Diagnosing Asd In The Context Of Id
Diagnosing mental conditions in individuals with ID presents challenges in general. For this reason, a separate diagnostic manual has been created to provide guidance about when DSM-5 criteria should be modified for the ID population . The Diagnostic Manual-Intellectual Disability-2 highlights complexities in distinguishing ASD in individuals with ID, but does not indicate any adaptations for the ASD diagnostic criteria beyond utilizing the DSM-5 requirement that deficits exceed impairment consistent with the level of intellectual disability . Similarly, Criterion E of the DSM-5 ASD criteria requires that disturbances are not better explained by intellectual disability or global developmental delay , though it does not specify how this should be determined. Thus, neither manual gives instructions about how or when ID may or may not explain symptoms of ASD. In addition, as discussed later, the ability to make such determinations may depend on the severity of ID and the age of the individual, as certain distinctions may be increasingly challenging at more severe levels of ID and/or at certain ages/developmental periods.
How Does An Intellectual Disability Happen
Intellectual disabilityformerly known as mental retardationcan be caused by injury, disease, or a problem in the brain. For many children, the cause of their intellectual disability is unknown.
Some causes of intellectual disabilitysuch as Down syndrome, Fetal Alcohol Syndrome, Fragile X syndrome, birth defects, and infectionscan happen before birth. Some happen while a baby is being born or soon after birth.
Other causes of intellectual disability do not occur until a child is older these might include severe head injury, infections or stroke.
Is Autism A Disability And If It Is A Disability Then What
Is autism a disability? The short answer to that question is yes. Autism is a disability.
But the conversation doesnt stop there. In fact, theres so much more to this conversation that we need to consider than just the disability label.
More specifically, autism is whats referred to as a developmental disability.
And whats a developmental disability? The term has a few nuances but refers to a condition that affects ones life-long development.
Autism is not considered a birth defect nor is it a learning disability. Birth defects apply more to observable abnormalities in bodily structures. A learning disability refers to difficulties in learning unrelated to intelligence or motivation.
So whats the definition of autism? Well, the official diagnostic term is Autism Spectrum Disorder, also known as ASD.
People with ASD have a condition where a compromise occurs in the brains development. As a result, individuals with autism typically have challenges in a few areas. These include difficulty with communication, social interaction, and behavioral challenges.
Autism affects approximately 1 in 60 children, mostly boys.
It doesnt take a long time to recognize autistic symptoms. In fact, you can recognize these symptoms before a child reaches the age of 2 years.
The cause of autism is unknown. Though some suggest that vaccines cause autism, there is no conclusive evidence to substantiate that claim.
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How Common Is Intellectual Disability In Autism
31% of children with ASD have an intellectual disability , 25% are in the borderline range , and 44% have IQ scores in the average to above average range .
How common is intellectual disability in autism?
About 1% of the general population is thought to have intellectual disability, and about 10% of individuals with intellectual disability have Autism Spectrum Disorder or autistic traits. However, a much higher percentage of individuals with ASD have intellectual disability3.
What percentage of children have an intellectual disability? The prevalence of intellectual disability was lower among younger children than older children: 0.73% among children aged 37 years, 1.45% among children aged 812 years, and 1.40% among children aged 1317 years.
Is autism a physical or intellectual disability?
Autism is not a mental health problem or an intellectual disability, although some people with autism will also have those problems. Doctors used to think that Aspergers syndrome and autism were separate conditions. They now think that they are all part of one condition, called autism spectrum disorder or ASD.
Therapeutic Implications And Challenges
As evident from the proceeding discussion, many known ID and ASD genes are involved in various physiological processes and many of these genes converge on distinct and common pathways altering neuronal functions . Furthermore, an understanding of genes, pathways and associated molecular and cellular mechanisms in many cases of ID and ASD further provides a means for exploring therapeutic approaches in at least some cases of ID and ASD. Indeed, several recent studies in model systems suggest that neurological disorders, like Rett syndrome, Angelman syndrome, Kleefstra syndrome and Fragile X syndrome, are not permanent and hint at the possibility of rescuing, reversing or ameliorating neurological deficits .
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Losing Control Of Emotions
Children with autism often lose control of their emotions and experience meltdowns . In autism, meltdowns are almost always the result of either sensory assaults, anxiety, frustration, or a combination of all three.
In a child who has not been diagnosed with autism, however, the symptoms may look like oppositional defiant disorder which is considered a behavioral disorder.
Children with higher-functioning autism may also receive a range of inappropriate diagnoses before receiving their autism diagnosis. Some of the most common include ADHD, hyperlexia, learning disabilities, and speech delays.
It’s important to note that some children with very high functioning autism may not be diagnosed until they are well into their teens or even adulthood. When that happens, it can be tricky. Developmental disabilities usually appear in childhood, and it may be necessary to dig into an individual’s past to unearth signs that disabilities existed prior to adulthood.
