ADHD, Autism, Asperger, LD, ADD - Are they
medical diagnoses? Or behavioral symptoms?
So often we view these terms as labels for
illnesses or diseases. We use words like
"suffer" or "stricken"
in conjunction with these labels, like "He
is stricken with severe autism.", or
"She suffers from Learning Disability."
The underlying assumption is autism and LD
belong to the medical model of diagnosis,
treatment and prognosis. This rationale is
taken as a matter of course when one uses
these labels prescribed by the DSM manual
(Diagnostic and Statistical Manual of Mental
Disorders) published by the American Psychiatric
Association, and insurance reimbursements
are strictly based on the DSM definitions.
I have long maintained that ADHD, Autism, Asperger, LD, ADD are not medical diagnoses but simply descriptions
of abnormal behaviors, symptoms if you will.
In a true medical diagnosis, the disease
is defined by the cause(s) and not the symptoms.
So AIDS is defined by the presence of the
virus (the cause), not by how the patient
behaves (the symptoms).
The problem with ADHD, autism, etc. as diagnostic
labels is that we don’t know the exact biological
defects that cause ADHD or autism, even though
we can surmise that there must be something
different in the autistic or the ADHD brain
than the ‘normal’ brain.
How about defining the cause of autism externally,
you ask, such as autism is caused by certain
environmental adversities like pollution,
prenatal birth, or early childhood experience?
But we can’t say for sure if any of these
is the actual, or even partial, cause of
autism or ADHD either.
Treatment, so far, is mainly external rather
than internal, that is, we modify the symptom
behaviors by changing the environment, rather
than treating the deficits in the brain through
chemical or surgical means. (Chemical includes
drugs, diet, herbal medicine, etc.) Over
the years, many have hoped to be able to
treat autism, or ADHD, or LD internally,
e.g., food coloring-free diet, Adderall,
Concerta, gluten-free diet, etc. In this
sense, the labels do not qualify as ‘medical’
and we see myriads of treatment procedures
with unpredictable outcome and prognoses.
Yet we have used the labels in the DSM as
if they are medical deseases, and insurance
companies, practitioners and parents alike,
for a lack of better alternatives, have used
them to justify claims and services. For
some, it is the bible of mental ‘illnesses’.
But it is heartening to see that not all
psychiatrists see the DSM rationale as sound
and the latest DSM-5 as useful. The New York
Times published two articles of dissent upon
the release of DSM-5. One psychiatrist, Dr. Satel,comments, "the manual medicalizes garden-variety
distress, leads doctors to prescribe unnecessary
medications,…" She then reveals a secret
-- most psychiatrists don’t use the manual
to treat. They tend to treat according to
symptoms (the behaviors).This is understandable.
For the illnesses listed in the manual do
not have a consistently identifiable biological
or environmental cause(s) and the diagnoses
thus cannot offer clear treatment procedures
and prognoses. The other article quoted Dr. Thomas Ansel, director of the National
Institute of Mental Health, as saying that
DSM-5 "does not reflect the complexity
of many disorders, and its way of categorizing
mental illnesses should not guide research.
As long as the research community takes the
D.S.M. to be a bible, we’ll never make progress."
While he was careful in commenting mainly
on DSM hinders mental illness research, the
principle is the same, that DSM does not
offer medical diagnosis and using it to determine
treatment leads us into a blind alley, and
could be dangerous.
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