In a perfect world where evidence trumps emotion, and D-list actresses stick to their scripts, the words “autism” and “vaccines” would never appear in the same sentence. So it was a relief to read Dr. Richard Grinker’s op-ed in today’s New York Times explaining the proposed changes to how autism is diagnosed in the Diagnostic and Statistical Manual of Mental Disorders.
The stigma of autism is fading fast, says Grinker, a professor of anthropology at George Washington University, and author of Unstrange Minds, which deconstructs the myth of the autism epidemic. The proposed changes to the DSM V would fold the current subtypes of autism into the category of “autism spectrum disorder”. Gone will be the labels of Asperger’s syndrome, autistic disorder, and PDD-NOS. Grinker makes a convincing case for the change.
When the American Psychiatric Association first recognized Asperger’s disorder in 1994, it was thought to be a subtype of autism. As the diagnosis became more common, it broadened the public understanding of autism as a spectrum. It helped previously undiagnosed adults to understand their years of feeling unconnected to others, but without bestowing what was considered the stigma of autism. And it helped educators justify providing services for children who, in the past, might have been unappreciated or even bullied because of their differences, but received no help from teachers.
But what is culturally convenient is not necessarily scientifically accurate. The differences between the “high functioning” Asperger’s and autistic disorder are not as sharply drawn as commonly thought. “People who now have a diagnosis of Asperger’s can be just as socially impaired as those with autism,” writes Grinker, whose 18-year-old daughter, Isabel, is on the spectrum. “So Asperger’s should not be a synonym for ‘high functioning.’ Likewise, people with autism who are described as ‘low functioning,’ including those without language, can have the kinds of intelligence and hidden abilities that are associated with Asperger’s — in art, music and engineering, for example — and can communicate if given assistance.”
The practical advantage of viewing autism on a continuum, rather than a collection of distinct subtypes, makes it easier for diagnosticians, and parents, to identify and appreciate the “often unpredictable changes among children with autism, ” says Grinker. He cites his own daughter as an example.
When Isabel was 3, she had all the symptoms of autistic disorder, but if she walked into a doctor’s office today as a new patient — a chatty, quirky high school senior — she would more likely be given a diagnosis of Asperger’s disorder. Narrow diagnostic categories do not help us understand the way a person will develop over time.
That’s something that is easy for parents to forget – that autisms are developmental delays, not stasis. These kids continue to grow, adapt and learn, just as their neurotypical peers do, albeit at their own pace. Vaccine rejectionists, and the spin-off autism recovery industry, simultaneously ignore and feed off of this fact. But given enough time, and lack of a control group, a diet of peanut butter sandwiches and grape Nehi is sure to be followed by a welcome developmental spurt.