The DSM-V and autism: Mary-Minn's Stim Page, 3-2012

The DSM-V and autism

In May 2013, the American Psychiatric Association will be publishing the DSM-V, an updated version of their Diagnostic Standard Manual (DSM). The DSM describes the criteria that medical professionals use to make a diagnosis. I think there exist additional criteria that are known to everybody else in the autism field––teachers, case managers, care providers, and autists themselves.

I have no formal education in psychology, let alone diagnostics. I embarked on this project only because I was alarmed by what I was reading in the media about the drastic impact the new DSM would have on autists and our community, especially when it comes to getting necessary services.

Fully armed with a mission to alert the autism community and to flout the psychiatric "experts" while I’m at it, I compared the DSM-IV TR (the previous DSM) with the proposed DSM-V, item by item. My findings were reassuringly anti-climactic—maybe just a tad disappointing for this former newspaper reporter, who knows all too well that bad news sells papers.

I read arguments on websites and blogs, and in magazines, trade journals and newspapers about the ramifications of the new DSM on the autism community. I read an opposing argument about the facile intention to write away the "autism epidemic", a creepy locution. Whose facile intention this was, the article did not specify, but my knee-jerk self attributed it to the APA.

I then read an argument by an APA author in favor of eliminating Aspergers, which was that it’s difficult to distinguish between an autist with early speech delays (such as myself) and someone who had no early speech delays. This made sense to me. It seems like an arbitrary distinction, once a person can talk.

When making comparisons, I need to physically check things off, so I printed out the DSM V for Autism, and the DSM-IV TR pages for Autism and for Aspergers. What upset me at first glance was that the physical length of the verbiage in Autism plus Aspergers in the DSM-IV added up to quite a bit more than Autism in the DSM-V, which pointed toward a collapsing of the criteria. Furthermore, diagnosis by the DSM-V required meeting more criteria, hence it appeared to be more restrictive.
Upon reading the criteria more closely, though, I noticed that they were more concretely described and less vague, and that each criterion included more traits, including some that hadn’t even been mentioned in the earlier DSM-IV TR. So the inclusiveness of each criterion made up for the requirement that the patient meet a greater number of the criteria. This spectrum approach brought Aspergers back into the fold.

The DSM-IV TR read more as though it was describing children than adults; whereas, the DSM-V sounded more age-inclusive. The more technical and ever so slightly more archaic style of the earlier DSM had a more sepulchral ring to it, at least to my ears.

What struck me most was that only the DSM-V included sensory processing difficulties, something that is common knowledge in the autism community.

I was also surprised to see no mention of coordination difficulties in either version. Nor did they include difficulties with executive function, which, in my opinion, is the root cause of most of the other difficulties, such as sorting out and tolerating distracting stimuli, self-regulating, tolerating interruptions, making transitions, taking turns, recognizing faces and multi-tasking.

I was pleased to see no mention in either version of the lack of imagination, sense of humor or empathy that I’ve read about in so many other places.

Since the DSM was written with the intention of helping people get treatment for problems ailing them, I was not surprised to find no mention of the positive attributes, such as the Aspergian single-minded focus and prodigious memory for interesting facts, the facility in classifying objects and concepts, the logic-based thinking and inductive reasoning style, the extreme empathy for non-human creatures or people in another age group, the photographic visual memory. No one autist possesses all these gifts but they are a part of our autistic makeup.

Perhaps these super-skills illustrate different types of autism; perhaps, though, these differences have more to do with individual temperament than subtypes of anything. Autism is a mixed bag, coming with deficits and challenges, behavioral traits, and strengths. There are more variations, though, than with other developmental "disorders" in the DSM, leading me to believe that autism is more complex and difficult to define. Describing autism is more like describing a culture than a geographical location.

Mary-Minn Sirag