Why are there now more cases of autism than before?

Normally, it's easy to see that someone has broken an arm: the cast gives it away. Or that they have a cold: they don't stop sneezing and blowing their nose. And with a simple analysis, we can know if a person is hypertensive or diabetic. On the other hand, mental illnesses, which can be just as painful and disabling as physical ones, tend to go more unnoticed, often because they don't show visible signs and because they don't have quantifiable biomarkers. Despite everything, their impact is great: it is estimated that one in four adults has a mental health problem.

The first step to being able to treat psychological disorders is to define them: their symptoms must be described and given a name. But this is not an easy task. That's why the DSM, an English acronym for the Diagnostic and Statistical Manual of Mental Disorders, an XNUMX book published by the American Psychiatric Association, is so important. It is considered the bible of the field because doctors, psychiatrists, and psychologists around the world use it for their diagnoses.

The first version is from 1952 and the current one, published in 2013, is the fifth, which is why it is known as DSM-5. Although it was updated in 2022, the fact that a dozen years have passed without major changes leads many to believe that it needs to be modernized and work is already underway on a new edition. As one might expect, a manual that aspires to be a reference text, even if it tries to reach consensus, is the focus of criticism from those who do not entirely agree with its criteria. After all, any choice will have a personal bias.

More autism diagnoses

In this context, the controversies surrounding the definition of autism must be framed. The DSM-5 represented an important change in this regard, because, based on common basic mechanisms, disorders as different as classic autism or Asperger's syndrome, which are at opposite ends of the functionality axis, were grouped under the same label (autism spectrum disorder, or ASD). This is why the arrival of the DSM-5 led to an increase in autism diagnoses.

A current trend, with broad support, would be in favor of creating new definitions for mental illnesses for the sixth edition of the manual that are not confined to specific categories, but are characterized by groups of more or less common symptoms quantified independently of each other. In the case of autism, this would imply using an even broader label, that of neurodivergence, which would view the mind as the result of a multidimensional matrix.

From this point of view, the human brain presents a wide range of functionalities, what we call neurodiversity. Some people, however, are on the margins of the spectrum, and are known as neurodivergent, as opposed to neurotypical, which would be all the rest. These individuals may have problems because they process reality in a way that others may find jarring and which can make it very difficult for them to interact with their peers. This divergence would be the sum of different parameters that usually go together, such as autism, attention deficit, obsessive-compulsive disorder, and intellectual disability, and each affected person would have a certain level of each parameter. This would explain why many of these disorders are often superimposed and the symptoms vary so much from one person to another, even though the underlying biology is identical.

The impact of neurodivergence

Precisely, an important factor that is absent from the DSM-5 is the effect that this divergence has on quality of life. Two people with the same diagnosis of ASD can suffer a very different functional impact from each other, which can range from feeling unable to lead a normal existence to not even considering themselves disabled. And socioeconomic factors also play an important role here: people from unstructured environments, without adequate support, or belonging to minorities may experience more severe consequences than others. Furthermore, we are now beginning to have some biomarkers that could facilitate diagnosis, such as certain genetic patterns that are seen more often in autistic individuals. Some experts are calling for all of this to be included in the next edition of the manual.

The future version of the DSM (which has already been said that it will probably change the adjective statistical in the title to scientific to reinforce the main parameter that should guide the definitions) will also aim to go beyond experts and reach the general population. This is important because many mental disorders, and in particular neurodivergences, generate more problems for users because they are not understood by the rest of the population. After all, breaking the myths and barriers that have been erected around mental health is, perhaps, the action that can have the most impact on the well-being of affected individuals. This new definition of autism may take a few years to fully materialize, but it will certainly be an important step forward in helping to better integrate people who have a brain that functions differently from the rest.