own thoughts of things that for many people seem utopic. For instance.

        Now: I am neurodivergent. Sort of Period.

        That kind of labeling I think obfuscates a true understanding of how one thinks of oneself.

        There some recent articles here at MIA that shows that labeling with ADHD and Autism monikers might be detrimental to the labeled, even when self-labeling. Even if for some might at least provide some hermeneutic understanding.

        * The ADHD label has been abused to get special considerations when applying for college. To get, I think, placed in better schools, or get other benefits. I think I read those in major newspapers, last I think on the college admisions scandal.

        And the ADHD label is sometimes used to get “legally” prescriptions for stimulants, etc., as performance enhancers, as nootropics. So those are concrete harms by a goodie goodie embrace the label.

        Hence my attempt at providing a balance to Kira’s and your comments.

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        • POSTING AS MODERATOR:

          Hi, 27/2017,

          I need to talk to you but your email does not function, in fact, appears to be a fake email. I will have to block your submissions until you post with a functioning email address. It is a requirement under the posting guidelines.

          Steve

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          • You sound so serious… 😛

            Is it a legal stuff?

            MIA got hacked?.

            Is it about my comments?.

            Or is it personal stuff?.

            Sorry can’t oblige simply, I’d be delighted, but, hey, my addres tells you much about it. There are reasons, and I did nothing wrong to be in THAT situation, far from it… but, maybe it’s the comments… 🙂 That I can admit I could have done something wrong, unintended, honestly…

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          • If I can’t discuss concerns about a comment or thread, then I can’t work with you. It’s part of the rules of posting. Otherwise, you can post whatever you want and I have nothing I can do except not publish your posts. Obviously, I have a concern to discuss. If you can’t do it, I’m sorry, but that means you won’t be allowed to post.

            Steve

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    • Can you provide any meta-analysis that shows evidence that using any labeling technique for autism provides positive benefit and that it is the most effective alternative for the aggregate, the average of “neurodivergents”?. Across all measures of well being would be ideal, not straw person picking one that looks positive.

      Because if there isn’t any, I think any statement of how positive it could be has no basis in reality.

      “In an ideal world”, imaginary on top, kind of thing…

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    • 🙂

      What seems clearer to me is that if one thing does not look clear, it might not be because we can’t see it clearly.

      Perhaps we can’t see it clearly because it is itself unclear.

      It’s opaque, fuzzy, undefined, unreal, even inexistant.

      Pehaps deciding is going one step ahead of the issue: is there something there to decide in the first place that could be decided?, 🙂 , sort of thing.

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  4. The article strikes me as pseudocritical in some instances while doing little in general to actually counter the problems inherent to defining, diagnosing and treating one or any non-physical diagnosis for that matter. This is not meant to “bash” the author. In fact, I applaud her for daring to speak up in the first place. Most psychologists/psychiatrists simply go along with the idea that “autism” can be anything and that the diagnosis is a wonderful thing. It’s clear why they would do that. Autism diagnoses are a huge money racket and the industry is keen on pumping those numbers up to 10 % prevalence rate and beyond.

    The author differentiates between autism and autistiform manifestation. Why make the difference if both things are superficially similar? …are documented, observed and diagnosed based on arguably superficial observations? How are you going to tell the difference? You can’t. So the author relies on circular reasoning to create a difference.

    If it looks like it’s permanent it’s “autism” because “autism” must be permanent. There is no good reason to believe that.

    If it doesn’t look like it’s permanent despite it being behaviorally indistinguishable from “autism” at some point, then it must be “pseudo-autism” or autistiform.
    But the distinction is actually meaningless and rests on the assumption that the psychologists got true “autism” right in the first place which they most likely never did.

    The author goes on and writes: “I have found it helpful when assessing autism-suspected children to keep the focused criteria of Kanner as a mental benchmark for a genuinely autistic condition.” Here, we see the same problem pop up again. No critical engagement with how diagnoses are constructed, reified and perpetuated. It is simply assumed that a doctor from the ’40s crudely describing problem behavior in children maps neatly into a real physical category despite the physical proof missing in the first place.

    How would the author know that Kanner’s patients did not have hearing impairments, did not have emotional difficulties, did not have autoimmune disorders? The short answer is, she can’t.

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    • I think the problem with autism is that it is constructed as fraud.

