How autism has changed over the DSM's incarnations
Roy Richard Grinker is kind enough to have this up on his site, in a much fancier way.
The DSM-I
1952.
Autism was not included in the DSM.
Schizophrenic reaction, childhood type label.
The DSM-II
1968.
Autism not a separate diagnostic category.
295.8* Schizophrenia, childhood type*
The DSM-III
1980
Infantile autism.
Diagnostic criteria for Infantile Autism
A. Onset before 30 months of age
B. Pervasive lack of responsiveness to other people (autism)
C. Gross deficits in language development
D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia,
metaphorical language, pronominal reversal.
E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest
in or attachments to animate or inanimate objects.
F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia.
The DSM-III-R
1987.
Diagnostic Criteria for Autistic Disorder
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)
The DSM-IV DSM-IVR
1994. 2000.
pervasive developmental disorders and several subtypes
autistic disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive
Developmental Disorder Not Otherwise Specified (PDD-NOS).
299.00 Autistic Disorder
A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and
(3):
Qualitative impairment in social interaction, as manifested by at least two of the following:
marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate social interaction.
failure to develop peer relationships appropriate to developmental level
a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g.,
by a lack of showing, bringing, or pointing out objects of interest)
lack of social or emotional reciprocity
Qualitative impairments in communication as manifested by at least one of the following:
delay in, or total lack of, the development of spoken language (not accompanied by an attempt to
compensate through alternative modes of communication such as gesture or mime)
in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation
with others
stereotyped and repetitive use of language or idiosyncratic language
lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at
least of one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is
abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole
body movements)
persistent preoccupation with parts of objects
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1)
social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.