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As a newly graduated PsyD in Clinical Psychology and the mother of a 5 year old son with high-functioning autism, I have intense interest in this topic. As a clinician, I use the DSM as a method for communicating with other clinicians; as a way to get coverage from insurance companies; and as a guide for directing treatment. As a mom, I work very hard to make sure the DSM does not define my child and put limits on what he can do and where he can participate.

Another area of consideration is communication with non-clinicians, particularly in the realm of education. Asperger's has less stigma in our society and there is not fear of behavioral problems that have been associated with the autism spectrum label. I have often described my son as having Asperger's with speech delay - which is an absurd phrase from a clinican's standpoint because Asperger's specifically rules out speech delay- but I have used this phrase to success with non-clinicians to explain in a short-hand way that my son does not have behavioral problems, is cognitively bright, but struggles with speech.

In viewing the DSM as a clinical manual, it is important to define a set of symptoms in a way that is most inclusive and provides the best clarification. Since autism is not a unified construct, but a broad set of symptoms, diagnosis is tricky and is not particularly useful for defining the individual. By creating an umbrella category, "Autism," it does make it easier to argue for clinical necessity and therefore access to services; but unless we more clearly categorize specific symtoms under that umbrella, we are obscuring individual experience and making treatment more difficult. It is my hope that we end up with many specific diagnostic names under the general "Autism" category, reflecting differences in etiology, prominent symptoms, severity, and prognosis.

There is some precident for having an umbrella diagnosis and specific sub-categories. Schizophrenia has broken down over the decades into bi-polar disorders I and II, delusional disorder, schizo-affective disorder, and personality disorders. It is my hope that Autism will come to have more specific diagnostic names as we learn more about its causes, symptoms, and treatments. Perhaps in the future I will descibe my son as having "Autism I" or "Autism I, primary speech delay" and clinicians and non-clinican's alike will have a clear idea of his individual set of symptoms and an idea of his capabilities.

posted 3 years, 3 months ago
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