Diagnosing Autism, Part 3: Growing Pains
This is going to make a whole lot more sense if you read Part 1 and Part 2.
In thinking about the evolution of the diagnosis of autism, it's instructional to look at another group of people whose traits have been similarly pathologized: the LGBTQ+ community.
Like autistic people, the various versions of non-heterosexuality have taken their turn through the DSM and its many revisions. And the description of these traits has undergone a similar evolution.
Both autism and non-heterosexuality began their psychiatric diagnostic journey as an "abnormal" expression of humanity, the specific characteristics of which were described as aberrations in relating to other "normal" humans. The focus of the language of diagnosis was on how uncomfortable these individuals made those around them.
But what happened next is interesting. While autism has essentially stalled out in its progression of understanding, psychiatric professionals eventually realized that homosexuality might be a normal variation of humanity in some people. For a while there, we hung on to the notion that those who did not desire to be homosexual should be "cured," but eventually we created clinical separation between a person's sexual traits and their co-occurring mental health conditions.
What's Next For Autism?
As I see it, there are two distinct groups of autistic advocates. One group would prefer to expand the diagnosis of autism so that more variations of autistic people would be eligible for diagnosis. The other would eliminate the diagnosis entirely, embracing autism as a normal human variation. And I think there's utility in both perspectives. While I believe that defining autism as a disorder does a great disservice to all autistic people, I also recognize that the diagnosis serves us in that it allows for access to services and supports that would not otherwise be funded. So how do we resolve this?
Truly, it's not entirely up to us. The medical community was slow to accept the reasoning of the LGBTQ+ community and I don't see it becoming more adept at adopting new social paradigms anytime soon. I think it's most likely that the diagnostic evolution of autism will follow the path of homosexuality in the medical community, and will eventually be considered a normal variation of humanity. So, we should expect an awkward phase of "curing" those who want to be normal while accepting those who are happy to be who they are. It's not ideal, but it is a painfully small step in the right direction. And it might be the best we can do for a while.
But if the diagnosis of autism leaves the DSM, how do we maintain access to necessary support services for autistic people? It's an unpleasant question because it assumes that external gatekeepers will always be present, limiting access to only those who are deemed worthy. But it's the real world, and I don't see the gatekeeper function being eliminated from our system in the near future. Until then, I think the wisest course of action is for medical providers to begin to view autism as a neurotype with many co-occurring conditions, and to start considering therapies and support services based on those conditions rather than for autism itself.
American Psychological Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.)
American Psychiatric Association. (1973). Homosexuality and sexuality orientation disturbance: Proposed change in DSM-II, 6th printing, page 44. APA Document Reference No. 730008. https://pages.uoregon.edu/eherman/teaching/texts/DSM-II_Homosexuality_Revision.pdf
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.).
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.