Autism & Diagnosis

When Finian was 3, he was diagnosed with Autism as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM).   

The diagnosis wasn't a big surprise; he had been lining up his toys and eating firelighters since he could move.  He was (initially) non-verbal.  Intense sensory issues caused him to disintegrate into hysterical meltdowns.  He rarely slept.  Pica meant that he had to be perpetually supervised to stop him eating dirt, paper and plastic.  When he took to his feet, bolting became a preoccupying hazard. I had been pushing for assessment for 2 years.  By the time we out-ruled a slew of genetic, metabolic and developmental disorders, Autism was the obvious last card on the table.  The diagnosis arrived with sad inevitability rather than appalling shock.

I did what most parents do, and became a diligent student of all things neurodivergent.  There wasn't a book left unread, or a therapy left unconsidered, including a fierce study of the clinical criteria necessary to diagnose Autism.  I devoured the DSM.  It was populated with deficits (in communication and social interactions), functional limitations, and categories of restrictive, repetitive behaviours.  These were measured on score charts by well-intentioned professionals.  In slow-motion horror movie style, I realised that accessing the services my son required depended on him being reduced to a set of deficits.

But, search as I might, I could not find my lovely, spontaneous, unguarded boy in the language of insufficiency used by the DSM.  

I'm pragmatic about Finian's needs; I recognise that he has requirements that are reluctantly met by an ableist world.  I understand that we need to identify the areas that autistic people struggle with to attempt to help them.  Measuring the 'deficiencies' of autistic people is an expedient way to plan services.  It is all too clear, however, that service planning consistently fails our kids, so the price of prudently labelling our kids as 'less-than' and 'other' is a false economy.  

Sometimes I indulge in a dangerous fantasy. Imagine living in a world where the lens was reversed, and we focussed on changing the wrongness of our society rather than the wrongness of our children.  I know it's not going to be realised in my lifetime, or probably Finian's, but I'm cursed with optimism that, in time, the world will learn to value difference.  

Autism & Definitions 2.0

A few weeks ago I wrote about how the official diagnostic criteria for Autism is often at odds with our lived experience of it.  The DSM-V is a necessary, but blunt, instrument.  It effectively diagnoses (or rules out) Autism, but neglects to mention many of the more colourful expressions of it.  That's not it's fault.  It's remit is that of a workhorse, not a show pony.  But it dulls the picture by brushing broad, two-dimensional strokes over vibrant personalities.  It's kinda a mood killer like that. 

For example, the DSM says it's looking for evidence that your kid has difficulty adjusting his behaviour according to social contexts.  In the real world, this clinical-speak may translate as your kid taking a dump in the display toilet on the shopfloor of B&Q (because a toilet is a toilet, right?).  But it doesn't spell this out in it's criteria.

Someone should give the DSM a box of crayons so it can express itself a little better.  You really don't want to get stuck with it at a party.

So I'm building on the Trojan work I slaved over in my previous post, by adding to my alternative diagnostic criteria.  

(sidebar; my legal team have advised me to add a caveat to my ground-breaking body of work;  it can only reliably diagnose Finian.  But science is science; the facts don't lie)

Here's more tell-tale signs that the DSM leaves out;

• experiencing the need to chase a naked man-child out of the kitchen
• being so accustomed to said man-child's nudity, that you sometimes don't notice him shake his jelly at the dishwasher
• only ever buying him long-sleeved tshirts because short-sleeved ones are stupid
• knowing who the fucking Enchantimals are
• nodding enthusiastically when a worried electrician points out that a mouse must have chewed on your cables.  Yes, Mr. Electrician.  An impossibly handsome, autistic "mouse"
• realising that everything you ever learned about nutrition is wrong.  It has been scientifically demonstrated (mostly in my house) that a human can thrive on a diet of nothing more than weetabix, mashed potatoes and pancakes.  In your face, Healthy Eating Pyramid
• knowing how to calibrate Lidl weetabix to the perfect temperature and consistency, or risk starvation of said man-child (altho......  I can't decide if this is an autistic thing or if my son is just a massive princess)
• with the above exceptions, noticing that your kid eats everything in the known universe except actual food
• when you elevate tooth-brushing to an exercise in stealth and tenacity, having first developed the fine motor skills of a master pianist.  If tooth-brushing requires Olympian hand-eye co-ordination, and has become all about hitting a moving target with colgate, then your kid may be autistic.  Just sayin'
• briefly considering leaving your adult-kid alone while you nip out to buy milk, but then remembering that you quite like it when said kid is alive, not on fire and boasting a full complement of limbs.  The kid always goes with you to buy milk
• when your kid enjoys wearing his (tiny) sister's pyjamas.  Commando.  The sister requires much therapy..... and frequent new pyjamas

I hope you find this helpful.  Out of the goodness of my heart, I'm sharing this cutting edge diagnostic tool with you for free.  However, if you'd like to show your appreciation by gifting me a two-year holiday in Barbados, or sending me a small lake of rioja, I graciously accept.

my legal team