A Guide to Understanding the Full Ramifications of Autism Spectrum Disorder
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With more and more children and adults being diagnosed with autism, people have many questions. What is autism? What are signs that a person is autistic? What is the “autism spectrum”? Can a person outgrow autism, or is it for life? Are there different kinds of autism?
With so much information, and misinformation available, it can be an extremely difficult task to know what is true. To make matters more confusing, psychologists and psychiatrists are still learning more about autism and are often updating their research and classification methods. Knowledge of autism can in some cases become outdated or irrelevant with time.
This article will work as an introductory guide to what autism is, and hopefully will answer some of the more pressing questions and concerns associated with this disorder.
What is Autism Like?
If you’re just learning about autism, you may wonder what it’s like. How do psychologists and psychiatrists diagnose autism? What criteria do they use to diagnose autism?
Doctors use something called the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) to determine if children and adults match certain symptoms that are most closely associated with certain disorders.
Below are some of the major indicators they use to assess Autism Spectrum Disorder (ASD).
What Are the Major Symptoms of Autism?
It’s important to point out that no two people who are on the spectrum exhibit autistic traits in exactly the same way. While there are often commonalities between ASD people, it would be in error to say that ALL autistic people have all the same symptoms or attributes. However, below is a list of symptoms that are often associated with ASD.
When it comes to social interactions, most ASD people have some difficulty. The degree of social difficulty varies, but it’s something that most people on the spectrum have in common.
ASD individuals may have trouble making friends or interacting with people around them. They often will not initiate play or conversations with others, often prefer to be alone, and may not show affection. In fact, they may be resistant or uncomfortable displaying or receiving affection.
Many ASD individuals have trouble expressing emotions and may seem detached. They consequently also have trouble relating to other people and other people’s emotions emotions, which may appear as a lack of empathy for others. In many cases, it may not occur to them to show empathy.
Another common sign of autism is trouble making eye contact, and inappropriate facial gestures or facial gestures that don’t match their emotions.
When it comes to speech, ASD people often struggle to understand tone, humor, or sarcasm. Children may have speech delays as an early indicator of autism. It’s not uncommon for them to use repetition of words of phrases. The repetition of phrases is not meant to communicate, but rather to self-stimulate or calm themselves.
Often ASD people have difficulty expressing their needs which may turn into a meltdown or tantrum, especially in children. Adults and children may struggle to keep a conversation going with people around them.
As with speech, sometimes ASD people will display repetitive body movements like hand flapping, rocking, or spinning. They may be clumsy, have unusual posture, or move in an unusual way.
People on the spectrum often have sensory processing issues that are either a hyper or hypo sensitivity to input. People who are hypersensitive may overreact to things like loud noises or uncomfortable clothing. People with hypo-sensitivity underreact to stimuli.
This may manifest as having an unusually high pain tolerance or seeking extra stimuli to regulate their system. Many ASD people show signs of both hypo and hyper sensitivity.
People on the spectrum may become obsessed with certain objects, or a primary field of interest. For children this may be about a certain subject (trains, for instance is a common one). For adults it may be a particular field of study or career. When something becomes of great interest, they will learn everything they can about it, and often repeat facts to anyone around them.
Many people who are on the spectrum have a difficult time when their routine or schedule is disturbed. When plans change too abruptly they can struggle to “go with the flow,” or to transition. For children especially this can lead to a tantrum or meltdown.
Children who are on the spectrum do enjoy playtime, but they do not always behave the same way as neurotypicals. ASD kids tend to not play with toys in an imaginary way or participate in make believe games. They may have a fascination with spinning things like the wheels on a toy, or they may spend a lot of time lining up toys or objects.
Some ASD kids become attached to inanimate objects like a key, a string, or a rubber band. Because ASD kids often struggle with communication and social skills, they may struggle to do things like sharing toys and taking turns.
Can Autism be Outgrown?
A simple answer to this question is no. Whether Autism is mild, moderate, or severe, it is something that people on the spectrum are born with. It is the way that their brains are wired.
While there are some small studies indicating that some children who have received intensive therapy have “outgrown” autism, the studies are extremely limited and the outcome is rare. Still in the beginning stages of research, it’s almost impossible to know whether the treatment had that significant of an affect on the children, or if they were possibly misdiagnosed from the beginning.
While this new discovery can offer some hope for parents, it can be equally damaging. Parents should understand that even if they receive the earliest intervention, with the most support and therapy, it is highly unlikely that a child will outgrow ASD.
What can offer hope is that many people with autism are able to adapt and learn to manage some of their symptoms. Early intervention is extremely helpful in managing symptoms that make life more difficult. It is also helpful in aiding children who have more severe symptoms become more independent and function with less support.
It’s also important to note that while autism offers drawbacks and many challenges, people on the autism spectrum also offer many unique gifts. Even referring to autism as something that could be, or should be, “cured” is offensive to some.
Some autism advocates believe that people should be more open to “neurodiversity,” and should not want or expect people with autism to be cured. Elizabeth Picciuto writes, “‘Neurodiversity’ advocates are not interested in finding a cure for autism. Rather than changing autistic people so that they fit into a narrow stripe of acceptable behavior in the world, they’d like to see the world expand its concept of acceptable behavior to include people with autism.”
