For the first time in seventeen years, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (D.S.M.) is undergoing a significant revision. One of the mental conditions facing major emendations in its D.S.M. definition is autism. If the changes go through, a recent analysis suggests that the rate of official diagnosis for autism, and related disorders like Asperger syndrome, could plummet. And that, some people worry, could be bad news for those marginalized by the new diagnostic criteria.
The revision of the D.S.M. puts the APA in the unenviable position of having to draw what the New York Times calls "the line between unusual and abnormal" in relation to mental disorders; in the case of autism, the fact that symptoms are widely believed to manifest themselves along a "spectrum" of class and severity makes the situation even more difficult to navigate. According to the Times:
At least a million children and adults have a diagnosis of autism or a related disorder, like Asperger syndrome or "pervasive developmental disorder, not otherwise specified," also known as P.D.D.-N.O.S. People with Asperger's or P.D.D.-N.O.S. endure some of the same social struggles as those with autism but do not meet the definition for the full-blown version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder, eliminating Asperger syndrome and P.D.D.-N.O.S. from the manual. Under the current criteria, a person can qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under the proposed definition, the person would have to exhibit 3 deficits in social interaction and communication and at least 2 repetitive behaviors, a much narrower menu.
If the proposed changes come into effect, an analysis conducted by Yale researchers Fred Volkmar, Brian Reichow and James McPartland indicates they could have a dramatic impact on everything from diagnosis rates (some estimates indicate that autism diagnoses have mushroomed to one child in 100 in recent years), to the ability for many people — people who presently reside somewhere on the autism spectrum of disorders — to access health, educational and social services.
"Our fear is that we are going to take a big step backward," said Lori Shery, president of the Asperger Syndrome Education Network. "If clinicians say, ‘These kids don't fit the criteria for an autism spectrum diagnosis,' they are not going to get the supports and services they need, and they're going to experience failure."