Neurodevelopmental Genes Have Not Read The DSM Criteria: Or, Have They?

Abstract

Most would recognize the situation: a young person presents with autistic features. While the patient himself has clear cut symptoms of autism classifiable according to any known classificatory system that is currently in use, his older brother has similar, yet different set of social deficits in that he has no friends and is being bullied due to his odd ways of communication and behaviors. Teacher reports clearly relay symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in your patient and parents report that the young person fidgets and twitches. While exploring the “tic” history, your registrar reminds you that he has only had motor tics but you notice him sniffing repeatedly. When asked about the sniffing, the parents confirm that he has had it for quite some time but attributes it to allergy as it comes and goes, although with no other associated features of allergy. You also find out that a paternal uncle is “socially awkward,” dad had tics during childhood and that there is history of obsessive compulsive behaviors (OCB) in paternal aunt and grandmother. As a doctor you are concerned about the nature, degree, and functional impact of the varying symptoms on your patient's daily life in order to develop an appropriate management plan. However you are also aware of the need to communicate the nature of your patient's symptoms to other professionals who are involved in his care, to his school for attracting additional support, and to the parents who are trying to make sense of the different sets of difficulties their two boys are presenting with, and seeking answers as to why this has happened and what can be done. In the meantime your registrar is getting exhausted trying to match the criteria as per the current version of the Diagnostic and Statistical Manual (DSM) for Autism, Tourette Syndrome, ADHD, and so on, and asks whether he would qualify for a diagnosis of Tourette Syndrome now that he has been noted to have “sniffing,” a vocal tic, which together with the multiple motor tics would get the tick of approval for such a diagnosis.