Will DSM-5 Contain Or Worsen The “Epidemic” Of Autism?

Allen Frances, M.D. has been an outspoken critic of the DSM-5 process and draft proposal.   In Psychology Today, he blogs about the proposed changes to Autism Spectrum Disorder, a topic I have blogged about here and here.   Dr. Frances writes, in part:

There has been an "epidemic" of autism in the last fifteen years. This used to be a very rare condition diagnosed less than once in every two thousand kids. Now it is diagnosed once in a hundred. We will elsewhere take up the foolish theory that this was cause by vaccination. Here we will trace the real causes.

People change slowly, if at all. In contrast, fads in psychiatric diagnosis can come and go in a fast and furious fashion. The autism fad resulted from changes in DSM4 (published in 1994) interacting with a strong societal push.

There were two DSM4 contributions:1) the inclusion of a surprisingly popular new diagnosis, Asperger’s Disorder; and, 2) much less importantly, editorial revisions meant only to clarify the criteria for Autistic Disorder, but which may have inadvertently lowered the threshold for its diagnosis.

[...]

The DSM5 proposal is highly controversial both within the professional community and among the advocacy groups- with strong supporters and equally strong critics and probably about an equal weight of argument on both sides. When it comes to labelling, the heat of the argument is often a direct reflection that there are no clear right answers. The major point is to ensure that DSM5 not provoke a further misleading "epidemic" of autism. The criteria set should retain and enhance items that will reduce the risk of false positive diagnosis. Proposed changes and alternative wordings need careful field testing in nonspecialist settings to determine their likely future impact on rates. Even small wording changes can have a profound impact on who is, and who is not, diagnosed.

Ultimately, there will not ever be a clear right verdict on the DSM5 proposal to unify autistic disorders within one rubric. The scientific evidence is not overwhelming either way and is subject to different plausible interpretations. The stigma question cuts both ways. The services issues will have to be dealt with whether there is one diagnosis or two.

Read more of his commentary here.

Bus safety: school aide accused of beating up student

WSB-TV in Georgia has a story on their web site today about how a surveillance camera on a special education school bus in Fulton County enabled school authorities to determine that a bus aide had grabbed an autistic 10-year old and put him in a head-lock.  The aide subsequently told the student’s mother that she had intervened after the child had allegedly been involved in an altercation with another student on the special education bus.

"Restraining does not come by restraining someone by the face," said the child’s mother.

"Protocols are in place and they were not followed. Immediately upon learning about this situation from the parent we launched an investigation. Based on our findings, we made the decision to terminate the bus employees and file criminal charges," Fulton County School official Allison Toller said in a statement to Channel 2 Action News.

The aide faces battery charges.

Read more

Autism service dog helps student

There’s a great feel-good news story by Kelley Atherton of The Triplicate in California about an autistic student and his service dog:

Wendy Going noticed her son Kegan had a natural inclination toward animals.

Whenever Kegan saw an animal he would start making sounds — talking in his own way. This was unusual for the boy because most of the time he’s silent, his mother said.

Kegan is autistic.

This week, Kegan, 8, brought his autism service dog Everett with him to Smith River Elementary School for the first time. Everett is expected to help Kegan stay calm and safe, both inside and outside the classroom.

[...]Since Everett has been in Kegan’s life, the difference has been “amazing,” she said.

You can read more here, including about how the community pitched in to help the family raise the $13,500 they needed to get the dog.

For more information on service dogs for autistic children, see autismservicedogsofamerica.com

Image credit: Kegan Going works while his service dog, Everett, chills. Photo credit: The Daily Triplicate/Bryant Anderson

Court: parent of autistic student didn’t exhaust remedies under I.D.E.A.

The Ninth Circuit Court of Appeals ruled this week on a case involving the use of a time-out room with an autistic student. Here’s a summary of the background of the case, Payne, v. Peninsula School District, taken from the court opinion itself:

D.P. suffers from moderate autism, which has delayed his academic progress and caused his resistance to work, his difficulties staying on task, and his impulsive, “inappropriate or aggressive” responses to his environment. In September 2003, as is required under the IDEA, see 20 U.S.C. § 1414 (2006), an Individualized Education Plan (“IEP”) was developed for D.P. to address these limitations and provide appropriate education. That plan placed him in a transition classroom at Artondale Elementary School, set out instructional goals, and, most relevant to this case, sought to address his behavioral issues through various intervention methods, including the use of time-out in a “safe room.”

This case concerns that safe room, a roughly 5′ x 6′ room located within the special education classroom. It is the teacher’s use of that room with D.P., rather than the room itself, that is at issue here. The parties dispute the details as to what Payne consented to (i.e. a locked, closed door, with no adult inside), the duration of D.P.’s periods of confinement, and whether the window was covered. However, they agree that
D.P. was locked in the room on multiple occasions in response to his classroom behavior. On several occasions, he removed his clothes in there, and urinated and defecated on himself. He helped his teacher, Jodi Coy, clean up his excrement. He began to exhibit anxious behaviors and experience emotional and scholastic setbacks.

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