Michelle Garcia, PsyD and Associates - "Improving Quality of Life"

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Diagnosis Lost?

Authors of a recent article published in the Journal of Child Psychology and Psychiatry (Fein et al, 2013) pose the question: can an individual with a life-long individual disability such as an Autism Spectrum Disorder lose their diagnosis. As a skeptic my initial response to this question is no. In my short experience in practicum with Dr. Garcia it would appear that these symptoms don't just dissipate completely over time. Then again I am reminded of one individual diagnosed with Asperger's during their childhood (over 15 years ago), who in my time with them now, shows very few signs of Asperger's. As a student clinician I am almost sure that she would not meet criteria for Asperger's anymore, but never having met this younger individual I wonder a few things: One of which is if the individual was properly diagnosed. The Diagnostic Statistical Manual serves to provide our community with consistency but there's no doubt there is room for error in clinical judgment. Another thought sparked by this article is whether it is possible that these clients still suffer from slight impairments in social and communication functioning, but not significantly enough to meet DSM criteria. A third question that comes to mind is the hypothetical thought of whether such individuals’ social functioning improves so greatly that they fall within the typical range.
The latter group is what the authors refer to as the optimal outcome. These individuals are described to have lost all symptoms of ASD and function within the non-autistic range of social interaction and communication; a phenomenon so rare and before this article so poorly supported that authors regard it as controversial. My firsthand experience with the client previously diagnosed with Asperger’s challenged me to think outside of what I learned in class, DSM classification. I have realized that the usage of the DSM to commonly classify behaviors and impairments are a part of the first step to a much bigger process of interpreting these clients as individual cases. The client may not have fit the stereotypic ASD classification, but it is still clear that the individual has social impairments that could benefit from services. But what about those that show a complete absence of ASD symptoms?
                Authors compared these optimal outcome individuals with individuals who had “high-functioning Autism”, and with non-autistic (typically developing) individuals. Results showed that optimal outcome and typical development groups did indeed show similar performance on an Autism measure. Authors noted that the difference between the higher functioning and Optimum Outcome individuals in early development consisted of a milder set of social symptoms from the Optimum Outcome clients, despite equally severe set of communication and repetitive symptoms. My questions after reading this article and having had the experience with this subtle symptomatic client are as follows: What does this mean for the ASD population? Given the frequency of the “optimum outcome,” does this article and any that follow provide false hope? Are articles for such a rare occurrence even useful? Where will research go from here?

What are your thoughts on the matter?

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