If childhood information isn’t readily available, it may be impossible to provide an autism spectrum diagnosis even if it is the most appropriate diagnosis based on symptoms and behavior.
A Variety Of Problems
The genetic defect has widespread consequences in the body, and people with even the trait or carrier status may have a variety of physical, emotional, intellectual and behavioral problems or they may be normal. Early menopause is a common problem for women who are carriers. Also, older carriers can develop tremor and balance problems as they age. All of these problems can vary widely in severity among individuals.
Although many children with fragile X syndrome clearly desire socialization, they are often overwhelmed by stimuli, leading to behaviors typical of autism.
About 80 percent of boys with fragile X syndrome demonstrate intellectual disability, compared to about one third of females. Intellectual abilities range from a normal IQ with subtle learning disabilities to severe intellectual disability. Female carriers who are intellectually normal are often found to share characteristic disturbances, such as difficulty in learning math, and emotional problems such as extreme shyness, anxiety, obsessive worrying and mood swings.
Health problems, related to the variety of underlying physical abnormalities, include frequent sinus and ear infections, a lazy eye, dental problems, and heart murmurs indicative of a floppy heart valve. Seizures are common, but are often outgrown by adulthood.
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Its Not Always Autism
The hazy line between autism and intellectual disability is challenging for parents and clinicians, especially when it comes to accurate diagnosis of developmental disorders.
Some parents admit that they dont care if their child with an intellectual disability receives a wrongful, additional autism diagnosis. The communication and behavioral challenges addressed in autism interventions are often appropriate for children with intellectual disabilities too. For these parents an autism diagnosis may not be accurate, but their childs condition receives treatment and their chance of stigma with an autism diagnosis is less than with an intellectual disability diagnosis. The idea that those with autism are entitled to better services than individuals diagnosed with other mental conditions seems quite pervasive.
The work of autism advocates is creating awareness, promoting education about the condition, and destroying the stigma surrounding neurodiversity. Elevating those on the spectrum should not, however, cast a shadow of stigma on other mental conditions like intellectual disabilities.
Perhaps this was the real intention of the person-first movement: whatever the condition, treatment and resources should be specialized to individuals, rather than catering only to diagnostic classification. Whether a child has autism, an intellectual disability, or both, they should receive the support best suited to enhancing their quality of life.
References:
Significant Limitations In Two Or More Areas Of Adaptive Behavior
Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently . To assess adaptive behavior, professionals compare the functional abilities of a child to those of other children of similar age. To measure adaptive behavior, professionals use structured interviews, with which they systematically elicit information about the person’s functioning in the community from someone who knows them well. There are many adaptive behavior scales, and accurate assessment of the quality of someone’s adaptive behavior requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:
daily living skills, such as getting dressed, using the bathroom, and feeding oneself communication skills, such as understanding what is said and being able to answer social skills with peers, family members, spouses, adults, and others.
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What To Say & Not To Say
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People with intellectual or developmental disabilities may find it hard to do many things most of us take for granted.
These disabilities can mildly or profoundly limit their ability to learn, socialize and take care of their everyday needs.
You may not be able to know that someone has this disability unless you are told, or you notice the way they act, ask questions or use body language.
Asd And Intellectual Disability: Not Synonymous But Sometimes Similar
When looking at researchwhere the co-occurence of autism and intellectual disability is examinedit illuminates why even doctors sometimes get the diagnosis wrong. It seems almost impossible to find a definite divide separating autism and intellectual disability and when the two co-occur the boundaries are even blurrier. Medical professionals should not be blamed too harshly for this diagnostic struggle research shows that there may be shared or overlapping genes linking these two complicated conditions.
Researching genes involved in ASD and intellectual disability
Researchers have made interesting discoveries about the genes involved in neurodevelopmental disorders. A recent study titled Distinct Pathogenic Genes Causing Intellectual Disability and Autism Exhibit a Common Neuronal Network Hyperactivity Phenotype illuminates the nature of biological convergence on neuronal activity.
Other studies have also found a genetic overlap between autism and intellectual disability. Research focusing on the genes involved in autism, and differentiating those from genes associated with intellectual disability, become important for more accurate diagnosis and subsequent appropriate interventions. A link between the increase in prevalence of ASD and decrease in prevalence of intellectual disability may also be important to examine.
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What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world. NINDS and several other NIH Institutes and Centers support research on autism spectrum disorder.
Nearly 20 years ago the NIH formed the Autism Coordinating Committee to enhance the quality, pace, and coordination of efforts at the NIH to find a cure for autism. The NIH/ACC has been instrumental in promoting research to understand and advance ASD. The NIH/ACC also participates in the broader Federal Interagency Autism Coordinating Committee , composed of representatives from various U.S. Department of Health and Human Services agencies, the Department of Education, and other governmental organizations, as well as public members, including individuals with ASD and representatives of patient advocacy organizations. One responsibility of the IACC is to develop a strategic plan for ASD research, which guides research programs supported by NIH and other participating organizations.
