Defining Autism

Last Thursday, major media outlets, including ABC News and The New York Times, [Click here for the article.] reported important news regarding potential changes to the diagnosis of autism. These changes come not in the form of better testing and evaluation methods, but rather in the revisions the American Psychiatric Association is currently proposing regarding the definition of autism. Since 1994, the Diagnostic and Statistical Manual of Mental Disorders-IV (along with text revisions in 2000) has been the primary reference used to diagnose autism. Since that time, the incidence of the diagnosis of autism has quadrupled, according to many statistics. One of the reasons given for the rapid increase in autism has been “better diagnosis,” instead of an actual increase in cases of autism. [However, I disagree with that theory.] As psychiatrists work together to develop the Diagnostic and Statistical Manual of Mental Disorders-5, scheduled to go into effect in 2013, they have been re-evaluating the definition of autism, trying to make diagnosing autism easier. However, some experts have asserted that these changes will greatly reduce the number of children diagnosed with autism. The Child Study Center at Yale University School of Medicine found that half of the patients diagnosed with autism under the DSM-IV criteria would not be classified as having autism under the DSM-5 criteria. For many parents, this news brings worries that their children may not be eligible for special education, treatment, services, and insurance coverage for therapies. In response to these changes, Dr. David J. Kupfer, psychiatry professor at University of Pittsburgh and chair of the task force making these revisions, commented, “We have to make sure not everybody who is a little odd gets a diagnosis of autism or Asperger disorder.”

When Alex was diagnosed in early 1996 with autism under the DSM-IV, I remember thinking that the criteria sounded like a Chinese restaurant take-out menu: Choose one from column A, two from column B, etc. In reviewing the definition of autism in the text of DSM-IV, it actually reads as follows: “A total of six (or more) from (1), (2), and (3) with at least two from (1) and one each from (2) and (3).” To briefly summarize these three decisive points, (1) deals with social interaction impairments, citing four areas; (2) concerns communication issues, also citing four areas; and (3) refers to repetitive behaviors, again citing four areas. [To read the specific examples, click here and then click on the DSM-IV tab.] In addition, the onset of these symptoms must be by age three, and the symptoms cannot be attributed to Rett’s Syndrome or Childhood Disintegrative Disorder. In contrast, the DSM-5 definition of autism is more restrictive, stating, “Must meet criteria A, B, C, and D.” To summarize, criterion A involves deficits in social communication, and the patient must have deficits in “all three of the following,” namely “social-emotional reciprocity,” “nonverbal communication,” and “developing and maintaining relationships.” Criterion B deals with repetitive patterns of behavior and interests, exhibiting “at least two of the following four”: speech, routines, interests, and sensory issues. [To read the specific details, click here.] In addition, criterion C states that the “symptoms must be present in early childhood.” Perhaps the most intriguing as well as subjective part of the definition, criterion D states: “Symptoms together limit and impair everyday functioning.” In comparing and contrasting both definitions, essentially autism affects communication, social interaction, and behavior, especially in terms of repetitive actions.

What each DSM definition fails to do, however, is to address any potential causes. In the nineteen years between DSM-IV and DSM-5, no one has figured out what causes autism, nor does the field of psychiatry have much to offer in terms of treatment. Although I am not a doctor, let alone a psychiatrist, my more than fifteen years of autism research and first-hand experience of parenting a child with autism leads me to believe that autism doesn’t even belong in the Diagnostic and Statistical Manual of Mental Disorders. With the various biomedical testing and interventions we have done with Alex, we have found him to have allergies, yeast overgrowth, nutritional deficiencies, and accumulations of toxic metals—all conditions that have responded to treatment. While I don’t have absolute proof, my mother’s instinct and common sense convince me that Alex has metabolic issues that are medical in nature, instead of being a “mental disorder.” Certainly, these issues have affected how his brain works, but I think that he, like many children currently being diagnosed as having autism, is a physically, rather than mentally, ill person. Until more in the medical community recognize the truth that these children have physical symptoms that affect their behavior, the DSM-IV and its successor the DSM-5 will not significantly help these children get better. Instead of trying to describe what autism is and is not, a much better use of resources would be to figure out why these children are ill and what can be done to cure them so that when the time comes to write the DSM-6, autism will no longer need to be part of that influential reference textbook.

“But ask those who have been around, and they will tell you the truth.” Job 21:29