Thread by @Richard_Autism

@ElaineMcgreevy Possibly, but there is this, a table for my chapter for Damian & Sara. It shows that PDA clinical features are often based against autism stereotypes. Stereotypes often seem to become accepted clinical fact.

@ElaineMcgreevy I have updated the table to this, mainly changing PDA to DAP. Also noting that demand avoidance generally is manipulative.

@ElaineMcgreevy There is something that is nagging me. So mental health disorders are meant to represent discrete constellation of traits/ "symptoms" that hang together to form a unique syndrome.
adc.bmj.com/content/archdi…

@ElaineMcgreevy I am not going to necessarily argue against this point Newson (& later Christie make). It seems reasonable to me/

What I would say is that it important to take this point in context of Newson's views on "autism spectrum" & Pervasive Developmental Disorders.

@ElaineMcgreevy Newson had broader definitions for Pervasive Developmental Disorders than what is accepted. She thought it was wider than the Autism spectrum.

She also thought anyone not meeting Autistic disorder/ Aspergers/ PDA was PDD-NOS.

@ElaineMcgreevy That people can transition into either Classic Autism/ Aspergers/ PDA.

Some parts are loosely inline with established understanding.

@ElaineMcgreevy PDD-NOS is a residual category, which most diagnostic groupings in DSM have, as APA accept that it is human nature for some people to not to meet diagnostic descriptions of some disorders.

@ElaineMcgreevy Autism clinical literature and research has established that people can transition between PDD-NOS/ Aspergers/ Classic autism throughout lifespan. Wing et al (2011) argue such issues apply to all proposed subtypes, which they considered PDA to be.

@ElaineMcgreevy My main issue with Newson viewing PDA to be diagnosed in those who would typically get PDD-NOS, is that it assumes that her definitions of Pervasive Developmental Disorder would be accepted by others & are valid.

@ElaineMcgreevy When we know that, this is not the case. For instance Specific Language impairments, in her diagram below have never been accepted as a PDD or an ASD.

@ElaineMcgreevy That Newson's broader definition of PDD has been fallaciously used by Christie to apply to a broader Autism Spectrum to include

"PDA is often diagnosed alongside other ASDs, such as attention deficit hyperactivity disorder (ADHD), dyslexia and dyspraxia"

@ElaineMcgreevy I really should not need to say ADHD, dyslexia and dyspraxia have never been considered part of the autism spectrum.

@ElaineMcgreevy Which means that PDD-NOS was envisioned to be used as Newson argues in relation to PDA.

PDD-NOS group is important as it tends to be persons who do NOT conform to autism stereotypes who receive this diagnosis.

@ElaineMcgreevy Which is where I come back to clusters/ grouping of traits/ "symptoms". Stereotypes often form from the features that people think cluster together.

It is now accepted that autism traits cluster is dyamic and can change substantially over time.

@ElaineMcgreevy Which is partly why PDD-NOS/ Aspergers/ Classic Autism are unstable disorders; why there is a single broader ASD diagnosis.

@ElaineMcgreevy The point is, the traits mainly covered in Asperger's/ Classic autism which Newson correctly identifies as overlapping each other, ARE stereotypes

This is an issue in how mental health disorders are reified social constructs (something abstract made to real)

@ElaineMcgreevy So in some respects autism, clinically is defined by its stereotypes. Yes, I know this is crap and is causing problems for various persons, in not receiving diagnoses and calls for lower diagnostic thresholds etc.

@ElaineMcgreevy This takes me back to point about PDA seems to be clinically derived from being opposite to autism stereotypes.

@ElaineMcgreevy If something is based on the opposite of autism stereotypes, it is very likely it is also based against the opposite of traits/ "symptoms" that cluster together to make the autism spectrum.

@ElaineMcgreevy So by definition, of how a syndrome is a discrete clustering of "symptoms"; PDA must not be part of the autism spectrum, as it clinically based on being the opposite of autism spectrum (classic autism and Aspergers).

@ElaineMcgreevy Which means logically, PDA cannot be something it is literally the opposite of.

Therefore, Newson is correct PDA is not an autism spectrum disorder.

@ElaineMcgreevy "PDA is a pervasive developmental disorder but not an
autistic spectrum disorder: to describe it as such would be like describing every person in a family by the name of one of its members."
adc.bmj.com/content/archdi…

@ElaineMcgreevy Worth also discussing Newson's stance that Pervasive Developmental Disorders, mean a person has problems making sense/ processing of certain aspects of communication.

@ElaineMcgreevy The first part here, is that this seems to be a continuation, of her own created diagnostic group "Pervasive Developmental Coding Disorders she used between 1989 - 1996.

@ElaineMcgreevy Again must be said Newson specialised in "Coding Disorders", so her bias in relation to those. I have discussed elsewhere how some features of her "Surface Sociability" seem to be not related to communication issues

@ElaineMcgreevy Newson's original diagnostic group for PDA can be found here:
autismeastmidlands.org.uk/wp-content/upl…
She created it as she thought PDD definition was too narrow & to help laypersons.

@ElaineMcgreevy Observe Newson's intelligence scale in the below diagram, she thought that intelligence impacts how symptoms/ features manifest in a person, i.e. comorbids interact with each other.

