Many Different Autisms; One Autism Spectrum
Autism is a “spectrum disorder,” meaning that people with autism may have a wide range of mild, moderate, or severe symptoms. But do all people with an autism spectrum diagnosis have the same disorder, no matter what their symptoms?
How Autism Diagnoses Have Changed in Recent Years
From 1994 to May 2013, the autism spectrum was represented by five autism spectrum diagnoses in the fourth version of the official Diagnostic Manual. They included Asperger syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Autistic Disorder, Childhood Disintegrative Syndrome, and Rett Syndrome.Unfortunately, these diagnoses were confusing. Not only were they difficult to define, but different practitioners selected different diagnoses for the same patients. To clarify their diagnoses, practitioners (as well as teachers and therapists) used terms like “severe autism,” “mild autism,” and “high functioning autism.” These terms, however, aren’t true diagnoses at all; they’re just descriptions. And while they were intended to help parents and teachers better understand a child’s status on the autism spectrum, each practitioner had their own idea of what “mild” or “severe” might look like.
How We Think About Autism Today
In 2013, the fifth version of the Diagnostic Manual was published. In the DSM-5, there is just one “autism spectrum disorder.”
Everyone with an autism diagnosis, no matter what his or her symptoms, is now lumped under that single diagnosis. Three levels of autism, along with descriptors such as “nonverbal” are intended to make diagnosis easier and clearer.
But that doesn’t mean we’ve stopped using the older or informal terms, some of which are a bit clearer than Autism Spectrum Disorder Level II. In fact, even doctors and other practitioners are likely to use terms like Asperger Syndrome while using the new autism spectrum code for billing purposes.Welcome to the complex world of many autisms.
What Is the Autism Spectrum?
The “autism spectrum” describes a set of developmental delays and disorders which affect social and communication skills and, to a greater or lesser degree, motor and language skills. It is such a broad diagnosis that it can include people with high IQs and mental retardation. People with autism can be chatty or silent, affectionate or cold, methodical or disorganized.Until May 2013, official diagnoses within the autism spectrum included autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), Asperger syndrome, Childhood Disintegrative Disorder, and Rett Syndrome.
Today, there is just one Autism Spectrum Disorder, with three levels of severity—but many therapists, clinicians, parents, and organizations continue to use terms like PDD-NOS and Asperger syndrome.
What Are Pervasive Developmental Disorders?
“Pervasive Developmental Disorder” is a formal term that, between 1994 and 2013, meant exactly the same thing as “autism spectrum disorder.” If your child was diagnosed before 2013 you may have heard this term from an evaluator or doctor, but it is no longer in general use.
Key Points:The term Pervasive Developmental Disorder is no longer in general use
- The term was synonymous with autism spectrum disorder
- People with PDD have a wide range of developmental differences which can be mild or severe
What Is Asperger Syndrome?
Asperger syndrome describes individuals at the highest-functioning end of the autism spectrum. The term—and the diagnosis—was removed from the diagnostic manual in 2013, but virtually everyone in the autism community continues to use it because of its usefulness in describing a very specific group of people.
People with Asperger syndrome generally develop spoken language in the same way as typically developing children but have a tough time with social communication.
These difficulties become more obvious as they get older and social expectations increase. Because people with Asperger syndrome are often very intelligent – but “quirky” – the disorder is sometimes nicknamed “geek syndrome” or “little professor syndrome.”
- Asperger syndrome is no longer a valid diagnosis
- Asperger syndrome was and is still often used to describe people with “high functioning” autism
- Most people with the symptoms of Asperger syndrome are of normal or above normal intelligence with strong verbal skill and significant difficulties with social communication
- Many people with Asperger syndrome have significant sensory challenges
- People with the symptoms of Asperger syndrome are now considered to have Level 1 Autism Spectrum Disorder Asperger Syndrome Is No Longer an Official Diagnosis
What Is Mild Autism?
The term “mild autism” is not an official diagnosis. It’s simply a more descriptive term than “Asperger syndrome” or “autism.” Generally speaking, when people use the term mild autism they are referring to individuals whose symptoms fit an autism spectrum diagnosis, but who has strong verbal skills and few behavioral issues.
