My issue with DSM-5-TR's ASD criteria.

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Does the Broad Autism Phenotype blur the differences between people with ASD and normal persons with autistic traits? To what extent does the Broad Autism Phenotype manifest into ASD and should get diagnosed as a young or older adult?


The problem I have with the DSM-5-TR diagnostic criteria for ASD is this “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).”

Are you autistic, or are you not?

I guess my question to you is, why do you care? Are you asking for a friend?

I agree

Criteria C might be in there to exclude people who were NTs early in life but then started showing autistic traits due to a head injury or reaction to trauma. They wouldn't be ASD but some other condition due to that factor.

The issue with almost all DSM-5 criteria is that diagnosing is not a perfect science. People come in with traits or symptoms from several disorders, and there is overlap between symptoms from different disorders. And people might have some symptoms but not enough to meet the diagnostic criteria. Does that mean they don't have the disorder? According to the DSM 5 it does, but they might have other ways the symptoms manifest themselves.

A case in point. One day I was reading a description of Obsessive Compulsive Personality Disorder (different from OCD) and typical behaviors of the person with OCPD. This was in something other than the DSM 5. I started laughing because it described by Dad perfectly, and then it clicked that that was his "issue". When I look at the DSM 5 criteria I didn't see him meeting them, but after reading that other article I could then fit his behaviors into the DSM5 criteria better.

It was that way with Asperger's and the DSM IV also. I remember seeing the criteria for that, and didn't feel like I met them. I don't focus on parts of objects, and I didn't think that I collected facts about something without being interested in the larger picture (or however they stated it). Then one day I saw a website that described ways Asperger's manifests itself in everyday life, and I was like "Wow! That is me!". I knew that there was something different about me, but I could never figure it out from the DSM IV or DSM 5 criteria. I asked a therapist I was seeing who know a lot about Autism (his son had Aspergers and eventually committed suicide) if I had Asperger's and he said yes, but not at a severe level. He said he figured that out by our third or fourth session.

Sorry to Ramble On (good Led Zeppelin song) but tried to show that diagnostic criteria are not always clear cut or perfect. They are the opinions of professionals, hopefully backed by some research, but far from perfect, which is why they change from edition to edition of the DSM

That is certainly possible, I suppose. I guess one problem is that we still don't know enough about ASD to know if it can lie dormant and then be triggered by environmental events later on. And that would be hard to determine. Do we know the exact genetic sequence associated with ASD? We would need to know that and be able to measure that in people to know who is predisposed or not. Then we would need to know the person's case history to know they weren't showing symptoms before the event, etc.

The more recent DSM manuals try to base any changes they make on empirical research, and trying to answer your question would be tough from a research standpoint. Doesn't mean we won't ever know that, though.

And if we can later determine that it might lead to a whole new disorder, something like "Stress Induced Autism Spectrum Disorder', since the treatment for it would probably be different than for those who had been demonstrating Autism since birth

I would like to go before the DSM’s editing board and share the list I’m composing of traits (not ‘symptoms’) which need to be included in the next updated edition. Things like paradoxical traits such as +/- pain tolerance, +/- rate of speech, +/- novelty seeking, etc. How do we inform the powers that be?

Those are two schools of thought should be taken into account as well, thank you