In 1975, 1 in 5,000 children were diagnosed with autism. By 2013, that number has risen to 1 in 55 children identified and diagnosed with autism spectrum. Some believe that these staggering numbers represent a rise in children born with autism, while others believe better research and understanding of this developmental disorder has led to a higher incidence in identifying children on the spectrum. The one thing that is for certain is the diagnostic criteria has changed drastically over the years improving doctor’s ability to more accurately identify Autism in the population—and the criteria is changing again.
Changes in the DSM eliminates PDD-NOS and Asperger’s Syndrome
The previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-IV published by the American Psychiatric Association (APA), was implemented in 1994 and included Autistic Disorder or “classic Autism”, Pervasive Development Disorder—Otherwise Non-Specified (PDD-NOS), and Asperger’s Syndrome all as part of the Autism spectrum. The new version, DSM-V, implemented in May of 2013, eliminated the terms PDD-NOS and Asperger’s Syndrome. These two diagnoses are now included in the umbrella diagnosis, Autism Spectrum Disorder (ASD). Under the new criteria to be diagnosed with Autism Spectrum Disorder you must meet the requirements listed in all of the following categories.
Deficits in Social Communication and Social Interaction
In order for an individual to be diagnosed (under the new criteria) with Autism Spectrum Disorder (ASD), they must display persistent deficits in social communication and social interaction manifested by all three of the following:1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to a total lack of initiation of social interaction.2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated-verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and the use of nonverbal communication, to total lack of facial expression or gestures.3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends, to an apparent absence of interest in people.
Restricted, Repetitive Patterns of Behaviors or Interests
Individuals must display restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:1. Stereotyped or repetitive speech, motor movements, or use of objects (such as simple motor stereotypes—hand flapping, foot tapping, rocking, echolalia (the automatic repetition of vocalizations made by another person), repetitive use of objects—spinning wheels, repetitively flicking light switches, or idiosyncratic phrases, which are considered “stimming” behaviors.2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).3. Highly restricted, fixated interests that are abnormal in intensity or focus (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). (Maybe you should put in here, sensitivities to sounds not heard by NT’s such as filaments humming in light bulbs etc.)
Additional ASD Diagnostic Criteria
In addition to meeting all of the above requirements, autism symptoms must have been present in early childhood (but may not become fully manifest until social demands exceed limited capacities), AND symptoms together must limit and impair everyday functioning.
Under the new diagnostic criteria listed in the DSM-V, all children and adults with current autism diagnosis (autistic disorder, PDD-NOS, or Asperger’s Syndrome) will now be labeled with one umbrella diagnosis—Autism Spectrum Disorder. The changes in the diagnostic criteria for autism spectrum disorders are the largest overall change from the DSM-IV to be implemented.