Autism

With the news today (2/10/2010) that the DSM* guidelines may be revised to fold Asperger’s into the broader spectrum of autism, it is worth noting that there are a number of companies in Encino who specialize in autism and they are competing with the ADHD companies. Empires rise, empires fall and what does it mean if diagnoses and treatment have moved from teens/tweens to pre-schoolers?

This is not intended to belittle the importance of understanding autism, so if you wish to contact these companies, go ahead. But I would argue that you have a choice to make: do you want your child to be identified as autistic? It’s not just a label after all. What are the strategic and tactical advantages and disadvantages of using it? Is it a stigma or is it a tool? Autism advocates break both ways on this question: the vast majority see it as a tool but many “Aspies” don't want to be lumped in with autism.

The most significant recent autism study – by UC Davis (here) - suggests that autism cannot be attributed only to chemicals (vaccines, heavy metals), nor local environmental problems (diet, smog), but points out a statistical correlation with well educated, professional parents in places like Los Angeles seeking out diagnosis and treatment. The implication, of course, is that they see advantages in doing so.

Many understandably freaked out parents worry that their kids are autistic, covering the same ground we went over with ADHD or schizophrenia before that. It seems evident that for really struggling kids these symptoms are not faked. So the argument turns on whether the underlying causes of autism are genetically driven or environmental and, like everything else in the sciences, it is likely to be a combination of the two – what some call a “biopsychocultural” model.

But this leaves out the critical role of language and power – the role of the professionals, drug companies and parents in all this. The debate itself has autism. No one can agree on what autism is, just as they can’t agree on ADHD or schizophrenia or much else, let alone on a suitable treatment. So if we use this generic label of autism, and every kid is different, what do these kids have? Do they “have” anything at all? Should they be described as “disorders” if the label itself is heavily negative? Is psychiatry expanding its empire to embrace ever larger segments of the population as mentally ill? Are there times when we might be better off pretending that everything is just fine?

I’m not being naïve here – the problems are real – but the objective is not to provide relief for the parent but to permit the child to feel that his or her world view is just fine thanks. With patience, love and help (and not medication) these things might sort themselves out. The prevailing view is that a diagnosis helps kids to know what they have and that anything else is simply denial, but these are options and they have consequences. “Waffling” and muddling through is not denial; caution can have positive benefits.

For the latest in academic research and how the media totally distort it, try this great blog. Or to see how DSM is culturally driven, try Ethan Watters’ recent book Crazy Like Us: The Globalization of the American Psyche here, or this Wall Street Journal story.

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 * DSM = Diagnostic and Statistical Manual of Mental Disorders. This is the bible of U.S. (and increasingly international) mental health professionals. Other proposed changes would add “sexual interest/arousal disorder” (that’s lack of sexual interest), “temper dysregulation disorder with dysphoria” (that’s kids having temper tantrums) and “apathy syndrome” (you can figure that one out!). Labels only an “expert” could love.

** Photo: Eubulides/Wikipedia