Autism is a spectrum of disorders that are diagnosed on the basis of an individual's behavior in two realms — social communication and social interaction, and repetitive or restricted patterns of behavior. While autistic people may share some characteristics, there is a huge variation in how the disorder manifests itself. Hence the use of the word "spectrum" in describing the condition. In fact, there is so much variation in autism symptoms that it is commonly said: "If you've met one autistic person, you've met one autistic person."

Asperger's syndrome was considered a subtype of "high-functioning" autism, characterized by the absence of a key symptom of classic autism — developmental delay in speech and language acquisition. However, DSM-5 eliminated this classification of Asperger's and autism is now categorized differently.

The prevalence of autism in the United States has increased dramatically in the past two decades, the most recent available estimate being 1 in 68 children. The disorder is 5 times more common in boys (1 in 42) than among girls (1 in 189).[1]

Defining Autism

Autism is an umbrella term for a wide variety of neurological, cognitive, psychological and behavioral characteristics. The use of the word "spectrum" is intended to convey the diversity of these characteristics. However, some experts believe that this is a temporary approach, and that with more research into the genetic and pathophysiological factors underpinning these characteristics, it will get divided into sub-types, and possible different conditions.

Today the accepted definition of autism comes from the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official diagnostic and classification tool for the American Psychiatric Association. In 2013, the fifth edition of this manual (DSM-5) was released and a big change was made to the classification of autism spectrum disorders.

DSM-IV Diagnostic Criteria

Until 2013, the autism spectrum was broadly divided into:

The only clinical difference between Asperger syndrome (often just called Asperger's) and classic autism was that language acquisition was not delayed in Asperger's and there was no significant delay in cognitive development. Individuals with Asperger's — often called Aspies — often have difficulty in social settings, which ranges from awkwardness to anxiety, lack of empathy (this is debatable) to preoccupation with a narrow subject, and one-sided verbosity. However, as kids grow up, they are able to better cope in a neurotypical world because their cognitive abilities are intact (and, some may argue, often superior).

Diagnostic criteria for Asperger's, DSM-IV (1994)
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Diagnostic criteria for Asperger's, DSM-IV (1994)

An Autist's Description

From an excellent autism FAQ, here is an excerpt that discusses Asperger's and autism:

The only difference in diagnostic criteria between Asperger's and Autistic Disorder is "no clinically significant delay in development of language." This has usually been understood to mean that people who begin to use speech by a normal age would be diagnosed with Asperger's, whereas people who do not use speech by a normal age would receive an Autistic disorder diagnosis.

In practice, the terms "high functioning autism" and "Asperger's" are used interchangeably, and many people receive both labels. Some people take issue with this distinction, and claim that there is no true validity behind it. They point to the extreme delay in acquisition of social or pragmatic use of language in people with Asperger's as a clinically significant delay in language, thus invalidating the criteria of "no clinically significant delay in language."

Indeed, individuals diagnosed with Asperger syndrome often interpret language literally. They may have difficulty understanding sarcasm, idioms or figurative speech. This can arguably be considered a delay in language acquisition, so "no clinically significant delay in language" is, to a certain extent, not technically correct.

This was one of the reasons the DSM definition of autism spectrum diagnosis was revised and the diagnosis of Aspergers was dropped altogether.

DSM 5 Diagnostic Criteria

A good guide to the (relatively new) DSM-5 diagnostic criteria for autism can be found here. A summary of the criteria is as follows:

  1. Social Communication: Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
    1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.
    2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated verbal and nonverbal communication, through abnormalities in eye contact and body language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
    3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.
  2. Repetitive Behaviors or Restricted Interests: Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least 2 of the following 4 symptoms:
    1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
    2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric ritual, insistence on same route or food, repetitive questioning or extreme distress at small changes).
    3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests)
    4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects)

With the new criteria defined in DSM-5, Asperger syndrome is no longer a separate diagnosis. The severity of autism is determined based on the severity of the symptoms outlined in the two broad areas.

Diagnostic tools

The MCHAT (Modified Checklist for Autism in Toddlers) is one of the most widely used assessment tools by psychologists and neurologists for the diagnosis of autism. The latest revision is called the MCHAT R/F.[2]

Treatment

Early intervention is important in autism treatment. Autism treatment options for children usually include:

Other systems that often help autistic individuals are

Treatments outside of the mainstream

There isn't a definite known cause of autism, nor is there a "cure". This has led many parents to resort to unconventional methods ranging from benign probiotics to potentially harmful chelation, hyperbaric chambers or methyl-B12 shots and pills. None of these have been scientifically validated, nor are they recommended by the American Academy of Pediatrics. Always consult your pediatrician before administering any medication or procedure to your child.

Autistic Person or Person with Autism?

The neurodiversity symbol is used to represent and show respect for the vast neurological differences between people.
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The neurodiversity symbol is used to represent and show respect for the vast neurological differences between people.

There are two schools of thought on whether it's better to use "person-first" language, such as "child with autism" or "person with autism". Proponents of person-first language believe that autism does not define the individual, and that respect for the individual is enhanced by use of language that puts the person first.

The other camp, which notably includes many autistic people themselves, believes that autism is a part of their personality. They prefer the use of autistic as a descriptor — "autistic people" is like saying "left-handed people." They feel that "person with autism" is somewhat like "person with diabetes", which makes autism seem like a disease. For them, autism is not a disease but simply a different neurology, one that makes them who they are. This point of view is somewhat analogous to homosexuality. Decades ago, before 1970, it was believed that homosexuality is a mental disorder and the DSM classified it as such.[6] However, it is no longer considered a disorder and gay and lesbian individuals have wide acceptance in society today. In a way, the struggle is similar for autistic individuals to be accepted for who they are instead of society trying to "cure" them. Stimming, being non-verbal, or not making eye contact are some characteristics that make it hard to be accepted in the neurotpyical world. Many autism advocates hope to change that by making society more tolerant and appreciative of neurological differences.

Low-functioning vs High-functioning

Another pair of labels often used is "high-functioning" and "low-functioning" autism, or "severe" and "mild" autism. However, advocates for autistic people feel that such labels should not be used. The "high-functioning" label makes light of the challenges and struggles faced by some autistics, who may appear neurotypical but often have to exert themselves really hard and deal with severe anxiety in order to behave in a way that is not natural to them. For example, suppressing their urge to stim. Conversely, the "low-functioning" label — often used for autistics who are non-speaking — automatically overlooks their strengths and abilities, disrespects them and makes their opinions less likely to be heard. What is wrong with Functioning Labels? summarizes this point of view, with quotes and links to several blog posts — here, here, and here — explaining why it is wrong to use functioning labels.

References

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