Join Dr. Regan for the first in a series on autism misdiagnosis. This episode focuses on why autism is misdiagnosed and how we can do better.
New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life
New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics
Book: Understanding Autism in Adults and Aging Adults, 2nd ed
Book: Understanding Autistic Behaviors
Autism in the Adult website homepage
Website Resources for Clinicians
Read the episode transcript below:
00:00:01,890 --> 00:00:04,590
Hello and welcome to autism.
00:00:04,590 --> 00:00:06,170
00:00:06,180 --> 00:00:07,450
00:00:07,450 --> 00:00:08,890
00:00:08,900 --> 00:00:10,830
00:00:10,840 --> 00:00:19,210
The director of an adult diagnostic autism clinic in central Illinois and the parent of an autistic teen.
00:00:19,220 --> 00:00:27,060
I am going to be starting a new series today and that's going to focus on misdiagnosis...
00:00:27,060 --> 00:00:27,360
00:00:27,360 --> 00:00:35,630
people who are on the autism spectrum, who have that autistic neurology, but are diagnosed with something else...
00:00:35,640 --> 00:00:42,180
typically a mental health diagnosis and oftentimes several diagnoses.
00:00:42,950 --> 00:00:50,480
We're going to talk about why that happens and how to understand how we can do better.
00:00:51,620 --> 00:00:53,560
00:00:53,570 --> 00:01:02,030
I am going to tell you a story and the story is called The Parable of the Elephant.
00:01:02,040 --> 00:01:04,890
And this is a very ancient parable.
00:01:04,900 --> 00:01:08,320
It has a few variations across cultures.
00:01:08,330 --> 00:01:09,370
00:01:09,370 --> 00:01:15,260
I think. speaks to this dilemma that we have about misdiagnosis.
00:01:16,520 --> 00:01:23,610
There was an ancient village and they had never seen an elephant before.
00:01:23,620 --> 00:01:30,450
And you can imagine that when someone brought an elephant into their village it was a big deal.
00:01:30,460 --> 00:01:36,070
People wanted to know "what does a creature called an elephant look like?"
00:01:36,540 --> 00:01:46,990
And there was also this group of villagers there who were blind and they thought well we aren't going to be able to see the elephant,
00:01:46,990 --> 00:01:56,670
but we could put out our hands and we could perceive the elephant through touch and this will let us know what the elephant is like.
00:01:58,350 --> 00:02:02,660
So indeed the villagers went to the center of town.
00:02:02,670 --> 00:02:06,250
They stood around this creature called an elephant.
00:02:06,260 --> 00:02:12,830
In each person put out their hand and they were able to experience the elephant.
00:02:14,020 --> 00:02:17,690
So what happened is that the first person said,
00:02:17,700 --> 00:02:19,650
00:02:19,660 --> 00:02:22,470
An elephant is like a fan,
00:02:22,480 --> 00:02:28,900
I've put out my hand and I can feel that it's broad and wavy and thin.
00:02:28,910 --> 00:02:31,150
An elephant is like a fan.
00:02:32,000 --> 00:02:37,980
And here the person had felt the ear of the elephant.
00:02:37,990 --> 00:02:40,510
Well the next person said,
00:02:40,520 --> 00:02:52,780
I do not know what you're talking about because I am right here feeling the elephant and I can tell you that the elephant is broad and tall and wide.
00:02:52,790 --> 00:02:55,130
I can't even put my arms out,
00:02:55,130 --> 00:03:00,660
but I can just say that that an elephant is like a wall,
00:03:00,670 --> 00:03:04,400
it's so big and massive and strong.
00:03:05,390 --> 00:03:07,820
The next person disagreed as well,
00:03:08,750 --> 00:03:10,290
00:03:10,290 --> 00:03:10,480
00:03:10,480 --> 00:03:11,150
00:03:11,160 --> 00:03:14,660
it's... I can put my arms around it,
00:03:14,670 --> 00:03:24,490
it's thick and tall but there is an end to it and and it's kind of like a tree trunk or a pillar.
00:03:24,500 --> 00:03:30,010
And this person was experiencing the leg ... touching the leg of the elephant.
00:03:30,410 --> 00:03:32,740
The next person was at the tail.