What are the Different Types of Autism?
As psychiatrists, psychologists, and therapists seek to understand and categorize autism, their definitions change over time. Pre-2013, autism was defined in 5 categories: Pervasive Developmental Disorders (PDDs): Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).
Post 2013, for simplification, autism is now defined as “Autism Spectrum Disorder” and no longer categorizes individuals the same way.
Below will outline how autism is defined today, but will also include former categorization since these terms are still sometimes used.
What is an Autism Spectrum?
Post 2013, people who are autistic are included in the “Autism Spectrum Disorder.” Because there is so much diversity among ASD individuals, it becomes almost impossible diagnostically to categorize people based on specific symptoms alone.
Instead, today, there are three levels of autism. These levels are not as much based on specific symptoms, but rather the severity of the symptoms. They are also used to help explain how much assistance, or what level of support, is needed for an individual to function.
ASD people within this category typically require significant support. Someone in this category may have very limited speech or communication and they will have severe impairments in functionality. They may be inflexible, struggle with interruptions in routine, and will most likely exhibit repetitive behaviors. They will be highly unlikely to initiate interaction with other people, or to respond to interaction from others.
People in this category will exhibit these traits “across all spheres.”
ASD people in this category will need moderate support. They are described as needing “substantial support.” Level 2 ASD people will have many of the same attributes as level 3, but less severely.
These individuals will have more communication abilities than those in level 3, but they will probably still have limited verbal skills and odd non-verbal skills. They will likely be inflexible, struggle with schedule changes, and exhibit repetitive behaviors.
Level 2 ASD people will experience difficulty in functioning in “a variety of contexts.”
Level 1 ASD individuals are described as “requiring support.” People in this category will likely be verbal, but will still struggle with social skills like back and forth communication. They will struggle to initiate interactions with others and may lack interest in the feelings or interests of others. They may struggle to make friends and may come across as odd or unusual.
They may experience difficulty in functioning in “one or more contexts.”
What is Aspergers?
While Asperger's Syndrome is now diagnostically considered an outdated term, it is still used in some contexts. It is understood to mean a person with “high functioning autism.” A person who had formerly been referred to as having Aspergers Syndrome will now likely fall into the category of “Level 1.”
Someone with Aspergers will likely be able to function in life independently, but will probably struggle socially. Because most people with autism lack typical social skills, they often struggle to gain and maintain friendships and relationships.
People within this category could also exhibit repetitive behaviors, irregular body movements, and have trouble making eye contact.
A person with Aspergers may be very intelligent and express great knowledge about a particular field of interest. It is most common that they would have an intense focus on one or two subjects of interest.
“Mild Autism” is not a diagnostic term, but it is a term that people use. This term is not very helpful in describing the level of someone’s autism. An individual might be considered “high functioning” under certain circumstances, for instance very verbal and highly intelligent, yet also have severe sensory processing issues making it difficult for them to live normally in public settings like school or a physical work space.
Alternatively, an individual with poor verbal skills might have less severe social or sensory restrictions, meaning that they would be more comfortable in social settings. It would be difficult to determine which of the two is exhibiting “mild” autism, in this case.
While the term is meant to express low severity, it can be misleading and is often connected more to the situation or setting that a person finds themselves, than it is to the specific individual.
What is Pervasive Developmental Disorder, not Otherwise Specified (PDD-NOS)?
PDD-NOS is another outdated diagnostic term meaning autism that is more severe than Asperger’s Syndrome, but less severe than “Classic Autism.” It is sometimes referred to as “atypical” autism because a child or adult diagnosed with PDD-NOS may not exhibit all the traits of classic autism.
For instance, someone who had been diagnosed with PDD-NOS might exhibit autistic traits socially, but may not exhibit other common signifiers like sensory issues or repetitive behaviors.
Childhood Disintegrative Disorder
Childhood Disintegrative Disorder (CDD), sometimes referred to as “Heller’s Syndrome,” was sometimes considered part of the autism spectrum because it shares similarities of autism. However, because CDD is a rare genetic disease, it is no longer included in the ASD.
CDD is a disease that would appear in children who show typical development, but would then begin to regress between the ages of 2 and 4. Children with CDD often develop seizures disorders as well.
Rett Syndrome is another genetic disease that was once associated with autism, but no longer is. Rett Syndrome shares some similarities to autism, but it is not on the spectrum. According to Rettsynrdrome.org, “Rett syndrome is a rare non-inherited genetic postnatal neurological disorder that occurs almost exclusively in girls and leads to severe impairments, affecting nearly every aspect of the child’s life: their ability to speak, walk, eat, and even breathe easily.”
Children with Rett Syndrome usually have repetitive hand movements and greatly impaired motor movements.
With Autism Spectrum Disorder there is a great deal of information and misinformation. It is compounded by the fact that diagnostics, categories, and explanations have changed a lot over the years.
What’s most important with people who are on the spectrum is not how they are categorized, but rather that they receive therapy or intervention of some kind. The earlier the intervention, the greater the benefit both for those with autism, and their caregivers. Over time, with care and patience, caregivers and ASD individuals will learn to adapt to the unique lifestyle of ASD.