Autism's confusing cousins

I think part of the tension here comes from the way autism is understood both as a broad, fully-continuous, multivariate spectrum, and as a binary diagnosis.

To be sure, clinically, thresholds are useful because services, insurance, and research all rely on clear binary classifications, in our current society. But outside that context, it isn’t obvious that everyday language needs to mirror that line. Self-identification can be a way of making sense of one’s life, not an attempt to claim a clinical label.

But at the same time, the spectrum includes people with very high support needs, and there’s understandable concern that broad or casual uses of the term can hide those realities in ways that impact care.

To me, none of this means people are wrong for wondering about autism. And I do not have the experience to advocate for or against "anxiety disorders" being weighted more heavily in clinicians' priors than they currently are (as the OP article heavily implies with its length). I mean only to highlight the mismatch between a binary diagnostic system and a very heterogeneous spectrum, and the need for language that acknowledges self-understanding without flattening anyone’s experience.

The largest confusion with Autism is the ever changing definition from one DSM to the next where whole areas are suddenly included and others excluded.

It seems in the DSM 5 the definition was narrowed specifically to focus on two performance deficits: 1) immediate harms either to the inflicted or to those they interact with due to social interactions, 2) catastrophic academic failures due strictly to input/output perception irregularities not otherwise explained by neuro-transmission disorders (things that can be treated with drugs) or low intelligence measures.

That excludes a massive host of social and perception abnormalities that do result in less immediate social rejection and abstract reasoning failures.

As far as I can tell, the definition of autism coincides with the desire of healthcare to address it without having to carve out 100+ variations of behavioral outcomes to get insurance to pay for it.

We know autism affects all sorts of long term outcomes, but if you tried to split it into actual diagnoses, you end up with insurance companies dividing and conquering approvals.

So instead of having several definitions, we put them all behind autism because that has already received appreopiate laws that establish requirements to treat both at school and in healthcare settings.

So basically, once it breached the "we need to address this", rather than every new diagnosis having to struggle to say "look, this problem effects society", it just grows offshoots and spectrum status.

Because it's definitely not a physically identifiable disability. It's all behavioral and that will always have more coincidences.

You nailed it. I've spoken with doctors who were involved in changing DSM V to have a more inclusive definition of ASD with the express purpose of getting more kids access early intervention that they wouldn't with the PDD-NOS and other diagnoses from DSM IV.

That might be the intent but in practice the opposite has come true. The more narrow definition is more exclusive, which means fewer child with autism can be diagnosed as autistic. For example criteria under the description of Asperger’s and PDA are excluded so those children cannot be diagnosed as autistic and therefore those children cannot receive additional support. That is a massive handicap that requires main streaming children that cannot function or learn in a normal classroom.

> It seems in the DSM 5 the definition was narrowed

I think it may have been narrowed in theory, but often not in practice.

Here in Australia, making DSM-5 ASD a shortcut to getting funded by our national disability insurance scheme (NDIS) caused a lot of pressure to broaden the diagnosis in practice - if clinicians have to stretch the diagnosis to get someone the support they need, they feel ethically obliged to engage in that stretching, since it is in the best interests of their client (who are experiencing real challenges, even if those challenges map poorly to the official diagnostic criteria).

And Australia is not unique in providing funding pressures for ASD diagnosis, although NDIS is arguably a global outlier in the scale of that pressure. Apart from funding, growing popular and clinical mindshare of the diagnosis creates independent pressure to broaden its definition.

So a theoretical narrowing coexists with a practical broadening - and the latter is arguably what really counts

So how do other countries other than US define autism?

The UK follows the DSM

I think you might be in the wrong state.

Many states require health insurance cover autism and have their own definitions.

It's definitely a broad sprectrum if the right healthcare system from the State's POV.