Fraud , misdiagnosis, hysteria
Posted: 11 June 2008 07:52 PM   [ Ignore ]  
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A good friend, Keith Marcum, just wrote the following essay/letter to somebody at Brown University and someone else at the NIMH. He’ll be putting together a more technical version of it seeking publication in a professional journal, but the letter below is entirely readable and relevant to today’s frequently hysterical and all too often pre-analytical world. By the way, the 8-year-old who is mentioned stayed in my home for a little over two years. Yes, life can contain real, “true” meaning—at least once in a while—for anyone who looks for it. Keith’s background includes cognitive/behavioral psychology and neuro-anatomy.
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The Epidemic of Autism is a myth created by circumstances that must be addressed realistically. I dismiss the C.D.C.’s notion that these factors have already been taken into account when examining the current epidemic. Although neurological anomalies seem to be on the rise, the disorder known as autism is not.

In the 1960s, no major reports could be found on television, radio, or in the news media regarding autism. Most doctors and teachers knew nothing about the subject. Even in the New York metropolitan area, no more than a dozen doctors knew much about autism, including pediatricians. They barely knew who to refer families to for workup and diagnosis.

A diagnosis of autism came from experts, usually psychiatrists. In the ’60s, ’70s and into the ’80s, the diagnosis of autism was the kiss of death. Many people with autism went undiagnosed and were hidden away, removed from public view. During my career throughout those decades, I saw many people who would today be labeled autistic but who were then labeled mentally retarded.

Forty years ago a child had to demonstrate most if not all of the symptoms to a level that was seriously disabling in achieving normal daily functioning in order to be labeled as autistic. In most cases, other diagnoses were employed instead.

We must remember our own history here. The condition of autism was considered to be the result of parental behaviors akin to abuse. We cannot ignore the notion at the time that “Refrigerator Moms” were causing their children to become autistic. Bruno Bettelheim misinformed the world about autism. Many psychiatrists were convinced that children with autism actually suffered from childhood schizophrenia and voluntary mutism. Let us not forget about Dibs, In Search of Self and other similar books.

After the release of the films “Rain Man,” “What’s Eating Gilbert Grape,” and the TV series “St. Elsewhere” with a supposedly autistic boy in the story line, the diagnosis of autism exploded. It was no longer an evil. World opinion began to change.

Popular media such as magazines, TV, newspapers and the Internet are now reporting about autism on a daily basis. Public awareness has grown to a level of hysteria and panic. Celebrities have spoken out on TV and to popular magazines with full spreads on their “autistic” children. The Internet is abuzz with parent support groups convincing other parents that if they want good services to get their child labeled “autistic.” Parents are now far more aware than they once were. They’re well informed, self-empowered and can utilize such tools as the Internet to inform one another about how to get an autism diagnosis and an increase of services and treatments for their children.

Services are now available that previously did not exist. Parents realize that an autism diagnosis allows access to these services, such as a small classroom, and one-on-one teaching assistance. I recently had a conversation with a boy and mother who had decided that he had autism because he got A’s in all subjects except English where he got a D, so it just had to be a cognition and language deficit, and thus “autism.” They were hunting for a professional so he could get one-on-one tutoring.

Diagnostic irresponsibility can tend to reverberate unpredictably and in unfortunate ways. About three years ago, I came across an 8-year-old child with a false diagnosis of autism. Sure, he displayed hand flapping at times, severe hyperactivity and difficulty forming lasting relationships, but he was not by any stretch of the imagination actually autistic. Out of desperation, the child’s mother had somehow managed to convince local diagnostic professionals otherwise several years prior to my entering the picture. Due to his autism diagnosis, extra services such as one-to-one teaching assistants and tutoring were in place, yet he was still failing desperately. As a result of his disruptive nature, his teachers refused even to allow him to participate in their classrooms, and at age eight, he was virtually uneducated and unsocialized. His mother found out-of-home residential placement, as she felt she had no choice. The primary problem for this child was that he’d been misdiagnosed. Once teachers and therapists became aware of what his actual nature was like, they approached him much more productively. After two years, the improvement was dramatic and he was reunited with his mother.

Let me reiterate what I said in the beginning. Medical awareness, knowledge, acceptance and willingness to use the term “autism” has gone through nothing short of a revolution.

