Conflicting autism vs aspergers

[claw3]

Ds had a social and communication assessment about 2 weeks ago. I asked the specialist what is the difference between autism and aspergers and what would ds be.

She explained that since ds has speech and language delays he would have autism as oppose to aspergers.

Went to see new Pead today for the first time and he is saying ds would have aspergers. When i asked again what the difference was, he told me autism is for the more severe non verbal children who do not attempt to interact in any way, with severe learning difficulties. (saying that ds hid behind the curtain in his office for an hour and half during the appointment and wouldnt speak to anyone!)

Anyhow no official dx has been made yet, but a referral for another social and communication assessment with recommendations for processing disorders to be checked too. Ds is also awaiting his appointment to CAMHS.

Firstly who makes the dx, Paed, speech and communications specialist or CAMHS? (Im a bit confused as i thought only Paed could, but was recently informed CAMHS can dx)

Secondly what is the difference between autism and aspergers?

this pdf seems quite good, I've not read the whole thing yet though.

This paragraph really stuck out to me -
There is also no clinically significant delay in age-appropriate selfhelp
skills, adaptive behaviour and curiosity about the environment in childhood. The
clinical profile of a child with Asperger's syndrome is also less likely to include motor
mannerisms and preoccupation with parts of objects as occurs in autism but the child
can have a circumscribed interest that consumes a great deal of their time amassing
information and facts. They also noted that the profile of social skills in children with
autism includes self-isolation or rigid social approaches, while in Asperger's syndrome
there can be a motivation to socialise but this is achieved in a highly eccentric, one-sided,
verbose and insensitive manner. Should the child's profile of abilities and developmental
history be consistent with the criteria for both autism and Asperger's syndrome, the
authors of the DSM state that a diagnosis of autism should take precedence.

I think that is why the paed decided on autism for ds diagnosis - it cmes down to the fact that he self isolates - he has no interest in other people whatsoever. There are also the language considerations, but I think this is simplistic, and there is more to it than that. The way are paed described them was def as two distinct conditions and not necessarily interchangeable.

I heard that camhs could diagnose too.

In our case, we are hoping to get a test report from somebody else, and then the paed will formally dx.

The autistic spectrum is very broad and ranges from 'classic' Kanners autism where the child is non-verbal through various levels of ability, with HFA/Asperegs at the other end of spectrum.

One of the diagnostic criteria for aspergers is no significant language delay. Having said that DS (Aspergers) had to see SALT because although he had the language he had difficulty with pronuncication.

I think it who makes the diagnosis depends on the type of service in your area.

If a multi-disciplinary service is offered, the lead is usually a paediatrician or psychologist (CAMHS). CAMHS undertake the ADOS interviews etc which form part of the process. This is then put together with SALT reports etc before the team diagnose.

This puts alot of emphasis on the role of CAMHS whose service varies wildly depending on where you are

Thank you chops i will have a good look after dinner. Ds does sometimes try to interact with others, just not very successfully, he would rather play alongside iyswim.

WetAugust - Speech specialist told me that since ds has had a speech and language delay from an early age ie 2, it would be autism (he also appears to have processing disorders ie hearing the difference between similar sounding letters and sounds)

I dont really care what the label is, i was just thinking in terms of getting help and support for ds, that one might be better than the other?

Debs, thats interesting. Perhaps i may have 2 on the go!

TAMHS kept suggesting a multi-disciplinary approach and our CAMHS referral has been accepted (13 week waiting list)

I mentioned this to Paed today and he said that CAMHS would leave it for him to do and he wants to take charge of ds's care (he was quite shocked that no one had taken the lead in 3 and half years!)

One minute i cant get anyone to help us, next they are fighting over us!

We have SALT reports, we are now awaiting referral for processing dysfunctions (which will become clearer once i get the 2nd SALT report)

From what i can gather ds wont be having the ADOS as such, as the SALT thought he had some processing disorders which she wanted him assessed for first (i think this could affect the ADOS)

Do you know if the Paed chooses to use the ICD or DSM criteria?

That should be searchable and should let you see clearly the criteria they use for DX. It is however bollocks to say that autism is for kids with learning disabilities only; a great many kids (most?) sit between AS and kanners- my ds3 for one, he's a bright little soul but way more severe than AS.

