Changing the labels: The DSM-V’s proposed revision

Okay, so a couple of posts ago, I tried to give an overview of how the 4th edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders (or the DSM) described the various diagnoses that fell under the category of the autistic spectrum.  The DSM provides guidelines for psychiatrists, pediatricians, and other medical professionals to use in diagnosing mental conditions.

Thankfully, it shouldn’t take me as long to tell about the way the 5th edition, planned for publication in 2013, defines the traits of autism.  Where before there were five different categories of “autistic spectrum disorders,” in the DSM-V, there will just be one:

Autism spectrum disorder

Must meet criteria 1, 2, and 3:

1. Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following:

a. Marked deficits in nonverbal and verbal communication used for social interaction.

b. Lack of social reciprocity.

c. Failure to develop and maintain peer relationships appropriate to developmental level.

2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by TWO of the following:

a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors.

b. Excessive adherence to routines and ritualized patterns of behavior.

c. Restricted, fixated interests.

3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).


It kind of looks like the criteria for autism, Asperger’s, Childhood Disintegrative Disorder, and PDD-NOS have all been rolled together into one more inclusive category.  The APA’s website has some interesting comments about why they have decided to make this change:

“…distinctions among [autism spectrum] disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder.”

Originally, autism and Asperger’s were discovered and described separately.  It seemed for a while that Asperger’s could be considered a “mild” or “high-functioning” version of autism, but the more we have learned about them both, the more difficult it has become to draw a clear line between the two.

The APA says that “previously, the criteria were equivalent to trying to ‘cleave meatloaf at the joints.'”  The new criteria reflect this.

1.  Communication skills

The one criterion that seemed to be used the most often to distinguish between Asperger’s and autism is whether a person’s development of language skills is delayed or impaired at an early age.  In many cases, autism can be detected when children are just 1 or 2 years old because they do not match an expected pattern of babbling, gesturing, or using words or phrases as they grow.

In other cases, children may fit the “schedule” for learning language skills perfectly or even be ahead of it, but once they are old enough to interact in conversations, something about their speech patterns seems stilted or overly formal, as if they know how to put all of the pieces together, but the whole sentence doesn’t fall into place as “naturally” as it seems to for other children.

The interesting thing to me is that the new criteria seem to be suggesting that these two cases are not as different as they appear.  In fact, they both have the same root:  difficulty with social communication skills.  There is a lot more to communication than the ability to speak in sentences at a certain age– human communication relies on a lot of nonverbal signals that we may not even be consciously aware of.  Maybe in some children, difficulty in this area makes it hard for them to get over the hurdle of understanding and using spoken language in the first place, while in others, it shows up when they try to put their knowledge of words to use?

And of course, every individual example is a little different.  I think it’s a mistake for a parent to assume that a diagnosis of autism or Asperger’s necessarily means that their child will never be able to [fill in the blank], just as it’s a mistake to expect any child to grow up exactly like another.

2.  Restricted, repetitive patterns of behavior, interests, and activities

A lot of things are incorporated into this one category.  In case you were wondering, “stereotyped” behaviors are repetitive behaviors, sometimes called “stims.”  Some autistic people rock in place or make sounds with their voices.  I have been known to do these, though I’m more likely just to bounce one leg up and down and whisper to myself.

This category also includes things like the specific “special interests” that can seem to border on obsessions but can also bring great joy to an autistic person and allow them to become very knowledgeable in a certain area.

I think this is also the first time that “unusual sensory behaviors” has been included as a criterion for autism or Asperger’s.  I’m glad they are including it, because I think sensitivity to sensory input may be a big reason for a lot of the other symptoms.

3.  Age when symptoms are present

The interesting thing here is that the criterion makes clear that it is possible for an autism spectrum disorder to go unnoticed for a long time “because of minimal social demands[,] and support from parents or caregivers in early years.”

That was the case for me.  I thought that my feelings of being disconnected were due to being shy and awkward, as a lot of kids are– and when I was down on myself, I would add “selfish and lazy” to the list.  It wasn’t until I was put into a situation that placed more demands on me– grad school– that I realized there was something more to my struggles.  I’ve encountered several stories like mine of people who were diagnosed with Asperger’s as an adult.

But at the same time, my Asperger’s traits have always been part of me, as long ago as I can remember.  I can see that  now, and it makes me look at my life in a different way.

God in his grace has given me an encouraging family and friends, and he has provided the strength I needed at every stage of my life to get through the things I faced.  I have often worried that I would disappoint God if I didn’t do something extraordinary with my life.  Could it be that he wanted to show himself by allowing me to do ordinary things?

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