The childhood mental health treatment industry has increased in size in the past three decades by an extraordinary amount. A staggering number of professionals now have credentials that did not even exist forty years ago. There simply are far more trained people everywhere. Today most mental health professionals consider themselves sufficiently knowledgeable about autism to make at least a tentative diagnosis without hesitation.
We have broadened the diagnostic criteria limits of the definition of autism and by doing so have committed an error of inclusion. With less stringent adherence to very narrow criteria, the diagnostic net is including many children who were previously undiagnosed. Once, a person had to have all the symptoms to a level of severity that would profoundly impact daily functioning. Today the “spectrum” covers anyone who is different, peculiar or has unusual behaviors. The inclusion of Asperger’s syndrome within the spectrum was a decision based more upon popular opinion than on clinical judgment.

Generalized developmental delays occur in many people but every time we see a developmental delay it is not necessarily autism. I liked Bryna Seigel’s term of Pervasive Developmental Disorder. It is a more accurate and useful diagnosis than the misused term “autistic.”

The ratio of the diagnosis of mental retardation to that of autism has not, in my opinion, remained the same. If the rate of the diagnosis of mental retardation had kept pace with the rate of the diagnosis of autism, then one in every fifty children would be labeled abnormal. The number of children labeled as mentally retarded has clearly dropped in relation to the number of children labeled as autistic. The term “mental retardation” has now become the “bad” label.
_________


Autism can’t be an epidemic because it is not a disease. We will never cure autism. The reason for this is that autism is nothing but a syndrome, a collection of symptoms—nothing more. There is no disease called autism.

There is a very serious increase in brain disorders; what many wise specialists call global developmental disorders. But these are a variety of brain diseases caused by several different pathological conditions with vastly dissimilar treatments and prognoses. To label them all as “autism” does a great disservice to the parents of and children with autism.

We may someday look back at the hysteria of the “epidemic of autism” with much shame. Only a calm approach to providing a differential diagnosis to each of these diseases will help solve this dilemma. Using all the variant types of PET/CT, fMRI, SPECT, ELISA and the many diagnostic tools we now have available, we will identify what each of these separate and distinct diseases are and how best to treat them. We should work together to diagnose and name these neuro-developmental disorders in an appropriate manner in the near future.

[ Edited: 11 June 2008 08:41 PM by nv]
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Posted: 12 June 2008 02:15 PM   [ Ignore ]   [ # 1 ]  
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Nice one Humanculus.  As a mental health professional, I enjoyed reading this and I agree with your friend.  I’d like to see the more technical version of this paper, if and when it ever gets accepted to a professional journal.  I’d be happy to even preview it, if he thinks it would help.  Please let me know. 

There is a tendency to over diagnose and over medicate in our culture.  We see lay idiots like Jenny McCarthy writing unqualified books and declaring autism a “global epidemic.”  She becomes the de facto spokesperson for autism and gets hours of TV exposure on Oprah, Larry King, The View, and others, to spout her alarmist, unscientific drivel thereby rattling the base-level fears of every soccer mom in the country whose ‘little emperor’ is turning out to be ‘only’ normal.  That is, despite their pretentious efforts to read Shakespearean sonnets to them in the crib and spike their soy-milk formula with wheat-grass juice.  Don’t get me wrong, I’m all for the essential and consequential seriousness of good parenting, it’s the other factors involved that I find disquieting.

Another one of those components is that of blame.  In this lawsuit-happy culture, these kind of people want someone (else) to be responsible for whatever random disadvantage, accident, or abnormality lands in their lap.  In the case of autism, vaccines are commonly blamed yet these claims have no scientific merit to date.  Although nobody can ever excuse incompetent treatment or research, people hunt for a scapegoat.  Hell, they might as well blame the alkaline-levels in the bar soap they used in the bathtub if their only criteria is for accusation is universally practiced consumption.

In fact, there are very legitimate reasons to use proper diagnosis when it applies, and the current generation of psycho-pharmaceutical medications has changed millions of people’s lives for the better.  However, far too often (as your friend, K. Marcum pointed out), over-zealous parents see a ‘diagnosis’ as an opportunity to get special treatment or considerations, thereby giving their child an unnecessary and undeserved advantage in schools and community programs. 

Moreover, these inappropriate uses of the system have a tendency to water-down the authentic usage of diagnosis and medication — creating a more jaded and cynical public — at the expense of those who really do suffer the very real and disturbing effects of mental pathologies — those who could genuinely benefit from the empathy most of us hold for their disadvantages.

