The Autistic Brain: Thinking Across the Spectrum Read Free Page B

autistic
behaviors
—in other words, have a checklist of symptoms. And a checklist of symptoms that didn’t overlap with the other symptoms of schizophrenia suggested the possibility of a separate diagnosis: infantile autism, or Kanner’s syndrome.
    The
DSM-III,
published in 1980, listed infantile autism in a larger category called pervasive developmental disorders (PDD). To receive a diagnosis of infantile autism, a patient had to meet six criteria. One of the them was an absence of symptoms suggesting schizophrenia. The others were:
     
Onset before 30 months
Pervasive lack of responsiveness to other people
Gross deficits in language development
If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal
Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interests in or attachments to animate or inanimate objects
     
    But that description was hardly precise. In fact, it became something of a moving target, changing with each new edition of the
DSM
as the APA attempted to nail down precisely what autism was—a common enough trajectory in psychiatric diagnoses that depend on observations of behavior. In 1987, the revision to the
DSM-III,
the
DSM-III-R,
not only changed the name of the diagnosis (from infantile autism to autistic disorder) but expanded the number of diagnostic criteria from six to sixteen, divided them into three categories, and specified that a subject needed to exhibit at least eight symptoms total, with at least two coming from category A, one from category B, and one from category C. This Chinese-menu sensibility led to higher rates of diagnosis. A 1996 studycompared the
DSM-III
and
DSM-III-R
criteria as they applied to a sample of 194 preschoolers “with salient social impairment.” According to the
DSM-III,
51 percent of the children were autistic. According to the
DSM-III-R,
91 percent of
the same children
were autistic.
    The 1987 edition of the
DSM
also expanded an earlier diagnosis in the PDD category, atypical pervasive developmental disorder, into a catchall diagnosis that covered cases in which the symptoms of autism were milder or in which most but not all symptoms were present: pervasive developmental disorder not otherwise specified (PDD-NOS). The
DSM-IV,
which was published in 1994, further complicated the definition of autism by adding a new diagnosis altogether: Asperger syndrome.
    In 1981, the British psychiatrist and physician Lorna Winghad introduced to English-language audiences the work Austrian pediatrician Hans Asperger had done in 1943 and 1944. Even as Kanner was trying to define autism, Asperger was identifying a class of children who shared several distinct behaviors: “a lack of empathy, little ability to form friendships, one-sided conversations, intense absorption in a special interest, and clumsy movements.” He also noted that these children could talk endlessly about their favorite subjects; he dubbed them “little professors.” Asperger called the syndrome “autistic psychopathy,” but Wing felt that because of the unfortunate associations that had attached to the word
psychopathy
over the years, “the neutral term Asperger syndrome is to be preferred.”
    This addition to the
DSM
is important in two ways. The obvious one is that it gave Asperger’s formal recognition by the psychiatric authorities. But when taken together with the PDD-NOS and its autistic-symptoms-but-not-quite-autism diagnostic criteria, Asperger’s was also meaningful in how it changed the way we think about autism in general.
    The inclusion of autism in the
DSM-III
in 1980 was significant for formalizing autism as a diagnosis, while the creation of PDD-NOS in the
DSM-III-R
in 1987 and the inclusion of Asperger’s in the
DSM-IV
in 1994 were significant for reframing autism as a spectrum. Asperger syndrome wasn’t technically a form of autism, according to the
DSM-IV
; it was