Local policies on DX vary but here the rule is that only a Paed or Psychiatrist can DX but the very most respected Ed Psychs can dx and have it signed off by a Paed (the lady I am thinking of is very well known in the firwld of ASD, a specialist). A SLT even one with a specialism cannot dx- although they can obvioously advise on a DX.

I've got all the flow charts for dx Claw, if you want I can scan them for you?

I would say that definition of AS does not describe ds1 at all well- he has loads of delays in self help skills, motor mannerisms, etc. He (and I in my time) also hs an inclination to self isolate but the comorbids asociated with AS can affect that significantly. But also- beneath every autistic spectrum child is a child whose personality is still there, and some kids self isolate regardlessof having an ASD..... it'snot clear enough to elimintae anything, its one of a great many things to consider instead.

The genberal rule here seems to be that triad plus language delays = autism; triad without language delays =AS. But a great many kids get a DX of ASD now anyway instead.

Only CAMHS psychiatrists can dx here. No SALTs or paeds etc. except for pre-5 year olds.

Otherwise known as the under-5s

Pipin we did the whole ASD V separate DX thing at Uni this MOnday

Blimey!

Ended up in a bit of a free for all.

And you know the only reasons I could get for being against were that SSD might have to actually assess rather than offering stuipid blanket policies, and that some people have read the neurodiversity literature and not cottoned on that it represents only a proportion of people with AS- and that those it does not represent are by far the most vulnerable. In order to sellt haat opinion so well after all you need a certain amount of capability that ds1 wouldn't have.

IN truth, the only reason against it I have is the writing I have read by a few on here with vrery severe children about how they feat their children will miss out and I can understand that, but I think that issolvable with moreinkis with LD services.

The ASD dx transition is well underway hereand I am pleased with it,my only real fear is that SSD will respond by applying a new policy of requiring the rpesence of LD which willman severely affected but bright in a few ways ds3 will be exemopted from services. As he needs lifelong care that could be a problem.

Actually there was one other person against it,a twunt who is there to decide how much impact ASD people had on the development of religion. I could answer that for him in an essay (first degree was in RE) but he in turn has no idea seemingly that these people he wants neatly categorised for his little theories are in fact human beings

Peachy could I be cheeky and ask for a copy of the dx flow charts too? Do you do CAT?

Me too Peachy. I'd love one. DS has been diagnosed using Gilberg (AS) and its quite diff to DSM.

If people CAT me I will try and send it over.

Pipin you'd not need to do it for the diss LOL_ the assessment assignment is several thousand words on the perfect diagnosis pathway.

The NICE guidelines arewell into creation it seems, as is the DSM and prototyps are out there on the net for the new DSM.

My Ds has no significant speech delay, he does need Salt but is at the lowest level of 'normal' for his speech. He also had poor pronounciation.
I asked his paed f that means he is Aspergers rather than autistic, but she said that Aspegers is not a useful term. Its all part of the autistic spectrum and so to call it different things hinders getting help, she doesnt like HFA either.
She said DS is autistic but on the milder end of the spectrum is how she would say it.

Starlight that does depend on where you live- schools can require a set DX (the unit we are looking at for ds only takes AS, and the ASD unit in town only takes autism).

There's also the regional SSD variants- here, if ds1 requires support at any stage, it can't come from SSD, we would probably be looking at the NAS help we currently rely on, or at the extreme a possible mental health scenario..... it'sworth finding out local policies on these things.

But you know, I really do like ASD as a dx especially with the way things are these days. DS3 is a good case in point- Autism dx,. hfa in terms of IQ but in reality most of thet ime he only accesses that IQ for certain school topics such as (surprise surprise) maths; generally he functrions as a toddler /preschooler (he and ds4 aged 20 months share a great many likes) and has a very real actual delay that simply wouldn't be covered by a DX of HFA.

The absolutes of autistic spectrum- not that many kids fit them, really. No eye contact / SOH / friendliness. .... many kids don't fit all those by any emans, indeed quite a few arelike ds3 and have no social restrictions IYKWIM, he's everybodies friend, no safety at all, scares the life out of thsoe who care about him.

And ds1- functional speech age at 6 of 16 - 21. Wahey you might say, until you find he talks at school in huinea pig speak which means he squeaks all day and occasionally nips (mainly with new faces etc, he seems OK with his TA). They describe him at school as 'severe Aspergers' which is an entirely new thing again LOL.

No, what matters is needs absed assessment independent of stereotyping categories that fit few, and looks at who they are now and what level they funciton rather than might be capable of.