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Autistic Spectrum Disorder: An Irreverent Commentary

The following is my irreverent commentary on the diagnostic criteria for Autism Spectrum Disorder according to The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5). I find the wording and implicit assumptions offensive. However, these are my thoughts, and I do not claim to speak for others or represent their views or experience. This is also not in any way meant to dismiss or disqualify the very real distress of anyone struggling with neurodivergence.

To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction plus at least two of four types of restricted, repetitive behaviors.

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):

  • Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation (in other words, not being able to engage in superficial chit-chat and talks about the weather is a serious 'deficit' because it makes other people uncomfortable, and there is something wrong with someone for not wanting to engage in this?); to reduced sharing of interests (not sure that sharing the same interests as others is a 'deficit', seems like a it not a 'deficit' to be like everyone else, or is that a sheep?) , emotions (because when you ask me how I am, I am supposed to know that you do not really want to know how I am, but I should still answer you, but I should not really tell you how I am, and then I should ask you how you are in return, even though you are not really going to tell me either, and we both know this, but not engaging in this bizarre exchange is the 'deficit'?), or affect (so to accompany the above play of the absurd you want facial expressions as well?); to failure to initiate or respond to social interactions.

  • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact (or perhaps I don't want to look at you and that can be ok, because eye contact is intimate and I don't want to be intimate with you and perhaps insisting on this intimacy with a complete strange is a bit 'inappropriate') and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

  • Deficits in developing, maintaining, and understanding relationships (yes, because all those other people have it all figured out and their relationships are all 'healthy'), ranging, for example, from difficulties adjusting behavior to suit various social contexts (because it is 'deficit' being consistent and not focussed on constantly changing yourself to keep others ok...and yes, we are not pleasers) ; to difficulties in sharing imaginative play (my imaginative world is pretty awesome thank you, just not sure you will get it if I shared it, and not sure I want you on my planet...yes, there is a whole world inside of here) or in making friends (yes, correct, this is hard work, and friendships when you are a child in particular are based on sameness...and we are different ); to absence of interest in peers (or maybe this is really scary and difficult because I am different, and the gaps feels enormous....nothing to do with interest, but maybe I have come to the point where it feels easier to give up on trying).

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

  • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys (noted...being organised and systematic is a 'deficit'...note to self to leave my sh*t all over the place) or flipping objects, echolalia, idiosyncratic phrases). Insistence on sameness, inflexible adherence to routines (which is why every organisation has policies and create exactly this, but if I do this myself it is a problem? or is it just inconvenient for someone else?), or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals (so..the greeting ritual of pretending to smile and pretending to like the other person and wait till the leave the room before we gossip about them is not a ritual? know i missed something there), need to take same route or eat same food every day (because this is the deal-breaker, unless I am vegan or something, then we call it a 'diet' ).

  • Highly restricted, fixated interests that are abnormal in intensity or focus (yeah, shoot me for really being into the things I am interested in, will work on being more apathetic) (e.g., strong attachment to or preoccupation with unusual objects (to clarify, always carrying and touching and engaging obsessively with your phone and twitter and tik tok is ok because there is nothing 'unusual' about it) that is, excessively circumscribed or perseverative interests).

  • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (happy to shout in anyone's ears and call it a 'deficit' when they freak out...didn't know being sensitive to noise is problematic) (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects (true, may seem weird, but did not know really valuing and using all my senses to engage with the world is a problem), visual fascination with lights or movement). (love them pretty lights...did anyone tell those thousands of people travelling to see the aurora borealis it is a deficit?!)

Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities (considering all of the above, capacity pretty limited over here), or may be masked by learned strategies in later life) (love it..."learned strategies"...the desperate attempts to fit in so you can have your basic emotional and relational needs met and get a job).

Symptoms (or read, Being different messes with your ability to do the same stuff as others, good to know) cause clinically significant impairment in social, occupational, or other important areas of current functioning.

These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay (love the alternative here guys...maybe he is just a bit dumb?). Intellectual disability and autism spectrum disorder frequently co-occur (or dumb AND strange? no offence meant, I am sure); to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.


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