00:03:32,750 --> 00:03:34,100
00:03:34,100 --> 00:03:34,890
00:03:34,900 --> 00:03:36,850
00:03:36,860 --> 00:03:38,400
00:03:38,410 --> 00:03:41,370
it's really... an elephant is like a rope,
00:03:41,380 --> 00:03:44,200
it's corded and thin and long.
00:03:44,210 --> 00:03:46,900
00:03:47,220 --> 00:03:58,960
the elephant is like a snake and they were there at the trunk and they said it's thick and curvy and I can just feel all the textures of the skin,
00:03:58,960 --> 00:04:01,670
it's really like a snake,
00:04:01,680 --> 00:04:03,820
that's what an elephant is like.
00:04:03,830 --> 00:04:08,290
And the last person was feeling the tusk and said,
00:04:08,290 --> 00:04:08,610
00:04:08,610 --> 00:04:10,440
00:04:10,450 --> 00:04:12,220
00:04:12,220 --> 00:04:22,020
but it's really hard and ah strong and smooth, and I would say an elephant is like a sword or a spear.
00:04:24,250 --> 00:04:30,670
So the parable is meant to teach that here,
00:04:30,680 --> 00:04:35,080
every person was correct about what was right in front of them,
00:04:35,640 --> 00:04:48,340
but they were all incorrect because they were only experiencing a piece of what an elephant is and an elephant is not like a snake or a rope or a wall.
00:04:48,400 --> 00:04:58,730
It's really many things put together in that description and an elephant is a whole creature with many of those features.
00:04:58,740 --> 00:05:06,480
So that is the lesson and it applies really well to this process of diagnosis regarding autism.
00:05:07,250 --> 00:05:07,570
00:05:07,570 --> 00:05:13,530
what happens in the area of diagnosis is that a client or patient will present,
00:05:13,540 --> 00:05:18,800
they'll have concerns and some characteristics that maybe they're struggling with.
00:05:18,810 --> 00:05:24,670
And the clinician will see that one little piece and label it with a diagnosis,
00:05:24,680 --> 00:05:28,360
but they won't see the big picture diagnosis,
00:05:28,370 --> 00:05:29,810
00:05:30,640 --> 00:05:30,950
00:05:30,950 --> 00:05:35,600
let me step away from the animal analogy for a moment,
00:05:35,600 --> 00:05:41,130
but we're going to go back and kind of weave this image through to make some other points.
00:05:41,140 --> 00:05:48,130
One point I want to make is that we define diagnoses based on certain criteria.
00:05:48,140 --> 00:05:55,320
So these are pieces of the condition or the diagnosis.
00:05:55,330 --> 00:05:55,890
00:05:55,890 --> 00:05:58,920
depression has a list of criteria.
00:05:58,920 --> 00:06:00,290
00:06:00,290 --> 00:06:04,590
Do you have these features? and then we diagnose depression.
00:06:04,600 --> 00:06:07,650
Alzheimer's has a list of criteria,
00:06:07,660 --> 00:06:09,820
bipolar has a list of criteria,
00:06:09,830 --> 00:06:12,140
autism has a list of criteria.
00:06:12,150 --> 00:06:23,700
Now the reason for having criteria is to make certain that we're talking about the same thing and also to help us research this diagnosis.
00:06:23,700 --> 00:06:25,810
We really want to know more about it.
00:06:25,820 --> 00:06:27,530
00:06:27,530 --> 00:06:35,330
we want to understand what kinds of things are not helpful and we want to know the prognosis.
00:06:36,310 --> 00:06:39,900
So we have to agree on some language for it.
00:06:39,900 --> 00:06:41,350
00:06:42,280 --> 00:06:44,020
When will we call something
00:06:44,020 --> 00:06:48,730
Alzheimer's? When will we call something bipolar instead of something else?
00:06:51,140 --> 00:06:53,510
In the example of the parable of the elephant,
00:06:53,520 --> 00:07:00,810
each person who encountered the elephant described a small element of one large thing.
00:07:00,820 --> 00:07:05,290
They defined it on the basis of one piece rather than the whole.
00:07:05,300 --> 00:07:11,330
So in this case it was like creating criteria for an elephant ear.
