Notes on Autism

NPR reported this morning on a study of South Korean school students related to autism.

“The researchers of this report stated that the 1 in 38 statistic was applicable throughout the world.  That the reason we are diagnosing so many children with Autism is that we are getting better at recognizing the symptoms of the full spectrum of Autism.

Many of the children were probably missed because they didn’t misbehave and they weren’t failing academically, Kim says.

These children could function at a level that was expected, even though they were having a lot of difficulties with their peers and social engagement,” she says.”

WHAT????   One in 38 children are eligible for a primary diagnosis of Autism?  (Even when the child is diagnosed with an Autistic Spectrum diagnosis, it is still within the realm of Autism.)

As a an “old” mental health practitioner, I am always amazed at how easily we label children.  I realize that the way school resources are allocated, that a label of “AUTISM” will open much-needed doors for helping children.

I am concerned about the interpretation of the criteria for assessment on the Autism Spectrum.  From the above quotation, it seems as though the children meeting this criteria  may have been doing so in such a quiet manner as to suggest that perhaps other issues may be present rather than a primary diagnosis of Autism or related diagnostic category.

Here’s a link to the DSM-IV’s criteria to meet Autism:

Children who struggle with socialization skills, as determined by developmental bench marks, need not necessarily be Autistic.  There are many reasons why a child may not demonstrate a total sense of security or comfort within his or her peer group.

If a child is able to demonstrate developmental competence in academics and expected group social behavior (e.g., in the classroom), then it would seem that before looking at a psychological diagnosis, one may look at the environment in which the child currently lives, or has been raised in, or the classroom or the actions of peers.

There is a way to diagnose a child by using V-codes that attend to the presenting issue without labeling the child with Primary diagnosis.  There are three V-Codes that might be quite useful here:

  • V61.20: Parent-Child Relational Problem
  • V61.8: Sibling Relational Problem
  • V61.81: Relational Problem.

Helping a child to achieve comfort in social situations is often the ability to help the child experience safety in situations where he can be himself and be creative.  Many children who struggle with social relationships have a poor self-image.  They doubt themselves, feel “less than,” and have a sense that they are unable to live up to other’s expectations of them.

If a child is capable of appropriately communicating in an age-appropriate, developmental-appropriate manner; and is able to conform with classroom behavior norms, as well as be successful in academics (at least an average student or above), then my first thought is not of Autism, but of an anxiety or fear of the child’s that is promoting a social/peer awkwardness or inability.

One of the gentlest forms of determining how a child is processing social information is through Theraplay for younger children:

Theraplay is different from Play Therapy.  However, play therapy may be utilized quite successfully with the child who is struggling with peer relationships.  Yes, through play, children heal themselves.  It is gentle and amazing.

One of the silent factors in mental health diagnosis is the old factor of “insurance payment.”  Insurance does not like to reimburse for mental health treatment that does not use medication.  It is quite rare for a child to need psychotropic medication.  And even rarer that child to be medicated for a relationship issue.  Schools are unwilling use scare resource monies on children with “peer issues.”

I believe that most children who qualify for the primary diagnosis of Autism will demonstrate their struggles with adults, animals, in groups and with “black and white” thinking.

Please, if your child or someone you care for is exhibiting social “peer issues,” take the time to offer the child a safe environment in which to explore, achieve and experience competence.

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