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Autism Spectrum: Are You On It?

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The publication of DSM-IV had unintended consequences. “We were glad that Asperger’s was included,” says psychologist Bryna Siegel, another working-group member, who directs clinical care at the autism clinic at the University of California, San Francisco, “but until the publication of DSM-IV, very few people had heard the term Asperger’s. And when it came out, a lot of clinicians let their fingers do the walking in DSM. There were fully trained practicing clinicians who really didn’t have any idea what Asperger’s was. Everybody with Asperger’s got diagnosed with Asperger’s, but a lot of other people got diagnosed with Asperger’s, too.”

Siegel, who has been running her clinic since the eighties, says she’s seeing “more false-positive assessments than ever before.” Of the roughly ten new assessments she’s asked to do every week—kids showing up with spectrum diagnoses from another therapist—six of them might not have an autism-spectrum disorder. This isn’t to say that they may not have psychological issues, only that those are either other disorders or they don’t rise to an impairing level. “A lot of kids are just delayed in development, slow to talk, or anxious, or hyperactive, and a lot of kids are just terribly parented.”

Siegel sees overdiagnosis and misdiagnosis as driven largely by economic and social priorities rather than medical ones. Some adults who might be very high-functioning seek a formal diagnosis because it enables them to, in Siegel’s words, “wallow” in their symptoms rather than “ameliorate” them, because they’re “a lunch ticket.” Poor parents want diagnoses serious enough to merit state-funded school services, and rich parents want the least stigmatizing diagnoses. (“When you say a kid is mentally retarded,” Siegel says, “parents try to talk you out of it.”) And some parents are simply flummoxed by their own kids’ irrational mood swings, refusal of food, or inability to express emotion. When these parents come to Siegel, they get a surprise: She diagnoses their children as suffering from childhood. “We see a lot of diagnosis-of-childhood kids, whose parents have never set limits, plus kids who are temperamentally difficult to raise.”

Also temperamentally difficult: husbands. Put-upon spouses have seized on the autism rainbow as a simple, esteem-boosting way to pathologize what used to be called “a typical guy.” Simon Baron-Cohen, a leading expert on Asperger’s at Cambridge (and, as it happens, the cousin of Sacha), has theorized that the autism spectrum represents the “extreme male brain,” turned up to eleven. Hence the ubiquity of spectrum references in the coastal power centers where Nora Ephron spent most of her time. And the Internet abounds with unhappy married women diagnosing their callous workaholic husbands with Asperger’s, whether or not a clinician has seconded their opinion. In a forum called Asperger Divorce Support Group, posters share war stories, some less harrowing than others: “My ex … did not GET a sunset. He took pictures of fall color trees last year and said, ‘I guess its cool looking, right?’ ”

“It’s become more frequent in the last five years,” confirms a Connecticut divorce lawyer who says she has represented parties in several cases where a wife accused the husband of being on the spectrum. “It’s women complaining, ‘He lines up my towels perfectly. He complains if his shoes aren’t lined up right.’ ”

Men have caught on and, in a kind of inverted gaslighting, begun to describe themselves as having Asperger’s as a way of controlling their spouses. “Having Asperger’s-like syndrome does not give you Asperger’s,” says David Schnarch, a Colorado-based couples therapist. “Having a big belly does not make you pregnant. I’ve not seen a single case of what I would consider to be diagnosable Asperger’s. But I have seen any number of cases of wives accusing husbands of it, any number of cases of husbands claiming to have it.” It’s the new ADHD, he says. “The wife doesn’t want to accept that the husband knows what he’s doing when he’s doing something she doesn’t like.” Schnarch recalls a man who phoned him the day before a scheduled initial couples session and announced that he’d just been diagnosed with Asperger’s. “As soon as this happened,” Schnarch says, “I knew I had difficulty.” He contacted the referring therapist, who said he’d suspected the man had Asperger’s because he said things to his girlfriend that were so cruel he couldn’t possibly understand their impact. As far as Schnarch was concerned, it was an all-too-familiar instance of ­sadism masquerading as disability. “If you’re going to perp, the best place to perp from is the victim position.”

Because Asperger’s lives on the outskirts of normal, and because its symptoms can resemble willfully antisocial behavior, there’s now a presumption of excuse-making whenever someone invokes it to get out of a pickle. Last October, South Park aired an episode in which the people at an Asperger’s group-therapy center turn out to be faking their symptoms and not even to believe in the reality of the disorder. (Cartman, meanwhile, mishearing Asperger’s as “Ass Burgers,” tries to fake it by stuffing his underwear with hamburgers.) “You’re not autistic,” a doctor tells Hugh Laurie’s abrasive character in an episode of House. “You don’t even have Asperger’s. You wish you did; it would exempt you from the rules, give you freedom, absolve you of responsibility, let you date 17-year-olds. But, most important, it would mean that you’re not just a jerk.”


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