This is a hypothesis that would have to be substantiated by data. No studies have been made that prove that a significant majority of the rise in autism consists of cases that would previously not have been diagnosed as autism. This is reasonable speculation, not proof.

If autism has become a default diagnosis for other categories of cognitive/emotional imparement, we would expect a statistical decrease in the frequency of non-autistic cognitive/emotional imparements that would be coterminous with the increase in frequency of autism. There seems to have been no attempt to establish that this is the case.

My 33-year-old daughter was diagnosed in 1986, at age 11, according to Kanner’s criteria - just before the disastrous changes in the DSM-III-R. She had been previously misidentified and wrongly diagnosed as emotionally disturbed by school district special education personnel, since at that time only the lowest functioning autistic children were considered “really” autistic.

Through the years since Kanner’s criteria were first diluted, then discarded, I have broken ranks with every professional, educational, and research organization involved in autism because of the rampant panic and lack of any critical appraisal of the increasingly ridiculous theories based on speculation, junk science, and most regrettably the APA’s snail’s-pace response to the resultant circus.

I’m cautiously pleased to see speculation and debunking appearing more and more. My question to EpiWonk is this: Will Kanner’s criteria be restored and the notion of ASD be clearly rejected in DSM-V? Will there be any opportunity for lay review and input based on case histories such as those of my daughter and thousands of others correctly identified pre-1987?

What is the future of what has become a wastebasket diagnosis?

I would love to see an end to the chaos somewhere on the horizon.

Many thanks for your scholarly work on this critical issue and the other commenters to this article.

Your question about comparing cases each time the criteria change is a good one. Special studies have to be done. I think there were 5 studies comparing DSM-III to DSM-IV on autistic disorder; all five found that DSM-IV broadened the diagnostic criteria. The study that is generally considered the best of the five was: FR Volkmar et al. Field trial for autistic disorder in DSM-IV. Am J Psychiatry 1994; 151: 1361-1367.

Also, is there any way of comparing the data [number of cases] each time the criteria changed? [Probably not very well phrased, but hopefully that makes sense]
Cheers

Parents likely send thier child to a pyhsician at this point,
however it would be my opinion that many physicians are
not the best source of developmental diagnosis. Some maybe,
but I am not sure how well they can evaluate a child based on
the minimal exposure most physicians have with each patient.

There is great varitability within school districts and
individual schools as to thier ability to correctly
diagnose the actual handicapping condition as well based on teacher
and staff experince ever decreasing funds and support.

As EpiWonk advised me as to the source of Autism data used in
the Gier study;
“In the Vaccine Safety Datalink the outcome files are based on “passively” collected
data from hospitalizations, emergency department visits, and outpatient visits within
the HMOs, and the diagnoses are then coded as ICD-9 codes. There is no active effort
to seek out, screen, or diagnose autism or autism spectrum disorders.”

I believe many of the universities (UCLA locally here) have programs that offer
exemplary developmental diagnostic evaluations for children.
Many parents faced with a problem will send thier child
or be recommended to send thier child to a institute like UCLA
for a “full workup” to determine with a bit more precision
the childs handicapping or predominant handicapping condition.

see UCLA’s website below;

http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=502&action=detail&ref=47

I am sure there are many similar university programs throughout the country,
but UCLA is local and what I have heard and become familiar with.