NeuroTribes: The Legacy of Autism and the Future of Neurodiversity

by Steve Silberman

In fact, the numbers were rising a little too steeply, because the DSM-IV editors had made a small but crucial error in the final run-up to publication. Instead of requiring that a child display impairments in social interaction, communication, and behavior before getting a diagnosis of PDD-NOS, the criteria substituted the word or for and. (In other words, a clinician could deliver the whole banquet by choosing one from column A.) This fateful typo went uncorrected for six years and was unacknowledged in the literature until the editor of the DSM-IV Text Revision, Michael First, finally copped to it in a notably understated article in an obscure journal in 2002. This certainly didn’t mean that every child diagnosed with PDD-NOS in the years between 1994 and 2000 was misdiagnosed, but the impact of the botched language was potentially significant. By reanalyzing the field-test data using the erroneous wording, Volkmar found that “about 75 percent of children identified by clinicians as not having the disorder (true negatives) were incorrectly identified as having it according to DSM-IV.” For epidemiologists gauging the DSM-IV’s impact in the crucial period that would go down in history as the years a mysterious “autism epidemic” took hold, it was a statistical nightmare. Yet, until author Roy Richard Grinker called attention to the typo in his 2008 book Unstrange Minds, hardly anyone outside the usual tiny circle of experts was aware of it.