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Home Tag: "Asperger"

Tag: Asperger

23Feb

Autism is a condition that has been with humanity since the start of the species, but unlike some other illnesses, such as tuberculosis, or pneumonia, it was not easily recognized. For centuries, autism wasn’t even regarded as a distinct condition but was often misdiagnosed as other forms of illness. It wasn’t unheard of, for example, for certain types of autism to be diagnosed as schizophrenia, and for patients with such a diagnosis to be treated with antipsychotic medication because some of their symptoms would respond to that treatment.

Today, however, it is a very different situation. Medical science has grown both more advanced and more nuanced, and autism, or Autism Spectrum Disorder (ASD) as it is currently known, is better understood, and given its own distinct medical category. That doesn’t mean that ASD is completely understood, or that there is a cure for it, but the more focused awareness of the condition and its related symptoms means that better research and treatment is now being done.

One of the unique things about ASD is how varied its symptoms are. It’s because of this that when ASD was first given its own category in medical texts, it was initially broken up into four categories. Today, this is no longer the case, but because the change in medical interpretation was recent, having only taken place in 2013, many people are still more familiar with the “classic” categories. There are the autism types people used to be classified under.

The Changing DSM

The classification and diagnosis of ASD are, at least in American medicine, largely defined by on important medical publication, and that is the Diagnostic & Statistical Manual of Mental Disorders, more commonly known as “DSM,” published by the American Psychiatric Association. The DSM was first published in 1952 and is now known as DSM-I. Every time there is a major revision, a new version of the DSM appears.

It was in DSM-II, in 1974, that ASD was first given an entry in the manual, although it was a very different interpretation of the disorder at the time, defined as a psychiatric condition arising from being raised by a cold or distant mother. In DSM-III in the 1980s, ASD was finally recognized as a neurological/developmental condition, and the four classic categories were established.

Asperger’s Syndrome

Considered the “high functioning” version of the disorder, people with Asperger’s experienced the “mildest” symptoms, to the point where some weren’t even diagnosed and were merely considered “eccentric” or “quirky” people. Those with Asperger’s were generally considered able to cope with daily life requirements, though there might be some difficulty in socializing.

Pervasive Developmental Disorder, Not Otherwise Specified

Usually referred to as PDD-NOS, this was a miscellaneous category for people with more severe ASD symptoms. Here the socialization issues are more pronounced, and there may also be additional behavioral symptoms that interfere with other aspects of life, such as work. PDD-NOS was a problematic category because so many people fell into this classification.

Autistic Disorder

This is the “classic” form of ASD, made most famous by the movie Rain Man. Symptoms are much more intense, often leading to an inability to live a normal life. This requires more extensive attention and treatment, and has more visible symptoms such as strongly repetitive motions, very specific means of communication, inability to maintain eye contact, aversion to touching and others.

Childhood Disintegration Disorder

CDD, as it is called, was often considered the most severe form, not only because of how intense the symptoms were but because of the regressive nature of the disorder. Unlike the others, that may have shown evidence early people with CDD may appear to develop normally for a few years, and then display regression, losing language skills, socialization etiquette and even reflexes.

ASD Today

In 2013, with DSM-V, the decades of research finally concluded that four categories of high and low functioning ASD were too simple to convey the condition of ASD accurately. So the four categories were done away with, replaced instead with Autism Spectrum Disorder, with the emphasis being on individual symptoms diagnosed individually, on a spectrum.

This does away with the big problem the previous classification system had, where so many people fell under “miscellaneous” that PDD-NOS diagnoses were out of proportion with other classes, since many people with ASD did not fit “neatly” into the other three categories, thus calling the accuracy and effectiveness of those categories into question.

There is still some lingering stigma from the previous categories, with some biases towards “high functioning” and “low functioning” ASD as a simple way to distinguish a mild case from a severe one. However, the more accurate diagnoses look at what each person’s symptoms are, and how severe or not those individual characteristics are, to come up with an individual approach for the treatment and symptom management, rather than trying to apply only one of four possible treatment possibilities based on categorization.

