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Autism Spectrum Disorder is a term that refers to the wide variety of types of autism that children are diagnosed with. Autism can present symptoms ranging from mild to severe and display a wide variety of characteristics from person to person. Because of all of the differentiation from one person to the next, the use of the word spectrum is extremely appropriate when diagnosing a child with autism.
Autism Spectrum Disorder (ASD) is far more appropriate because of the wide variety of characteristics that each individual with autism displays. Oftentimes, it is referred to as low functioning or high functioning autism during conversations between educators and parents or others who work closely with students who have autism. But, that is such a brief and inadequate description because each child on the autism spectrum has a unique presentation that puts them in a different place on the spectrum.
One example of an image that is used to portray the range of abilities on the spectrum is a rainbow, with the lower functioning characteristics of autism on one side of the rainbow and the higher functioning abilities of autism on the other side of the rainbow. In between, are all of the variables of autism from low to high with some abilities on the higher end of the spectrum and others on the lower end. There is no truly consistent pattern from one child to another- only common traits that qualify them to be diagnosed on the spectrum.
How Many Types of Autism Are There?
With such a wide range of characteristics in the diagnosis of Autism Spectrum Disorders, you might wonder how many types of autism there are and how they are categorized.
Autism has been defined by five different types:
Childhood Disintegrative Disorder
A rare neurological disorder that affects children who have normal development for the first three to four years and then suffer a reversal in language, motor, and social skills within a matter of months.
A neurological impairment that affects social interaction, communication, and speech, restricts imagination, sometimes causes repetitive motor behavior patterns and rigid inflexibility that makes any changes in routine or environment very difficult for the person with autism.
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
A child that is diagnosed with PDD has a developmental delay, and usually shows many traits of higher functioning autism but doesn’t meet all of the criteria for autism. Many children who are diagnosed with PDDs outgrow the symptoms over time.
Aspergers (Level 1)
This would be considered high functioning autism
In 2013, Asperger Syndrome was removed from the Diagnostic and Statistical Manual, 5th Edition (DSM-5 is a diagnostic tool used by physicians) and placed under the umbrella of autism spectrum disorders. It made a lot of “aspies” unhappy because they enjoyed the unique position of being placed on a long list of brilliant minds who were suspected of having Aspergers. From Hans Christian Andersen to Jerry Seinfeld to Wolfgang Amadeus Mozart to Tim Burton- the list is impressive and so are many of the accomplishments of those with Aspergers.
A neurological disorder with severe physical impairments that are primarily found in girls.
There have been some exceptions and changes over time as research has progressed.
In 2011, Rett Syndrome was removed from the Diagnostic and Statistical Manual, 5th Edition (DSM-5 is a diagnostic tool used by physicians) and it is no longer considered an Autism Spectrum Disorder. It was removed because it was discovered to be a genetic mutation that can look very similar to autism for a short time when a child is developing.
The Controversy with Rhett and Aspergers
Both Rhett and Aspergers are controversial because they are considered Autism Spectrum Disorders but they both stand alone on their own. Rhett has been removed because the autism symptoms only appear for a small window of time and it is almost exclusive to girls. Aspergers has been wrapped into the spectrum rather than standing apart as its own type of autism- mostly because it was felt that “aspies” should be included in aba services and be eligible for insurance to receive services- so it was necessary to put them under the umbrella rather than stand-alone. So, the DSM has gone from 5 types to 3 levels in order to continue to include Rhetts and Aspergers as spectrum disorders.
Levels of Autism
According to the DSM-5, there are three levels of autism that require some level of support.
Level 1 – (Requiring Support)
As mentioned above this would be the level that a person with high functioning autism or Aspergers would fit into. Level 1 would require the least amount of support. Socially, this person might find it difficult to initiate a conversation without someone else’s support, maintain a conversation or stay interested in what the other person is saying and may not respond as others would expect. Change might be difficult to manage in new situations or environments. Time management, organization skills, and planning are also areas that someone in this category may struggle with. It is also common for a person with high functioning autism to have rigid or inflexible habits, schedules, or behavior patterns.
Level 2 – (Requiring Substantial Support)
This person would have greater difficulty with communication than someone who is considered a level 1. The communication with this person may be reduced to short sentences, limited topics, incoherent speech, odd facial expressions, and sometimes inappropriate responses and gestures. People with level 2 autism are more visibly distressed in social situations and have a much more difficult time with change. Daily life is difficult to cope with and the prospect of living and working independently without support is unlikely. However, some do very well in transitional programs out of high school with mentors and living in adult assisted living while working a part-time job.
Level 3 – (Requiring very substantial support)
People with level 3 autism are extremely limited in verbal and nonverbal communication. Because of their inability to communicate, they are unable to interact with other people, establish friendships, and join peers in activities. These people are usually highly focused on their own behaviors which are almost always repetitive- hand flapping, waving, clapping, flailing, rocking, spinning, or flipping objects- to the point where they cannot focus on anything else. If anyone tries to take their attention away from their focus it causes distress for them. People with level 3 autism do not like change whether it be in their routine, food, activities, or to people they are exposed to. Any sort of change causes distress. It is unlikely that a person with level 3 autism will ever become independent, communicate fluently or be free from the repetitive behaviors that they seem to enjoy and focus so intently on.
Mild to Severe Forms of Autism
When you hear terms such as mild autism or high functioning autism this is usually considered level 1 autism which will require some support in communication, social skills, and behavior. As the levels progress, the support that is required increases. Level 2 autism, for example, may require more support in teaching proper communication skills and how to behave in certain social settings. Level 3 autism would require a substantial amount of support and this support would most likely extend throughout this person’s lifetime.
That is exactly why it is called a spectrum disorder. By definition, the word spectrum is used to classify something, or suggest that it can be classified, in terms of its position on a scale between two extreme or opposite points. The two extreme opposite points of the autism spectrum are mild and severe. Everything between those two points as you move from mild toward severe is open to variations in the characteristics or deficits that you may see in each person with autism.
Does Autism Run in Families?
We have learned a lot about autism since it was first diagnosed in the 1940s by Dr. Kanner. There is still a lot we don’t know but one thing that seems to be true about autism is that it does have some genetic tendency to run in families. To put it very simply without summarizing entire studies, the average risk of a subsequent child being born after one child with ASD has been born into a family is 10% based on group averages. This is a very loose number, but the point is that it has been well established that the tendency is there.
It is not unusual for therapists who work in the field to serve families who have more than one sibling who has been diagnosed with ASD.
As research on autism continues, sometimes we see changes that can seem a little confusing. That’s where our autism experts at Circle Care New Jersey can help. Are there five types or are there three types of autism? To put it simply, the three levels of autism include all of the disorders that were mentioned in the five types. By placing Aspergers and Rett Syndrome under the umbrella of spectrum disorders, it is easier for families to receive referrals for applied behavior analysis (ABA) services. If these disorders were not categorized with autism spectrum disorders, chances are that these children may have been referred to another type of doctor (or no doctor at all) rather than receive ABA services.
So, to sum all this up-there are basically three levels of autism but how many specific types of autism and varieties of characteristics differ from one child to the next from one side of the spectrum to the other. The answer to this question could change as research continues and we continue to learn more about our loved ones on the spectrum!