The DSM

The DSM is the 'bible' from which autism spectrum disorder (ASD) is diagnosed. The DSM is actually "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)". 
The most recent version of this manual was issued in 2013, but with lots of controversy. 

In its former version (IV), the manual had the various diagnoses comprising ASD (Pervasive Developmental Disorder (PDD)) listed as their individual names, with slightly different criteria for each. These included Aspergers, Autism and PDD-NOS (pervasive developmental disorder - not otherwise specified). The newer version rolled everything in together under a big umbrella of Autism Spectrum Disorder.

The DSM-5 has faced much criticism ranging from accusations of non-disclosure and secrecy in the development of the manual, industry ties for the majority of the panel and the inclusion of normal processes of society now technically listed as mental disorders. Even the US National Institute of Mental Health (NIMH) has distanced itself from the document.

I personally have a problem with such subjective diagnosis of anything, especially when medications are handed out on the basis of essentially a checklist, with little other testing required. Anyway, our son was diagnosed according to the DSM-IV, the previous iteration.

The criteria for autism diagnosis under the new standards are these (courtesy of the CDC)

Diagnostic Criteria for 299.00 Autism Spectrum Disorder

1. 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):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
   3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

2. 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):
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

For a diagnosis of ASD, all the components must be met. I do have concerns that our son might not actually meet the new criteria for ASD diagnosis these days, but, he is technically grandfathered because of his diagnosis under DSM-IV. This is also a concern of many in the autism community, ie, what happens to children who might not meet the diagnostic criteria under DSM-5, who formerly would have under DSM-IV. Many health insurance programs (including ours) requires an ASD diagnosis for access to some forms of therapy, such as Applied Behavioural Analysis (ABA). Those children might well now not get the help they need to be independent adults. 

The explosion in autism occurrence (the current numbers are 1 in 68 children in the US) over the last 10 years gives me grave concerns as to why any changes in the criteria for autism diagnosis were made. How are we meant to track real changes in prevalence when the criteria has changed? Keeping in mind the current 1 in 68 number is from children born in 2002. We still have several years of data before our son is even included... 

Anyway, back to the DSM. Most developmental pediatricians will use other test batteries (including ADOS-2) to diagnose ASD, but, the DSM is the main one. My recommendation at this point with the DSM-5 is to ask your doctor to diagnose to BOTH DSM-IV and DSM-5 standards. That way you cover both sets of criteria and a doctor who might not diagnose under 5, if he/she sees that a child meets under IV might lean that way. 

I am a firm supporter of early diagnosis and thus treatment. A child can have the diagnosis removed if they no longer meet criteria after intervention, but, sometimes, as I explained above, it's the "label" that makes a child eligible for the services they might need to get them to that point. 

It is just a label and nothing more. Consider it an entry ticket if needs be. It does not change who your child is or how much you love them. It also does not change what they can achieve. 

After our son was diagnosed, we drove home from the hospital and I cried. For about 10 minutes. Then, I decided I would waste no more time grieving for a child who I hadn't actually lost. He was still my amazing, funny, beautiful little boy and was the same child who had accompanied us to that appointment. I would better spend my time on helping him to achieve all he could. We just needed to adjust the way we got there.