Jared’s kindergarten teacher has voiced her concern to Jared’s parents about his difficulties with interacting with other children and his delay in developing normal language. Jared is able to maintain eye contact and enjoys mixing with other children, but he cannot communicate with them very well. He often responds to questions or comments with long-winded speeches about trucks or some other topic that interests him, and he seems to lack awareness of other children’s wishes and needs.
Jared’s concerned parents took him to a multidisciplinary child development center for consultation. Here he was tested by a pediatric neurologist, a psychologist, and a child psychiatrist.
The pediatric neurologist found that Jared’s hearing was normal, and there were no signs of any neurological disorder. He diagnosed Jared with a pervasive developmental disorder, because while his comprehension and expressive language was poor, he was still able to carry out nonverbal tasks, such as drawing a picture or doing a puzzle.
Based on her observation of Jared’s difficulty interacting with his peers, and the fact that he did not respond warmly to his parents, the psychologist diagnosed Jared with autistic disorder (autism), a disorder of neural development characterized by impaired social interaction and communication and by restricted and repetitive behavior, and in which symptoms begin before 7 years of age. The psychologist believed that the autism diagnosis was correct because, like other children with autism, Jared, has a poorly developed ability to see the world from the perspective of others; engages in unusual behaviors such as talking about trucks for hours; and responds to stimuli, such as the sound of a car or an airplane, in unusual ways.
The child psychiatrist believed that Jared’s language problems and social skills were not severe enough to warrant a diagnosis of autistic disorder and instead proposed a diagnosis of Asperger’s disorder, a developmental disorder that affects a child’s ability to socialize and communicate effectively with others and in which symptoms begin before 7 years of age. The symptoms of Asperger’s are almost identical to that of a utism (with the exception of a delay in language development), and the child psychiatrist simply saw these problems as less extreme.
Imagine how Jared’s parents must have fe lt at this point. Clearly there is something wrong with their child, but even the experts cannot agree on exactly what the problem is. Diagnosing problems such as Jared’s is difficult, yet the number of children like him is increasing dramatically. Disorders related to autism and Asperger’s disorder now affect almost 1% of American children (Kogan et al., 2007). 1 The milder forms of a utism, and particularly Asperger’s, have accounted for most of this increase in diagnosis.
Although for many years autism was thought to be primarily a socially determined disorder, in which parents who were cold, distant, and rejecting created the problem, current research suggests that biological factors are most important. The heritability of autism has been estimated to be as high as 90% (Freitag, 2007). 2 Scientists speculate that autism is caused by an unknown genetically determined brain abnormality that occurs early in development. It is likely that several different brain sites are affected (Moldin, 2003), 3 and the search for these areas is being conducted in many scientific laboratories.
But does Jared have autism or Asperger’s? The problem is that diagnosis is not exact (remember the idea of “categories”), and the experts themselves are often unsure how to classify behavior. Furthermore, the appropriate classifications change with time and new knowledge. The American Psychiatric Association has recently posted on its website a proposal to eliminate the term Asperger’s syndromefrom the upcoming DSM-V. Whether or not Asperger’s will remain a separate disorder will be made known when the next DSM-V is published in 2013.
- More psychologists are involved in the diagnosis and treatment of psychological disorder than in any other endeavor, and those tasks are probably the most important psychologists face.
- The impact on people with a psychological disorder comes both from the disease itself and from the stigma associated with disorder.
- A psychological disorder is an ongoing dysfunctional pattern of thought, emotion, and behavior that causes significant distress and that is considered deviant in that person’s culture or society.
- According to the bio-psycho-social model, psychological disorders have biological, psychological, and social causes.
- It is difficult to diagnose psychological disorders, although the DSMprovides guidelines that are based on a category system. The DSMis frequently revised, taking into consideration new knowledge as well as changes in cultural norms about disorder.
- There is controversy about the diagnosis of disorders such as ADHD, autistic disorder, and Asperger’s disorder.
EXERCISES AND CRITICAL THINKING
- Do you or your friends hold stereotypes about the mentally ill? Can you think of or find clips from any films or other popular media that portray mental illness positively or negatively? Is it more or less acceptable to stereotype the mentally ill than to stereotype other social groups?
- Consider the psychological disorders listed in Table 12.3 "Categories of Psychological Disorders Based on the ". Do you know people who may suffer from any of them? Can you or have you talked to them about their experiences? If so, how do they experience the illness?
- Consider the diagnosis of ADHD, autism, and Asperger’s disorder from the biological, personal, and social-cultural perspectives. Do you think that these disorders are overdiagnosed? How might clinicians determine if ADHD is dysfunctional or distressing to the individual?