DSM3 to DSM 4: Epidemic?

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I also am someone diagnosed with AS who meets those criteria both in childhood and now. I think there was a difference in how diagnosis happened that was far more than just changing the criteria.

Personally I have the traits (generally worse as a kid, but still present now)
A: 4 5
B: 2 4 5 6
C: 1 2 5

That's enough to fit the criteria, yet I wasn't diagnosed under that or even as a child at all (I was 5 when the DSM-IV came out).

Attention to the "more two symptoms somewhere".

Perhaps the big change was from the DSM-III to the DSM-III-R.

At least, the criteria of the DSM-III seems much more difficult to match (specially because C and D):

I'd agree that these seem much more difficult to match

What I was thinking. Ok the dsm3 outlines all the autism symptoms however the severity which it seems to make it clinically significant was greater. Yes a lot of aspies have the symptoms but we have it to a milder degree. When you look at the wording for the autism in dsm4, they revise the wording so the severity can vary. The dsm3 wording seemed more absolute. Aspies have these symptoms except the severity is not as bad most of the time. I guess if we were to reword the dsm3, it would make it more encompassing for all on the spectrum. Heres what I had as a kid if we were allow for varying severity. Ok, I dont make the crieria, got 7 symptoms, not 8.

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)

It seems to describe my severity pretty well, actually, for at least some of the symptoms - if not all. I can't speak for anyone else. I was autistic enough for it to be noticeable when I was around 10-12, for sure, but I never got diagnosed or referred for diagnosis because my parents basically didn't push to get me much mental health care. I had counseling at 6 years old because I had disappeared wandering for most of a day, and while I have no recollection of what actually happened, my mother believes I experienced severe trauma - so the counselor who did see me may have written my behavior off as caused by trauma.

I do agree that the autism "epidemic" is a matter of improved diagnostic criteria and better diagnostic practice.

I used to wander off too as a small child my mom had to get me a ID bracelet. Then she took it off me when I was about seven because I could talk now and say my name and I knew my address and phone number. Plus I knew not to wander off far anymore. But I never ever wandered out of the house so my parents never had to put extra locks on windows or doors. I did wander out of the house a few times but I knew doing that would get my mother yelling at me and then a time out. I always needed permission to leave the yard.

Most of the ones I listed matched the severity they had listed, if I needed to have it to that extreme of a severity I might not have matched, lets see

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:
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) -
I often preferred my books to anything with people, even while very young. When associating with others they were used as someone to compete with (not to beat, but like playing chess against a computer), or eventually as I got older, sometimes to play specific roles so I could do what I wanted to in imaginative play because I could not make up imaginary friends to play with
When young enough I definitely matched the severity listed, by 13 I might have been slightly less than.
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.) - "no interest in making peer friendships despite interest in making friends" is actually an accurate description of me still at age 22.
I still match this now

Matched 2 in A with severity.


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:

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); I feel like this is one most aspies meet still - "does not look at the person or smile when making a social approach, does not greet parents or visitors" are both accurate for me when I was young - now I try to smile and try to greet people after they greet me.
Likely still match for severity now


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) - Let's just say that I had about a decade of speech therapy covering most of these areas of abnormalities mentioned as well as the inability to pronounce certain letters
Without question matched

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) - I do stop when people point out that I'm repeating everything they say...
Likely matched, but not as strong as other things have been


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) - They don't have an example for unable to initiate a conversation, but there's no way I was able to do so as a kid - now I can do so if I have a particular reason to do so)
Seem to match severity listed

Matched 4 in part B


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) - I never had big complicated stims, but finger twisting was something I definitely did and definitely still do.
Probably match, my stims have always been something mostly invisible to people not looking for them but very noticeable to anyone looking

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)
I actually don't have good memory of how strong this was, so I'll assume it wasn't severe enough


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. - Begging parents to teach me math constantly and having the copy of The Hobbit more often than the library (I wanted to read /that/ copy even, it had pretty pictures)
I think I matched, the fact that I did well in school in other subjects might have hidden it too much though

Likely matched 2 in section C.

Overall: 2 in A + 4 B + 2 in C = 8

I'd have been borderline being diagnosed under these criteria, but I think it could have happened if it was attempted - however I was only 5 when the DSM-IV came out, and none of my actions were overly worrying to my parents who were happy to have a child at all after struggling for a pregnancy. After that point I was doing well academically, so the only question that came up was whether I was ADD/ADHD, which was shot down quickly.



This just reminds me that when I was really little my parents tried putting a toddler harness on me so that I wouldn't run away - apparently my reaction was to crawl around barking because only dogs were on leashes. It embarrassed them so much that they gave up on the idea of having a Tuttle on a leash.

Last edited by Tuttle on 02 Oct 2011, 12:29 am, edited 2 times in total.

I was one or two years old when my parents got a chain lock on the front door because I had managed to leave the house and get across the street before they realized I was gone, and then they caught me a second time before I'd left the house. After that, they locked me in at night. In the house, anyway, not my bedroom.

I must have been in middle school when I got in serious trouble for just going to the park one day. The park was about a mile away and I walked there barefoot.

