Friday, June 6, 2008

Bullying and Aspergers: Some needed changes to the DSM

One of the proposals that some neurodiversity advocates make in terms of what they believe to be necessary changes to looking at autism in a different light is rewriting the DSMIV-R, which I think soon will be the DSMV if it is not already. The proposal is to eliminate autism entirely as a category in the psychiatric manual. They believe it is insulting to pathologize autism in any way. They use the analogy of homosexuality being considered a disorder in the 1960s and then being removed from the DSM. I believe the analogies between the two are poor. Homosexuality certainly does not cause the individual to be dysfunctional in society the way autism does. I can't believe that even the staunchest neurodiversity advocate would claim that any autistic could function normally in society. Be that as it may, perhaps changing the DSM in some other ways might not be such a bad idea.

I was reading Michelle Dawson's TMOB comment board and was intrigued by the following comment from Michelle:

E.g., Dr Shattuck trots out the common and stupefying premise that when autistics are bullied, this is evidence of autistics'--not bullies'-- inappropriate social behaviour. I nearly turned the radio off.Later Dr Shattuck also states that there should be criminal penalties for those who deliberately take advantage of developmentally disabled people. This is interesting, but there is no suggestion that bullies and harassers (etc.) and others who take advantage of autistics, etc., need treatment for their grossly inappropriate social behaviour. Instead, Dr Shattuck wants a lot of treatment for autistics who get bullied and taken advantage of, presumably so we become less autistic or not autistic at all (this being the purpose of autism treatment).

Though Michelle and I have had our differences in the past and have locked figurative horns on some matters, I believe in this instance Michelle has some valid points. However the argument Michelle seems to be espousing is treatment of autistics and non-treatment of bullies versus treatment of bullies and non-treatment of autistics. However, why can't there be a third scenario where not only is autism considered a pathologic condition but so is bullying amongst children. I don't believe there is any reason there has to be mutual exclusion from considering either one condition or the other pathologic. One of the arguments against mainstreaming special education students is that they will be picked on by bullies in mainstream schools. Of course it is never recommended that the bully be disciplined or sent to a special education school. Also, people who espouse this argument have probably never been special education students themselves and don't know the same things that this eight year veteran of special education knows, that special ed students do bully each other at times.

So my suggestion is this. Not only do we keep autism as a DSM category but add bullying as well. Though I am not sure what treatment would turn a bullier into a non-bully, assuming there was one and the criminal charges that Dr. Shattuck recommends, one of the conditions of sentencing could be that a bully is referred to a psychiatrist or appropriate doctor for treatment under the DSM. Though such a treatment may be pie-in-the-sky dreaming, I believe it would be a good idea to add bullying into the DSM category so that this behavior can be considered pathologic and the consciousness of person's would be raised in terms of the problems that autistic children who are often bullied both in and out of mainstream schools have to endure.

I have had to endure tremendous bullying, have been beaten up and even had my car vandalized as a high school teen. Of course not all kids are like this. There is no question that the most extreme bullies had some sort of psychiatric issues and would need help if such help were available. Just as people arrested for DUI have to sometimes undergo counseling as a condition for their probation perhaps bullies could also.

This does not mean of course that autistic persons should not be made less autistic or even non-autistic if the option is available. Autism presents many challenges for the person outside of having to contend with bullies.

Another needed change to the DSM in my opinion is either eliminating Asperger's syndrome alltogether or at least making it its own separate category and not considering it as part of the autism spectrum. The Autism Self Advocacy Network is not called the Asperger's Self Advocacy Network. Ari Neeman, the young stalwart who runs this organization never had a speech delay, one of the DSM indicators of autism. He was not diagnosed with Asperger's until he was 12. He is now 20 years old. At the time Ari was 7, he would not have been diagnosable as autistic under the criteria which was in existence at that time. This is probably also true for many other neurodiversity advocates who in some instance seem to want to speak for all autistics and protest a non-existent cure for autism. I had a speech delay before the age of 3, so I guess according to DSM criteria I would be considered autistic rather than asperger's, though I suppose I have some commonality with Asperger's in that I am clumsy and score relatively well on the verbal portion of Wechsler IQ tests and poorly on the performance part. The inclusion of Asperger's also gives the false perception that 1 out of 150 persons in the U.S. have conditions that are in any way analogous to people on the lower end of the spectrum (this could even include myself in comparison to many if not most neurodiversity adherents who claim to be autistic).

For all of these reasons I recommend changing the DSM as soon as possible. Include bullying, either exclude Asperger's or make it separate from autism.


Mie Naim said...

Taking Autism out of the DSM will give people like me even less help. When ever you meet a shiny happy aspie, send them over to my blog and show them the truth of where autism can lead. Greetings from the Dark Side:

Anonymous said...

I would like to make a few comments on my own experiences:
1. My main response to bullying was to withdraw from ANY social interactions.
2. In hindsight, I think that active bullying largely ended after 6th grade, but I continued to BELIEVE that I was being bullied all the way thru 12th grade, mainly through the noises other students made. If I could not distinguish between accidental irritation and intentional abuse, neither would I have had much chance of recognizing well-meaning criticism.
3. The worst bullying was from people I did NOT know.