[thesheriff443]

Originally Posted by ThomasC

Yeah that's fair enough.

Like I say though, for someone to have an official diagnosis of Autism or Aspergers they have to meet the triard of impairments. Difficulties in communication, social imagination and social interaction. Whilst she may well have, what has been described could be anything. She might meet one, but not the other, in which case she would have pervasive development disorder not otherwise specified or A typical.

She might also have mental health problems. She might have suffered early trauma, neglect, been witness to substance abuse, domestic violence... she might have global development delay or some form of learning disability, she may have lived a sheltered life, she might be vulnerable due to z,y,z.

The point I'm making is that there is a whole dictionary of conditions which could fit what has been described.

I think if you tend to know more about one condition, it might be your go to without having thought more holistically about it. I understand why you would in this case, but would suggest you are likely to be way off the mark. Who knows.

You say I’m likely to be way off the mark but who knows

It’s just thread on tibb I’m not handing out professional advice just chewing the fat.

[ThomasC]

Originally Posted by thesheriff443

You say I’m likely to be way off the mark but who knows

It’s just thread on tibb I’m not handing out professional advice just chewing the fat.

True.

Hope your daughter is managing with her Autism well.

If you ever need any help let me know

[Toy Soldier]

Originally Posted by ThomasC

Yeah that's fair enough.

Like I say though, for someone to have an official diagnosis of Autism or Aspergers they have to meet the triard of impairments. Difficulties in communication, social imagination and social interaction. Whilst she may well have, what has been described could be anything. She might meet one, but not the other, in which case she would have pervasive development disorder not otherwise specified or A typical.

Sorry Thomas but I’m afraid this is completely outdated, incorrect, and not at all the absolute diagnostic criteria for ASD. I have a 9 year old daughter who has been diagnosed ASD with learning disability since she was 4, and does not fit that criteria. Her diagnosis is autism - not PDD nor atypical. I can show you her letter of diagnosis if you want . She also attends specialist ASD school provision with multiple children who would not meet the “triad of impairments” criteria. Current ASD diagnosis by anyone who actually knows what they’re doing is person-centred and holistic, not checkbox-based and (to be blunt) the misconception of “required features” is outdated and offensive. The social features of autism in females is markedly different to males.

I should also mention that my wife is a registered mental health professional and has worked extensively alongside CAMHS. While it can be DIFFICULT to get a diagnosis of ASD without associated learning disability, anyone who insists that certain features “must” be present is either misinformed or simply making excuses, or un-confident about making an executive decision on diagnosis. An experienced paediatrician 100% can sign off on an autism diagnosis without checkbox criteria.

[edit] I forgot she’s 9 now not 8

[Toy Soldier]

To add to that though, back on thread topic, I’m afraid I suspect the parents thing was an excuse in this case and she had some other reason. Not much to be done really, always a shame to lose a friendship but time to move on I’d say.

[ThomasC]

Originally Posted by Toy Soldier

Sorry Thomas but I’m afraid this is completely outdated, incorrect, and not at all the absolute diagnostic criteria for ASD. I have a 9 year old daughter who has been diagnosed ASD with learning disability since she was 4, and does not fit that criteria. Her diagnosis is autism - not PDD nor atypical. I can show you her letter of diagnosis if you want . She also attends specialist ASD school provision with multiple children who would not meet the “triad of impairments” criteria. Current ASD diagnosis by anyone who actually knows what they’re doing is person-centred and holistic, not checkbox-based and (to be blunt) the misconception of “required features” is outdated and offensive. The social features of autism in females is markedly different to males.

I should also mention that my wife is a registered mental health professional and has worked extensively alongside CAMHS. While it can be DIFFICULT to get a diagnosis of ASD without associated learning disability, anyone who insists that certain features “must” be present is either misinformed or simply making excuses, or un-confident about making an executive decision on diagnosis. An experienced paediatrician 100% can sign off on an autism diagnosis without checkbox criteria.

[edit] I forgot she’s 9 now not 8

Well I can't be bothered to screenshot literature for you. Whilst certain terminology is phased out, during assessment there are three main categories it is assessed on and as I'm sure you know there is no set test, it's subjective based on the assessor. It's not offensive at all, don't start getting all woke. In an ideal world there would be no labels. Just like high and low, things are phased out and it's now a continuim. If you've met one autistic person then you've met one autistic person.

Well you'd probably get a diagnosis of Asperger's. That's normally the difference.

And checkbox criteria. I'm not going on about that. It's like dementia, there's 3 types, but dementia is the umbrella.

[ThomasC]

https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

DSM 5

[ThomasC]

https://www.autism.org.uk/advice-and...essment/adults

[Toy Soldier]

Originally Posted by ThomasC

https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

DSM 5

This is US diagnostic criteria which is hyper-medicalised and rigid because of health insurance implications. Note early and repeated use of “must”. There is a reason for that (financial). Comparatively;

https://www.scottishautism.org/about...tism-diagnosis

Notably;

”These examples are intended to be indicative rather than prescriptive and are given to illustrate the diversity within each area of the triad across the spectrum. It is also important to bear in mind that the impact from each area is not distinct”

And, more importantly,

”Development and debate in relation to diagnostic criteria is useful and necessary in terms of enhancing the current body of knowledge available to clinicians. From a practice perspective, particularly for novice practitioners, ambiguity can make an already complex condition appear even more complicated. Establishing criteria is clearly important, however diagnosis relies on accurate assessment, understanding and interpretation as individual presentation is rarely straightforward and can often be subtle.”

