Comments on: The Difference a Diagnosis Makes http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/ Family, Health, Home and Lifestyles Thu, 10 Dec 2009 08:01:52 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Autism Vox http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529718 Autism Vox Fri, 22 Dec 2006 05:33:31 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529718 [...] But the question that Herbert leaves hanging is, might it be possible that our understanding, our knowledge, of autism in our culture might change so fast that we have only begun to realize this? Herbert outlines a number of “major environmental changes” in Time to Get a Grip —but these changes have affected all of us, and not only autistic persons: “We are all polluted,” she writes. The notion of “better understanding of autism, better diagnosis, increased prevalence” cannot simply be dismissed as Herbert and Kirby so quickly suggest. The changes in the diagnostic criteria for autism are evident if one reads the various versions of the DSM and, even more, if one reads Roy Richard Grinker’s account of how the diagnosis of autism (and of child psychiatric disorders) has evolved in Unstrange Minds: Remapping the World of Autism (forthcoming in February 2007). [...] [...] But the question that Herbert leaves hanging is, might it be possible that our understanding, our knowledge, of autism in our culture might change so fast that we have only begun to realize this? Herbert outlines a number of “major environmental changes” in Time to Get a Grip —but these changes have affected all of us, and not only autistic persons: “We are all polluted,” she writes. The notion of “better understanding of autism, better diagnosis, increased prevalence” cannot simply be dismissed as Herbert and Kirby so quickly suggest. The changes in the diagnostic criteria for autism are evident if one reads the various versions of the DSM and, even more, if one reads Roy Richard Grinker’s account of how the diagnosis of autism (and of child psychiatric disorders) has evolved in Unstrange Minds: Remapping the World of Autism (forthcoming in February 2007). [...]

]]> By: David N. Andrews MEd (12-2006) http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529189 David N. Andrews MEd (12-2006) Thu, 16 Nov 2006 07:17:39 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529189 One of the major issues, of course, is that - certainly in education - a medical/clinical diagnosis is needed in order to get services for which money is ringfenced. And the major problem with medical/clinical diagnosis is that it is based on the presence of certain characteristics, all matched with a list that was drawn together by (in the case of DSM IV) a bunch of SMEs who used clinical reporting as the basis for their decisions (this is essentially a way of arguing validity in a very circular fashion). The only way to properly diagnose anything - without begging the question - is to compare, using reliably operationalised criteria, how well a person is able to complete tasks in relation to how well most people can perform them. By this I mean that it is not enough to look at clinical reports and deside on the basis of those what a diagnostic category should look like... and in fact, I do believe that the task force on DSM IV have stated that it is not a recipe list... and that, even when something appears to be a subclinical presentation, provided that it is sensible to do so a diagnosis should be made. This doesn't do for research diagnosis, since that needs to be of a higher and tighter standard; but for most daily-life issues, an approximate diagnosis should suffice (e.g., with Gillberg & Gillberg's criteria for Asperger syndrome, for research purposes, all six areas must be met; for clinical practice, it is deemed that the social interaction area and any four of the five others shouold suffice for the diagnosis). However... would the best way of diagnosing for educational services be to diagnose on the basis of performance in work samples and make the work sample task sets sufficiently large enough to assess skills rather than 'abilities'? What someone *can* do, not what we surmise they could do based on a standardised test? Or maybe is it not better to assess skills and abilities separately in order to see what the differences are... because a learning difficulty is usually said to exist if the learner cannot perform a task up to the same level as their ability level would suggest that they could (in this case, I'm defining an ability as a potential skill). I'm grappling with this issue because I'm having to devise a set of tests for my daughter.... :/ One of the major issues, of course, is that – certainly in education – a medical/clinical diagnosis is needed in order to get services for which money is ringfenced. And the major problem with medical/clinical diagnosis is that it is based on the presence of certain characteristics, all matched with a list that was drawn together by (in the case of DSM IV) a bunch of SMEs who used clinical reporting as the basis for their decisions (this is essentially a way of arguing validity in a very circular fashion). The only way to properly diagnose anything – without begging the question – is to compare, using reliably operationalised criteria, how well a person is able to complete tasks in relation to how well most people can perform them. By this I mean that it is not enough to look at clinical reports and deside on the basis of those what a diagnostic category should look like… and in fact, I do believe that the task force on DSM IV have stated that it is not a recipe list… and that, even when something appears to be a subclinical presentation, provided that it is sensible to do so a diagnosis should be made. This doesn’t do for research diagnosis, since that needs to be of a higher and tighter standard; but for most daily-life issues, an approximate diagnosis should suffice (e.g., with Gillberg & Gillberg’s criteria for Asperger syndrome, for research purposes, all six areas must be met; for clinical practice, it is deemed that the social interaction area and any four of the five others shouold suffice for the diagnosis).

