New Coke and the Autism Diagnosis

How many of you remember the New Coke debacle of 1985? It took place during the heart of the cola wars between Coke and Pepsi. Coke, one of the most popular products ever sold, was worried about losing market share to Pepsi. Despite the fact that  zero people were clamoring for it, Coca Cola pulled the old product and started selling a new formula. It tasted terrible and the backlash was so strong and immediate, they pulled it off the market after a mere 79 days, replacing it with the original formula, which they branded Coca-Cola Classic. Pepsi had a lot of fun with this blunder as did David Letterman, who started one of his monologues by saying "Well, they changed it again! More garlicky this time!"

That Letterman line came back to me a few weeks ago when I came across the first of several articles about the autism diagnosis and what seems to be the stirrings of a drive to change it again. Autism made its first appearance in the DSM in 1980 and since then, it has undergone a number of changes. Most recently, in 2013, it went from several subtypes in the category of Pervasive Developmental Disorders (PDD) in the DSM IV - TR to a unified listing as autism spectrum disorder in the DSM-5. The thinking behind that change centered on the idea that the old system, while doing a reliable job of distinguishing people with autism from people who don't have autism, was much less effective at helping distinguish one subtype from another. Clinicians seemed to use the old subtypes interchangeably so the American Psychiatric Association, the organization that puts together the DSM, decided to cut their losses and group all the subtypes together as autism spectrum disorder. At the time, there was a good deal of division in the field about the wisdom of the changes introduced in the DSM-5.. Personally, I didn't love them. My thought then was that the old system, flawed as it was, had done a great job in bringing together a community known for its challenges in forming community. In the writing I did on the subject, I expressed the concern that the new approach didn't have the specificity that such a nuanced diagnosis calls for and with the new criteria, people would be inaccurately and unfairly pigeonholed. 

As I write this, it's been nearly 13 years since the publication of the DSM-5. As a counselor whose main focus has been in the area of social skills, I interact with autism on a daily basis. I was starting to come to the conclusion that maybe I had been too alarmist in my thinking 13 years ago. For people on the spectrum and those who interact with them, life has gone on. In my experience, people had learned to come to grips with the new classification system without the kind of horrible fallout I anticipated. Sure, a little more specificity might be nice but we could all deal with that, right? 

But then, a couple of months ago, I received an email from one of my clients that got some of my "just below the surface" misgivings about the state of the diagnosis to crystallize. This mom wrote to tell me that one of her 5th grade son's classmates had tried to insult him by calling him autistic. She went on to say that despite the fact that 5th graders have never been known as qualified diagnosticians, the incident got her and her son thinking that maybe he had been right. She asked if I thought her son might be autistic. 

Aside from the ludicrous idea that "autistic" has become a playground insult used by elementary school kids, it was an interesting question. Whether or not he's autistic, this boy is a great kid. He's good hearted, smart, and fun to be around. But the question of whether or not he's autistic involved more than just a yes or no answer. His most recent diagnosis is ADHD, primarily inattentive presentation. But one consequence of the new classification system and its broader set of criteria is that the prevalence of autism has gone up dramatically. At the turn of the century, autism's prevalence in the general population was approximately 1 in 150. Today, it's 1 in 31. So, one of two things is happening. Either pregnant moms have been ignoring RFK Jr.'s 'sage advice' and slamming back Tylenol at a record clip or our understanding of what constitutes autism has changed dramatically. I can say with some confidence that 15 years ago, it's unlikely that this boy would have received an autism diagnosis. When I answered the mom's email, I said that, the chances that he was autistic were 50/50 at most. He has mild presentations of 1 or 2 traits but, to me, he doesn't FEEL like someone with autism. In 2026, I'm sad to say, that means he just might receive the diagnosis anyway. In addition to the expanded definition in the DSM, evaluators seem to be more willing than ever to give the diagnosis to so many of those 50/50 kids. Most evaluators are conscientious and disciplined about it but there are some who recognize that autism tends to open more IEP doors than other diagnoses or than no diagnosis at all. In effect, they give the customers what they want. Maybe at one point the definition of autism was too narrow but in 2026, it feels like it's getting too broad.  

That mom and I went on to have a constructive email exchange and she pointed me in the direction of an episode of The Daily, the New York Times podcast, in which the autism diagnosis was the subject of the day. The Times did a nice job covering the issue and they interviewed Dr. Catherine Lord, a psychologist who served on the DSM committee responsible for the changes to the diagnosis in 2013. She acknowledged some unintended but problematic consequences of the changes that she's moving to rectify as the APA puts together the next DSM. This may come across as a bit "Inside Baseball" but I need to point out the irony of her pointing out the lack of specificity as being problematic when that was one of the main critiques leveled when the DSM-5 was being formulated. Be that as it may, the DSM-6 is likely to come out sometime within the next few years.

I also had the chance to read an article in the Washington Post that describes a large study (over 5000 subjects) that integrated brain imaging, genetics, and computational science to lead its authors to suggest that there are 4 distinct types of autism. 

My intention is not to say that in short order, the challenges of diagnosing autism will be solved by genetic testing, brain imaging, or other cutting edge medical magic. In the end, diagnosis will retain a strong subjective nature well into the future. Most mental health diagnoses involve some traits that are common to everyone at one level or another and determining where it stops being "normal" and starts becoming pathological is, to some extent, a judgement call. And none of this is meant to diminish the value of neurodiversity or of neurodivergent people; it's about making sure our diagnostic tools and criteria do the best job possible when it comes to serving the people they're meant to help. 

In the end, the Coca Cola company discontinued the production and sale of New Coke because it listened to its customers and changed course. I'm hoping the APA does something similar when the DSM-6 is published.