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View Diary: They're Saying the Shooter Had Asperger's. (370 comments)

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  •  But, as I understand it, (8+ / 0-)

    not all people who are on the Autism Spectrum have Asperger's. I'm confused, because many people, as I understand it, don't have the symptoms typical of Aspberger's.


    Torture is ALWAYS wrong, no matter who is inflicting it on whom.

    by Chacounne on Fri Dec 14, 2012 at 10:33:27 PM PST

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    •  I can't speak for professionals (14+ / 0-)

      but my understanding from experience is Asperger's is a partial form of autism - i.e., you're a little bit autistic, and it's enough to significantly complicate your life, but you've also got a lot of normal things going on.  If they're called just autistic, that means the symptoms are profound enough that it pretty much completely envelopes their lives.

      In Roviet Union, money spends YOU.

      by Troubadour on Fri Dec 14, 2012 at 11:21:58 PM PST

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      •  There's only one difference (17+ / 0-)

        Kids with high functioning autism started speaking a year or two later than kids with asperger's.  By the time a kid is 6 or so the two are indistinguishable.   It was decided that the existence of a one year speech delay was not grounds for maintaining an entirely separate diagnosis.

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        by VelvetElvis on Sat Dec 15, 2012 at 12:02:53 AM PST

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        •  What VelvetElvis said n/t (3+ / 0-)
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          Troubadour, politicalceci, sb
        •  And it's because (12+ / 0-)

          no evidence suggested that a meaningful distinction (age of onset of speech was not bimodal among people with mild autistic characteristics) that the distinction has been abandoned.

          Also the lack of evidence for a bimodal distribution of autistic characteristics - hence the word "spectrum".

          But there's nothing to stop people using the word "Asperger's" to describe people at the high-functioning end of the spectrum, it's the categorical distinction that has been dropped.

          WRT Lanza: Asperger's/autism may not have been his only problem.  Some people who meet diagnostic criteria for Asperger's early in life later develop symptoms that meet criteria for psychosis.

          •  People who are neurotypical can also be (11+ / 0-)

            psychotic. People who are autistic can be psychotic, too. This shooter didn't kill people because he was autistic (if he even was), he killed them because he was psychotic.

            •  Even that is too simple :) (18+ / 0-)

              The overwhelming majority of people with psychosis don't harm other people.

              Diagnostic labels, in psychiatry are just that - labels.  The interesting thing about the demise of the Asperger's label is that it is one of the few instances where DSM V has adopted a dimensional/spectrum approach to diagnosis, rather than a categorical one.  Originally the hope was that far more dimensional descriptions would replace categorical ones.

              Impaired social cognition is a feature of both Austistic Spectrum Disorder and Schizophrenia, but, again, impaired social cognition does not make someone dangerous, or even unkind - lots of people with ASD are extraordinarily kind, but come to their ethical positions by a somewhat different route to the rest of us.

              Paranoid delusions are  feature of psychosis, but paranoid delusions don't necessarily result in harmful or dangerous behaviour.

              However, couple paranoid delusions with specific content (say fear or resentment of certain people), with impaired social cognition, and perhaps impaired impulse control, and maybe you start to get a predictor of dangerous behaviour.


              People are complicated.  Psychiatric diagnoses remain a very crude set of simplifying models, even with DSM V.

              •  Spectacular explanation. (3+ / 0-)
                Recommended by:
                Belle Ame, Febble, Troubadour

                Most people in our society wants simple, definitive explanations for everything. Certainty over nuanced explanation. That complexity refuses to cooperate only increases anxiety and suspicion. But  stuffing people into a box with a short label on it seldom has any meaningful outcome. It really takes time and effort to understand which are things so many of us have or refuse to expend if we do. Thanks for this one.

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                by VTCC73 on Sat Dec 15, 2012 at 11:11:55 AM PST

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                •  And what makes it more complicated, (3+ / 0-)
                  Recommended by:
                  Febble, Troubadour, jes2

                  I believe, is how we define mental illness. It seems to be limited to something that doctors have a pill for, e.g. schizophrenia. But, like all other organs, the human brain is subject to wide variations in development. And not only does it control the basic clearly defined biological life functions, it controls the elusive and relatively poorly defined areas of personality and behavior.

                  It's obvious that people vary in their ability to process words and language and numbers and music and sound and colors etc. People would generally label me as very smart, and I have met certain academic standards for that label, but I am totally useless when it comes to music. "Tom, I can name that tune in 83 notes!" (I'm also old.) And I can't understand most sung lyrics. So apparently that skill never properly developed in my brain, but you wouldn't suspect that just from the way I act, right? I seem perfectly "normal", until you go with me to Karaoke night.