Intellectual Skills Vs Social Communication
Intellectual Disability manifests itself in tasks such as reasoning, problem solving, planning, abstract thinking, decision-making, academic learning or learning by own experience. All this is observed on a day-to-day basis, but it can also be evaluated using standardized scales.
In the case of Autism Spectrum Disorder, the main diagnostic criterion It is not the intellectual area, but the area of social communication and interaction What is manifested in the following way: little social-emotional reciprocity unwillingness to share interests, emotions, or affections the presence of a qualitative impairment of communication and a difficulty in adapting behavior to the norms of different contexts.
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Autism Vs Intellectual Disability: Are They Synonymous
For parents who want to find out more about autism, it is important to know what autism is and what its not. For others there is concern that promoting pride in autism sometimes ventures into adding to the stigma of other mental conditions or intellectual disabilities.
A by Russell Lehmann caught my attention recently in a video the motivational speaker talks about how the autism community insulting the mental health community grinds his gears. Defining autism, especially for those who found their identity in the condition, elicits strong emotions. Many on the spectrum, with high intellect, are vocal about autism not being like other intellectual conditions or disabilitiesto them autism exists in a separate sphere to disabilities, disorders and the uber offensive term mental retardation.
Believe it or not, mental retardation was a medical term used for people with intellectual disabilities decades ago, but the terminology was officially changed when then President Obama signed Rosas Law. Unfortunately, individuals with intellectual disabilities are often more stigmatized and socially excluded than any other group.
Why Children Are Misdiagnosed
Autism is not always a child’s first diagnosis, particularly if he or she is verbal and of average intelligence. Not infrequently, children who wind up with an autism diagnosis receive a range of other diagnoses firstincluding, in some cases, other types of mental disorders.
There is a simple reason for these misdiagnoses: a child who is bright and verbal may not be evaluated for autism. As a result, the child’s symptoms are viewed not as a set of related challenges, but as individual issues that could potentially be signs of another mental illness. There are a number of behaviors in autism and other mental illnesses that may share characteristics and lead to an erroneous diagnosis.
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Common Conditions Among People With Autism
While many people with autism are misdiagnosed with other types of mental illness, many are also appropriately diagnosed with both autism and mental illness. In fact, mental illness is more common among people with autism than it is among the general population.
The most common co-occurring mental illnesses for people with autism include depression and anxiety.
It’s not completely clear why this may be the case. One theory suggests that there is a genetic link between autism and mental illness. Another theory points to the extreme challenges of living in the modern world with autism. The fact is that for many people with autism, it is anxiety-provoking and depressing to attempt to overcome social, sensory, and/or intellectual challenges that are simply part of who they are.
In addition to mental illness, many children and adults with autism receive additional developmental diagnoses. While it can be argued in many cases that the symptoms are associated with autism, it is sometimes helpful to know that a child is both autistic and, for example, diagnosable with ADHD, learning disabilities, hyperlexia, Savant Syndrome, or another disorder.
A secondary diagnosis, while it may or may not be completely appropriate, can sometimes provide direction for therapy, academic support, and services. Hopefully, in doing so, this could correct any potential misdiagnoses moving forward.
The Blurred Line Between Autism And Intellectual Disability
Doctors often conflate autism and intellectual disability, and no wonder: The biological distinction between them is murky. Scientific progress depends on knowing where the conditions intersect and part ways.
by Emily Sohn / 15 April 2020
Soon after Patrick Kelly started school at age 5, his teachers told his parents he belonged in special-education classes. His academic performance was poor, and his behaviors were disruptive: hand-flapping, rocking, hitting his head with his wrists and tapping his desk repeatedly. He often seemed as if he was not paying attention to people when they spoke to him. He would stare off into the distance, head turned to the side.
Kellys teachers assumed he had intellectual disability, known at the time as mental retardation. Then when he was around 9, a routine eye exam at school revealed that he could barely see. With glasses, he went from underperforming to outperforming his peers in every subject but English in just two years. And it turned out that he had been listening in the classroom all along. Finally, at age 13, a psychologist diagnosed him with pervasive developmental disorder-not otherwise specified, a form of autism.
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Human Rights And Legal Status
The law treats person with intellectual disabilities differently than those without intellectual disabilities. Their human rights and freedoms, including the right to vote, the right to conduct business, enter into a contract, enter into marriage, right to education, are often limited. The courts have upheld some of these limitations and found discrimination in others. The UN Convention on the Rights of Persons with Disabilities, which sets minimum standards for the rights of persons with disabilities, has been ratified by more than 180 countries. In several U.S. states, and several European Union states, persons with intellectual disabilities are disenfranchised. The European Court of Human Rights ruled in Alajos Kiss v. Hungary that Hungary violated the applicant’s rights by a blank disenfranchisement of persons with intellectual disabilities who did not hold legal capacity.