Part 1 - Introduction

Part 1 – Introduction

1 settembre 2020

The Autism Spectrum in the DSM-V:

The diagnostic criteria for Autism Spectrum Disorder often seems vague – Many autistic people, including myself, have had the experience of reading it for the first time and immediately going “no, that's not me”. The autism spectrum is so broad, that any list of criteria will either exclude some people or be so vague that at first glance, we don't really know what to do with it.

So I want to do my best at giving examples to explain what the different parts of the criteria actually mean. In a multiple-part series, I will take different quotes from the DSM and give you examples of the traits described in them. The examples are based partly on scientific papers about autism, but mainly on the experiences of autistic people who have contributed to the list

Issues:

The DSM-V criteria is written based on what autism looks like to an outside observer. That's probably one of the main reasons we don't relate to it. It also means that the categories don't always make sense from an autistic person's perspective. For example, category B1 mostly covers self-stimulating behavior (stimming), but also some forms of communication. This is because they can look similar to an outside observer
Also, the DSM-V is written for professionals who are qualified to diagnose the conditions classified in it. It is not directed at us, nor does it have an interest in us understanding it. However, I think that, as autistic people, we have a right to understand how our minds are described.

For reference, here is the full DSM-V diagnostic criteria for Autism Spectrum Disorder. Note that the chapter does not only include this criteria, but also other sections such as specifiers, prevalence, differential diagnosis, and others.

“A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. [...] B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circum scribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse re sponse to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity: Severity is based on social communication impairments and restricted, re petitive patterns of behavior (see Table 2). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other im portant areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual devel opmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that ex pected for general developmental level.”

This is going to be a list of experiences by autistic people as they relate to the DSM-V diagnostic criteria. I have been working on the list for a few weeks now and will publish them over time.

Continue to: Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors