As parents, it is essential to understand the diagnosis of autism and how it has evolved over the years, from the first diagnosis of autism up to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this article, we will discuss the diagnosis of autism. We’ll look at the various criteria used to diagnose autism, the multiple treatments available, and what parents can do to help their children.
The history of the diagnosis of autism
Autism was first described in the 1940s by Austrian psychiatrist Leo Kanner, who observed a group of children with difficulties in social interaction, communication, and imaginative play. Kanner called this condition “autism,” from the Greek word “autos,” meaning “self.”
Since Kanner’s initial description, the diagnostic criteria for autism have evolved significantly. In 1980, the American Psychiatric Association (APA) published the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which included a category called “Autistic Disorder.” The DSM-III criteria for autistic disorder required the presence of social and communication deficits, as well as the presence of unusual behaviors or interests.
In 1987, the APA published the revised third edition of the DSM (DSM-III-R), which expanded the criteria for the autistic disorder to include a broader range of social and communication deficits. The DSM-III-R also introduced the concept of “Asperger’s Disorder,” named after Austrian pediatrician Hans Asperger, who had described a similar condition in the 1940s. Deficits in social interaction and communication characterized Asperger’s Disorder, but with typical language development and cognitive abilities.
In 1994, the APA published the fourth edition of the DSM (DSM-IV), which retained the categories of Autistic Disorder and Asperger’s Disorder, but added two more related disorders: Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) and Rett’s Disorder. PDD-NOS was used to describe individuals with some, but not all, of the characteristics of autistic disorder or Asperger’s disorder. Rett’s Disorder was a rare genetic disorder that caused severe impairments in social interaction and communication, as well as repetitive hand movements and loss of purposeful use of the hands.
The evolution of the diagnostic criteria
The diagnostic criteria for autism have evolved significantly over time, with the DSM-III, DSM-IV, and DSM-5 all making significant changes to the criteria for diagnosing autism. The changes to the diagnostic criteria have been driven by a combination of scientific research and clinical experience, as well as a desire to improve the accuracy and reliability of the diagnosis.
The DSM-III and DSM-III-R criteria
The DSM-III, published in 1980, was the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to include a specific category for autism. The DSM-III criteria for diagnosing autism included abnormal social interaction, communication problems, and repetitive behaviors or interests. The DSM-III-R, published in 1987, revised the criteria for diagnosing autism to include a broader range of symptoms and to allow for the diagnosis of autism in individuals who had previously been diagnosed with childhood schizophrenia.
The DSM-IV and DSM-IV-TR criteria
The DSM-IV, published in 1994, further refined the criteria for diagnosing autism. The DSM-IV criteria for autism included qualitative impairments in social interaction, communication, and repetitive behaviors or interests, as well as the requirement that symptoms be present in the early developmental period. The DSM-IV-TR, published in 2000, made minor changes to the DSM-IV criteria for autism.
The DSM-5 criteria for diagnosing autism
The DSM-5, published in 2013, significantly changed the criteria for diagnosing autism. The DSM-5 combined the previous DSM categories of autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) into a single category called “autism spectrum disorder.” The DSM-5 criteria for autism spectrum disorder include deficits in social communication and social interaction, as well as the presence of repetitive behaviors or interests. The DSM-5 also includes a severity rating scale for autism spectrum disorder based on the level of support an individual needs to function daily.
The DSM-5 and ICD-11
The DSM-5 represents a shift from the multi-categorical approach of the DSM-IV to a single diagnosis based on multiple dimensions due to the lack of evidence for the existence of subcategories within ASD and the poor diagnostic reliability and predictive power of these subcategories. The ICD-11 also uses ASD as an umbrella term but retains a multi-categorical system to differentiate individuals with varying levels of history and intellectual and language abilities. Both systems use principles rather than specific examples to define symptom subdomains and provide specifiers for co-occurring medical and psychiatric conditions. Despite the shifts towards more dimensional approaches, there are still limitations in the validity and reliability of both systems, particularly in terms of their ability to capture individual differences within ASD.
The current state of the diagnosis of autism
The diagnosis of autism is currently based on the DSM-5 criteria for autism spectrum disorder. The DSM-5 criteria for autism spectrum disorder are widely accepted and used by clinicians worldwide. However, there is ongoing debate and research into the diagnosis of autism, including the validity and reliability of the DSM-5 criteria and the possibility of alternative methods of diagnosis. Some researchers have suggested that the DSM-5 may be too narrow and exclude some individuals with autism-like symptoms but do not meet the full criteria for autism spectrum disorder. There is also ongoing research into biomarkers, such as brain imaging or genetic testing, to diagnose autism more accurately and objectively.
Challenges and Controversies in Autism Diagnosis
One of the main challenges in diagnosing autism is the lack of objective tests or biomarkers. Currently, autism is diagnosed based on a combination of clinical observation and parental reports, which can lead to variability in diagnosis. In addition, the DSM-5 criteria for ASD are based on behavioral observations, which can be affected by various factors such as cultural differences, language barriers, or co-occurring conditions.
There has also been controversy surrounding the potential for cultural and gender bias in diagnosing ASD. Some studies have suggested that autism is underdiagnosed in girls and women, who may present differently than boys and men. For example, girls with autism may be more likely to use compensatory strategies to hide their social difficulties, leading to a delay in diagnosis. Similarly, cultural differences in communication and social norms may affect how autism is diagnosed in individuals from different cultural backgrounds.
Another challenge in diagnosing autism is the wide range of severity and symptom presentation within the ASD population. Some individuals with ASD may have only mild impairments and be able to live independently, while others may have severe impairments and require significant support. This can make it challenging to identify a “cut-off” point for diagnosis and may lead to over- or under-diagnosis in some cases.
Overall, the diagnosis of autism has come a long way since Leo Kanner first described it in 1943. The DSM-5 criteria for autism spectrum disorder are widely accepted and used by clinicians worldwide. Still, there is ongoing research and debate into the validity and reliability of these criteria and the possibility of alternative methods of diagnosis. Despite the challenges and limitations of the current diagnostic process, identifying and diagnosing autism is essential in accessing support and services for individuals with autism and their families.
Rosen, N. E., Lord, C., & Volkmar, F. R. (2021, December). The diagnosis of autism: From kanner to DSM-III to DSM-5 and beyond. Journal of autism and developmental disorders. Retrieved January 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531066/#Sec10title
Evans, B. (2013, July). How autism became autism: The radical transformation of a central concept of child development in Britain. History of the human sciences. Retrieved January 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757918/#:~:text=The%20concept%20of%20autism%20was,concept%20he%20had%20also%20created.