In other words, unlike the strict diagnostic requirements of insurance-based healthcare in the US, diagnostic criteria is a diagnostic tool in the UK and a holistic diagnosis can absolutely be made, with diagnostic criteria in mind, but not rigid nor essential to diagnosis. I’ve seen plenty of parents fobbed off with it, of course, which is why as a parent of a child with special needs it’s important to have your **** on point.

[Toy Soldier]

Originally Posted by ThomasC

https://www.autism.org.uk/advice-and...essment/adults

“There are several diagnostic tools available, and diagnosticians aren't obliged to use a specific tool.”

Again immediately clear that diagnosis in the UK differs to the US, being a holistic assessment without rigid requirements.

[ThomasC]

Originally Posted by Toy Soldier

This is US diagnostic criteria which is hyper-medicalised and rigid because of health insurance implications. Note early and repeated use of “must”. There is a reason for that (financial). Comparatively;

https://www.scottishautism.org/about...tism-diagnosis

Notably;

”These examples are intended to be indicative rather than prescriptive and are given to illustrate the diversity within each area of the triad across the spectrum. It is also important to bear in mind that the impact from each area is not distinct”

And, more importantly,

”Development and debate in relation to diagnostic criteria is useful and necessary in terms of enhancing the current body of knowledge available to clinicians. From a practice perspective, particularly for novice practitioners, ambiguity can make an already complex condition appear even more complicated. Establishing criteria is clearly important, however diagnosis relies on accurate assessment, understanding and interpretation as individual presentation is rarely straightforward and can often be subtle.”

In other words, unlike the strict diagnostic requirements of insurance-based healthcare in the US, diagnostic criteria is a diagnostic tool in the UK and a holistic diagnosis can absolutely be made, with diagnostic criteria in mind, but not rigid nor essential to diagnosis. I’ve seen plenty of parents fobbed off with it, of course, which is why as a parent of a child with special needs it’s important to have your **** on point.

Yes as it says, interpretation!! It's subjective, there's no such test.

And social imagination will include such things as restrictive and repetitive movements/tasks etc. 3 main headings broken down into so many traits you see on the spectrum.

I've worked with lots of Autistic people both in this country and abroad.

I'm not depriving anyone of any diagnostic. You need the label for the support, benefits, SOEN, SENCO, etc. DISCO etc, diagnostic tools will look at those main 3 categories.

I'm sure your daughter has varying traits, as does everyone on the spectrum....but I think you'll find that along the line they will fall into those categories somewhere.

[ThomasC]

Would you really give someone a diagnosis of autism if they came into your clinic with only social communication issues? Baring in mind they could be introverted, Shy, withdrawn, depressed and dyslexic?

And then again, social interaction?

Then jump to the conclusion it's Autism?

My point still stands and you'll find that given the correct assessment tools and knowledge of the assessor that they will draw from that to make a diagnosis and could conclude that they don't meet the criteria for an autistic diagnosis.

However, to eat my own words. Yes, it's not completely rigid....that has changed somewhat, but I would expect an assessor to find issues in all those areas, varying degrees, or to opt for a different diagnosis.

[Toy Soldier]

No, and I would probably agree on balance that autism is probably over-diagnosed, partly because of over-stretched services using it as a catch-all for more nuanced developmental conditions. But sadly CAHMS is so swamped and under funded that the time and resources are just not there. A separate issue really.

The main issue with the diagnostic triad though is that one aspect could present far less obviously than others, and that becomes more pronounced with age.

My own daughter was easier to get diagnosed because she has other associates learning disabilities, functional communication problems rather than behavioural, etc. BUT (to give examples) she actively seeks social interaction, is highly creative and engages in advanced imaginative play, despises routine and enjoys novelty… things that are generally contrary to the diagnostic criteria.

I do suspect that her “full” diagnosis is probably more complex if we were to investigate further, but we’ve not gone down that route as yet, as there’s not really been a need to. The main point I suppose is that her diagnosis IS, on paper, “just plain autism” and it was made by an experienced paediatric consultant holistically just before her 4th birthday, and was not strongly linked at all to the written diagnostic criteria. Unfortunately the “most common” route for kids in the UK is going undiagnosed until nursery or even early primary school and then having to go via the education system and CAHMS which is just… “not ideal” as things are currently.

