Redefining Illness – Wholly Misleading Half Truth

This looks awful, doesn’t it? Yes, except that “Autism” has different meanings early in the period vs. late in the period. Lets look at the definitions (stolen shamelessly from here).

Criterion DSM-III (1980) DSM-5 (now)
Onset Onset before 30 months of age Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies later in life).
Responsiveness Pervasive lack of responsiveness to other people Deficits in social-emotional reciprocity must be present (or have been present earlier in development). However, these can range from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction
Language development Gross deficits in language development.

If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal

ASD can be diagnosed with or without accompanying language impairment

“Peculiar speech patterns” are not required for a diagnosis. However, echolalia and idiosyncratic phrases are considered examples of Stereotyped or repetitive movements, use of objects, or speech – one of four nonsocial features (see E below)

Behavioral issues Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects. Any two of the following must be present (currently or earlier in development): (1) Stereotyped use of objects; (2) Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour; (3) Highly restricted, fixated interests that are abnormal in intensity or focus; (4) Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
Delusions (lack thereof) Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia. Hallucinations and delusions, which are defining features of schizophrenia, are not features of ASD

The lack of delusions criterion is very similar in both definitions. But all the other criteria are a lot looser in DSM-5. This is like saying that there’s an infant mortality epidemic because more kids are dying now prior to puberty than died in the 1950s prior to reaching one year of age.

h/t Andrea Doucette


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