If you've never actually looked into the diagnostic history of autism, it's worth your time to compare and contrast today's "autism spectrum disorder" with earlier diagnostic labels and symptoms. I just came across a nicely-packaged collection of prior descriptions of "autism" as presented in earlier versions of the Diagnostic Manual versions I, II, III and III-R, available at Roy Grinker's "Unstrange Minds" blog. It makes intriguing reading!
For example, autism (not ASD as we know it today) was lumped in with childhood schizophrenia until the 1980 DSM III, and was then listed as "infantile autism" with these descriptive criteria:
DSM III (1980)
Diagnostic criteria for Infantile Autism
A. Onset before 30 months of age
B. Pervasive lack of responsiveness to other people (autism)
C. Gross deficits in language development
D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal.
E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects.
F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia.
Even more interesting (to me!) are the criteria for PDD-NOS, which was first described in the 1980 DSM III. Based on these criteria, my son would come nowhere NEAR PDD-NOS - his present diagnosis!
Diagnostic Criteria for Childhood Onset Pervasive Developmental Disorder
A. Gross and sustained impairment in social relationships, e.g., lack of appropriate affective responsivity, Inappropriate clinging, asociality, lack of empathy.
B. At least three of the following:
1. sudden excessive anxiety manifested by such symptoms as free-floating anxiety, catastrophic reactions to everyday occurrences, inability to be consoled when upset, unexplained panic attacks,
2. constricted or inappropriate affect, including lack of appropriate fear reactions, unexplained rage reactions, end extreme mood lability,
3. resistance to change in the environment, e.g., upset if dinner time is changed, or insistence on doing things in the same manner every time, e.g., putting on clothes always in the same order,
4. oddities of motor movement, such as peculiar posturing, peculiar hand or finger movements, or walking on tiptoe,
5. abnormalities of speech, such as question-like melody, monotonous voice,
6. hyper or hypo-sensitivity to sensory stimuli. e.g., byperacusis,
7. self-mutilation, e.g., biting or hitting self, head banging.
C. Onset of the full syndrome after 30 months of age and before 12 years of age.
Absence of delusions, hallucinations, incoherence, or marked loosening of associations.
Exploring these past and future diagnostic criteria has really opened my mind to how idiosyncratic such distinctions really are! It reminds me forcibly of the classification activities often undertaken in elementary school classrooms. Kids are broken into groups and given identical collections of 100 buttons, and asked to organize them into groups. Naturally, each group takes a different approach: some organize by color, some by size, some by number of holes, some by shape, and so forth. Which organizational approach is correct? The answer, of course, is "there is no right answer."
Where would you or your child have fit under past diagnostic criteria? How helpful is the present DSM-IV? And... how do you feel about the idea that such diagnostic categories are changed and changed again over the course of any individual lifetime?