Autism Spectrum Disorder (ASD), as its name states, consists of a spectrum. That means it can vary widely from one individual to another. In our previous article titled “The Diagnostic Criteria and The 3 Levels of Autism”, we shared information on the diagnosis of ASD according to the Diagnostic Statistical Manual 5 (DSM-V). The definition and diagnosis of ASD has evolved according to research done over the years. As someone who works closely with individuals with autism, it was interesting to see how the diagnosis of autism has evolved over the years. This article serves to provide a brief history of autism - how people viewed it and how the diagnosis has changed.
ASD is recognised as a developmental disorder. But did you know that autism was first defined as a psychiatric condition as a form of childhood schizophrenia in the DSM-II (published in 1968)? An Austrian-American psychiatrist and physician, Leo Kanner described autism as an emotional disturbance that does not affect cognition levels (Zeldovich, 2018). His perspective then shaped the second edition of DSM.
Between 1950 and 1960, the concept of “Refrigerator Mothers” was coined, describing mothers who were cold, distant, and rejecting as being the root cause of autism. Mothers of children with autism then suffered as they were needlessly blamed for causing their child to become autistic. Thankfully, this concept was disproved in the 1960s to 1970s, as research showed that autism has biological underpinnings. As such, autism was established as its own separate diagnosis, distinct from schizophrenia in the DSM-III (published in 1980). Additionally, specific criteria for a diagnosis was listed, listing three essential features: (1) A lack of interest in people, (2) severe impairments in communication, and (3) bizarre responses to the environment.
DSM-IV (released in 1994) was the first to introduce autism as a spectrum. DSM-V (published in 2013) then combined the 4 independent diagnoses in DSM-IV, namely Autistic disorder, Asperger Syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS) and childhood disintegrative disorder, into a single label of ASD. The reason for this step was that these conditions have similar essential symptoms but vary in the level of severity. Hence, ASD became a single umbrella label, a single disorder on a wide spectrum. Additionally, a diagnosis of social communication disorder was included for children who only meet one criteria of language and social impairment.
The DSM is not a constant and will evolve as more research is being done. Diagnoses are important as they can shape society’s view and more importantly, help in identifying appropriate interventions and strategies to support individuals with ASD. However, a ‘fact’ can later be disproved to be a myth as more research is done, as seen in the case of the concept “Refrigerator Mother”.
To date, there is still much to explore, discover and learn about ASD. I personally find the DSM a useful tool to help in the identification of symptoms - individuals present different symptoms and at varying levels and severity. We must take precaution that these labels (ASD, ADHD, etc.) do not define them. Yes, they are different but simply in their ability to see and interpret the world differently. And this difference does not signify that they are lesser than any of us.
Written by Winnie
Refrigerator mothers – a discredited cause of autism. (n.d.). Retrieved from http://www.autism-help.org/points-refrigerator-mothers.htm
Wright, J. (2013). DSM-5 redefines autism. Retrieved from https://www.spectrumnews.org/opinion/dsm-5-redefines-autism/
Zeldovich, L. (2018). The evolution of ‘autism’ as a diagnosis, explained. Retrieved from https://www.spectrumnews.org/news/evolution-autism-diagnosis-explained/
Herman, E. (2019). The autism history project. Retrieved from https://blogs.uoregon.edu/autismhistoryproject/topics/autism-in-the-dsm/