**2.3 Psychology of autism**

*Autism Spectrum Disorder - Profile, Heterogeneity, Neurobiology and Intervention*

more an article of faith with them' [9].

Eisenberg's two criteria gave a diagnosis of 220 [10].

'lacks biological and construct validity' [14].

the limitations of diagnostic instruments: ultimately, these measures cannot solve a difficult diagnostic decision, and they may not be universally necessary. Experienced clinical judgement is essential for a correct diagnosis'. This would be in line with the NICE [5] Guidelines. The ADI-R (Autistic Diagnostic Instrument Revised) [6] and ADOS (Autism Diagnostic Observation Scale) [6] criteria to define autism are very narrow concepts of the disorder. I see many parents who come to me in great distress knowing that their child has autism and that the school also observed this, but having been told that their child did not have autism according to the ADI-R. This instrument is not appropriate to making a sole diagnosis of autism in clinical practice. It not uncommonly misses high functioning autism. In addition, Ventola et al., [7] have shown that the ADI-R was significantly under-diagnosing toddlers. How biased and unrepresentative the patients in this survey can be seen by Professor Gillian Baird's work [8] on autism in the general population. Indeed, using these narrow criteria gives a prevalence of autism of 25 per 10,000. When you use the broader autism spectrum, you get a truer rate of 116 per 10,000. One of the problems also is that the National Institute for Health Care Excellence, [5] Guidelines on the diagnosis of autism which are accepted throughout the world, are not followed. Professor Dorothy Bishop, Professor of Developmental Neuropsychology at the University of Cambridge told Adam Feinstein, [9] that, 'if it could be shown that there were real benefits in accuracy of diagnosis from adopting this lengthy procedure, then I would be happy to say 'okay', but the originators of the instrument have never demonstrated this – it is

The problems with different criteria for diagnosis was demonstrated by Fitzgerald et al., [10] from a sample of 309 persons referred with, 'autistic tendencies', found that 272 met criteria for autism on the Autistic Disorder Diagnostic Check List by Lorna Wing [11] which was the predecessor of the DISCO (Diagnostic Interview for Social Communication). 144 met ICD 10 criteria [10]. Kanner and Eisenberg, [12] five criteria gave a number of 24 with autism while Kanner and

Replication of research findings in autism is and continues to be quite a problem. Replication is central to our understanding of science. Indeed, we usually require multiple replications before we would feel that a finding is secure. Ioannidis [15] stated that, 'there is increasing concern that most current published research findings are false'. There are problems with study power, sample size, data mining and hypothesis being tested at the end of a study which weren't there in the beginning. Bottema-Bentel et al. [16] studied autism treatment studies in one hundred and fifty papers and found that only 6% of them with genuine conflicts of interest admitted to them in the original paper and could not complete their statistical analysis on these papers because there was insufficient numbers of high quality papers. The authors of this paper were equally concerned about the lack of mention of adverse events, and only 7% of the one hundred and fifty studies examined

Steven Hayman, former Director of The National Institute of Mental Health in the United States stated that the diagnostic and statistical manual enterprise was, totally *̔* wrong… an absolute scientific nightmare. Many people who got one diagnosis, got five diagnoses, but they don't have five diseases – they have one underlying condition', [12]. Insel [12] said that the psychiatric diagnosis, 'have no reality. They are just constructs', and he wanted a, 'diagnostic system based upon biological foundations'. While females with autism are more likely to be missed, there is the paradox that women are more likely to be given a psychiatric diagnosis with less physical tests done on them, then males and more physical diagnosis to be missed [13]. ASD diagnosis,

**4**

adverse events [16].

There are problems with TOM (problems with theory of understanding other peoples' minds) and autism. TOM deficits have been a dominant theory of autism for many decades. It is mentioned endlessly by psychologists and psychiatrists and has been presented as a, 'fact'. The situation is much more complicated. It is not as universal as the theory proponents have suggested and there is considerable nonreplication. This has been reviewed by Gernsbacher and Yergeau [17]. They pointed out that this stereotyping has been particularly damaging for persons with autism. It has stigmatised them. The neurodiversity movement has challenged this stigma [18]. The deficit in TOM undermines persons with autism's independence, truthfulness and trustworthiness and makes them unsuitable for many jobs. This is unhelpful and isolates them and leads to further social exclusion.
