Aspergers: A diagnostic conspiracy

Andrew Bolt published a letter from “Reader B” today, who claims that the diagnosis of Aspergers Syndrome is nothing more than well meaning, easily manipulated doctors ticking whatever box is put in front of them, for no other reason than unfairly claiming government funding for those undeserving children.  Reader B claims to be a “very senior medical practitioner in this field”.

If he was a very senior medical practitioner then he would know that Autism, Aspergers and Pervasive Developmental Disorder can only be formally diagnosed by paediatricians or psychiatrists. Other doctors, allied health and other professionals can have suspicions, but no funding will be released until the diagnosis has been confirmed by the relevant specialist. If anything, this has lead to underfunding, as children are forced to wait for assessment by the bottleneck of public health services.

He would also know that to be diagnosed as having an autistic spectrum disorder, the child’s condition has to meet specific criteria in the DSM – the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders. “Not a charming little extrovert” is not one of the criteria.

He would also know that the diagnostic criteria are about to be revised. A change which autism groups believe will make “the diagnosis of autism spectrum disorders will be more specific, reliable, and valid.” However, “legitimate concerns have been raised regarding how these changes might impact people on the spectrum. One of the biggest concerns is that some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services.” (1) So tighter diagnostic rules will apply to a condition which is already under diagnosed.

Meanwhile, the CDC in America states that “On average, medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD.” (2)

I am just a humble GP working in Brisbane’s northern corridor. My son is “not a charming little extrovert”. He was diagnosed as having Aspergers by one of those “bright, sincere” but obviously misguided developmental paediatricians, who incidentally has three other Bachelors Degrees and a Masters.  If Reader B would like to take my son for a couple of weeks.  He is welcome to make pithy, judgemental statements after that.

Even at the “mild” end of the spectrum, the Carers Payment of $115.40 per fortnight from Centrelink would only pay for half of what therapy costs for my son. For many of my patients, this modest amount is the difference between some therapy and none at all.

As for the potential cost blow outs, it depends on how you look at the issue. Say the funding for “mild” ASD dries up. Ok, so should we stop funding healthcare for mild diabetics or mild asthmatics as well? Besides, I would argue that spending money on healthcare for even “mild” ASD is an investment. An ASD child will grow up into an ASD adult. Maximising their development now will cause them to be more productive in the future, more likely to be taxpayers than welfare recipients.

As Reader B explained in his opening paragraph, “there is no conspiracy, just well meaning misguided bias.” And it’s true. But it doesn’t come from the ASD community. It comes from an outspoken few who stand on the sidelines and smugly wag their fingers at those who struggle, while never truly understanding how sometimes even the simplest tasks like brushing teeth can become a 2 hour ordeal.

Please, stop wagging your fingers. Instead, lend us a hand.

(1) http://www.autism.com/index.php/news_dsmV
(2) http://www.cdc.gov/ncbddd/autism/data.html

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