Autism spectrum disorder (ASD) has, thanks to the hard work of advocates, become much more well known in recent years, and yet, many questions remain. A common question is whether autism is a mental health disorder or whether it falls under a different diagnostic category.
Unfortunately, this debate misunderstands the nature of mental health diagnostics. A better and more important question may be how can we best meet the deep needs of those with autism spectrum disorder and their families.
Is Autism Spectrum Disorder a Mental Health Diagnosis?
Mental health disorders are most commonly defined by problems with behavior, emotions, and thinking that affect a person’s ability to function in one or more life areas. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) provides specific diagnostic criteria. People often assume mental health diagnoses only cover problems such as depression or anxiety, but the DSM-5 has a broad range of categories.
ASD falls under the Neurodevelopmental Disorders category. The DSM-5 defines these disorders as “developmental deficits that produce impairments of personal, social, academic, or occupational functioning.” In other words, these problems start in childhood and affect the person’s day-to-day functioning.
To better understand autism spectrum disorder, consider the other disorders in this category: intellectual disabilities, communication disorders, motor skills disorders, specific learning disabilities, and ADHD. While we might not always think of these conditions as “mental health” issues, they affect the same daily functioning as challenges you would consider mental health issues.
The ASD diagnostic criteria reflects our current understanding of ASD problems, such as language delays, learning problems, and levels of outside support needed. When people argue that ASD isn’t a mental health condition, they misconstrue the meaning of the term mental health.
Mental health includes all areas of functioning, not just feelings and emotions. Arguments to the contrary ignore the now widely accepted notion that body and mind work together. Therefore, developmental disorders —like ASD — hold a rightful place in the DSM-5.
Mental Health Stressors for Caregivers
Sometimes when we get caught up in whether ASD should “count” as a mental health diagnosis, we neglect to recognize the concerns of those living with the condition. The more important concern is solving the real problems these individuals and their families face.
Autism spectrum disorder is a serious, life-long diagnosis that often requires long-term care. Like any other chronic medical condition, it takes a toll on family members providing that care. Here are just a few things to consider:
People with ASD, especially children, often have impulsive behaviors and little sense of danger. Some need constant supervision to ensure their safety. For example, they may dart away without awareness of risks such as oncoming traffic or getting lost. They may also engage in self-stimulatory behaviors that require intervention, such as head-banging or skin-picking.
These supervision needs require abundant resources and time, making other activities hard to accomplish. If the individual with ASD also has siblings, parental resources can be slim or stretched by the high level of care demanded; the other children in the family may suffer as well. In these situations, siblings may develop their own behavioral or emotional difficulties, which, of course, further tax parental resources.
Because of the constant and demanding need for care, individuals with ASD often have parents or guardians dealing with exhaustion or burnout. Unfortunately, it’s also difficult to find inexpensive, reliable, quality caregivers to substitute for the family members who know the individual’s needs so well, but require time away to rejuvenate.
This is an especially challenging area since many with autism spectrum disorder have limited language abilities. It’s difficult to leave a loved one with a caregiver when your special needs child can’t tell you if something goes wrong. Therefore, caregivers often get little respite, and seldom ever time to recharge and relax.
Most of us count on our children needing less care as they grow older and, hopefully, being self-sufficient or capable of caring for us in our old age. This isn’t the case for those with autism spectrum disorder. Perhaps one of the greatest strains I see when working with these families is their worry for the future.
Caregivers don’t know who will be able to care for their special needs loved one if they themselves are unable to do so. In addition, parents struggle with the idea of asking siblings to care for the adult child with ASD — it often feels like an unfair and demanding life-long burder — however such arrangements are often the only option.
Many insurance companies limit coverage or fail to cover care and services for those with autism spectrum disorder, which are both time consuming and expensive. Families face ongoing financial burdens, and often must make difficult financial choices about the services they procure. Again, if there are siblings, it becomes difficult to balance the needs of each child. and the financial burden contributes to the emotional distress and fatigue of the entire family. It can feel like no one is actually getting their needs met.
While ASD might not seem like a typical mental health disorder — as one may consider anxiety or depression typical — it holds a logical place in the diagnostic manual, along with all other developmental disorders that affect thinking, learning, and behavior. More important is addressing the needs of individuals with autism spectrum disorder and their families. For more information about ASD, check out the National Institute of Mental Health information or the Centers for Disease Control.