I am curious as to why the American Psychiatric association has chosen to call “Autism Disorder” Autism Spectrum Disorder when you consider looking at the relatively short list provided below! This does not make sense logically is inconsistent and frankly makes their association look foolish.

I am enraged that in the DSM 5TR they came out calling it autism spectrum disorder. When you look at the following definition, spectrum indicates a continuum. This definition is from www.Merriam-Webster.com:

In Criterion:

2. A: a continuous sequence or range.

In these dictionaries, it is quite clear that it means it’s a continuum or continua unless you’re trying to redefine the word spectrum. If you’re trying to come up with it in your own terms and redefine it then you can do that I suppose. You’re just violating rules of language. They’re trying to call that continuum because the average person who reads about autism spectrum disorder, does not know the wiser. The average lay person has not looked in the DSM-5-TR, which is in most libraries in the United States. For that matter many clinicians that I have met have not in detail looked at the criteria. In no way shape or form in the DSM-5-TR “Autism” is actually a continuum. You have to meet the initial A,B,C,D,E criteria. When you meet those criteria, you have to indicate the level. Which is on a separate page. You have a level 1: requiring support, 2: Requiring substantial support, 3: Requiring very substantial support. This means it is still categorical. It is not a continuum you’re not gauging on a scale of 1 to 5, 1 to 10 you’re not gauging on any scale of 1 to 100. That is a continuum.

See part of the problem in this discussion is that the American psychiatric Association owns the DSM-5-TR and psychiatrists are not trained in the sophisticated testing methods that we are as psychologists and generally in psychology. They do not take advanced coursework in assessment and diagnostic training like we do in psychology. They are not qualified to give the IQ test, or any of the other personality tests or other sophisticated psychological instruments we have. They like their categories, neat, cut and dry because then they can code it and charge your insurance. According to law, you have to have a codable disorder to dispense a psychotropic medication otherwise you’re in violation of law. This is why psychiatry loves neat cut, and dry categories. Now when you look at the teams who came up with the categories in the DSM-5-TR and the individual disorders, they are full of people with masters in counseling and clinical psychology and psychometrics and PhD’s in psychology. This is because we are more well trained to do research on these concepts. Again, psychiatry does not specialize in research. Yes, you can do as part of your training, you can choose a research route, but it’s still not nearly at the level and depth that psychologists do training in research. Over the years I’ve talked to numerous psychiatrists who don’t understand some of the basics of actual research.

I rented a room years ago from a medical school student and I started to go into a lengthy explanation regarding a psychological study and how it was designed. She politely interrupted me and said Eli you have to understand in medical school, we get no more further research training than I did in my senior year of biology, chemistry and physics, etc. She said that the last research training I ever got was senior year physics to understand how research is done. Psychiatry does not understand research very well as compared to psychologists. What they do in these committees is they farm out the research to PhD’s in psychology because we have more advanced training. I’m very happy to see that autistic disorder, which is what it should be called instead of autism spectrum disorder, that they have moved towards more of a continuum approach with those levels of indicating the severity of autism present. Yet I was talking with a friend of mine just the other day Who does have a child who is autistic. I met the child and I definitely concurred at least upon a very brief meeting it appeared as though he met the 3 criteria necessary for the A criterion of the disorder. It was/is very apparent. That being said she had a very deep appreciation of psychology and very well educated and she looks at it as a continuum. Even though I showed her in the book that this is categorical. But I appreciated her liking the continuum approach which is where it should move to. It’s just officially in the DSM-5-TR. It is categorical. There is no spectrum. There is no continuum end of discussion. They call it that to try and act as if they care about it being a continuum but it’s not a continuum. I don’t know what other social and political motivations they have for calling it a spectrum diagnosis. What psychologist will tell you is what we want our cut scores or even a gray area so on a scale of autism’s symptoms. What we would like to see is OK they match this number of symptoms or on a scale of ideally something like 1 to 20 or one to even 100. So patient X, they match these symptoms to this level on the continuum. It is causing as in most diagnoses, distress or impairment and social occupational or other important areas of functioning. Or they can function normally but just are off on certain things like reading facial cues and that is problematic.

I’m just throwing out random numbers as examples but let’s say from 60 to 70 if they’re scoring in that range that might be considered the gray area but if it’s over 70, they’re definitely autistic. Or whatever number the research bears out. The point is we do want it on a continuum but the problem is psychiatry is uncomfortable with a continuum approach. Then it would also for insurance coverage have to change as far as oh did they score above this cut point, then it’s covered for treatment. That gets very tricky as far as how is insurance going to cover it if you’re in that gray area as the example I gave 60 to 70 versus then you know the patient scored 85 on the continuum.

Part of mental health is sometimes we don’t have a neat category for things I’ve met people and a friend of mine says aren’t they a bit weird and what would you diagnose them as? And I say to my friend and this has happened numerous times over the years I say, “they are weird you know and kind of because I’m casually talking to my friend I’m like yeah they’re crazy”. Which is a meaningless term (crazy) psychologically but it means yeah they’re “out there” (again meaningless except for normal daily speak). They’re strange, but I can’t pin them down with an actual DSM-5-TR diagnosis. This is because when you’re looking at categories, people fall through the cracks. We’ve all met those people who are just socially awkward or socially strange. There is no official diagnosis. They are just socially strange, but that’s where a continuum approach is useful.

Related to this continuum/Spectrum issue is the that the DSM-5-TR is completely lacking in consistency. They call Autism Spectrum Disorder as such yet they do not call other disorders that have “levels” spectrum diagnoses as well. Here is a short list of examples. I’m giving a short list because upon reviewing the DSM-5-TR there are numerous disorders (in the range of 40 to 50 some depending on how you rank them) that have Mild, Moderate, Severe specifiers. Just look at the following examples.

Intellectual Developmental Disorder (this one even has 4 categories)

Mild

Moderate

Severe

Profound

Most of the Substance Use Disorders have the categories of so arguably 9 categories:

Mild

Mild

            In Early Remission

            In Sustained Remission

Moderate

Moderate

            In Early Remission

            In Sustained Remission

Severe

Severe

In Early Remission

            In Sustained Remission

Attention Deficit Hyperactivity Disorder

Mild

Moderate

Severe

Major Depressive Episode/Disorder

Mild

Moderate

Severe

Arguably here you can even add on:

With Psychotic Features

In Partial Remission

In Full Remission

Sleep disorders

They have severity levels and also dependent on oxygen deprivation which is clearly on a continuum in biomedical measurement.

Schizophrenia

This one actually does have a continuum approach, of a 0 to 4 rating. Yet they DO NOT CALL IT Schizophrenia Spectrum or continuum.

Anorexia (again 4 categories)

Mild

Moderate

Severe

Extreme

Binge-Eating Disorder

Mild

Moderate

Severe

Extreme

In the end I am curious as to why the American Psychiatric association has chosen to call “Autism Disorder” Autism Spectrum Disorder when you consider looking at the relatively short list provided above! This does not make sense logically, is inconsistent and frankly makes their association look foolish.