Just a quick reminder that although I'm knowledgeable about Aspergers, I'm not a medical professional. I can only apply what I know and see to my own, my childrens and my friends/acquaintances conditions.
This post is in response to an interesting question I received via comment.
I am confused by the list in the DSM - IV that describes this condition a bit. I know aspergers is on a spectrum, so it doesn't look the same in everyone. Yet in the DSM -- IV it states that the traits which people have when they have aspergers have to significantly detract from a persons ability to thrive in social situations.
So assuming a case is borderline, where would asperger's end and a neurotypical person with a lot of aspie traits begin?
The DSM and Diagnosis
The DSM by itself is very confusing and opinions vary greatly from one doctor to another. Unlike diseases or physical problems, aspergers is still undetectable by electronic means such as X-rays, CAT scans etc. (Although I believe that some amazing results are starting to come through). This makes any diagnosis extremely subjective.
Some doctors don't actually believe in the condition, while others have very fixed ideas about the condition, for example; dismissing any children who make even the most rudimentary eye contact despite the fact that the DSM quite openly states in its criteria that you need not display all symptoms.
The other thing to remember about the traits of aspergers is that they aren't necessarily impossible for NTs. There are some NT people who dislike eye contact, some who have specific social interests and many who stim in one way or another. At this point, the only guide we have is the DSM which requires that you meet certain minimum criteria - all of which can be determined subjectively.
We are all still learning about Aspergers and nobody is quite sure where the boundaries lie.
There are two major schools of thought;
- Those who feel that aspergers is a base-level difference. A difference in the very wiring of the brain.
- People who feel that aspergers is simply a difference of characteristics. (the curebie approach).
The Curebie Approach
If we look at the second option for a moment, it suggests that the difference is simply in the presence and strengths of the characteristics. In this model, there would be a sliding scale where at one end, there would be low functioning autism, while at the other, neurotypicality.
The benefit (and the problem) with this approach is that it gives parents false hope. It suggests that if you can eliminate the characteristics, then the child will "become" neurotypical. This is the basis on which a lot of (in my opinon, "crackpot and unsafe") therapies, such as behaviour modification, chelation, shock treatment and confinement are tried.
In this world, there are cases of varying degrees and it is possible to "learn how to be neurotypical". A borderline case in this world would be a child who is "mostly normal".
The Evolutionary Approach
The evolutionary approach is quite different. Put simply, it suggests that the brains of aspies are "wired differently". In this world, it is quite impossible for an aspie to become neurotypical but it doesn't mean that they can't learn to "present as NTs" when called for.
There are a number of reasons for my belief in this theory including the fact that the symptoms of aspergers spread far beyond mental characteristics and into the realm of muscluature. Aspies are often described as hyptonic (having low muscle tone) and this has very little to do with their mental state. It points to a wider genetic issue.
In this world, there would be no "borderline" aspergers cases. Simply cases where some aspies have learned to hide/control their symptoms better than others. All would think differently.
The Deer Example
I thought I might finish up with an example from the animal kingdom. About three years ago, I heard a doctor talking about ADHD (but it could just as well have been aspergers). He cited a BBC animal documentary that he'd been watching. There were a group of deer grazing in grasslands where a lion was prowling. All of the deer were happily eating - all that is, except for one. There was one deer who couldn't hold it's focus on the grass for very long. It kept lifting it's head an looking around. The slightest sound would distract it.
The distracted "ADHD" deer was the one who first spotted the lion. Although it wasn't a fast runner compared to the other deer, it had an advantage. It started running first. This deer was also particularly important to the herd as it acted as a lookout.
The documentary crew followed that particular herd of deer for a long period. They found that the particular "ADHD" deer repeated the pattern over and over again. It wasn't a designated lookout and the task wasn't "shared" with other deer. I think, that they hinted that the behaviour continued in the deer's offspring suggesting either "training" or more likely, a genetic difference.