The DSM 5 autism criteria rewritten from a neurodiversity perspective

I recently had a look at the autism criteria in the DSM 5 (the criteria used to diagnose autism in a number of countries including Australia). It made me sad as it was so strongly focussed on deficits and negatives. I know it is for the purposes of accessing support so it probably needs to focus on challenges rather than strengths but it still makes me sad. I decided to whip out my advocate brush and give it a neurodiversity-based touch-up. I hope you like it. I’m not sure how a doctor would use it but I prefer it to the original version.

Text in blue is what is in the DSM and text in black is what I have written. It si a bit tongue in cheek but there is a serious side to this as well. Autistic pride all the way! Nothing abotu us without us and other positive and radical sentiments.

A. Persistent deficits in social communication and interaction across multiple contexts, as manifested by all of the following (currently or by history):

1. Deficits in social-emotional reciprocity

2. Deficits in nonverbal communication behaviours used for social interaction

3. Deficits in developing, maintaining, and understanding relationships

Specify current severity based on social communication impairments and restricted, repetitive patterns of behaviour.

A (Ausome) Different ways of communicating and relating to others. This is part of the person’s basic make-up. It is not a deficit or a disorder, it is just a different way of communicating. Some ways in which this might be demonstrated include:

  1. Different ways of relating and experiencing emotions. Some people may have hyper-empathy.  They may make excellent psychologists or counsellors or just be really good and thoughtful friends and partners.
  2. Interacting in different ways. Being honest and straightforward and not generally using things like manipulation or sarcasm.
  3. Approaching relationships differently to allistic people. Autistics may be very loyal and/or have strong bonds with an individual or small group of friends. Autistic people often have a great connection with non-human ‘people’ too and a connection to the natural world.

B. Restrictive, repetitive patterns of behaviour, interests or activities, as manifested by at least two of the following, currently or by history:

1. Stereotyped or repetitive motor movements, use of objects, or speech

2. Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal

or nonverbal behaviour

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the

environment

B (Brilliant) May be experts in a particular area, have a strong focus and determination. May have very strong interests on a topic and activities related to these interests may result in a great sense of joy and satisfaction.

  1. Innovative and imaginative use of objects. Creativity.
  2. The ability to follow a schedule. Seeing patterns in things – very useful if the person wants to work for the police as an investigator or be a mathematician or climate scientist.
  3. Passionate engagement in a particular interest. As life progresses, Autists can develop a huge general knowledge based on all the topics they may have been interested in. Very useful if the person wants to be a university professor or lots of other things! Also, the interests can form an excellent self-soothing tool should the person be depressed or overloaded.
  4. Exceptional, accurate and perceptive sensory skills. This is highly useful in areas like being a chef or a musician.

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). 

C (Curious and Clever)

Young children may be quirky, smart and individual. As they grow older, the world can dampen their amazing spirit but do not be disheartened as Autistic people are often resilient and resourceful.

.
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

D (pretty Damn awesome) The weight of a world which often does not value or respect Autistic people can mean that they struggle to navigate life. This is not due to their inherent deficiencies, rather it is mostly a result of a focus on some arbitrary ‘norm’.  With the right support, understanding and self-confidence, Autistic people can rise above this and be their best ‘them’. This is an area for further work.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

E (Exceptional) Autists are Autists. They are amazing as is and defy this sort of diagnostic negativity through their brilliance.

Individuals with a well-established diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits is social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Autistics should be given a ‘diagnosis’ of human being along with all the other human beings. Functioning labels do not help but kindness and respect do. 

*Disclaimer: This is not meant to be one of those ‘all autistics have superpowers’ posts. It is more focussed on countering deficits thinking. We all have different capabilities and interests – we all have our own different kinds of brilliant – and that is a good thing.

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