Those individuals may, however, have significant problems with social communication. They may also have problems coping with too much sensory input (loud noise, bright lights, etc.).
- Mild autism is essentially similar to or identical to Asperger syndrome
- People with mild autism may be difficult to recognize until they are under stress or coping with complex social situations
- Most people with mild autism are now considered to have Level 1 Autism Spectrum Disorder
What Is High Functioning Autism?
Like “mild” autism, high functioning autism (sometimes shortened to HFA) is a made-up term that’s become more and more commonly used. At one point (before 2013), the term was used to distinguish “autism” from “Asperger syndrome.”The official distinction made by practitioners before 2013 was that people with HFA had or have speech delays while people with Asperger Syndrome have normal speech development. Of course, these days there IS no Asperger syndrome, making the distinction moot.
- High functioning autism, like mild autism, is similar to Asperger syndrome and would now be termed Level 1 Autism Spectrum Disorder
- Unlike people who were diagnosed with Asperger syndrome, people with HFA developed language slowly or idiosyncratically
- Like Asperger syndrome and mild autism, HFA is a real and significant disability which can lead to challenges in managing social situations, school demands, work expectations, or recreational activities.Why High Functioning Autism Is Hard to Define
What Is PDD-NOS?
“Pervasive Developmental Disorder Not Otherwise Specified” is a mouthful of words that, until 2013, were used to describe individuals who didn’t fully fit the criteria for other specific diagnoses but are nevertheless autistic. Because there is no easy way to define the symptoms of PDD-NOS, which may range from very mild to very severe, the diagnostic category no longer exists, though a new diagnosis, Social Communication Disorder, may become a similar “catchall” category.
- As of 2013, PDD-NOS is no longer a valid diagnosis
- PDD-NOS was a “catchall” for disorders with autism-like symptoms that didn’t fit the full criteria for
- People with PDD-NOS could have mild or severe symptoms
- Those people who were diagnosed with PDD-NOS prior to the DSM-5 will now have an autism spectrum diagnosis and may be diagnosed at Level 1, 2, or 3 depending on the severity of symptomsPDD-NOS Was Part of the Autism Spectrum
What Is Severe Autism?
- Severe autism is usually diagnosed as Level 3 Autism Spectrum Disorder
- Severe autism is extremely challenging and may include aggression and other difficult behaviors
- Most people with severe autism never gain meaningful use of spoken language
- Some people with symptoms of severe autism do gain the ability to communicate through signs, picture boards, or other means
What Is Rett Syndrome?
Rett syndrome is a genetic disorder that affects only girls. It is the only one of the former autism spectrum disorders that can be diagnosed medically (so far); as of May 2013, it is no longer included in the Autism Spectrum.Girls with Rett syndrome develop severe symptoms including the hallmark social communication challenges of autism. In addition, Rett syndrome can profoundly impair girls’ ability to use their hands usefully.
- Rett syndrome is no longer part of the autism spectrum
- Rett syndrome is a genetic disorder which can be medically diagnosed
- Rett syndrome impacts only girls
- Symptoms of Rett syndrome include social communication challenges and the loss of purposeful use of one’s hands
What Is the Broad Autism Phenotype?
The broad autism phenotype includes those people with the merest touch of autism. This is sometimes described as having “shadow symptoms.” These sub-clinical symptoms can include social awkwardness, anxiety, a preference for sameness and routine, and an unusual degree of discomfort around bright lights, loud noise, and other sensory “assaults.”Such mild symptoms, which are recognizable but which do not significantly impair daily functioning, are common among family members of people with full-blown autism. Is this really autism? Or just a personality type? As with many issues related to autism, it depends on whom you ask. Either way, it is often helpful for people with such symptoms to seek help with building social communication skills and coping with sensory challenges.
- There is a “broad autism phenotype” which includes people with milder autism-like symptoms
- Many people with such symptoms have children or other relatives on the autism spectrum
- Many of the treatments available for autism can be helpful for people with milder versions of the same symptomsMaking Sense of the 3 Levels of Autism
Autism Terms Aren’t Always Helpful
While some autism-related terms are descriptive, they’re not always terribly helpful. That’s because each and every individual on the autism spectrum is unique. Even if you think you know what a term means, it’s always important to learn more about a particular individual’s strengths and challenges.