Join Date: Jun 2008
Location: La Nouvelle-Orléans
Originally Posted by TactiCool
I appreciate you looking up that study for me, really I do. However the study is from 1992 and says nothing about the subsequent publications, so it does not conclusively correlate to the dramatic increases in autism cases that we see under the use of DSMIV and DSMIV-TR.
Really, I don't think DSMIII-R is culprit, since the drastic spike in autism occurred after the newer DSMIV was published in 1994.
In a psychobiology class, I was told that the DSM-IV significantly broadened the defining criteria for what constitutes autism over what was in the DSM-III. I've found the relevant text, but it's not really something I know how to interpret.
Diagnostic Criteria for Autistic Disorder
At least eight of the following sixteen items are present, these to include at least two items from A, one from B, and one from C.
A. Qualitative impairment in reciprocal social interaction (the examples within parentheses are arranged so that those first listed are more likely to apply to younger or more disabled, and the later ones, to older or less disabled) as manifested by the following:
1.Marked lack of awareness of the existence or feelings of others (for example, treats a person as if that person were a piece of furniture; does not notice another person's distress; apparently has no concept of the need of others for privacy);
2. No or abnormal seeking of comfort at times of distress (for example, does not come for comfort even when ill, hurt, or tired; seeks comfort in a stereotyped way, for example, says "cheese, cheese, cheese" whenever hurt);
3. No or impaired imitation (for example, does not wave bye-bye; does not copy parent's domestic activities; mechanical imitation of others' actions out of context);
4. No or abnormal social play (for example, does not actively participate in simple games; refers solitary play activities; involves other children in play only as mechanical aids); and
5. Gross impairment in ability to make peer friendships (for example, no interest in making peer friendships despite interest in making fiends, demonstrates lack of understanding of conventions of social interaction, for example, reads phone book to uninterested peer.
B. Qualitative impairment in verbal and nonverbal communication and in imaginative activity, (the numbered items are arranged so that those first listed are more likely to apply to younger or more disabled, and the later ones, to older or less disabled) as manifested by the following:
1. No mode of communication, such as: communicative babbling, facial expression, gesture, mime, or spoken language;
2. Markedly abnormal nonverbal communication, as in the use of eye-to-eye gaze, facial expression, body posture, or gestures to initiate or modulate social interaction (for example, does not anticipate being held, stiffens when held, does not look at the person or smile when making a social approach, does not greet parents or visitors, has a fixed stare in social situations);
3. Absence of imaginative activity, such as play-acting of adult roles, fantasy character or animals; lack of interest in stories about imaginary events;
4. Marked abnormalities in the production of speech, including volume, pitch, stress, rate, rhythm, and intonation (for example, monotonous tone, question-like melody, or high pitch);
5. Marked abnormalities in the form or content of speech, including stereotyped and repetitive use of speech (for example, immediate echolalia or mechanical repetition of a television commercial); use of "you" when "I" is meant (for example, using "You want cookie?" to mean "I want a cookie"); idiosyncratic use of words or phrases (for example, "Go on green riding" to mean "I want to go on the swing"); or frequent irrelevant remarks (for example, starts talking about train schedules during a conversation about ports); and
6. Marked impairment in the ability to initiate or sustain a conversation with others, despite adequate speech (for example, indulging in lengthy monologues on one subject regardless of interjections from others);
C. Markedly restricted repertoire of activities and interests as manifested by the following:
1. Stereotyped body movements (for example, hand flicking or twisting, spinning, head-banging, complex whole-body movements);
2. Persistent preoccupation with parts of objects (for example, sniffing or smelling objects, repetitive feeling of texture of materials, spinning wheels of toy cars) or attachment to unusual objects (for example, insists on carrying around a piece of string);
3. Marked distress over changes in trivial aspects of environment (for example, when a vase is moved from usual position);
4. Unreasonable insistence on following routines in precise detail (for example, insisting that exactly the same route always be followed when shopping);
5. Markedly restricted range of interests and a preoccupation with one narrow interest, e.g., interested only in lining up objects, in amassing facts about meteorology, or in pretending to be a fantasy character.
D. Onset during infancy or early childhood
Specify if childhood onset (after 36 months of age)
Diagnostic Criteria for Autistic Disorder
I. A total of six (or more) items from A., B., and C., with at least two from A., and one each from B. and C.
I. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
- A. qualitative impairment in social interaction, as manifested by at least two of the following:
B. qualitative impairments in communication as manifested by at least one of the following:
- 1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
C. restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
- 1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
- 1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
III. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder
- A. social interaction
B. language as used in social communication
C. symbolic or imaginative play
DSM-I and DSM-II hardly mentioned autism at all.
Non Sibi, Sed Suis