00:07:11,710 --> 00:07:21,430
And then calling the ear the elephant... an elephant is like a fan because I've experienced this piece,
00:07:21,440 --> 00:07:26,250
this ear. or a criteria for the tusk,
00:07:26,260 --> 00:07:29,800
and saying that an elephant is something with the tusk.
00:07:29,810 --> 00:07:38,880
Instead of realizing that a tusk is a little piece of an elephant that does not define the elephant.
00:07:38,880 --> 00:07:50,960
So you get the picture that there is a problem with defining such a large creature based on one feature or one experience with ...
00:07:50,970 --> 00:07:58,710
with the characteristic. So related to diagnoses ... autism like the elephant ... the big picture.
00:07:58,720 --> 00:08:08,110
It's the diagnosis with seven diagnostic criteria and each of the criteria could be diagnosed separately as something else.
00:08:08,700 --> 00:08:20,220
So if the tribe of people were encountering our concept of autism and they had never come across autism before and one individual encountered the social criteria,
00:08:20,240 --> 00:08:22,650
they might diagnose social anxiety.
00:08:22,660 --> 00:08:24,010
Well that's what autism is ...
00:08:24,010 --> 00:08:25,040
00:08:25,040 --> 00:08:28,080
let's just call this social anxiety.
00:08:28,250 --> 00:08:35,920
Another person could encounter autism and say actually... really autism is a difficulty with flexibility,
00:08:35,930 --> 00:08:37,770
00:08:37,780 --> 00:08:41,910
The person wanting to repeat things... for things to be predictable,
00:08:41,910 --> 00:08:44,150
perhaps having rituals for the day.
00:08:44,730 --> 00:08:46,510
00:08:48,680 --> 00:08:53,680
They're looking at this one piece of the larger autistic picture.
00:08:54,540 --> 00:09:01,490
Another individual may encounter the executive function difficulty that an individual on the spectrum has.
00:09:01,500 --> 00:09:02,960
00:09:02,960 --> 00:09:06,540
well look this is executive function difficulty.
00:09:06,540 --> 00:09:07,670
00:09:07,680 --> 00:09:08,320
00:09:10,550 --> 00:09:23,300
Another person may encounter problems that the individual presents with ... emotional regulation, with sleep, and sometimes a really encompassing obsessive interest in an activity.
00:09:23,310 --> 00:09:33,580
And they might say wow it looks like this person is kind of manic and emotionally labile and... and I think this is actually bipolar disorder.
00:09:33,590 --> 00:09:36,690
That's what this creature is.
00:09:36,690 --> 00:09:39,710
That's what this autistic experiences.
00:09:43,190 --> 00:09:53,060
So it's akin to having the tribe's person encounter the ear of the elephant and labeling this as a fan or the tail and labeling it as a rope.
00:09:53,070 --> 00:10:24,090
In this case a clinician might encounter autism but not be familiar with it and not see the big picture and then label a piece of autism as if that were the whole. The way that we ensure that as clinicians we're seeing the big picture instead of just one piece of something is to make sure we're really doing a thorough differential diagnostic process.
00:10:24,100 --> 00:10:33,040
A differential is a list of diagnoses to consider that could be present based on the few things that we first encounter.
00:10:33,050 --> 00:10:35,490
So let's take the animal example.
00:10:35,490 --> 00:10:36,050
00:10:36,240 --> 00:10:41,100
if we encounter a huge, gray, lumbering animal with eyes,
00:10:41,110 --> 00:10:41,720
00:10:41,720 --> 00:10:43,390
00:10:43,400 --> 00:10:44,420
00:10:44,420 --> 00:10:48,020
well that's all the criteria for a rhinoceros.
00:10:48,770 --> 00:10:52,660
So I think this animal is a rhinoceros.
00:10:54,200 --> 00:11:02,640
But the person who understands the importance of differentials will say... other animals also have these features.
00:11:02,640 --> 00:11:05,250
You're right ... a rhinoceros does.
00:11:05,260 --> 00:11:07,100
00:11:07,110 --> 00:11:13,000
there are also things to consider such as an elephant or a hippo.
00:11:13,010 --> 00:11:15,800
So based on what we know,
00:11:15,800 --> 00:11:19,140
we can't quite conclude that this is a rhinoceros,
00:11:19,150 --> 00:11:21,670
we have to do a little more detective work.
