Three cases of “Autism”

Three children with the same diagnosis, but little else in common. Most autistic children, their parents and their siblings have a tough and expensive life ahead of them. TIME estimated that it cost between $1.4 and 2.4 million in 2014 to raise a child with autism.

The cost of special schools in the UK – is in the region £100,-000 to £150,000 each year – five years of education and you are looking at a black hole of £3/4 million pounds before they have reached adulthood. The label, the life sentence comes on the back of a paediatric or paediatric psychiatric opinion, backed up by his team, but rarely by any kind of investigations.

I saw three children last week, all with a diagnosis of autism, but nothing else in common. When I qualified they might have had very different diagnoses, and at least some investigations. As it is, those children had one MRI between them and nothing else but hot air from MDTs or Multi-Disciplinary Teams. Is this a reasonable use of resources? I think not.

There was no suggestion that these were abused or neglected children. The problems the parents described came from the child rather than any external failure of parenting, even though neglect abuse and mis-parenting can lead to the diagnostic triad:
1 – Lack of social interaction
2 – Poor verbal and non- verbal communication
3 – Repetitive behaviours or interests
Which are the supposed hallmarks of autism. Any child, with any developmental disability is likely to fit into those broad categories – because they represent childhood development. Children learn to interact socially, develop language and a range of skills to cope in a range of situations. What is on the label is in the tin. A developmental disorder is a failure to develop. Childhood development can be briefly summarised in those three criteria. Hence all children who are not developing as expected fit the diagnosis of Autism or at the very least Autistic Spectrum Disorder.

Autism or Autistic Spectrum Disorder is nothing other than a label for a collection of symptoms that despite decades of research are about as clear as the evolutionary swamp from which we emerged. For every apparent answer, a dozen questions are raised. We have not even reached the foothills of the mountain range we need to climb, in oder to understand how our minds. AI has about as much in common with how the brain works, as an abacus does with a calculator. A label is just that – it is a name for what we see – ‘dog’ ‘cat’ ‘person’ and ‘autistic disorder’. However there is a difference between labels such as ‘dog’ and ‘cat’ and ‘autistic disorder’ they are backed by science. However cat- like a dog might appear, ultimately it is possible to test the dog’s DNA ad conclusively confirm the material fact that it is not a ‘cat’. There is no such option as far as the Diagnostic & Statistical Manual of Mental Disorders is concerned. The closest the DSM comes to mentioning diagnostic investigations is “Imaging studies may be abnormal in some cases, but no specific pattern has been observed”. This is not good enough!!! Scans, blood tests, looking for infections, full physical examinations are crucial in every other area of medicine in order to make a diagnosis.

In fairness the DSM does offer a few other labels for the “Developmentally Impaired” there are other options, Rett’s syndrome, Childhood Disintegrative Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder. Rett’s syndrome is a rare inherited disorder- 1/12,000 children, compared to between 1 in 90 and 1 in 150 given the diagnosis of Autism; Childhood Disintegrative Disorder is to all intents an old fashioned name for ASD, where there is definite evidence of deteriorating development and regression, Asperger’s syndrome cannot be distinguished from ASD and Pervasive Developmental Disorder is another old fashioned name from a time when a detailed diagnosis was considered important.

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