Autism in the DSM
Page by Stephanie Watkins
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychological Association, is the standard for the classification of mental disorders. Giving psychologists a common language and set guidelines for the diagnosis of hundreds of disorders, the DSM has gone through various revisions to compensate for changing times and criteria. Although the DSM is primarily used in the United States, it can also be found in other areas of the world as well. As autism spectrum disorder (ASD) became known throughout the United States and common symptoms and behaviors were agreed upon by many researchers, it gained increasingly specified diagnostic criteria in the DSM. Here, autism is traced throughout the four main revisions of the DSM (Grinker, 2007):
-DSM-I (1952)- Because the idea of autism had recently began circulating, it was not given it’s own diagnostic criteria in this first edition of the DSM. Instead, children demonstrating autistic-like symptoms were classified as ‘childhood schizophrenic’ (American Psychiatric Association, 1952).
-DSM-II (1968)- Autism was not included as it’s own diagnostic category in the second release of the DSM. Continuing to be labeled as ‘childhood schizophrenic,’ some of the behaviors fitting the criteria for diagnosis were “autistic, atypical, and withdrawn behavior” (American Psychiatric Association, 1968, p. 35).
-DSM-III (1980)- Autism is included as a distinct diagnostic category. However, ‘infantile autism’ was designated as the only form and solely 6 characteristics were listed, an individual having to possess each of which to be labeled ‘autistic’ (American Psychiatric Association, 1980).
- Between the DSM-III and the DSM-III-R criteria for autism, there were some tremendous differences. Diagnostic criteria were more concrete and observable, specifying that such behaviors must reflect abnormalities in the individual’s level of development (American Psychiatric Association, 1987). These changes in the field yielded a rapid increase in the number of individuals being diagnosed with autism (Factor, Freeman, & Kardash, 1989).
-DSM-IV (1994)- Following a debate about infantile autism and it’s connotations, several subtypes and a category of pervasive developmental disorders were added. On top of these drastic changes, 16 symptoms were now listed and only six needed to be exhibited in order to be diagnosed with autism. Two of the six symptoms must be based on “qualitative impairment in social interaction,” one based on restricted and repetitive behavior, and one of qualitative impairment in communication (American Psychiatric Association, 1994). Examples of other symptoms are a lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with parts of objects. While many diagnostic tests are available from ASD specialists and can be received following an investigation and referral by a pediatrician, onset must be prior to the age of three (Grinker, 2007).
-Controversy surrounding the DSM-V: Although Asperger’s Syndrome and Pervasive Developmental Disorder-Not Otherwise Specified have always been considered to be a part of the autism spectrum, they will not be featured in the new edition of the DSM (American Psychiatric Association, 2010). Before, in order to be diagnosed as autistic, an individual would need to demonstrate 2 markers of impairment of social interaction, as well as impairments in communication as well as repetitive and stereotyped behaviors. In the DSM-V, in order to be diagnosed as autistic, an individual must meet all markers of impairment of social interaction and communication, as well as at least 2 signs of repetitive behavior. Following these new guidelines, an individual who would have previously met the criteria for Asperger’s Syndrome would now be diagnosed under the autism spectrum disorder. Here is a link to the APA’s website on proposed revision for the DSM-V.
American Psychiatric Association. (1952). Diagnostic and statistic manual: Mental disorders. Washington, DC: American Psychiatric Association: Mental Hospital Service.
American Psychiatric Association. (1968). Diagnostic and statistic manual of mental disorders (2nd ed.). Washington, DC: Author.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association (2010). Proposed revision: APA DSM-V. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94.
Factor, D. C., Freeman, N. L., & Kardash, A. (1989). Brief report: A comparison of DSM-III and DSM-III-R criteria for autism. Journal of Autism and Developmental Disorders, 19(4), 637-640.
Grinker, R. R. Unstrange Minds. New York: Basic Books, 2007.
DSM photo retrieved from: http://parentalalienationhurts.com/wp-content/uploads/2010/02/dsm-grows.gif