00:11:23,960 --> 00:11:28,640
The differential then is rhinoceros, elephant, hippo.
00:11:28,650 --> 00:11:35,360
That's the list of considerations in our consideration of diagnosis.
00:11:35,370 --> 00:11:38,330
A person may struggle with executive function.
00:11:38,340 --> 00:11:39,290
00:11:39,670 --> 00:11:41,300
00:11:41,310 --> 00:11:47,300
But after all... there is executive function difficulty in other conditions as well.
00:11:47,310 --> 00:11:47,920
00:11:48,310 --> 00:11:49,370
00:11:49,920 --> 00:11:50,520
00:11:50,520 --> 00:11:56,730
every autistic individual will also have some pattern of executive function difficulty,
00:11:57,430 --> 00:12:05,760
we would also want to know... has this person had any recent injury or illness, because this can also cause executive function difficulty.
00:12:05,770 --> 00:12:08,110
And how old is this person?
00:12:08,110 --> 00:12:09,970
What characteristics do they have?
00:12:09,980 --> 00:12:13,990
Is this someone who's showing some early signs of dementia?
00:12:14,270 --> 00:12:16,070
Also have there been an MRI or any other neurologic features?
00:12:18,580 --> 00:12:20,590
Perhaps this is part of a demyelinating process like multiple sclerosis.
00:12:23,810 --> 00:12:29,510
So that could be the differential ... rather than seeing executive function problems,
00:12:29,520 --> 00:12:31,110
noting that that's what ADD
00:12:31,530 --> 00:12:32,780
00:12:33,480 --> 00:12:45,610
We can invite more complexity in and realize that we really need to have a detailed analysis to get to that big picture... that just right description of what the big picture is.
00:12:48,860 --> 00:13:00,710
The clinician using the process of differential diagnosis is differentiating autism from other states with similar features.
00:13:02,190 --> 00:13:04,650
Although it's true that a rhino is large,
00:13:04,650 --> 00:13:05,710
00:13:05,720 --> 00:13:06,290
00:13:06,290 --> 00:13:07,160
00:13:07,170 --> 00:13:08,300
00:13:08,330 --> 00:13:18,100
We can't define the creature based on that description without differentiating it from other animals with the same features such as hippos or elephants.
00:13:18,150 --> 00:13:25,170
Now it's not that we would mistake a hippo for an elephant if we really could see the big picture.
00:13:25,460 --> 00:13:29,530
But if we're only presented with little clues at the beginning,
00:13:29,540 --> 00:13:34,740
we know that there are distinct creatures that may have similar elements.
00:13:34,780 --> 00:13:42,370
Not that the creatures are so similar that they can't be distinguished when we see the whole big picture,
00:13:42,380 --> 00:13:47,820
but that if we're only seeing a few elements present at a time,
00:13:47,830 --> 00:13:50,810
we need to know what kind of detective work to do.
00:13:51,790 --> 00:13:53,190
00:13:53,200 --> 00:13:56,540
how fast does this animal run?
00:13:56,560 --> 00:14:05,020
A Rhino runs faster than an elephant or a hippo at about 34 mph or 55 km/h.
00:14:06,220 --> 00:14:09,040
All three are found on the african continent,
00:14:09,040 --> 00:14:13,760
but hippos gravitate toward environments with aquatic elements nearby.
00:14:13,990 --> 00:14:14,580
00:14:14,580 --> 00:14:18,060
both rhinos and elephants have horns or tusks.
00:14:18,070 --> 00:14:18,930
00:14:18,930 --> 00:14:22,650
the material in the horn of a rhino is more like our fingernails,
00:14:22,660 --> 00:14:27,100
while the tusk of the elephant is made of material closer to our teeth,
00:14:27,130 --> 00:14:32,830
Of course an elephant has that distinctive trunk not found in the other creatures.
00:14:33,990 --> 00:14:37,720
So this process is the differential process.
00:14:37,730 --> 00:14:40,180
If we're only seeing a few elements.
00:14:40,180 --> 00:14:51,480
At first we do detective work and we say what other creatures or diagnoses have these same features.
