Diagnosis of autism

I discussed the history of autism diagnosis a previous post. As the science matured, the psychogenic origin (blame for autism on the ‘refrigerator mother’) was replaced by consideration of the premise that autism could arise from biological origins.

Both versions of Diagnostic and Statistical Manual of Mental Disorders (DSM) use behavior as criteria

In Diagnosis, the Beginning, I stated the fact that criteria for diagnosing autism (Autism Spectrum Disorder (ASD)) have changed from DSM-IV to DSM-5. I don’t think I made it clear that a diagnosis of autism is made on the basis of behavior. Both versions of the DSM use behaviors as criteria to diagnose autism. There are predictions the change in diagnosis will lead to fewer cases of autism [1] as well as predictions that the autistic people diagnosed under previous version will keep their diagnosis. [2] [3]

Even though the premise of DSM-5 development was to base diagnoses on objective testing, the science is simply not advanced enough to do that now. Since each case of autism is unique, and there are no laboratory tests that can diagnose it yet, there is no alternative to using behavioral criteria.

What to do after getting a diagnosis of ASD?

I am making some progress in discovering some successful approaches that parents have taken to treat their diagnosed children. The prevalent approach has been to treat the symptoms. This makes little sense to me. The symptoms are behaviors, and behaviors can have many causes. Wouldn’t it make more sense to try figuring out what is causing the behavior in the first place? Dr. Martha Herbert expresses this perfectly: “While autism is defined behaviorally, it is clear both that it is biologically based and that better understanding of its biology is critical at this juncture.” [4] There is more information on a biological approach at her web site: http://www.marthaherbert.org/.

Pointed in the right direction

I must thank Robyn, who posted a comment to More About Biomedical Intervention in Autism. She has met with success with some biomedical intervention, and pointed me to Defeat Autism Now! (DAN!). As a project of the Autism Research Institute (ARI), DAN! is primarily dedicated to educating parents and clinicians about biomedical interventions in autism. [5] I found some papers that addressed my concerns directly: In What is Biomedical? Dr. Sidney Baker poses two questions that form the basis for intervening to help the autistic patient:

1. “Does this person have a special unmet need to get something beneficial?
2. Does this person have a special unmet need to avoid or get rid of something allergenic or toxic?” [6]

The rest of his article is equally informative.

Dr. Paul Lee’s article [7] about treatment protocols also clarified some points for me:

1. There is no clear-cut treatment protocol for ASD – it wasn’t just me not finding one.
2. ASD seems to consist of several disease entities which result in similar behaviors

The most interesting point that Dr. Lee made was: “Many researchers now believe that ASD is triggered by an autoimmune process, affecting multiple systems including the GI tract, the brain and the liver.” [8]

Top 3 interventions

Dr. Lee ends his article by suggesting that parents ask their clinician about three major areas of intervention: Gastrointestinal (whether the GI tract causing problems); Detoxification (whether the liver is doing its job properly); Oxidative Stress (whether biochemical processes functioning properly).

Defensive

Drs. Lee and Baker both seem to feel the need to defend biomedical intervention as “alternative medicine”. However, their reasoning seems perfectly fine to me. Addressing the causes of behaviors as opposed to addressing the behaviors themselves, seems a much more reasonable way to approach treatment.

More research

I would like to find treatment protocols that do not use biomedical intervention and understand their rationale.

If anyone can point me in that direction, I would appreciate it.