The DSM-V Saga Continues

You can't make this stuff up.

To recap: Certain members of the American Psychiatric Association (the "APA") have proposed sweeping revisions to the DSM-IV, which is used to diagnose, among other things, autism. With respect to autism and other conditions, the proposed DSM-V will include "dimensional ratings" and "subclinical" designations. This is said to represent a paradigm shift. The chair of the DSM-IV task force, Allen Frances, sharply criticized the proposed revisions and the lack of transparency of the process. The APA came out swinging with its rebuttal, in which it accused Frances of bias and financial motivation: the DSM V revisions will render the DSM-IV handbook, which Frances authored, obsolete.

Update:

1. Predictably, Frances took umbrage. Those royalties he'll be forfeiting when DSM V is published? $10,000 per year. Which, for him, is probably nothing. He doesn't write that, because that would be crass, but that's the implication. Frances also challenges the APA to be tranparent and make public the exact wording of the proposed revisions, and the research in support thereof.
   
   
2. One of the members of the Workgroup on Disorders and Childhood and Adolescence has resigned in protest. This is the group that is deliberating over the inclusion of sensory processing disorder in the DSM V. She writes:
   
   "I am increasingly uncomfortable with the whole underlying principle of rewriting the entire psychiatric taxonomy at one time. I am not aware of any other branch of medicine that does anything like this....There seems to be no good scientific justification for doing this, and certainly none for doing it in 2012."
   
   So even if SPD were included in the DSM V, who is going to respect it? The process appears to have little integrity.

Related: Bitterness, Compulsive Shopping and Internet Addiction [via Slate]
Secrecy and Made Up Illness: The Latest Fight Over Psychiatric Illness [Via Doublex]

Brad in motion.

A quick update on motor development:

We have pencil grasp!

We have pedaling!

Brad's motor developing is taking off. I wouldn't say he's caught up, but he's moving in the right direction (puns intended). That having been said, his fine motor is still a little wonky, and his tone is still low.

And we have another piece of the puzzle: turns out he has an orthopedic problem - he's pigeon-toed. His left foot turns in when he walks. His pedi assured me this is orthopedic, not neurological. In addition, he's flat-footed, and this apparently is neurological; it's like having low muscle tone in the arch of his foot. What are the odds of having both a neurological issue and an orthopedic issue affecting gait? In any event, this explains his walk.

The good news is that being pigeon-toed is very much a condition he'll grow out of on his own with no therapy. In the old old days, pedis used to prescribe orthopedic shoes. In fact, I wore orthopedic shoes when I was a child (for what, I have no idea). Turns out, those ugly shoes aren't actually therapeutic. Just ugly.

And so, I am on a mission. To keep Brad's therapy roster free of ugly shoes, actual and symbolic...

"Excuse me, Mommy."

Music to my ears.

After what has felt like a verbal plateau for the last six months, it appears Brad's speech is taking off again. He's surprising us lately with a fullness of expression and a budding personality. My fave: "excuse me, Mommy", used appropriately when he wants my attention. And if I don't attend right away, he keeps saying it, with increasing volume. And I'm only too happy to pay attention.

Speech Assessment

Now for the numbers.

I received a full evaluation report from Brad's private speech pathologist. The conclusion:

Brad presented with a mixed profile in receptive-expressive language skills with average receptive and expressive vocabulary, mild deficits in direction following, question comprehension and verbal reasoning, mild deficits in semantic organization, and severe deficits in language formulation for a variety of purposes. Deficits were also noted in Brad's symbolic play, as he did not engage in pretend play and dmonstrated some rigid and atypical play behaviors. With regards to speech skills, Brad presented with a mild phonological disorder with a motor component.

Drilling down:

Behavior: "bruxism" noted. That's medical-speak for teeth grinding, which is self-stimulatory. He does this quite a bit now. Also observed: reduced eye contact. But: "Brad maintained selective and sustained attention for the entire two-hour assessment and complied with both play and language based tasks."

Play: Rigidity observed. For example, "when given a chair, table, tablecloth, fork, knife, plate and doll, Brad placed the doll on the chair, pushed her to the table, and then set the table. He did this silently and did not narrate his play scheme or interact with the doll." Tough grader. I guess I should get used to it.

Receptive language:

• The Peabody Picture Vocabulary Test-4: Brad scored 88. The mean is 100 with a standard deviation of 15
• Verbal Comprehension Scale A from Reynell Development Language Scales: Brad scored 82. The mean is 100 wiht a standard deviation of 15.
• Informal probe: Answers yes/no and what questions accurately. Inconsistent accuracy for where questions. Innaccurate for why questions.

Expressive language:

• Expressive One Word Picture Vocabulary Test: Brad scored 98. Mean is 100.
• Expressive Language Scale from the Reynell Developmental Language Scales. Brad scored 70. The mean is 100 with a standard deviation of 15. This is by far his lowest score. Based on this, he was judged to have a severe expressive language impairment. "Error responses consisted of visual/verbal association errors. For example, when asked to label and illustration of a window, Brad responded 'book.'" But it was only pictures that tripped him up. He scored 100% identifying actual objects, and 63% with illustrations.
• Informal analysis: Possible language organization and/or word retrieval deficits. "Several lengthy response latencies were noted during both word-level and sentence-level testing. Response latencies ranged from two to eight seconds. this degree of response latency might have resulted from mild word retrieval deficits. Further characteristics of word retrieval difficulties were noted in Brad's use of non-specific terminology throughout assessment. Characteristics of language organization deficits were noted in difficulties disambiguating illustrations of visually similar objects, such as a feather and a leaf, and reduced use of specific vocabulary to describe part/whole relationships."

Speech

• Goldman Fristoe Test of Articulation- 2. Brad scored 108. Mean is 100. Mild speech dysfluency observed.

Potent Potables for $800

As Brad continues to phrase his observations in the form of a question, I am reminded of the original Jeopardy satire which gave us brilliant categories such as:

• Colors That End In "-urple"
• Months That Begin with "Feb-"
• The Number After 2
• Point to Your Nose

A Little Bit Autistic presents...Celebrity Jeopardy, featuring the awesome Will Ferrell as Alex Trebec [via Funny or Die]:

SNL Celebrity Jeopardy 10-23-99 - watch more funny videos

(Click here if the embed isn't working.)

Ferrell's comic genius is undeniable, but is it...special? As in, a special talent associated with an autistic spectrum condition. I have it on good authority that Ferrell had some familiar spectral traits as a child:

Born and raised in the Los Angeles, California, suburb of Irvine, in 1968, Ferrell was an easygoing child. "He was born like that," his mother, Kay, told Scott Raab in Esquire. "You know those little Matchbox cars? Will would line up his Matchbox cars, by himself, and be totally happy. You'd say, 'You wanna go to Disneyland today or line up your cars?' and he'd have to think about it." Ferrell was known as a funny kid even in elementary school, where he would punch himself in the head just to make girls laugh.

Makes me wonder. I know what a quirky kid looks like as a kid, but what does one look like as a grown up?

Of course, some would say spectral sitings are misguided, and that our energy would be better spent examining the relationship between autistic spectrum conditions and talent, and the nature of talent itself, rather than inferring autism where we see talent.

Chew on that. Or watch Funny or Die. Either one.