00:14:53,000 --> 00:14:57,790
We're aware that certain elements are present that occur in one category,
00:14:57,790 --> 00:15:00,020
whether that's a species or a diagnosis,
00:15:00,020 --> 00:15:08,660
but we realize that this needs to be tested to differentiate it between other categories with those features as well.
00:15:08,670 --> 00:15:12,640
So the differential process for diagnosis should be similar.
00:15:12,650 --> 00:15:13,440
00:15:13,450 --> 00:15:17,200
if an individual presents with emotional regulation difficulty,
00:15:17,380 --> 00:15:21,710
let's say in this case that looks like mood swings or anger outbursts,
00:15:21,720 --> 00:15:28,600
although in others it could look much quieter like dissociation or fleeing,
00:15:28,920 --> 00:15:30,030
00:15:30,630 --> 00:15:31,640
00:15:31,650 --> 00:15:34,080
if there's mood swings or anger outbursts,
00:15:34,090 --> 00:15:43,160
a clinician might diagnose bipolar and maybe even show the person that all the criteria for bipolar are present.
00:15:44,000 --> 00:15:45,020
00:15:45,030 --> 00:15:49,130
no one has checked whether there's social reciprocity,
00:15:49,130 --> 00:15:52,500
difficulty or sensory processing characteristics,
00:15:52,510 --> 00:15:54,430
00:15:54,550 --> 00:15:55,890
00:15:55,890 --> 00:16:03,100
nobody has done detective work to see if a different big picture is actually present in this case,
00:16:03,100 --> 00:16:05,510
the big picture being autism.
00:16:07,750 --> 00:16:13,130
Another individual may present with difficulty understanding "who am I?
00:16:13,130 --> 00:16:16,360
I just don't have the stable sense of who I am,
00:16:16,370 --> 00:16:19,910
I can't reach my internal state,
00:16:19,920 --> 00:16:22,120
what's going on inside of me?"
00:16:22,860 --> 00:16:26,960
They also have difficulty keeping an even keeled mood.
00:16:26,970 --> 00:16:36,800
They struggle to start and maintain and understand relationships well. A person may present with these features and the clinician will say,
00:16:36,800 --> 00:16:37,330
00:16:37,340 --> 00:16:41,880
all the criteria for borderline personality disorder have been met.
00:16:43,800 --> 00:16:45,190
00:16:45,200 --> 00:16:46,220
00:16:46,230 --> 00:16:49,690
even though all the criteria for one condition may be met,
00:16:49,700 --> 00:17:01,860
the diagnostic manual stresses that you make that diagnosis only if the characteristics are not better explained by a different diagnosis,
00:17:02,750 --> 00:17:05,670
it's not that the features aren't present.
00:17:05,680 --> 00:17:13,900
It's whether the big picture of features is explained best by that diagnosis or by a different one.
00:17:13,910 --> 00:17:15,990
If these features are present,
00:17:15,990 --> 00:17:19,110
but there are also stereotype verbalization,
00:17:19,120 --> 00:17:20,560
00:17:20,560 --> 00:17:23,220
difficulty processing social information,
00:17:23,230 --> 00:17:26,050
all of which have been present in childhood,
00:17:26,060 --> 00:17:29,690
then the better big picture diagnosis is autism.
00:17:31,960 --> 00:17:43,030
So the crux of the problem is this autism is rarely, rarely, rarely included in a clinician's differential process.
00:17:44,170 --> 00:17:46,250
This is improving somewhat.
00:17:46,260 --> 00:17:51,870
But most patients I see who have been misdiagnosed carry often multiple diagnoses,
00:17:51,880 --> 00:17:55,110
all of which reflect core autistic characteristics.
00:17:55,120 --> 00:17:57,550
00:17:57,560 --> 00:18:00,720
maybe borderline personality, eating disorder,
00:18:00,720 --> 00:18:01,750
00:18:01,750 --> 00:18:01,850
00:18:03,230 --> 00:18:10,500
But really the suspicion should be that all of these together maybe describing the big picture diagnosis of autism.
00:18:10,510 --> 00:18:13,890
But autism has never been considered.
00:18:13,950 --> 00:18:19,650
It's not been ruled out and the better diagnosis assigned.
