Tuesday, May 01, 2007

Cho : Asperger's and Autism

I've been asked to take a closer look at Asperger's Disorder and Autistic Disorder as a differential diagnosis and I am reading some of the newer research now.

But you should know.

The reason I didn't diagnose Cho with either is that both require features of Cluster B in Asperger's in the DSM IV. In Autistic Disorder it's Cluster A, the third grouping.

I have not yet heard anything to indicate that Cho had symptoms from Cluster B (below), or for that matter, proof of Clusters D & E. Those require that he had no clinically significant delay in language, no clinically significant delay in cognitive development and no delay in the development of age-appropriate self-help skills, adaptive behavior or curiosity about the environment.

There are 6 areas of differential diagnosis for Asperger's Disorder (299.80). All must be met to meet diagnostic criterion.

But let's just look at Cluster B for Asperger's Disorder:
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements

(4) persistent preoccupation with parts of objects

Does Cho meet this?

Sure he met criterion for the clusters A and C, primarily impairments in social interaction and functioning. But what about the other necessary criterion?

I'll keep reading, and if you know more of the facts of Cho's life story, fill us in.



John Elder Robison said...

It troubles me when people discuss conditions like Asperger's in the same breath as criminals like Cho.

The implication is that 1) Asperger's is a cause for such crimes, which is false., or 2) Asperger's is an excuse for such things, which is false, too.

For an Aspergian like me, it's offensive.

How is it different from associating rape with blue eyes, or assault with brown hair?

I do agree that some Aspergians are angry, but that anger is generally a result of inconsiderate treatment they received at the hands of others, and as such, it's an environmental thing.

I have net seen any evidence that would suggest Aspergians as a group have any greater propensity for violence than the general population

I have talked about some of these issues on my own blog (which I invite you to visit), and in my books.

TherapyDoc said...

John, Thank you so much for this. Several people have challenged me to make this "diagnosis" .

Let me emphasize that nowhere does anger even appear in a DSM IV list of symptoms of Asperger's.

I will visit, you bet.

Karen said...

I find your posts very interesting. Got here via Postie Carnival.

Eric said...

I think the list that classifies autism is a little sparse, but most parents know what child autism is when it becomes obvious. Unreachable children, unresponsive to voice, delayed language development. The far away look without any real eye contact.

Interesting points but not detailed enough.

TherapyDoc said...

I'm working on it, Eric, I'm working on it.

Syd said...

This isn't related to the current post but I was wondering what your thoughts are on this article:

It seems to me that one can't totally blame parenting and abuse as the cause for schizophrenia. There are studies of identical twins who were adopted in different and distant families--yet both of whom developed schizophrenia. I always thought that there was solid, scientific, double-blind-type studies that suggest so convincingly a neurochemical (and genetic) basis for schizophrenia. An experienced clinician doesn't waste time saying the behavior is because the parents were so massively abusive or hung up that they twisted a child's mind to that degree and that's what really causes schizophrenia. Anyway, thought it would be a good topic for you to discuss.

TherapyDoc said...

Uh oh.

If ANY of you get the impression from this blog that schizophrenia is caused by family behavior, think again!

It's for sure a genetically transmitted disorder. It generally presents when a person with a genetic predisposition is in a stressful context, like going away to college.

Anonymous said...

What about reports from a neighbor that Cho spent hours riding his bike around in circles. Sounds like spinning stim behavior, possibly.

therapydoc said...

I hadn't heard that. I heard he rode his bike late at night, but nothing about circles. I haven't ruled out Asperger's, btw, I'm still researching it.

Anonymous said...

I heard it in a Greta Van Susteren interview, which I can't find. But here is another reference from a VT suitemate.


We may never have enough info for a diagnosis. But the autism community appears to think it fits, judging from the forums.