JOHN ROSEMOND: Are many cases of autism wrongly diagnosed?
Q: In the school district where I used to teach, I attended many meetings concerning children with special needs. Many of the kids in question were said to be “on the [autism] spectrum.” In fifteen years I witnessed the number of supposedly autistic children go from practically zero to enough to fill a special education class at almost every one of our 30-plus schools. A good number of these children were eventually mainstreamed into my class, and I felt then and even more strongly now that they were wrongly diagnosed. I can only think of two kids who in my estimation were classically autistic. Will you please clarify the difference between a legitimate autism diagnosis and one involving the so-called “spectrum”?
A: By risking an answer your excellent question, I’m likely to make a lot of people upset with me, but I long stopped worrying about that, so here goes:
Having done a good amount of reading on this issue over the past few years, I fail to see the usefulness, much less the validity, of saying that certain children, while not classically autistic, nonetheless qualify as “sort of” autistic – other than its usefulness as an income-generator for mental health professionals and public schools, that is. By the same standard, it could be argued that lots of functional, responsible but slightly odd folks are on the “schizophrenic spectrum.”
Following the usual trend, the diagnostic parameters of autism have expanded over the past thirty years. The diagnosis of autism spectrum disorder – included in the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders, replaces four previous diagnostic categories. The result has been obfuscation rather than clarification. Consistent with your classroom observations, I conclude that lots of kids who are nothing more than a tad peculiar (which, as you point out, often comes out in the proverbial “wash”) are being saddled with a potentially counterproductive psychiatric diagnosis.
I do believe in classical autism of the sort portrayed by Dustin Hoffman in the movie “Rain Man.” In my estimation, however, the classical version is not a mental disorder. It does not belong in the DSM. For one thing, the symptoms – including unresponsiveness to parental affection and a host of developmental, communication, and socialization problems – are present far too early in an autistic child’s life to be considered a “mental” phenomenon.
I think that we are eventually – soon, hopefully – going to discover that classical autism involves brain-based issues yet-to-be discovered. When (and, of course, if) those issues are discovered, the idea of an autism “spectrum” will be superfluous. A child will either be autistic or he will simply be peculiar in certain ways (which describes lots of children and even a good number of otherwise functional adults).
But given those circumstances, I predict that the mental health industry will simply rename “autism spectrum disorder” and continue to peddle the spurious notion that being even slightly odd requires professional and perhaps even pharmaceutical “treatment.” Speaking as a former peculiar child, I’d like to thank all those teachers who believed in the idea of children eventually “growing out of” their eccentricities (albeit in my case, the proposition is arguable).
MORE FROM JOHN
In a letter to the editor of the La Crosse (Wisconsin) Tribune, psychologist Afton Koball and two colleagues raise objections to a recent column in which I asserted that one can be parented badly and still parent well. It comes down to one’s perspective, and is, therefore, a matter of choice. Said another way, parenting is influential but not deterministic.
Koball contends that I am ignoring research linking “high levels of toxic stress in childhood to chronic health conditions and even a reduced lifespan.” Noted, but that was not the subject of the column in question. Furthermore, I contend that even someone who experienced an adverse childhood and suffers compromised health as a result can still be a very good parent.
Furthermore, studies report norms, not individual outcomes. Undoubtedly, there were subjects in the study Koball cites who suffered adverse childhoods but who as adults did not suffer chronic health issues. Some of these individuals may even have had abnormally healthy adulthoods. The “link” in question does not, by a long shot, refer to a one-to-one correspondence. Said otherwise, what is “toxic” stress to some is not to others. The question becomes: How is it that some abused children fare rather well as adults, even as parents?
The list of high-functioning individuals who experienced significant hardship, even abuse, as children is quite long. It includes Oprah, Howard Schultz of Starbucks, Louis Armstrong, and Eleanor Roosevelt. Many such individuals attribute their success as adults, at least in part, to the adversity they experienced as kids.
Numerous studies corroborate my contention that it is not abuse or adversity itself that disposes one to a negative outcome, but rather the individual’s mental response to the abuse or adversity. All of these studies – including the ongoing Kauai Longitudinal Study begun in 1955 and a 2010 study done at the University of Oxford -cite folks who did well despite bad childhoods.
Koball ends his letter by saying that people who have experienced adverse childhoods need counseling. That is psychology’s central narrative, but speaking of studies, no consistent body of research compels the conclusion that any form of mental health counseling/therapy can be relied upon to produce positive results. In fact, a significant percentage of consumers report that mental health counseling was a negative experience, that it made matters worse.
Writing in the Wall Street Journal (November 10, 2017), clinical psychologist Meg Jay shares the story of two brothers raised in a home in which the father was a violent alcoholic. One brother is a drinker and an abuser, while the other is abstinent and a model parent. When asked how they came to be who they were, both brothers gave the same answer: “Given who my father was, how could I not?”
The anecdote illustrates my point: Whether flight or fight, an individual’s response to adversity is clearly a matter of choice. As the old parenting proverb has it, every child has a mind of his own.
Family psychologist John Rosemond: johnrosemond.com, parentguru.com.