Cited: CNN

The number of cases of people diagnosed with autism, and the percentage of children born with autistic disorders seems to increase every year and now reaching alarming high numbers.  However, defining autism, and who has autism, or displays symptoms of this disorder is not as clear as some might believe. Recognizing the need to re-define autism, the American Psychiatric Association, is updating what it defines as autistic disorders in it’s handbook called the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of the psychiatric field.

The changes are being prompted by greater understanding of autism gained in the recent past given the increasing number of children seemingly born with autism as well as practical considerations having more to do with the business of psychiatric care than the treatment of this disorder. The DSM is the handbook when it comes to deciding what is and what is not a psychiatric disorder and further, who qualifies for insurance coverage for the treatment of these illnesses. Therefore, having a working definition for an illness that has become so pervasive is of the utmost importance.

Autism is a complicated illness, and one for which the medical community still is hard pressed to say what the causes of the disease are. Especially vexing about autism is that people suffering from this brain disorder display various levels of mental prowess and capacity for complicated thought and computation. The stories about autistic people that have incredible recall ability for things such as historical dates, exact recall, and complex math problems are commonplace. On the other hand, the more common experience for families that have loved one suffering from autism is their detachment from their surroundings and their obsession with repetitive actions and body movements, and their shunning of physical contact.

With such a wide chasm of behaviors displayed by those with severe autism versus those that seem to be able to function, and some at very high levels, the psychiatric community is in the process of making sure that everyone agrees on the definition of this extremely perplexing mental disorder. However, when it comes to mental disorders, coming up with an exact definition is not as easy as it might appear on the surface.  Medical professionals will tell you that at its very core the problem with defining any mental illness is in finding where to draw the line between normal behavior and the fringe of mental illness.  Specifically as to how this relates to autism, the spectrum of symptoms ranges from the child that seems to be somewhat introverted, an outsider from his peers to those with severe symptoms that are obvious to everyone. Where does the medical professional draw the line to say that the “offbeat” child is simply and offbeat, or that he or she has symptoms of autism?

The problem in defining autism becomes even more complex when you consider that far more people have mild forms of autism than severe, so being careful to diagnose their behaviors correctly is critical in their care, treatment, and of course medical coverage for these services.

One of the main things that the new definitions in the DSM hopes to do is to change the criteria; those mild cases at one end of the autism spectrum will no longer be declared autistic. Many in the medical community feel that the increasing number of children being diagnosed with mild forms of the disease probably are not autistic and that by making the criteria for the diagnosis stricter, the trend that has been seen in recent years of every more cases arising will be reversed. Advocates of this re-definition point to examples of people who, years ago, were considered odd, or eccentric, many of whom now might be diagnosed with a mild form of autism.

Of course there are others who feel that changing the definition will cut services off to many that truly have mild forms of autism and who benefit from the treatments that they receive. Cutting them off from these services by re-defining autism threatens to turn back the clock to some extent in trying to get to the bottom of this disease and providing care for everyone that has even the most mild form of it.

My take:

It sounds like a very complicated problem and with good reason. There are so many more children being diagnosed with autism these days that either something is going wrong with the gene pool, our environment, or some other mitigating factor, or as the psychiatric community believes, too many children with even the most mild cognitive issues are being diagnosed as autistic. As long as the changes are motivated by science and not the insurance companies looking out for their bottom line I think it is a good thing.