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Roger N. Meyer "...of a different mind "
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Just how Inappropriate a Co-Morbid Diagnosis can be

Roger N. Meyer © 2000



     Parents of HFA/AS children should exercise extreme caution when a clinician slaps the Oppositional Defiant Disorder (ODD) label on their children.  It is a very inappropriate diagnosis.  ODD is a catchall, old-time, psycho dynamically oriented explanation for “inappropriate” behavior, and is unsuitable for persons on the autistic spectrum.


     Clinicians who have a strong authoritarian bent favor ODD.  Any time a patient disagrees with them or fails to follow their direction or instruction they have a propensity to take autistic  resistance and label it with a DSM diagnosis.  HFA/AS children and adults are prone to resisting direction, since that is a defining diagnostic criterion of this Autistic Spectrum Disorder.  Adding ODD to the shopping list of co-morbid diagnoses does the patient no good, fails to enlighten anyone reading this characterization, and puts the stamp of self-satisfied approval to the clinician’s arrogance in the face of something he or she does not understand or is interested in learning about.


     The label also feeds into the authoritarian, negative disciplinary propensity of many educators and administrators, whether they are special education “trained” or not.


     First, by applying the label, the clinician assumes that reality or talk therapy will work to modify the person’s thought patterns and behavioral manifestations.  Nothing is further from the truth for autistic children and adults.


     Second, the very term itself suggests that the behavior of the autistic person is willed, and subject to the “rational” control of the child or adult.  Our children’s capacities to control many manifestations of HFA/AS are not subject to the same kind of self-generated automatic monitoring and control typical of non-disabled persons.  Although autistic children and adults may be manipulative and perhaps even thought of as “devious,” in such acts and by using thought patterns that imperfectly apply to a new situation, they are more often acting out according to a script learned much earlier.  They use behaviors that had beneficial results under different circumstances.  Failure to accurately generalize from previous “lessons,” and having a limited capacity to differentiate new situations, events, or directions from ones they experienced in the past often leads to “incorrect” behavior.  Autistic people rarely INTEND their outbursts to have the effect it has on others.  This is far different from neurotypical children or adults kids who deliberately choose tantruming as a means to get their way.


     Tantrums, meltdowns, violence, hitting, stimming, and resistance to direction or redirection are common behavioral manifestations by persons on the spectrum.  The antecedent to such reactions is often environmental, such as stimulus overload, a condition perceived as a threat or anxiety producing, taunting and other behavior of others, including teachers and other authority figures who are perceived as challenging the person’s need to control.


     What others perceive and experience as defiance is the effort by the person to regain control over his or her environment and to re-establish a state of personal equilibrium temporarily lost.  To restore such a state, the person often reverts to “regressive” kinds of thought patterns and behaviors.  The same thing occurs when the person is experiencing runaway emotions that they cannot recognize or even give a name to at the time.  If perceived by others as a global defense and protective mechanism, an autistic person’s behavior, though disturbing, can be accurately interpreted, and the conditions prompting the behavior can then be analyzed and understood for developing an effective behavioral intervention plan or therapeutic contract.


     The process of monitoring and adjustment of thought and behavior cannot be intuited by children on the spectrum any easier than monolingual and monocultural foreigners can intuit the meanings of a strange tongue or the correct understanding of the non-verbal rules of social intercourse and communication in a new culture.


     Cognitive behavioral therapy and applied behavioral analysis utilize deliberate approaches in teaching “persons without a clue” to interpret their environment and understand language pragmatics.  Using proven methods, children can be trained using very deliberate step-by-step techniques to become efficient self-monitors of their environment and their emotions.


     Diagnosing and treating professionals ignorant of the unique meanings involved in each person’s autistic communication verbal and non-verbal language mistake the response for the cause.  Although their conclusion that the autistic person is engaged in oppositional-defiant behavior makes the individual practitioner “feel better” by indulging in stereotypic thinking and blame-casting, it is destructive to the relationship with the autistic person.  Broadcast of erroneous conclusions to untrained rigid-thinking teachers and school administrators lends legitimacy to placement of autistic spectrum students in destructive settings and their social association with the worst kinds of behavioral role models.


     Parents are wise in remembering that the principal motivation of many "experts"—be they medical or educational-- is to control the child, not help him/her learn to control the environment or themselves.  A punitive or negative disciplinary approach to a child exhibiting autistic behaviors is wrong.  Research over the past twenty years has proven it.


     School administrators and other authority figures, including many teachers are the last persons to admit the validity of positive behavioral intervention plans and a positive disciplinary approach to behavior problems.




     Because they challenge educators to update their thinking about differentness, not sameness in their students, and how students learn in vastly different ways.



Copyright Issues


This article is copyright, all rights reserved by the author, Roger N. Meyer.  It may be reproduced in single copy once for personal use, and in no more than ten copies total for educational purposes.  Fair Use is authorized for all purposes and under conditions established by US Statute and the International Copyright Convention, to which the United States is a signatory nation.  No person shall publish, distribute, copy, or by other means make this material available to others for purposes of personal gain or professional self-aggrandizement.  Individuals wishing permission to exercise other than fair use or limited distribution as outlined above must contact the author, in writing, and receive explicit written permission from the author prior to engaging in further use of this material.

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