                  So it should not be so hard to believe that same applies to  the development in the brain of the mechanisms people use everyday in their relationships with other people. We like to think that people who commit these actions have a nice clearly defined disorder that causes them to do this and makes them an "Other". It's uncomfortable to think that it comes from having the right (or wrong) combination of just the critical amount of several impairments. Impairments that are commonly found individually and are not generally considered illnesses.

                  •  Well, diagnostic labels are not (2+ / 0-)
                    Recommended by:
                    Troubadour, Belle Ame

                    "limited to something that doctors have a pill for"!  If only :)

                    Many psychiatric disorders with diagnostic labels can be helped by drugs, but many are intractable, and for some, there simply isn't a drug treatment (autism, for example).

                    But agree with the rest of your post!  The developmental perspective is really important I think.

                    •  Sorry, when I said "we" I meant (1+ / 0-)
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                      the general public and the media. Professionals do know better. That's clear from watching some of the coverage. The anchor on MSNBC this afternoon kept throwing Asperger's at the psychological professionals he had on, as if that one condition could explain it, even though I had the sense he hadn't even bothered to look up what it is. The pros, of course, deflected it and tried to point out there is usually no simple answer. The media throws around the phrase mentally ill as if to say "why wasn't this guy on meds or  locked up in a psych ward!"

                      •  Exactly. Excellent point! (1+ / 0-)
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                        And one thing that really bothers me, is the gun nuts who say that people with "mental health issues" shouldn't be allowed guns.  That's Soviet psychiatry all over again - depriving people their citizen's rights because of what they say, not because of any crime they have committed.

                        And thus a violation of the First Amendment!  The problem here it seems to me (as a UK citizen) is with the Second Amendment itself - if you deprive citizens of their Second Amendment rights because of what they say, then you also violate the First, and open the way to undermining the entire rationale for the Second.  What use is "The Right To Bear Arms" if that right can be removed from a non-criminal simply because society doesn't like their views?

                        I'm aware that the Second Amendment is unlikely to be repealed, but boy is it problematic.

          •  high functioning (7+ / 0-)

            doesn't actually mean mild autism.  It means intelligence as measured by IQ is in the average range, meaning above 85 typically.  I have worked with individuals with high functioning autism who had severe behavior problems, severe deficits in social interaction etc.  And some whose autistic characteristics were so mild no one recognized them as having autism (including evaluators who gave them labels such as Central Nervous System Dysfunction, ADHD, OCD, and depression in one case).  

            •  Well, "high functioning autism" doesn't actually (2+ / 0-)
              Recommended by:
              Troubadour, CA wildwoman

              have an entry in DSM IV, so there is no consensus definition,and it tends to be used in different ways by different people.   But one use was to distinguish high functioning individuals with the autistic "Triad of Impairments" who had impaired language development from those whose language development was spared ("Asperger's").  And it has turned out that this simply isn't a categorical distinction.

              Also, in DSM IV, autism was to be an exclusion criteria for ADHD - DSM V (I think) will recognise that the two sets of symptoms can be comorbid.  Certainly there is some evidence that some children with ASD with ADHD symptoms can be helped by treatment for ADHD.

      •  Because I try to refrain consistently from (19+ / 0-)

        diagnosing anyone who is not a client of mine and not diagnosing people from afar....but just guessing based on what I know as a retired therapist;  I thought from the beginning it was more of a personality disorder such as anti social aggressive.  

        I think society has to look more at teaching people coping skills and not acting on their rage and perhaps their violent fantasies.

        As an advocate for the mentally ill and as a therapist, I am always telling people that the chronic mentally ill are very seldom violent.  Very few schizophrenics are like Jared Loughner or the guy from Aurora CO.  It is rare and it is more likely our patients will be suicidal and we are always on guard for that.

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        by wishingwell on Sat Dec 15, 2012 at 02:17:21 AM PST

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      •  The way I understand it from our experience with (10+ / 0-)

        our son, who had Asperger's and now is classified as having ASD, "Autism" was the only federally-recognized or -created non-physical or non-mobility category of handicap created for the channeling of ADA monies to school districts for the purposes of meeting ADA requirements concerning intervention specialists, IEPs, accommodations, etc.  A whole bunch of kids with behavior issues and diagnoses such as ADHD, ADD, etc. were requiring intervention and accommodation in schools, but many school psychologists and outside doctors were not giving them diagnoses that fit into the category "Autism."  Asperger's WAS included in that category at the federal level at least in terms of practice in interpreting the guidelines for the category; but things like ADHD weren't.  So they expanded the category to "Autism Spectrum Disorder" so that a range of overlapping or related behaviors might be accommodated and aided through the schools."

