Understanding Typical Autism

Typical Autism: The American Psychiatric Association (APA) has been instrumental in providing guidelines for the diagnosis of psychiatric and mental disorders through its publication, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Over the years, the DSM has undergone several revisions, with the first edition dating back to 1952.

In 1980, the DSM-3 marked a significant milestone by introducing autism as a distinct diagnosis. Before this, children exhibiting autism-like behaviors often diagnosed with childhood schizophrenia. The subsequent DSM-4, published in 1994, further refined the categorization of autism, delineating it into five diagnostic categories, including autistic disorder, Asperger syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).

For a diagnosis of autism under the DSM-4, a child had to meet three specific criteria, including impairments in social interaction, communication, and repetitive behaviors. PDD-NOS, considered a milder form of autism, required meeting two criteria, with impairments in social interactions being a mandatory element.

PDD-NOS, also known as subthreshold autism or atypical autism, became a term associated with cases where some but not all autism traits were present. It hinted at a less severe manifestation, which some might characterize today as autism with low support needs or  high support needs autism, although the latter term remains contentious.

Pervasive Developmental Disorders (PDD) encompass various conditions characterized by impaired communication and socialization skills. Alongside PDD-NOS, conditions like Asperger syndrome, Rett syndrome, and childhood disintegrative disorder fall under this category.

With the release of DSM-5 in 2013, the APA consolidated the five distinct autism categories into a single diagnostic category known as Autism Spectrum Disorder (ASD). This shift acknowledged the diverse presentations of ASD and emphasized a broader understanding of the condition.

The DSM-5 criteria for ASD focus on difficulties in two primary areas: social communication skills and restricted, repetitive, and sensory behaviors or interests. These criteria are designed to identify a range of traits and intensities, recognizing that ASD manifests in various forms.

Diagnosing ASD requires assessing difficulties in both social communication skills and narrowly focused, repetitive, or sensory behaviors, which must have been present since early childhood. The DSM-5 introduced three levels of ASD, reflecting the amount of support individuals require, ranging from low to high.

A notable departure from the past is how mental health professionals approach the treatment of ASD compared to PDD-NOS. In the past, PDD-NOS and Asperger’s syndrome received similar treatment, given their perceived milder nature. However, the DSM-5 emphasizes tailored support based on the individual’s level within the ASD spectrum.

As of 2022, PDD-NOS was excluded from the International Statistical Classification of Diseases and Related Health Problems, Version 11 (ICD-11). Regardless of the specific diagnosis, whether PDD-NOS or ASD, treatment typically involves a combination of therapies, including behavioral, developmental, speech, occupational, and physical therapies, along with social skills classes for older children.

Source

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
2. Lord, C., et al. (2018). Autism Spectrum Disorder. The Lancet, 392(10146), 508-520.
3. Matson, J. L., & Shoemaker, M. (2009). Intellectual Disability and its Relationship to Autism Spectrum Disorders. Research in Developmental Disabilities, 30(6), 1107-1114.
4. McPartland, J. C., & Volkmar, F. R. (2012). Autism and Related Disorders. Cambridge University Press.
5. Volkmar, F. R., et al. (2014). Handbook of Autism and Pervasive Developmental Disorders (4th ed.). John Wiley & Sons.