Unpopular Opinion: Clarifying DSM-5 Autism Criteria Doesn't Mean Restricting Diagnosis
Updated: Mar 6, 2022
I'm sorry that you might be missing the ball here with an opinion like that. When a person in a position of extreme privilege and power wants to artificially shrink the prevalence rate of autism diagnosis, we have a big, systemic, motherfucker of a problem, my people.
Adding "clarifying language" to further restrict the DSM-5 criteria goes against all recent peer-reviewed, clinically significant evidence that autism, at its core, is a fundamental difference in neurotype and is HIGHLY prevalent in the global population. Clinicians in this space now believe that more autistic people exist and have existed throughout time. However, it has been our failure as a society and in the medical/behavioral health fields to recognize people with all presentations of autism. People who show less outward impairment, and who have been deemed by the system to have less overall support needs are barred from receiving a diagnosis, even when they themselves have spent countless hours researching in earnest of a self-diagnosis. (While we're on our lil soapbox, it should be said, please remember that we have no idea what someone's social location or support needs are just by looking at them...ever.)
What It Really Means To Us
Any change that supports an artificially-imposed drop in the rate of diagnosis inherently disenfranchises that entire population of people from getting proper care, treatment, insurance coverage, school/workplace accommodations, and social supports to meet their needs. Many autistic people require substantial accommodations to sustain employment or make it through institutions that are designed for neurotypical people, such as academia and the workforce.
People with all levels of support needs rely on proper clinical diagnosis to guide their therapeutic treatment. So, when someone's battle cry from atop the information hierarchy of medicine/behavioral healthcare is to provide less diagnoses for seemingly arbitrary reasons, we have to consider the trickle down and what that means for a population:
who are already fundamentally denied resources;
who are already constantly marginalized in every social system;
who are already routinely barred from receiving proper diagnosis, treatment, and medical care;
who constantly endure unfathomable acts of ableism and microaggression;
who are subjected to countless atrocities, violence, and police brutality;
who face bullying and hatred on a daily basis;
who face high rates of anxiety, PTSD, and depression;
who experience job inequities and a lifetime pay disparity;
who are forced into abusive ABA therapies that fundamentally deny autistic, neurodivergent, and disabled people their rights and autonomy;
who wind up living in isolation without proper community, representation, and social supports;
who are subjected to lifetimes of misdiagnosis and missed diagnoses;
who show one of the highest suicide risks of all of psychiatric populations;
who have an disproportionately high rate of job failure and unemployment;
who are constantly denied and fighting for school/workplace accommodations;
who are also female, nonbinary, and transgender;
who are people of color;
who are fat or in atypically shaped bodies;
who are LGBTQIA+;
who have multiple comorbidities, health conditions, and disabilities;
who struggle in all types of relationships and social settings;
who are constantly told they are wrong and abnormal by the outside world;
who are fucking sick, tired, and colossally burnt out from masking our way through life in this capitalistic hellscape—
When our best attempt at revising a foundational psychiatric tool is to take away the opportunity for a marginalized group to find representation, community, proper therapeutic treatments, and life-sustaining supports, YOU BET WE'RE CONCERNED. Research also shows that a diagnosis can help autistic people find freedom, self-acceptance, and relief from the suffocating confines of said patriarchal, capitalistic hellscape. We can continue to provide this through the use of a diagnostic framework that explains the autistic neurotype and outlines some basic considerations for support needs.
The true prevalence of autism (and most neurodevelopmental conditions) is already completely underrecognized. It comes down to a lack of clinical education and a lack of access to proper diagnosis for so many people. Artificially lowering the prevalence of diagnosis can only provide even greater challenges for neurodivergent people and their caregivers who are already struggling.
This is a massive systemic problem; and yes, it's bigger than just the DSM-5, which is a pedagogical mainstay in nearly every medical college, counseling school, social work program, and treatment facility. At the very, very least that foundational tool could be up to date and made more inclusive. We need to pave the way for more accessibility, more inclusion, more accommodations, more intuitive care, and more social supports—not less. #micdrop