My parents got me a child leash once and I hated it so they never put it on me again. I was screaming and crying. But my mom found another child leash and it was something that went around the child's wrist and the grown up's so mom got it for me and it worked for a while until I figured out how to take it off.

I hated seat belts then too so my parents didn't strap me in my stroller or to my high chair and it was a struggle to keep me buckled in the car but yet I didn't mind being in my car seat, even the one I had at three years old.

Why did you get in trouble for walking to the park Verdandi? I remember mom yelling at me a few times in my later childhood for taking off when we be somewhere. She yell at me about how someone could have taken me and drove off with me. I was just bored so I went for a walk and I knew where I was and knew my way back. One time I was at soccer practice and it got over and mom wasn't there yet to pick me up so I played on the playground and I was far away from everyone else and mom scolded me for that. I also remember these two men talking to me when I was nine and mom told me that was very dangerous and they could have taken me. I just had no stranger danger then. I assumed everyone was good even though I knew there were bad people in the world because I was told but I still assumed every person I saw was good. No one could never get me to follow the never talk to stranger rules either. From my logic, you had to talk to strangers to get help or to make new friends or to find the bathrooms or to get help looking for items in the store so of course that rule was bogus. Everyone was a stranger and I knew I was a stranger too to everyone else I had never met. because they don't know me right and strangers are people you don't know so everyone would be a stranger, employers, teachers, parents, police officers, everyone and I was being told to never talk to them. Then mom told me as an adult those aren't really strangers because you know who they are but I said yeah but you don't know them. I think those were one of the rules I never followed. I saw grown ups doing it so I did it and knew you had to talk to them. My mother called that intelligence I did there. She never taught me the stranger rule of course, my school did and she said I was very smart to not follow it.

I got in trouble because I wasn't wearing shoes and because I didn't tell anyone where I was going. Strangely, I went even farther on my bicycle but never got in trouble.

Ok I perhaps my theory is invalidated? I dont really know very many aspies in real life. And I dont know how many of them were when they were kids soo...I have insubstantial evidence. My only guess is psych awareness? People mistaken autism as something else too often in the past. I have no idea?? Back then autism wasnt a big deal. How the diagnosis's started rising and the awareness starting spreading, got no clue?? I mean now we can say aspergers/autism is a trendy diagnosis. Soon enough aspergers is gonna earn its way to ADHD status. And all the NTs are gonna be making jokes out of it. I mean my Pchem prof was already theorized as aspergers by some of the students in my class....sigh....And I bet ya dumb people are gonna start blaming all the electronics and technology for social isolation leading to aspergers. Many dumb theories are made by people who have little to no psych knowledge, pop psychology

I aint a psych, I only got diagnosed in 2007 has a HS senior because my social skills were pretty bad after being mute for almost 10 years of my childhood. Im probably borderline so I dont face 1/2 of the aspie symptoms significantly. Only the social crap....

Your theory is actually fairly accurate - it's not that none of us fit the criteria, but that many of us did not fit the expected criteria - many clinicians looked for "LFA" cases and clearly nonverbal or at least speech delayed children, plus there was an expectation of MR, even though MR was not required for diagnosis. While the popular view is of Asperger's Syndrome as a mild form of autism, it's more like AS made it significantly easier for people who were previously ruled out of autistic disorder diagnoses to be diagnosed with AS, because it specified "no speech delay," among other things. Plus people who were clearly dealing with impairments but could not ever meet the criteria as described.

It's just that when you lay out a list of criteria or some such thing, people are going to examine them, take them apart, and try to see how closely they fit.

I tried to run away from home once in 4th grade (to avoid surgery) but realized I didn't exactly know how. I got as far as the end of the block. I wasn't supposed to go any farther on my own (although the bus stop was two blocks further).

since the dsm-3 descriptions were mentioned, i thought i'd share a link for the dsm-ii:
http://www.psychiatryonline.com/DSMPDF/dsm-ii.pdf

Searched the whole thing an 'autism' doesn't come up once. 'autistic' does, twice:

295.8* Schizophrenia, childhood type*
This category is for cases in which schizophrenic symptoms appear
before puberty. The condition may be manifested by autistic, atypical,
and withdrawn behavior; failure to develop identity separate from
the mother's; and general unevenness, gross immaturity and inadequacy
in development. These developmental defects may result in
mental retardation, which should also be diagnosed. (This category
is for use in the United States and does not appear in ICD-8. It is
equivalent to "Schizophrenic reaction, childhood type" in DSM-I.)

301.2 Schizoid personality
This behavior pattern manifests shyness, over-sensitivity, seclusiveness,
avoidance of close or competitive relationships, and often
eccentricity. Autistic thinking without loss of capacity to recognize
reality is common, as is daydreaming and the inability to express
hostility and ordinary aggressive feelings. These patients react to
disturbing experiences and conflicts with apparent detachment.

now i know this post is about DSM 3 to 4, but I thought maybe showing the differences between DSM 2 & 3 would maybe be interesting to some, and provide further examples of how drastically things can change from one edition to the other.

I could never run away from home, every time I tried, I didn't get very far and I always ended up coming home. I didn't know how to run away from home.