        Our son has Asperger's and ADD.  If he'd just had ADD until recently, he wouldn't have merited any school assistance.  His Asperger's got him an IEP, intervention specialists, etc.  Now, however, his particular condition (ADD and Asperger's) is reflected well within the larger, expanded category of ASD.  

        I'm fine with it.

        That's one more thing to add to my long list of small problems. --my son, age 10

        by concernedamerican on Sat Dec 15, 2012 at 05:31:23 AM PST

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        •  children with ADHD (3+ / 0-)
          Recommended by:
          sb, Troubadour, Febble

          with or without hyperactivity can be eligible as Other Health Impaired for special education classification purposes. Or may qualify for special programming under 501C rehab guidelines.  Not every child would qualify but if the ADHD is causing sufficient functional impairment they should.

        •  Note, though, that special education service (2+ / 0-)
          Recommended by:
          Febble, CA wildwoman

          categories do not directly correspond to medical diagnoses, since they're supposed to be the outcome of educational assessments rather than medical diagnosis.

          In a dog-eat-dog world, rabies is an advantage in the short term.

          by ebohlman on Sat Dec 15, 2012 at 06:28:17 PM PST

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      •  Asperger's (4+ / 0-)
        Recommended by:
        Troubadour, sb, VTCC73, doinaheckuvanutjob

        does not mean "partial form of autism".   If an individual meets some, but not all, of the criteria for autism with significant impairment in functioning,  they are labeled as having Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).  
        Asperger's is a syndrome used to describe children with autistic behaviors who fall within the average range of intelligence or higher, and who do not present with language delay in early childhood.  They often overlap in characteristics with children who have Nonverbal Learning Disability (NVLD), with problems in visuo-spatial problem-solving and visual-motor coordination.  Saying the IQ is in the average range or higher means the IQ might be 85 or it might  be 165!    

        If you think about that you can see that the individual's functioning can have quite a range.  For those with higher IQ's it is often found that they are much better able to develop compensatory strategies, hence their differences maybe less handicapping or less evident to other people.  This would give the impression that they are only " a little bit autistic".   And keeping in mind that autistic behaviors occur in all individuals with autism with a range, some individuals at all levels of intellectual ability will present with varying types and degrees of behaviors associated with autism.  So some have varying sensory processing problems, some have hand-flapping or self-stimulatory behaviors such as rocking, some have problems with eye gaze, some have echolalia etc.

         The only thing they all have are the behaviors that fulfill the criteria for autism--impaired social communication/social interaction, and restricted and repetitive behaviors and interests, with the DSM V adding sensory interests and aversions into the mix of symptomatology.  

    •  You're confused because it's confusing- (25+ / 0-)

      both my son and my granddaughter are now diagnosed with ASD. The difference in their symptoms and their level of functioning is enormous. My granddaughter is probably much like a younger version of the diarist- her issues are real but most people meeting her would not even notice them. My son has lived in a CLA (group home) with 24 hour supervision since he was 21, and would not be able to function without it. I think we needed finer distinctions in diagnosis, not this broadening of a diagnosis to the point where it loses meaning.

      •  You can have finer distinctions under a (3+ / 0-)
        Recommended by:
        murrayewv, Troubadour, sb

        broad category. In fact, they can make things clearer, if you know there's one basic disorder and different degrees of being affected.

        •  That's part of the problem- (6+ / 0-)

          I'm not at all convinced that it is one basic disorder. There are some similarities re social cues etc., but that's about as far as it goes.
          My son is completely non-verbal. His level of functioning in the world is that of maybe a four year old. I won't go into a laundry list, but there's very little he can do without help or supervision.
          It's very hard for me- for anyone who knows both of them- to accept that they just represent different degrees of the same disorder. It's pretty obvious that my son't brain is impacted in different ways, and not just quantitatively.
          Forgive me if I don't place a lot of trust in the AMA and the psych community as far as their understanding of autism is concerned. Lots of bad experience there.

      •  What purpose would that serve? (2+ / 0-)
        Recommended by:
        Troubadour, sb

        What use would there be in having two different labels for your granddaughter and son?

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