Summary

The article critiques the DSM-V's autism criteria for perpetuating a "tragedy" narrative and for being developed from a neuronormative perspective that pathologizes autistic communication and behavior.

Abstract

The author of the article expresses dissatisfaction with the DSM-V's criteria for diagnosing Autism Spectrum Disorder (ASD), arguing that it is rooted in a neuronormative perspective that privileges neurotypical communication methods over autistic ones. The criteria are seen as reinforcing a narrative that portrays autism as a deficit, particularly in social communication and interaction, as well as in restricted, repetitive behaviors. The author points out that the DSM-V's focus on deficits overlooks the diversity of communication methods used by autistic individuals, including Augmentative and Alternative Communication (AAC), and fails to recognize the value of autistic ways of being. Additionally, the article challenges the notion of "abnormal" intensity in autistic interests and behaviors, suggesting that statistical anomalies should not be equated with inferiority. The author also highlights the sensory experiences of autistic individuals, noting both the challenges and the joys they can bring, and emphasizes the importance of accepting and appreciating autistic people for who they are.

Opinions

The DSM-V's autism criteria are criticized for being based on observations of a narrow demographic, primarily white, male children, which does not represent the full spectrum of autistic experiences.
The author argues that the DSM-V's criteria for social communication and interaction are flawed because they assume neurotypical communication is the standard, thus pathologizing autistic methods of communication.
The article suggests that the DSM-V's severity assessment for ASD is problematic because it is based on a comparison to neurotypical norms rather than recognizing the inherent diversity in human neurology.
The author takes issue with the term "abnormal" as used in the DSM-V, stating that it incorrectly implies a defect rather than simply a difference from the norm.
The author appreciates the DSM-V's acknowledgment of sensory processing differences in autistic individuals but cautions against pathologizing these experiences, which can be both positive and negative.
The article emphasizes that autistic individuals' special interests and stimming behaviors should be respected and not dismissed or altered by others, as they can provide comfort and joy.
The author calls for a shift from viewing autism as a set of deficits to recognizing the strengths and contributions of autistic individuals to society.

The DSM-V’s Autism Criteria Sucks

It continues to perpetuate the “tragedy” narrative

I mean “sucks” in the most professional, respectful way possible… but it still sucks.

DSM-V Criteria for Autism

To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction, plus at least two of four types of restricted, repetitive behaviours.

I’m going to stop you right there, DSM.

Adults can be autistic too.

Okay, go on.

A) Persistent deficits in social communication and social interaction

Deficits in social-emotional reciprocity.
Deficits in nonverbal communicative behaviours used for social interaction.
Deficits in developing, maintaining, and understanding relationships.

Let me put this as plainly as possible

A group of neurotypical clinicians who have only ever observed autistic children, primarily little white boys, got together and created this list.

“Autism is frequently talked about, but rarely is it listened to.” — Dr. Stuart Murray

The criteria above comes purely from a neuronormative perspective, meaning it automatically assumes that the neurotypical way of communicating is superior to the autistic way of communicating.

Social-emotional reciprocity (SER) refers to an individual’s ability to engage in social interactions between two or more people. That’s it. Well I’ve never met a living, breathing human being who wasn’t capable of engaging with another in one form or another.

Whether that be through typing, Augmentative and Alternative Communication (AAC), through one’s behaviour and gestures, signed languages, handwriting, speech… to name just a few.

What the clinicians who developed this DSM criteria seem to be saying without saying it is based on neuronormative, male-centric, white-centric, child-centric ideas of what “normal” communication is “supposed” to look and sound like, our ways of communicating are thereby deemed subpar.

Approximately 2% of the population has been formally diagnosed with autism, but there are many more who are self-identified autistic or not at all identified. Regardless, there’s no doubt being part of a neurominority can pose challenges.

That said, why is it automatically assumed being in the statistical minority places autistics in a lower status, to be considered an undesirable neurotype? Oh, but do go on, DSM. Please pardon the interruption, it’s part of the ADHD thing (that’s described in a different chapter).

From what I’ve seen, plenty of neurotypicals struggle with relationships, communication, and social interactions too. I’m not sure they should be held up as the almighty neurotype to which everyone should aspire.

Back to you, DSM.

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of behaviour.

B) Restricted, repetitive patterns of behaviour, interests, or activities

Stereotyped or repetitive motor movements, use of objects, or speech.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour.
Highly restricted, fixated interests that are abnormal in intensity or focus.
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.

To be clear

The intensity of our focus is abnormal? What if the majority of the population has an abnormally low intensity in how they focus on their interests?

When you read the word “abnormal”, it doesn’t (or at least, it shouldn’t) mean an autistics are defective, despite the flattering descriptions in the DSM (no really, DSM, you shouldn’t have, I’m blushing).

Abnormal is very literally a statistical anomaly, defined as “deviating from what is average, typical, or usual.” Similarly, hyper- or hypo- are just words to indicate greater or less than the norm (higher or lower than the statistical mean, or average).

Statistical anomalies are inherently neutral: neither good nor bad, just different, until they are more specifically defined.

There have been plenty of times in history (okay, in present times as well) where the majority was most certainly not ideal, nor superior to the minority. Take racism, sexism, classism — any number of isms, for example.

More of something is not automatically better. Sometimes being unique and divergent are assets, especially when innovation, invention, and creativity are needed (which is always).

It’s not all bad

I think the DSM-V did a much better job in category B. Autistics certainly do experience the sensory world in a significantly different way from allistic people. Many of us experience certain senses much more intensely than most people, while experiencing other senses as much weaker compared to others.

As with most things, this is a mixed bag. Sometimes we derive great pleasure from our heightened sensory experiences, and other times they can cause us distress and discomfort.

Many autistics enjoy stimming (aka “stereotyped movements”). Many of us struggle with change and feel comforted by routine — there are a lot of allistic (non-autistic) people who also share that trait.

Many autistics have special interests, subjects which fascinate us and bring us great joy. We may study every bit of information we can about this topic, delving as deep as we can go, seeming to obsess over it.

The familiarity of the subject matter becomes a comforting blanket we can wrap around our brains, creating a layer of protection between ourselves and the otherwise chaotic world.

So don’t mess with it. Let us enjoy our fascinations, and be happy for us when we find something that fulfills us in a world which so often overwhelms us.

Happy Autism Acceptance Month!

The DSM-V’s Autism Criteria Sucks

It continues to perpetuate the “tragedy” narrative

DSM-V Criteria for Autism

Let me put this as plainly as possible

Specify current severity:

To be clear

It’s not all bad

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References