      Fraud as a crime is not biological, it’s not in the brain even if there is a “guilty mind”, mens rea.

      Fraud is socially constructed, defined, and interpreted, prosecuted and punished, addressed even treated in socially defined and accepted ways, more or less.

      That does not make Fraud a reality in the scientific sense of the word. Fraud lacks several qualities that things that are real have and must have to be called real in the scientific sense. Precisely because it comes from the human mind alone, even if we can agree a Fraud was comitted under numerous, constantly changing, constantly expanding definitions of it, criteria to be fulfilled to call it Fraud.

      Fraud, properly defined does not seem to lack objectivity in it’s apparent recognition, in part because the definition was built that way: to be agreed among uninterested parties, i.e judges, legislators and justices. There are borderline/frontier cases, and it’s strictly intersubjective, and finally the judiciary is about everyone agreeing at the end, even if the “conclusion” is ludicruous. Settlement is the purpose of the definition of Fraud in the long run: was there or wasn’t there?.

      And the law is way less problematic with “thoughts”, the hermeneutics of law, than psychology and psychiatry, way less problematic…

      What the author proposes is saying something like, instead of the multiple criteria for fraud, let’s dial it back to obvious intent to deceive and loss. Getting rid of invincibility of the deception, etc..

      I am no lawyer, but I think crimes and mental disorders are as much fabricated, except crimes definitions do achieve sometimes usefull social outcomes, even if done in very brutal ways on offenders many times. I have always strongly disagreed with the last part.

      And crime, as psychiatry has been used to oppress and persecute people in callous, evil ways too, where victims can’t defend themselves. There is another parallel that makes my conviction they look a lot alike stronger: the way those fabrications, those constructs, those artificialities are used are almost identical…

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  5. I’m having a hard time understanding the criticism in the comments. The idea that there can be no perfect diagnostic system so the current system is as good as any is patently ridiculous. And many comments seem almost defensive.

    All I see Shoshana arguing for is better engagement with the patient, better diagnostic tools, more time spent before a diagnosis is made, more critical analysis of symptoms; how can these be bad things?!

    Currently, psychiatry seems to have tunnel vision for reaching the diagnosis itself, rather than the focus being on what is actually troubling the patient, which specific symptoms are causing them the most difficulty, which skills should they focus on etc. and developing a tailored approach from there.

    Diagnosis is still important but it must not be the only objective and must not guide all treatment. Because, especially where medications are concerned, misdiagnosis leads to real suffering.

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  6. The problems that come from the diagnosis of autism don’t have anything to do with whether you use the DSM or not, they come from pathologising human difference and casting people as “other”. If a child experiences the difficulties you stated as not autistic, they are still marginalised and pathologised in different ways, with the majority of so called treatments aiming to normalise their behaviour. Society doesn’t see itself as the problem. I don’t deny that some children, autistic or not, do not need support, I just don’t understand why that support can’t be provided without the “need” for a diagnosis. My child needed some simple sensory accommodations at school but was denied these until he had a diagnosis and the school was provided recommendations from a “professional”. Utter stupidity and ridiculous bureaucracy.

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    • I think the issue is “severe” autism.

      If health care and accomodations, support was easily available, we probably would not need to define it clearly or prove what difficulty children have individually.

      But given there aren’t enought resources and time to try everything, there is the need to narrow down who gets what help and when, etc.

      That’s not burocracy, I think, respectfully, it’s economics, saddly… and education, being part of a comunity are basic human rights, specially for children, in them they are fundamental, inalienable rights, they can’t choose not to…like an obligation for them…

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    • The only problem with seeing “society” as “the problem” is that this answer is too diffuse and generalized. It might well be on the right track, though.

      I was trained, for example, in a set of healing practices that “society” rejects. But was it really “society” that rejected those practices? Or was it some individual or interest group that felt threatened by those practices who then mounted a shaming campaign that eventually resulted in “everyone” rejecting those practices? Of course, not everyone does reject them; they are in quite wide use daily, considering all the bad words spoken about them.

      The point is, our problems on Earth can’t realistically be blamed on generalities like “society.” We NEED society to function! The closest I can get to a generality about problems is that certain individuals that would normally be seen as psychopathic have generated the bulk of the ill will, destruction, and poor functioning that we see on Earth today. But if we don’t correctly identify them and handle them as individuals, we will eventually succumb to their destructive influences.