[Ammi]

Originally Posted by Lewismacfarlane

Im sad but i think its for the best

..thank you for the update, Lewis…I think that you’ve made the only decision that you could for you to be able move on…it doesn’t feel like a friendship that’s meant to be atm and not in your control to change that in any way…there are so many things that you can enjoy and control so just enjoy those……

[ThomasC]

Originally Posted by Toy Soldier

No, and I would probably agree on balance that autism is probably over-diagnosed, partly because of over-stretched services using it as a catch-all for more nuanced developmental conditions. But sadly CAHMS is so swamped and under funded that the time and resources are just not there. A separate issue really.

The main issue with the diagnostic triad though is that one aspect could present far less obviously than others, and that becomes more pronounced with age.

My own daughter was easier to get diagnosed because she has other associates learning disabilities, functional communication problems rather than behavioural, etc. BUT (to give examples) she actively seeks social interaction, is highly creative and engages in advanced imaginative play, despises routine and enjoys novelty… things that are generally contrary to the diagnostic criteria.

I do suspect that her “full” diagnosis is probably more complex if we were to investigate further, but we’ve not gone down that route as yet, as there’s not really been a need to. The main point I suppose is that her diagnosis IS, on paper, “just plain autism” and it was made by an experienced paediatric consultant holistically just before her 4th birthday, and was not strongly linked at all to the written diagnostic criteria. Unfortunately the “most common” route for kids in the UK is going undiagnosed until nursery or even early primary school and then having to go via the education system and CAHMS which is just… “not ideal” as things are currently.

Pervasive development disorder not otherwise specified was phased out not too long ago. Just double checked as things change constantly. However, this term only really came about in 2013 and for me is a good one because it gives the assessor a diagnosis where someone would meet some, but not all of a,y,z. Having said that I do believe it needs to be flexible, hence the ‘continuim’ because there are such varying degrees presented in so many differen5 ways.

You were lucky to get that diagnosis so quickly. IT can take up to 5 years.

Don’t get me started on underfunding. It really is dire. I see the pain and hear the pain a lot. I have to sit in meetings, where families are at crisis point and no one really has any options or you just repeat what has already been said, go through tick lists..... the crooks of it lies within funding. There aren’t the services or people to provide the needed help.

[Lewismacfarlane]

Im sad now that I've lost this friend

[ThomasC]

Originally Posted by Lewismacfarlane

Im sad now that I've lost this friend

You need other avenues to explore.

You are focusing too much energy on this one person.

Do you have any hobbies or things you enjoy? Do you have other friends?

[Lewismacfarlane]

Originally Posted by ThomasC

You need other avenues to explore.

You are focusing too much energy on this one person.

Do you have any hobbies or things you enjoy? Do you have other friends?

I have loads of friends

[ThomasC]

Originally Posted by Lewismacfarlane

I have loads of friends

Can you try and arrange an outing to take your mind off of this?

You’ll look back soon and wonder what all the worrying was about.

[Lewismacfarlane]

Originally Posted by ThomasC

Can you try and arrange an outing to take your mind off of this?

You’ll look back soon and wonder what all the worrying was about.

Im meant to be catching up with a friend soon actually

[Ammi]

…as Thomas has said, that’s a good channel for your emotional energy into other friendships, Lewis ….it’s ok to feel a bit sad over a lost friendship but it does give an opportunity also for other friendships to grow and become closer as well…?…and for opening possibilities…I hope you have a lovely catch up with your friends……

…I think this last year, we’ve all had so much thought time and not enough contact time with our closest people and that’s about to change so enjoy all of those much needed catch ups…

[Toy Soldier]

Originally Posted by ThomasC

You were lucky to get that diagnosis so quickly. IT can take up to 5 years.

We weren’t lucky, we were persistent and privileged (which I suppose is a form of luck, really) enough to be already well educated and well read when we took our concerns to a paediatric diagnostician. Though I suppose there’s also an element of luck in having one who was open to listening. Her verbal communication issues are very obvious though which makes things “easier”, much harder for people to get a diagnosis when there isn’t a “very visible” impairment like that, and as I said even worse when it’s got to the point of battling through the education system and CAHMS to even get near a consultant.

We had all of our i’s dotted and t’s crossed long before she even started nursery (they actually got some major upgrades because they got a nice big chunk of funding for her, lol) and have never needed a sniff of CAHMS. Which I am very glad about because it seems like it can be an absolute minefield.

[arista]

Originally Posted by Lewismacfarlane

Im sad now that I've lost this friend

OK
but you have many others

[ThomasC]

Originally Posted by Toy Soldier

We weren’t lucky, we were persistent and privileged (which I suppose is a form of luck, really) enough to be already well educated and well read when we took our concerns to a paediatric diagnostician. Though I suppose there’s also an element of luck in having one who was open to listening. Her verbal communication issues are very obvious though which makes things “easier”, much harder for people to get a diagnosis when there isn’t a “very visible” impairment like that, and as I said even worse when it’s got to the point of battling through the education system and CAHMS to even get near a consultant.

We had all of our i’s dotted and t’s crossed long before she even started nursery (they actually got some major upgrades because they got a nice big chunk of funding for her, lol) and have never needed a sniff of CAHMS. Which I am very glad about because it seems like it can be an absolute minefield.

Good to hear.

Yeah, a minefield indeed.