[ Edited: 12 June 2008 02:19 PM by JET]
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Posted: 13 June 2008 06:43 AM   [ Ignore ]   [ # 2 ]  
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Now that you mention it, I’m a little surprised Keith didn’t go into vaccinations (or their preservatives) in his essay,  and their supposed etiological component. He’s mentioned that it’s possible that stress can play a significant role in certain forms of autism becoming active, but that more than enough studies have shown that vaccines do not cause autism.

In 1998, I took in a severely autistic 16-year-old child, Jason, whose parents said had regressed into autism around age 2 immediately following a traumatic visit to the dentist. He’d been socializing and speaking, then almost nothing, almost overnight. It’s known that genes express themselves according to environmental factors, so such an—at least partial—cause-effect relationship should surprise no one, I suppose. Stress caused me to break out in shingles when I was in my mid-thirties, and it only surprised the dermatologist because I was so young when it happened. With the current autism hysteria, emotion is ruling the day rather than reason and quiet, plodding patience. This is most unfortunate, since over-emotion rarely succeeds in the subtle yet monumental task of solving seemingly intractable problems. It’s particularly frustrating for me to watch because I took care of Jason for 8+ years and now I’m emotionally attached to the issue, as well.

I will try to remember to e-mail you if Keith’s next piece gets published, JETurnbull. Many thanks.

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Philosophy may in no way interfere with the actual use of language; it can in the end only describe it. For it cannot give it any foundations either. It leaves everything as it is.
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Posted: 13 June 2008 04:47 PM   [ Ignore ]   [ # 3 ]  
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homunculus - 13 June 2008 10:43 AM

I will try to remember to e-mail you if Keith’s next piece gets published, JETurnbull. Many thanks.

…And many thanks to you H, for you humane and compassionate work.  You’re a good example of someone who does the things you do — not for religious ‘points’ from above — but because it’s simply the decent thing to do.

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Posted: 14 June 2008 06:17 AM   [ Ignore ]   [ # 4 ]  
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JETurnbull - 13 June 2008 08:47 PM

And many thanks to you H, for you humane and compassionate work.  You’re a good example of someone who does the things you do — not for religious ‘points’ from above — but because it’s simply the decent thing to do.

I appreciate it, J.

I was a believer back when I began planning to start my current business, but by then my faith was extremely unorthodox, as I’d already spent about 20 years pondering how ridiculous many of the details of Christianity are. And now that I’ve shed my faith, I’m still the same person I was as a child and young adult. I still get more of a kick out of assisting people who need help than putting together print ads, which was how I’d made my living.

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Philosophy may in no way interfere with the actual use of language; it can in the end only describe it. For it cannot give it any foundations either. It leaves everything as it is.
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Posted: 14 June 2008 07:16 PM   [ Ignore ]   [ # 5 ]  
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Thanks for this excellent article.  As a teacher I have thought frequently about the blitz of labels and conditions we have applied to children and the recent culmination   of said labels, and I have often (silently) objected to the plethora of band aid approaches to   controlling and manipulating children through the use of medication and labels.  (It reminds me of a popular 60’s motto:  “Better living through chemistry.”)


While your specific article is not about medicating children’s behavior, I think there is a very close parallel between the explosion of labels in the areas of autism and Asperger’s syndromes , along with ADHD and bipolar disease and the use of medications to   thwart non-social and defiant behaviors that we adults often react to in knee-jerky ways.

I only wish I had answers to these extremely complex and disturbing problems that create much stress and anxiety in children and parents and that often hamper their educational and social developments.

We need an Einstein to clear the fog.

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Posted: 15 April 2009 12:14 PM   [ Ignore ]   [ # 6 ]  
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Keith’s article appears in the current issue of Exceptional Parent. He had to be wrestled into toning down his words, unfortunately.

The title: The Epidemic of Autism: One Professional View from a Parent

http://www.eparent.com/resources_ep_magazine/April_2009_Issue.asp

The website doesn’t link it, but it now reads too politely for the hardened, skeptical eyes of most regulars around here anyway.

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Philosophy may in no way interfere with the actual use of language; it can in the end only describe it. For it cannot give it any foundations either. It leaves everything as it is.
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