A Brief History of the DSM and Autism

Autism Lexicon [Measures] - DSM

A Brief History of the DSM and Autism 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a critical tool used by mental health professionals worldwide to diagnose and classify mental disorders.

The Modern Era: DSM-5

• DSM-5 (2013): The most recent edition introduced significant changes to the diagnosis of autism. Key updates include:

• Autism Spectrum Disorder (ASD): The DSM-5 combined the previously separate diagnoses of Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder, and PDD-NOS into a single diagnosis: Autism Spectrum Disorder (ASD). This change reflects the understanding that these conditions are part of a single continuum with varying degrees of severity.

• Two Domains: The DSM-5 criteria for ASD are based on two domains instead of three. These are:

• Social Communication and Interaction: Persistent deficits in social communication and social interaction across multiple contexts.

• Restricted, Repetitive Patterns of Behavior, Interests, or Activities: This includes repetitive movements, insistence on sameness, highly restricted interests, and hyper- or hypo-reactivity to sensory input.

• Severity Levels: The DSM-5 includes severity levels to indicate the level of support needed: Level 1 (requiring support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support).

• Specifiers and Comorbidities: The DSM-5 allows for specifiers to provide additional detail about the presentation of ASD, such as the presence of intellectual or language impairments, and acknowledges common comorbidities like anxiety, depression, and ADHD.

Refining the Diagnosis: DSM-IV and DSM-IV-TR

• DSM-IV (1994): This edition further refined the classification of autism under Pervasive Developmental Disorders, which included Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). This allowed for greater differentiation among various forms of autism.

• DSM-IV-TR (2000): The text revision did not significantly change the criteria but provided updated information and clarified diagnostic guidelines.

The Emergence of Autism: DSM-III and DSM-III-R

• DSM-III (1980): This edition marked a significant shift by introducing "Infantile Autism" as a distinct category under Pervasive Developmental Disorders (PDD). This was the first time autism was recognized as separate from schizophrenia.

• DSM-III-R (1987): The revised edition expanded the criteria and changed the term to "Autistic Disorder," providing more specific diagnostic criteria and acknowledging a broader range of symptoms.

The Early Years: DSM-I and DSM-II

• DSM-I (1952): The first edition of the DSM did not include autism. At the time, autism was not widely recognized as a distinct condition.

• DSM-II (1968): The second edition included a diagnosis of "schizophrenic reaction, childhood type," reflecting the early belief that autism was related to childhood schizophrenia.