I wrote several posts about diagnosis (Diagnosis and Mental Health, Diagnosis, the Beginning, Diagnosis (dx) Basics), trying to unravel some of the reasoning or at least the criteria used by doctors, psychologists and social workers to treat their patients appropriately, not to mention to be reimbursed appropriately by insurance companies.
One of my readers, Womanunadorned.Wordpress.com thought it would be interesting to trace the history of autism diagnosis in particular. I just came across some information relevant to that query, which I present below. Thank you Womanunadorned, for the suggestion! I hope I can do this subject justice.
What does the term ‘autism’ mean
Autism is a word derived from the Greek word autós (αὐτός), meaning self. The Swiss psychiatrist Eugen Bleuler coined the term in 1910 as he was defining symptoms of schizophrenia. In the late 1930s, Hans Asperger used the term to describe the condition of the children he was working with; in 1943, Leo Kanner applied the term ‘infantile autism’ to those children who exhibited an insistence on routine and an ‘aloneness’.
The 1940s through the late 1960s saw autism characterized as psychogenic in origin. This means that the scientist at that time did not see a biological origin for this condition. Enter, the refrigerator mother. Yes, the parents were blamed for the unfortunate condition of their children. Imagine the stigma associated with a diagnosis of autism at that time.
Refutation of psychogenesis
Dr. Isabelle Rapin, in the Introduction to The Neurobiology of Autism credits several lines of evidence which suggested a biological origin, in refutation of the psychogenic origin argument: “[O]bservation that a highly significant portion of autistic children developed epilepsy; the realization that children born of the 1964 rubella epidemic were at a disproportionately high risk for autism; and the demonstration that the parenting skills of parents of autistic children were equal to those parents of normal children and of children with other handicaps.”
To illustrate the state of autism awareness presently (2013), a further quote from Dr. Rapin is particularly apt. In 1994, she wrote the following: “The diagnosis of autism is the schizophrenia or cancer of the developmental disorders. It is a diagnosis to whisper, avoid altogether, or couch in less-damaging terms such as ‘not autistic but with autistic trait,’ Asperger syndrome, pervasive developmental disorder, atypical child, communication disorder with impaired pragmatics, and others. … There is no longer any rational reason to eschew this diagnosis, although it will take a major effort to convince professionals, the public, school systems, and insurance companies of this fact. [emphasis added]”
The ‘major effort’ is succeeding! Congratulations, everyone who is working so hard on this issue.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Roy Grinker published a listing of the definitions of autism in each version of the DSM. The article can be found here: http://www.unstrange.com/dsm1.html, and is summarized below:
In 1952, the American Psychiatric Association (APA) published the first DSM, DSM-I; autism was under the category, Schizophrenic reaction, childhood type.
DSM-II, in 1968 mentioned ‘autistic behavior’ in the childhood schizophrenia diagnosis.
The 1980 edition of DSM, DSM-III separated autism from the childhood schizophrenia diagnosis, using the term ‘infantile autism’ and added the term ‘pervasive developmental disorder’ (PDD). There were criteria addressing the age of onset.
In 1987, the revised third edition of DSM, DSM-III-R, the age of onset was removed, and replaced by ‘autistic disorder’. Autism was described in different terms. To be diagnosed as autistic, a certain number of criteria met. Individuals with a lesser number of criteria were diagnosed as “PDD not otherwise specified’ (PPDNOS).
The changes in criteria from DSM-III to DSM-IV (1994) and DSM-IV-TR (2000) would require much study. There are so many scientific papers on this subject, I only list a few examples: I will not be able to make any meaningful comparisons here.
DSM-5 will require even more study. The most prominent change is the folding of Asperger’s Syndrome into Autism Spectrum Disorder.
[Note –I have not delved into individual criteria as this requires quite a bit more space than this short post. I hope to look at the literature and find a way to summarize the salient points. Perhaps others have done so, and I can report on what they have done. If any of you are aware of resources for this effort, I would appreciate knowing them.]
 Bauman, M.L. Kemper, T.L. The Neurobiology of Autism. Johns Hopkins University Press 1997
 Ibid pg 2-3
 Sponheim E. Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC. J Autism Dev Disord. 1996 Oct;26(5):513-25.
 Pisula E. [Pervasive developmental disorders: controversies concerning the classification of autism]. [Article in Polish] Psychiatr Pol. 2000 May-Jun;34(3):447-55.
 Poirier N, Forget J. [Diagnostic criteria of autism and Asperger’s syndrome: similarities and differences]. [Article in French] Sante Ment Que. 1998 Spring;23(1):130-48.
 Waterhouse L, Morris R, Allen D, Dunn M, Fein D, Feinstein C, Rapin I, Wing L. Diagnosis and classification in autism. J Autism Dev Disord. 1996 Feb;26(1):59-86.
That’s. great summary – thank you! I remembered someone telling me that autism used to be connected up with schizophrenia and couldn’t quite believe it. Now I can see how that all fits together. It’s hard to believe all these different descriptions are of the same problem, isn’t it? I wonder how autism will be described in the DSM of 2052.
Hopefully there will be more precision by 2052 and there will be more tests to indicate physical causes in he brain for mental conditions.