However… would the best way of diagnosing for educational services be to diagnose on the basis of performance in work samples and make the work sample task sets sufficiently large enough to assess skills rather than ‘abilities’? What someone *can* do, not what we surmise they could do based on a standardised test? Or maybe is it not better to assess skills and abilities separately in order to see what the differences are… because a learning difficulty is usually said to exist if the learner cannot perform a task up to the same level as their ability level would suggest that they could (in this case, I’m defining an ability as a potential skill).

I’m grappling with this issue because I’m having to devise a set of tests for my daughter…. :/

]]> By: Kristina Chew, PhD http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529145 Kristina Chew, PhD Mon, 13 Nov 2006 04:02:30 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529145 It sounds odd, but sometimes I think we have been quite fortunate not to have encountered "diagnostic ambiguity" in Charlie's case. I have known parents who have worried over a PDD-NOS or AS diagnosis and (in particular in the former case) have sought an autism diagnosis to obtain more services. It sounds odd, but sometimes I think we have been quite fortunate not to have encountered “diagnostic ambiguity” in Charlie’s case. I have known parents who have worried over a PDD-NOS or AS diagnosis and (in particular in the former case) have sought an autism diagnosis to obtain more services.

]]> By: Juli http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529132 Juli Sun, 12 Nov 2006 21:12:46 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529132 I read the New York Times article and it really opened my eyes... in school we're taught how to deal with "this type" or "that type" of child and the label often determines what kind of services a kid gets. On one hand it's frustrating not to know what's going on with a kid or how to help him, but on the other it's a little scary that diagnoses can be applied without any scientific basis. I read the New York Times article and it really opened my eyes… in school we’re taught how to deal with “this type” or “that type” of child and the label often determines what kind of services a kid gets. On one hand it’s frustrating not to know what’s going on with a kid or how to help him, but on the other it’s a little scary that diagnoses can be applied without any scientific basis.

]]> By: Kristina Chew, PhD http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529123 Kristina Chew, PhD Sat, 11 Nov 2006 23:59:56 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529123 The quote from the mom named Evans was the very ending of the Times article and I really liked havig the article end with a quiet but strong statement of why just getting a diagnosis that best suits the child (whatever associations the "label" comes with) is the first step to getting the right services. The quote from the mom named Evans was the very ending of the Times article and I really liked havig the article end with a quiet but strong statement of why just getting a diagnosis that best suits the child (whatever associations the “label” comes with) is the first step to getting the right services.

]]> By: Daisy http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529120 Daisy Sat, 11 Nov 2006 20:28:54 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529120 Touchy, isn't it? I have seen kids who languish without services because of parental fear of a "label", and students who are thriving after an accurate and complete evaluation shows not only their diagnosis, but individual needs. Touchy, isn’t it? I have seen kids who languish without services because of parental fear of a “label”, and students who are thriving after an accurate and complete evaluation shows not only their diagnosis, but individual needs.

]]> By: mcewen http://www.blisstree.com/articles/the-difference-a-diagnosis-makes/comment-page-1/#comment-529118 mcewen Sat, 11 Nov 2006 18:03:41 +0000 http://www.autismvox.com/the-difference-a-diagnosis-makes/#comment-529118 Thanks for the links. I'm glad to hear that we're not the only ones who have a variety pack of labels that change from year to year and from specialist to specialist - makes life so much more exciting. Cheers Thanks for the links. I’m glad to hear that we’re not the only ones who have a variety pack of labels that change from year to year and from specialist to specialist – makes life so much more exciting.
Cheers

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