[PEN-L:31555] RE: Re: RE: Re: Re: Autism on the rise

["Devine, James" <jdevine@xxxxxxx>]

Title: RE: [PEN-L:31549] Re: RE: Re: Re: Autism on the rise

 From: Charles Jannuzi
> E-mail discussions often work against coherence
> and consistency, so to these problems I plead
> guilty.

it's true that e-mail discussions have that problem.

> I think I have been consistent, though in saying,
> one reason why we have difficulty at getting to
> cause with problems like autism is because we
> don't even have clear concepts to start with(but
> I'm not claiming we will ever have such clarity).
> In this case, I'm quite sure there are all sorts
> of disorders, and we are projecting
> classificatory order onto them, as usual.

It's true that autism is hard to pin down sometimes. I heard one psychiatrist discuss 6 different kinds of (hard-core) autism, some of which aren't considered to be forms of autism by other experts. It would be useful to know what kinds are now becoming more prevalent.

 
> I also think I've been consistent in saying that
> some causes could quite well be genetic and
> congenital. I wasn't advocating the refrigerator
> mother theory--but I do remember a similar one to
> explain other problems, such as schizophrenia,
> which no doubt is also an array of problems with
> the cognitive part of the soma.

Poor parenting can clearly make autism, schizophrenia, etc., worse, since they may encourage the persistence of behaviors that an individual is predisposed to (by genetic and/or prenatal factors). This in turn may encourage brain development that allows the persistence. As the man said, it's overdetermined.

> You say that psychiatrists don't want to medicate
> autistics, but this doesn't exactly agree with
> what I've been told. Psychiatrists want their
> cut, including business with school districts.
> And I also said that often misdiagnosis goes hand
> in hand with getting funds and with prescribing
> drugs.

My experience is that it's primarily pediatricians who are engaged in over-diagnosis and over-medication, often encouraged by school districts and the like. But this is mostly for ADD and ADHD, not for autism. The psychiatrists may be over-prescribing for the _symptoms_ of autism (since basically that's all that can be treated, according to current knowledge). I haven't heard of that (though I have heard a lot of complaints about psychiatrists from parents). It seems most likely that such over-medication would occur in an HMO setting (or similar), where the docs are encouraged to provide minimal care.

One thing to note is that, in my experience, most parents (and many older patients) resist over-medication, partly due to the cost and partly due to a reasonable squeamishness about drugs. This counteracts the bureaucratic tendency toward over-drugging.

Jim