Know What You Don’t Know – Part II

My last post Know What You Don’t Know may seem a bit abstract. Let me make it more concrete. Like last time, I am going to use a story to make my point. This time, the story concerns an 8 year old boy, who was referred to me for evaluation of poor school performance and temper tantrums. Let’s call him Billy Smith (not his actual name, and I have altered the history a bit to preserve the family’s confidentiality). Billy makes limited eye contact, and has an obsessive interest in the solar system. He prefers to play by himself, and has no close friends. Academically, he did well in kindergarten and first Grade, but lately he seems to be having trouble with reading comprehension. He has difficulty with transitioning between tasks at school, and at home he gets into frequent arguments with his father. Billy’s father is a software engineer. At work, Mr. Smith does everything “by the book.” At home, he expects his wife and son to follow all rules to the letter. “Billy is always focused on himself,” Mr. Smith declares during my interview with mom and dad. “He’s stubborn, and he needs to learn to obey his parents.” Mrs. Smith says nothing, but she looks unhappy. Read the rest of this entry »

Out and About

It’s always good to get out into the real world, to share my ideas face to face. I was fortunate enough to be invited to give a presentation this past week at the Autism Society of America’s annual national convention: (Mental Illness in ASD – The Elephant in the Room  ). It was hard trying to squeeze six hours of material into a 75 minute session, but I managed to cover the key points:

• The bright line between ASD and “mental illness” is a myth.

• DSM-5 perpetuates the “gumball model” of psychiatric diagnosis: A given patient may have one or more discrete disorders, that happen to co-exist. “Co-Morbidity” is the necessary fiction on which this model rests. In reality, disorders shade into one another along a continuum, or undergo metamorphosis over time.

• ASD, Schizophrenia, ADD, Bipolar Disorder, Generalized Anxiety Disorder and Depression have shared biological roots. A given genetic defect can give rise to disorders that “look different” on the surface (pleiotropy). Conversely, disorders that look the same on the surface may actually be due to very different underlying genetic mechanisms (phenocopies).

Myth and Reality in the etiology and classification of ASD and mental illness.

 (Click on graph to enlarge.)

Myth and Reality in the etiology and classification of ASD and mental illness Read the rest of this entry »