13. Redefining Autism

Over the past 3 decades, reported prevalence of Autism aka Autism Spectrum Disorder (ASD) has increased by 2000%. By 2020, the Centre for Disease and Control Prevention (CDC) reported 1 in 36 children have ASD.

This increase in prevalence is partly due to better awareness and less missed diagnoses of ASD. But even factoring this, many have said the numbers are far too high to make sense. Amongst the explanationsraised, a major one pertains to the broadened definition and lowered diagnostic threshold introduced by the contentious DSM5.

Combining Aspergers with Autism

In 2013, the DSM5 merged Autism and Asperger’s Syndrome into ASD. Before the merger, Asperger’s refers to those with autistic traits but lack the verbal and intellectual disabilities typical for Autism. Roughly 50% of those with classic Autism used to remain non-verbal, down to 33% in later eras partly thanks to early intervention. Words acquired by Autistic children may be lost, on average around 20 months old. Even when speech could be developed, they may be limited and non-social in nature (eg, running commentary about oneself to oneself, regurgitating lengthy movie dialogues). This neuro-developmental condition’s disabling effects on cognitive development meant Autistic children often attend special schools, and adults frequently struggle with self-care. Clearly, is not classical Autism that has increased 2000% to affect 1 in 36 children.

Merging classical Autism with the milder Asperger’s do offer benefits. Since ASD includes high-functioning individuals, it enables the normalizing narrative that autism is just a form of neuro-diversity and not a disorder or disability. As well, it allows those with less disabling struggles to have their challenges affirmed like those with classical Autism. Both ends of the spectrum may benefit, but not without costs.

Consequence of Merging Distinct Conditions

For starters, merging similar-but-different conditions means we lose the specificity of the originally distinct constructs. Unsurprisingly, researchers have voiced concerns about the artifactually inflated heterogeneity of ASD, noting how informative findings about Autism or Asperger’s or other meaningful sub-types gets diluted and drowned out when studying the ASD collective.

Socially, it is also confusing when some assert autism is their “superpower” and is why they can excel, while others are evidently disabled by this condition. This is akin to conflating tender feelings of sadness that enriches one’s emotional life, with the kind of depression where one loses the will to live, and altering our vocab so they are labelled the same.

Clinically, merging diagnoses and stretching the boundaries of this spectrum has also muddled the meaning of autism. For example, deficits in theory of mind and limited empathy used to be a defining trait of autism, but having too much empathy can now also be a sign of autism. Likewise, unusual and restrictive interests used to be thingslike spending hours jotting down licence plates and reorganising them, but in a recent case, regular knitting was considered unusual enough to classify as a symptom. The fact that some can mask their autism to blend into society is also frequently cited to stress how those who do not appear autistic, may still be autistic.

Diagnostic Creep and Implications

With such blurred and creeping boundaries ASD overlaps too much with, and is often indistinguishable from, neuro-typical difficulties in social skills, empathy, emotion regulation, cognitive or behavioural rigidity, self-control, expressing vs concealing one’s individuality or eccentricities to fit in, and so on. When misdiagnoses occur, efforts may shift away from trying to change and improve oneself, to deciding these are innate neurological differences that cannot or should not be expected to change.

Similarly, since it takes very little to cross the vague and low threshold for ASD, it is too easy to get a marginal diagnosis, then get misled into thinking it contains the same meaning as classic Autism, which can then unduly distort the person’s sense-of-self and social interaction.