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  7. I’m a 62 y/o who was diagnosed with Asperger’s 20 years ago. It was and is extremely frustrating that the “experts” slid valid dx’s into a wide umbrella or “spectrum”, if you must, labeling with high function (good) and low functioning (bad) on this made-up continuum. Im using the words “good” and “bad”, because now matter how you present something high is…well, good, per se, and low is sad and and distressing in the context of societal expectations and norms. I’m a person with Asperger’s…and I understand when the word Asperger’s is heard, most everyone (or at least they used to…) knows, for the most part, what the “symptoms” entail. Now I know the word “Asperger’s” fell out of favor because of some bad guy scenario from 80 years ago…but, that logic would also exclude the following: Volkswagen, Citibank, Merck, Mercedes, Bayer…well you get the picture. As a psychiatric RN, I can attest to the fact that people don’t fall on a line or spectrum…they fall onto a scatter chart as vast and unrelated as one can imagine. Kids grow up into adults (as I can also attest to) who need to know who they are…not “what” they are…they need to know they matter, but they don’t need to be indoctrinated into the idea that they “matter” any more than any other kid. They need to be individualized, strengthened, affirmed, appreciated and…taught how to live practical lives undisturbed or afflicted by predators of the “well-meaning” type…this is also a worthy goal to have for every child. I’m not autistic and someone who doesn’t know me can think they do, but this whole “he or she is on the spectrum” nonsense shows they don’t get everything right; I’m a human being with a different way of thinking known as Asperger’s…I’ve grown to love my way of seeing the world, every kid should be afforded the same opportunity. My favorite line of this article: “Using the term ‘autism spectrum disorder’ does enormous disservice to children, because it glosses over the many developmental specifics that might underlie a child’s challenges related to social communication.” Maybe de-emphasizing the need many have in this overly complicated new age to require labels and diagnoses and odd-needy-kids-for-parent-clout and the intense desire to virtue signal…autism would be used a lot less, the “experts” would get back to a little less conversation and a little more ACTION (isn’t that an Elvis song?). I’m rambling now as people like me are sometimes known to do. I’ve appreciated the info presented in the piece and the “conversation”. Adios!

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  8. Very good article.Sensitively written. Behind the labels there has been a huge growth in the Psychiatric/Psychology industry. More jobs created. More opportunities to look after or tend for those individuals slightly different to the rest of us.
    Sometimes misdiagnosis can be intentional. What care providers are available or even availability of medication.
    You have correctly indicated the predicament of the child and what the child has to make of all this. Are practicioners overly concerned about the effects upon the child about having a diagnosis of autism?
    Or are they more concerned with following a particular script for a particular type of patient?
    Is the long term effects of a child and what the child thinks about his/her diagnosis as they go through life really considered?

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  9. I suspect we may soon come to see what we once called “autism” and “ADHD” as expressions from towards one end of an absolutely continuous spectrum along which we all endlessly move –

    not disease

    not disorder

    not syndrome

    but human spectrum.

    And I think this other way of viewing our human struggles will prove immensely beneficial – to us all!

    Much love.

    Many thanks!

    Tom.

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  10. This is a very technical article, but could be considered rather arrogant (in the sense that these diagnoses help in any cases) in its own way.

    The bottom line is that diagnoses in mental health are used about the same way that diagnoses in body health are used – to enable the practitioner to charge for treatment. In fact, the whole modern medical care system seems to be centered around the concern that the practitioner gets paid rather than on the health benefits of the treatment.

    Though some label this “capitalist” and thus advocate for some sort of more socialistic model, I don’t think that’s the point. State doctors can be as greedy and poorly trained as private doctors. I think the more basic problem is that practitioners have not been properly trained on what the full range of factors in mind and body health really are. These include spiritual factors which most practitioners are trained to believe are “unscientific.” Well, I frankly don’t care how “scientific” the healing arts are; CAN THEY HEAL?

    I think too many practitioners have seen too many failures and have become cynical and apathetic about their work. They need full and proper training which today is simply not available to them. Don’t look to documents like the DSM for answers; that’s not what the DSM is for. Look into the full range of the healing arts and find out what really works. Until we do, we will be stuck with this cynical system of “health” that ends up ruining too many lives.

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