With professionals around the world debating how autism spectrum disorders will be listed in the DSM-V, now is a good time to look back at the history of autism in the DSM, starting with the DSM-I and ending with the DSM-IV.
The Diagnostics and Statistics Manual of Mental Disorders (DSM) is the standard by which autism spectrum disorders are diagnosed in the United States. Autism was not included as a separate diagnostic condition in the original release of the DSM in 1952. As of the most recent release of the DSM, the DSM-IV, there are five types of autism spectrum disorders specifically identified. The journey of autism in the DSM is useful in understanding the increased diagnostic rates of today.
The DSM-I was originally released in 1952. Although autism was recognized as a unique condition as early as 1943, it was not included in the DSM. Instead, children who exhibited autistic-like symptoms were diagnosed under the schizophrenic reaction, childhood type label.
The second release of the Diagnostics and Statistics Manual of Mental Disorders came in 1968. As with the first release, autism was not included as a separate diagnostic category. In Roy Richard Grinker’s book, Unstrange Minds, the DSM-II included the following language: “the condition may be manifested by autistic, atypical and withdrawn behavior.” Children exhibiting these behaviors were diagnosed as schizophrenic, childhood type.
In 1980, the DSM-III was released and we finally see the inclusion of autism as a separate diagnostic category. At this point, there was only one autism designation and it was entitled infantile autism. There were only six characteristics listed and each of these six symptoms must be present in order for an individual to be diagnosed with infantile autism. Due to some controversy surrounding the descriptor infantile, this category was changed to autistic disorder in 1987.
The most recent complete release of the DSM, the DSM-IV, occurred in 1994. At this point, the category of pervasive developmental disorders and several subtypes were added. In addition to autistic disorder, a diagnosis could be made under the categories of Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).
Besides the inclusion of four new subtypes, drastic changes were made to the criteria that needed to be met in order to receive a diagnosis of autistic disorder. The current release of the DSM has a list of 16 different symptoms used to describe autistic disorder and a patient only needs to exhibit six of the 16 to receive the diagnosis. This is in stark contrast to the language used in the 1980 release of the DSM-III.
The DSM-V is currently in the works and there are large groups of individuals working on changing the language used to describe the various pervasive developmental disorders. Autism has evolved through the four releases of the DSM and it is only natural to expect that it will be refined even further in the DSM-V.
This article first appeared on Suite101.com in January 2008: History of Autism in the DSM: Diagnostic Criteria for Autism Spectrum Disorders.