July 28th, 2014 by drcoplan
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.)
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April 2nd, 2013 by drcoplan
In the last few posts I laid out a 3D picture of ASD that integrates degree of atypicality, level of general intelligence, and age (or Time). In this model, we can think of atypicality as a chunk of ice floating in the water. The size of the chunk of ice corresponds to the degree of atypicality, and the water temperature corresponds to the IQ. Just as in the real world, the warmer the water (i.e. the higher the IQ) the faster the “ice” (atypicality) melts over time.
Children who start out with moderate to mild atypicality combined with normal IQ, shed many of the outwardly visible features of ASD during childhood: Eye contact and language improve, while social isolation, stereotypies and sensory issues diminish. As adults, some of these individuals no longer meet the behavioral criteria for ASD.
Even though the outwardly defining features of ASD (stereotypies, echolalia, etc.) have faded, however, these individuals continue to manifest the cognitive profile of persons on the spectrum: relative weakness in skills tapping “theory of mind” and “central coherence,” which translate into persistent difficulty understanding social signals or seeing the “big picture.”
These individuals also are at risk for neuropsychiatric disorders (anxiety, depression, mood disorders, OCD), all of which tend to run in families of individuals with ASD. Thus, even though a child may gradually “outgrow” his or her ASD diagnosis, the child may simultaneously “grow into” an anxiety disorder, depression, or a mood disorder. As you might expect, there are lots of individuals who manifest persistent features of ASD, plus neuropsychiatric impairment. It’s not a matter of “either/or,” but “both/and.”
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