Autism, as a psychiatric disorder, is defined by the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), published by the American Psychiatric Association (A.P.A.), which covers all mental health disorders for both children and adults. That definition matters — an official diagnosis of autism is what opens up access to services and treatment to many affected individuals, both children and adults.
But The Times’s Benedict Carey reports that as it prepares for a new edition of the D.S.M., the A.P.A. is revisiting the question of what it means to be officially diagnosed as “autistic.” A proposed change in that definition would eliminate Asperger’s syndrome and “pervasive developmental disorder not otherwise specified” from the diagnosis, and in the process remove up to a million people, statistically, from the numbers of those diagnosed with autism. One expert suggested that the narrower definition would “nip [the autism epidemic] in the bud” — without, of course, changing the daily lives of those disabled by their symptoms one bit.
Some experts, including Dr. Allen Frances, who co-authored the last edition of the D.S.M., have long suggested that the broadened definitions of autism, attention-deficit hyperactivity disorder, and bipolar disorder included in that edition were mistakes with “terrible consequences.” Gary Greenberg, writing for Wired in 2010, suggested that Dr. Frances “thinks his manual inadvertently facilitated these epidemics — and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.” Dr. Frances’s assessment may be valid. But it’s hard to get around the fact that a changed diagnosis is going to change lives, and probably not for the better.
James C. McPartland, an assistant professor in the Child Study Center at Yale University, is one of the authors of the new analysis, and he has agreed to answer some questions from readers about how it was done and what it indicates on the Consults blog (today only). So take your questions to Consults, but we can discuss further here — what will this mean for newly undiagnosed kids?
If your life or your child’s may change if autism is redefined, how are you getting your family ready? Do you have any advice (particularly if you raised a child on the autism spectrum before services were relatively readily available) for families who face these changes?