At Psychobabble, Hannah Spier traces the rise of autism from its first formal definition to something that 1 in 36 kids is diagnosed with:
When Leo Kanner first defined autism in 1943, it was estimated that 4 to 5 children per 10,000 were affected. Today, the CDC puts that number at 1 in 36, almost one child in every classroom. If any other medical condition, blindness, epilepsy or paralysis showed a spike like this, it would trigger a pandemic-level outcry. But with autism, we see at best a curious murmuring as to what this is, and at worst, a growing chorus of people insisting, they too, belong in the group.
From experts, instead of raised alarms or calls for serious public health investigation (as would be expected for any other childhood disorder) we get calls for inclusivity and a self-congratulatory attitude toward their advancement in diagnostic understanding and tools. Another example of ideological capture of psychiatry by cultural sentiment.
Characters like Sheldon Cooper and Sherlock Holmes have helped turn the image of autism into a badge of honour. It means you’re socially odd, intellectually superior, and emotionally detached in an edgy and endearing way. For many, especially mothers with narcissistic tendencies hungry for a narrative of exceptionalism, this offered a seductive reframing of their child’s misbehaviour and non-conformity as evidence of giftedness. She could thus become the one who gave birth to the quirky but special genius. She alone saw the hidden brilliance beneath the “weird” behaviour. She became the martyr and the insider to an elite subculture. It’s Munchausen by proxy, 2025 edition.
People with narcissism and psychopathic traits exploit wherever they can, we know this. And yet again, psychiatry, the ones who should be the best at recognizing these, made it easy pickings by flinging the diagnostic gates wide open. Longtime readers will recognize the pattern: I’ve written before about the diagnostic creep in trauma, expanding definitions that blur the line between disorder and ordinary variation. The same diagnostic creep has unfolded here. Autism, once narrowly defined, was steadily loosened through each revision of the DSM.
The Great Diagnostic Expansion
Originally, Kanner’s autism was unmistakable: nonverbal children, socially disconnected, cognitively impaired, often with seizures. These were not quirky introverts. These were children who required full-time care and specialized schooling. In the DSM-III of the 1980s, it was called infantile autism. The criteria required clear onset before 30 months, marked language delays, gross deficits in social interaction, and repetitive behaviours. These were developmental dysfunctions, not misunderstood personalities. And neither clinicians nor parents had a problem naming them as such.
Then came the DSM-III-R in 1987, which introduced pervasive developmental disorder not otherwise specified (PDD-NOS) and broadened the field significantly. Suddenly, language delay and intellectual disability were no longer central. Subclinical cases were included. Asperger’s Syndrome followed in the DSM-IV in 1994, adding high-IQ individuals with no language delays but poor social functioning. A child who spoke on time but didn’t understand jokes, had poor eye contact, and rigid routines was now also autistic.
But the most dramatic change came with DSM-5 in 2013. The subtypes were eliminated. Autism became one spectrum. The criteria were thinned down to two domains: social communication difficulties and restrictive, repetitive behaviours. A person needed to meet just six out of twelve traits, spread across these two clusters. Language and cognitive delay? Optional. Even the requirement for early onset was removed. A diagnosis could now be given based on historical symptoms. Questionnaires like the Autism Spectrum Quotient (AQ) are so broad and subjective they can be easily gamed. This made it possible for 30-year-olds to recall feeling “socially overwhelmed” in school and not liking itchy clothing to receive the same diagnosis as a nonverbal child requiring lifelong care.
The diagnostic category has become a black hole, pulling in people with no clinical resemblance, collapsing distinction into sameness. From what I’ve observed, three distinct autism “patients” now account for much of the increased prevalence, none of whom would have qualified under the original criteria.