00:18:19,660 --> 00:18:22,570
No it's just never been considered.
00:18:23,730 --> 00:18:32,580
Someone has seen the characteristics they are familiar with and they have not met this creature called autism.
00:18:32,960 --> 00:18:38,400
So they assign diagnoses to the parts based on what they're familiar with.
00:18:38,410 --> 00:18:42,430
Not realizing that autism can also present similarly.
00:18:42,430 --> 00:18:43,960
But for different reasons.
00:18:43,970 --> 00:18:53,890
And of course that the big picture of autism is different than the pieces that they've labeled schizophrenic, OCD...
00:18:54,930 --> 00:18:56,990
Just as in the case of animals,
00:18:56,990 --> 00:19:00,330
it's not that bipolar and autism are so similar.
00:19:00,330 --> 00:19:02,010
We just can't tell the difference.
00:19:02,020 --> 00:19:06,840
Well no, we can tell that an elephant is not a hippo.
00:19:06,840 --> 00:19:28,610
If we see the whole creature... it's just that if we're presented with pieces on an initial visit and we don't know how to see the big picture and we've never encountered an elephant, or in this case autism... then we look at what we see and what we know and we label that instead.
00:19:28,610 --> 00:19:46,200
And that's how we get into this problematic situation of misdiagnoses... the person hasn't considered or ruled out autism, and therefore we have this collection of piecemeal diagnoses that really don't capture the accurate neurologic picture.
00:19:46,640 --> 00:19:53,580
I'm not going to get into the nitty gritty of when autism and another diagnosis should be made together.
00:19:53,590 --> 00:19:56,950
There are rules and guidelines for that as clinicians,
00:19:56,960 --> 00:20:02,870
but there are situations where you will have more than one diagnosis.
00:20:02,870 --> 00:20:06,290
So let's say autism and bipolar,
00:20:07,340 --> 00:20:16,810
essentially a second diagnosis would be made if there's a constellation of characteristics that are not entirely accounted for by autism.
00:20:16,820 --> 00:20:18,230
00:20:18,230 --> 00:20:22,410
in over 500 patients that I've diagnosed,
00:20:22,420 --> 00:20:38,870
I believe I've made an additional diagnosis of bipolar twice because I did not feel the sleep disturbance and emotional regulation difficulty and other features were explained entirely by autism.
00:20:39,460 --> 00:20:40,340
00:20:40,340 --> 00:20:43,560
I believe I also made a diagnosis of OCD
00:20:44,610 --> 00:20:45,560
00:20:45,560 --> 00:20:46,680
00:20:46,690 --> 00:20:50,430
And borderline essentially the same... once or twice.
00:20:51,160 --> 00:20:52,120
00:20:52,130 --> 00:21:00,340
a second diagnosis may be appropriate if ... even though the characteristics are rooted in autism ...
00:21:00,350 --> 00:21:12,950
if this second thing becomes an area of such concern for the person's well being and health that we really need to go after intervention specifically for this thing.
00:21:12,960 --> 00:21:14,920
00:21:15,270 --> 00:21:24,000
even though many individuals on the spectrum have differences in their eating profiles that can lead to restricted eating,
00:21:24,490 --> 00:21:38,440
... actually eating disorder should still be diagnosed if this really gets to the point where medical problems and health difficulties are stemming from really extreme nutritional deficits.
00:21:38,440 --> 00:21:43,380
So even though we know it's not separate from autism neurology,
00:21:43,390 --> 00:21:50,560
it still has become an area of significant and distinct concern that needs its own intervention.
00:21:51,260 --> 00:21:51,820
00:21:51,820 --> 00:21:56,160
the intervention should be made in light of the neurologic base.
00:21:58,940 --> 00:22:02,990
Similarly for depression or PTSD.
00:22:03,000 --> 00:22:10,190
Sometimes people have these diagnoses ... and they are misdiagnoses for what is actually autism.
00:22:10,190 --> 00:22:11,360
00:22:11,370 --> 00:22:19,110
certainly if autism has been diagnosed or if it has been assessed and ruled out,
00:22:19,120 --> 00:22:25,480
you can still also have depression or post traumatic stress disorder.