@ElaineMcgreevy Newson's views on how PDD's should have coding aspects linked to them. To answer this we need the definitions she is referring to. I am assuming Christie's definitions are the same as Newson's. Taken from his 2019 NAS PDA conference.

@ElaineMcgreevy Pervasive: Suggests that the effects can be seen in all of the child’s development.
Developmental: Means that the disorder is present at birth, gradually becoming apparent during the course of development.
Disorder: Implies more than straightforward delays.

@ElaineMcgreevy My problem here is that these definitions when combined together seem to apply to many neurodevelopmental disorders.

@ElaineMcgreevy There broad definitions would explain why Christie has viewed ADHD, dyslexia and dyspraxia as part of the autism spectrum (when they are not).
emerald.com/insight/conten…

@ElaineMcgreevy From my limited understanding of ADHD, it is often from birth, or soon after. Its features are described as pervasive in their effect. I would argue the DSM5 criteria for ADHD meet the DSM4 PDD definitions.
cdc.gov/ncbddd/adhd/di…

@ElaineMcgreevy So a disorder can meet Christie's definitions of a PDD, not be based on "Coding" issues and not be part of the autism spectrum.

It does seem that Newson is mistaken to argue that PDD's should have "Coding" issue to them.

@ElaineMcgreevy Which indicates that Newson was biased in taken this view, it would help to explain why Newson noted non-communication features, like panic attacks to "Surface sociability, but apparent lack of sense of social identity, pride, or shame"

@ElaineMcgreevy Panic attacks would be more suited to Lability of Mood, trait.

One can challenge PDA conforms to Newson's PDD definitions.

@ElaineMcgreevy First off, Newson observes that persons can transition into PDA, especially from those whose "symptoms" are not clear from infancy, i.e. PDD-NOS.
adc.bmj.com/content/archdi…
Others, mainly Wing et al (2011) also state people can transition into PDA.

@ElaineMcgreevy Now if CYP and adults can transition into PDA over lifespan, it not necessarily "developmental" by their definition.

Developmental: Means that the disorder is present at birth, gradually becoming apparent during the course of development.

@ElaineMcgreevy There are at least 5 studies indicating PDA is developmentally unstable, i.e. that its features may not be pervasive.
acamh.onlinelibrary.wiley.com/doi/abs/10.111…

@ElaineMcgreevy "One adult has “no sense of right or wrong”, and in seven cases parents are “uncertain” whether the individual has a sense of right or wrong; this represents an improvement over earlier fears," (Newson et al, 2003, p596 - p597).

@ElaineMcgreevy This comment by Newson suggests that "Surface sociability, but apparent lack of sense of social identity, pride, or shame" is developmentally unstable, in line research on broader behaviour profile.

@ElaineMcgreevy Which would suggest "Surface sociability, but apparent lack of sense of social identity, pride, or shame" is not pervasive, as it is not seen throughout the child's lifespan.

Pervasive: Suggests that the effects can be seen in all of the child’s development.

@ElaineMcgreevy Disorder: Implies more than straightforward delays.

The obvious issue with the above definition, is that a delay CAN be straight forward.

Meaning observer can be interpreting features as being more severe than they actually are, i.e. to conform to biases.

@ElaineMcgreevy Worth mentioning Newson's aetiology for Pervasive Developmental Disorders is known to be wrong.

"None of these children chooses to be the way they are. These are biological, sometimes genetic, disorders." (Newson et al, 2003, p598).
adc.bmj.com/content/88/7/5…

@ElaineMcgreevy Point about mental health disorders lack biomarker evidence to underpin them & that we should not expect any research to support that. That mental health disorders are social constructs.
acamh.onlinelibrary.wiley.com/doi/abs/10.111…

@ElaineMcgreevy Examples, where Newson is wrong about:
- PDA' & other conditions aetiology.
- Nosology of some conditions, mainly Specific Language Impairment.
- Some features associated to "Surface Sociability", when are RRBIs.
- PDD's needing to have "Coding issues."

@ElaineMcgreevy - Probably PDA being a Pervasive Developmental Disorder, using her own definitions.

@ElaineMcgreevy I also need to some other points to strengthen the above points, in case anyone tries to challenge it.

@ElaineMcgreevy One can assume that Christie's definitions are the same/ similar to those used by Newson.

Newson used definitions from DSM4. Christie states his definitions were used in both DSM4 & ICD10, which were current in 2003).

@ElaineMcgreevy I suspect Christie's three PDD definitions are the rationale underpinning Help4Psychology PDA definitions. I do not have time to explain why.

@ElaineMcgreevy Many of the points about Help4Psychology definitions are not valid & do not represent PDA literature are also valid for use in why PDA is not a Pervasive Developmental Disorder:
…emandavoidancecom.files.wordpress.com/2020/09/17-sep…

@ElaineMcgreevy Newson did not have the evidence to say PDA is a Pervasive Developmental Disorder, as she did not establish the validity , nor specificity of her observations.
adc.bmj.com/content/88/7/5…
&
thelancet.com/journals/lanch…

@ElaineMcgreevy So Newson should not have been claiming PDA belongs to any nosology group, except ones she is confident it is not.

@ElaineMcgreevy She can say it is not autism, as she did not systematically investigate autism features & it does appear to be based on being opposite of autism stereotypes.
pdaresource.com/files/An%20exa…

@ElaineMcgreevy Now, I am done.

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