31Jul

As the name implies, ASD, or autism spectrum disorder, is a condition that lies along a broad range of different symptoms and degrees of severity. Someone that is diagnosed as being in the “mild” end of the spectrum may be able to function more or less normally, and only be considered by others to be a little introverted or maybe eccentric in some habits.

On the other end of the spectrum, symptoms can be so severe that someone diagnosed with ASD can be unresponsive and experience great difficulty interacting with others and performing normal, daily activities without significant challenges. Today, regardless of where along this spectrum a person diagnosed with ASD is, that person is said to have ASD.

However, this was not always the case. As recently as six years ago, there was another form of diagnosis used, primarily in American medical circles, to evaluate ASD. The system used different grades of the spectrum, and it had a specific class of ASD called “Atypical Autism.”

So what was Atypical Autism, and how would someone be diagnosed with it?

All In The Book

Between 1994 and 2013, a specific edition of a document known as the Diagnostic & Statistical Manual of Mental Disorders was used as the textbook reference for medical professionals when diagnosing, identifying, and classifying mental disorders.  There have been five editions of this book, known as DSM since it first started publication in 1952. It was not until the 1980s, with DSM-III that autism was even acknowledged as a unique condition. Before DSM-III children with ASD were diagnosed as schizophrenic and received treatment for such.

After the publication of DSM-III, autism got much more specific examination from medical professionals and had treatments tailor-made for those diagnosed, rather than assuming schizophrenia, which was not an effective treatment and in some cases, even harmful. From this new understanding came the idea that there were different types and “grades” of autism, and one of these was known as Atypical Autism or Pervasive Developmental Disorder-Not Otherwise Specified, also known as PDD-NOS.

What Is It?

The other types of autism were considered Pervasive Developmental Disorders, or PDDs, and fell under five categories; autism, Asperger’s syndrome, childhood disintegration disorder (CDD) and Rett’s Syndrome. The fifth, Atypical Autism, or PDD-NOS, was a “miscellaneous” category for people diagnosed with some autism characteristics who didn’t fit into the other four existing PDD categories.

In effect, atypical autism was an admission that a person being diagnosed had traits of autism, but not “enough” in any one of the four categories to conclusively “drop that person into a box.” In some respects, it is because of the organic, nebulous nature of autism symptoms, and their varying degrees, that when DSM-V eventually came out, the five categories were abandoned, and atypical autism got folded into the others.

What Are The Symptoms?

Atypical autism, when it was still being referred to as such, as had a mix of different symptoms. In the DSM-III and DSM-IV era, Asperger’s Syndrome was considered the “highest functioning” form of autism, with some of those diagnosed with it able to function without any special medical treatment, while those diagnosed with other autism, such as CDD, required more intensive attention and treatment.

Atypical Autism was, in terms of severity, considered somewhere between Asperger’s and typical CDD autism, a “mild” form that didn’t require serious treatment or therapeutic intervention for those diagnosed to have a normal, productive life. The symptoms of atypical autism included:

Atypical/Unusual Social Behavior

This was another broad “umbrella term” that includes potentially everything from delayed responses, to an inability to maintain eye contact. The only consistent thing was that, compared to other people within that culture, the behavior was considered abnormal.

Language/Communication Deficit

Another very broad range of behaviors that could even fall under unusual social behavior. Atypical autism has characteristics such as communication difficulty. This could manifest in delayed communication acquisition, taking much longer to learn to speak, or in unusual speech patterns, such as speaking in a flat monotone, like a “robot,” having never learned to use tone or voice inflection to add nuance to words.

Repetitive Motions/Behaviors

Atypical autism could be characterized by a focus on ritual and repetition. The AA patient would fall back on repeating certain actions or rituals over and over again, either as a way to relax or to feel a sense of control in stressful situations.

Atypical Sensory Experience

Someone diagnosed with atypical autism could have a sensory experience that was different from others, either more intense or less. For example, some could have a much more sensitive experience with touch, reacting much more strongly and negatively to changes in temperature. On the other hand, that sensory stimuli could also be much less refined, such as an atypical autism child have little or no sense of smell, and unable to participate meaningfully in smell-based activities.

Because of this large range of differences, it was eventually decided in 2013 to eliminate the different autism categories. ASD or Autism Spectrum Disorder is now the sole diagnostic category.




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