00:22:27,220 --> 00:22:55,830
These are things that in themselves create distress and symptomotology that need to be addressed specifically for the individual's well being. Another challenge that we have because of this history of mixing diagnoses and missing autism is that the research that occurs does not really reflect in a reliable way
00:22:57,110 --> 00:23:00,600
the differences between autism and other diagnoses.
00:23:01,400 --> 00:23:05,760
The reason for that is that a study will take,
00:23:05,760 --> 00:23:06,550
00:23:06,550 --> 00:23:12,590
people who have been diagnosed with autism and people who have been diagnosed with bipolar and compare them.
00:23:12,600 --> 00:23:13,570
00:23:13,570 --> 00:23:16,800
when you really read how that process has gone,
00:23:16,810 --> 00:23:26,160
nobody has culled through this group of bipolar individuals to make sure that none of them are actually misdiagnosed autistics.
00:23:26,160 --> 00:23:26,320
00:23:26,320 --> 00:23:36,990
you've got really strong potential for an autistic group being compared to a group of mixed diagnosis,
00:23:36,990 --> 00:23:40,640
perhaps bipolar and autism,
00:23:40,650 --> 00:23:43,910
... similarly for other diagnoses.
00:23:45,970 --> 00:23:50,060
Other research studies don't even use diagnosed groups.
00:23:50,060 --> 00:24:05,710
Sometimes they'll use people who self report autistic qualities or who complete a questionnaire reflecting autistic qualities to see if higher autistic qualities compares in some way with people who have a different diagnosis.
00:24:05,810 --> 00:24:14,920
The group with the different diagnosis or even no diagnosis has not been specifically assessed and autism ruled out.
00:24:15,080 --> 00:24:16,080
00:24:16,080 --> 00:24:29,200
you can't really conclude much on the basis of a questionnaire of autistic characteristics if you're wanting to compare the actual diagnostic threshold with another state,
00:24:29,210 --> 00:24:30,920
00:24:32,060 --> 00:24:33,850
00:24:33,860 --> 00:24:36,210
00:24:36,850 --> 00:24:38,450
00:24:38,840 --> 00:24:41,240
Can include social difficulties.
00:24:41,250 --> 00:24:41,390
00:24:41,820 --> 00:24:43,480
Can include sensory issues.
00:24:43,480 --> 00:24:43,610
00:24:43,980 --> 00:24:45,920
00:24:47,180 --> 00:24:53,100
... That may be true but we actually don't know that it's true because the ADD
00:24:53,470 --> 00:25:02,890
group has not been actually professionally assessed for people missing a correct diagnosis of autism.
00:25:03,400 --> 00:25:09,400
So many of my clients that come for diagnosis have had a diagnosis of ADD
00:25:09,870 --> 00:25:12,400
since very early in their life.
00:25:12,410 --> 00:25:22,480
And not everyone ... but you do get this problematic mixing and so you can't really be sure what the overlap is.
00:25:23,000 --> 00:25:30,520
We do know that people with these other diagnoses have been misdiagnosed to some extent.
00:25:30,520 --> 00:25:39,520
We don't know how much because we don't have a correct diagnosis of autism across adulthood and across the lifespan yet.
00:25:39,530 --> 00:25:42,380
So we're moving in a good direction,
00:25:42,390 --> 00:25:44,540
but these are the complexities.
00:25:44,550 --> 00:25:48,240
If we want to talk about diagnosis and why it gets missed,
00:25:48,250 --> 00:25:50,080
why it gets misunderstood,
00:25:50,090 --> 00:25:54,380
and how come the research can be a little difficult to interpret.
00:25:55,730 --> 00:25:59,660
This is foundational knowledge about misdiagnosis.
00:25:59,670 --> 00:26:03,920
We are going to be doing a series of a few more episodes,
00:26:03,920 --> 00:26:08,300
looking at some of the common misdiagnoses in more detail.
00:26:09,230 --> 00:26:13,060
I'm glad you could join me for this conversation about autism,
00:26:13,070 --> 00:26:14,230
00:26:14,240 --> 00:26:16,120
00:26:16,130 --> 00:26:23,480
and I hope it was illustrative to just set that foundation for the complexity that we are diving into.
00:26:24,190 --> 00:26:25,840
I hope you join me next time.