Discussing Autism

There has been a common theme on autism blogs this week concerning the Virginia Tech tragedy. Sorrow for the victims and their families and friends. Horror that such a thing could have happened. And a deep-seated, usually unspoken fear that with the increased attention on the shooter and his motives (over stories of the victims which we REALLY would have rather heard), there would be a Monday-morning-quarterbacking type of diagnosis.

As I scanned through my newsfeeds this morning, my heart sank, because there it was, a headline reading: Cho had autism say Korean relatives.

There’s been no confirmation of this from any official agency. And yet this story will play out in the press as a sensation piece, undermining what Autism Awareness Month is all about. Kids with autism spectrum disorders will be viewed with a suspicious eye, with people wondering if that could be the next school shooter.

AUTISM DOES NOT MEAN ANTISOCIAL. Most kids with autism WANT to socialize. They just don’t know how. What this individual did was sociopathic. It demonstrated a deep-seated HATE that isn’t there with autism. People with autism don’t HATE people; they just don’t understand how the rest of us seem to interact.

I cried when I read this headline. Cried that so many kids will now be viewed in the same light. Even if the shooter WAS autistic, that had NOTHING to do with what he did. Yes, on occasion, kids with autism will lash out in frustration, but not like that. Not a planned attack with video documentation and a message of hate. They just don’t have it in them.

The “diagnosis” that’s being presented in this article is done by relatives who admitted they didn’t even recognize the shooter in pictures, since it had been so long since they had seen him. They claim that he was diagnosed as autistic once he came to the States. What is more important is that this is an individual who had a HISTORY of mental illness, not autism. He was documented as a stalker, and at one point, was deemed potentially dangerous by a judge. THAT should be the focus: how to identify individuals who are disturbed and not blame such an atrocity on autism. Social awkwardness does not equal the sociopathic tendencies that this individual displayed.

Autism is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Now look at the DSM criteria for Dissocial Personality Disorder (F60.2):

usually coming to attention because of a gross disparity between behavior and the prevailing social norms, and characterized by:

* callous unconcern for the feelings of others;
* gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
* incapacity to maintain enduring relationships, though having no difficulty in establishing them;
* very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
* incapacity to experience guilt or to profit from experience, particularly punishment;
* marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.

Which diagnosis seems to fit? An awareness of autism means understanding it, and not applying it to everything. Might the shooter have been on the spectrum? Possibly. But that obviously wasn’t the only issue, and shouldn’t be cited as the cause of his actions. If this story gets sensationalized, there will be many more victims of this tragedy in kids who will be looked at in a way that relates them to this horrifying violence, for no other reason than that it made a good story at the time, and sounded more familiar than citing “Dissocial Personality Disorder.”