As the meaning of the word, “Spectrum” is the case of having many different points and characteristics within a certain range. Just like a fan or a rainbow, the spectrum should also be considered as when there are many different points and situations in it.
One of the neurodevelopmental disorder which is autism is called as a spectrum disorder. Because every individual with autism demonstrates the symptoms of autism at different levels.
In some individuals with autism, all symptoms can be clearly observed, whereas in some individuals some symptoms manifest themselves at a much lighter level or maybe some symptoms could not be observed at all.
In this article, I will try to clarify first what spectrum is in detail and what Autism Spectrum Disorder is. Then I will move on to why autism can be considered as a spectrum. And lastly, I will be talking about the type of Autism Spectrum Disorder. These are the main issues that will be discussed in this article.
What Does “Spectrum” Mean?
At the basic level, the spectrum is a condition. But different than we know. It is not limited by specific limitations and specific values. It can vary, you cant fşnd two same variables at the same time. In the beginning, the word “spectrum” was first used scientifically in optics to describe the rainbow of colors in visible light after passing through a prism.
As science improved, the meaning of the word has expanded. It is used by mental health professionals in order to describe disorders and diseases which have same symptoms can be observed at different levels in different conditions. The disorder should be a wide range in order to call it is a spectrum disorder.
Why Can Autism Be Considered as a Spectrum?
Autism Spectrum Disorder is a delay in the development of language skills, social interaction and abstract perception, or the fact that it is not completely delayed. Stereotypes and repetitive behaviors are very common in children with autism.
ASD doesnt choose any specific group. It can be seen in all ethnic, racial, and economic groups. It is a lifelong disorder, there is no point in life that you can treat your disorder. But there are some treatments and services that can improve a person’s symptoms and ability to function. Generally, professionalists recommend to parents that all children be screened for autism. All parents need to talk to their doctors about autism screening or evaluation.
These conditions in individuals with autism are completely independent of intelligence or mental capacity. This is due to the different functions of certain regions in the brain. Autism considered as a spectrum as a result of a change in the symptoms between mild or nonexistent symptoms.
Autism is a spectrum condition and therefore affects individuals to varying degrees. Also, more males tend to be affected by the condition than females. All people with autism share certain difficulties, however, having autism will affect them in different ways. Some of them also may have learning disabilities, mental health issues, or other conditions. It means that people with autism need different levels of support. On the other hand, all people on the autism spectrum can learn and develop themselves.
Autism degrees vary from person to person because the autism symptoms can be seen at different levels in each individual. Therefore, each individual demands different education because their needs are different. Most children with autism have different levels of intelligence. However, regardless of the intelligence level, all children with autism have difficulty understanding their environment.
The diagnosis of Autism Spectrum is based on the internationally agreed diagnostic systems which are Diagnostic and Statistical Manual of Mental Disorders (DSM- 5). There are different diagnostic criteria for all disorders within the spectrum.
For the diagnosis of autism, abnormal developmental characteristics should be initiated before the age of 3 years in children and impaired social communication should be observed in the child at the same time. All the conditions on the autism spectrum must display a certain number of symptoms. The symptoms that the person shows should not be explained by other medical diagnoses.
Autism Spectrum Disorder, which is known as congenital, is defined as a neuro-developmental disorder. After birth, symptoms of autism do not occur immediately. After a certain age, it shows itself more. Especially in children who are older than 3 years of age, parents may start to see troubles and problems more clearly.
Individuals with autistic spectrum have the triad of impairments. They typically have problems with social interactions and relationships. They find it difficult to form and maintain a relationship. As a result or cause, they have problems with speech.
They would only be involved in a narrow range of repetitive activities. A significant proportion of individuals with autism never develop speech and so alternative methods of communication need to be adopted in order to make contact with them.
For the evaluation of Autism Spectrum Disorder, there should not be only one professional. You need to get advice and opinions from different doctors with different specialists. And, you need to go proper hospitals. The team of doctors and other health professionals who are experienced in diagnosing ASD should be examined.
- The developmental pediatrician who is a doctor has special training in child development.
- The child psychologist/ psychiatrist who is a doctor has specialized training in brain development and behavior.
- The neuropsychologist who is a doctor focuses on evaluation, diagnoses, and treating neurological, medical, and neurodevelopmental disorders.
- The speech-language pathologist who is a health professional has special training in communication difficulties and language problems.
These people should also examine because every professional can see different details or symptoms of the disorders. These evaluations may asses cognitive levels, language abilities, and age-appropriate skills that needed to complete daily activities independently such as eating, dressing, toileting, and personal hygiene.
Autism is a complex disorder. It has a tendency to occur with some other disorders and conditions, which means there is a high chance of comorbidity. Mostly, for example, learning disorders is seen along with autism. Thus, a comprehensive evaluation is needed. This evaluation also may include blood tests and hearing test, it is up to professionals’ requests.
According to some professionalists and researchers, autism is just one syndrome that falls under the heading of Autism Spectrum Disorder. Previous disorders, which are classic autism, Asperger’s syndrome, pervasive developmental disorder (PDD), childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD- NOS), are classified under the umbrella diagnosis of Autism Spectrum Disorder.
Moreover, these disorders are known as types of ASD. And these are also sometimes classified under the umbrella of social communication disorder. Because they are related to each other.
Types of Autism Spectrum Disorder
Autism occurs in a spectrum. There is a rangefrom mild to severe. They show different symptoms and different behaviors according to their place on the spectrum. To make it easy, to make treatment easy, professionals classify autism into several types. This helps to assess the severity of a child’s impairment and determines the best treatment to help the child develop the necessary skills for good functioning throughout life.
Although autism seems to be a complex problem, it is a disorder that very easy to understand. Until 2013, when DSM- 5 was published, official diagnoses within the ASD included autistic disorder (classic autism), pervasive developmental disorder- not otherwise specified, Asperger syndrome, childhood disintegrative disorder, and Rett Syndrome.
Today, there is only Autism Spectrum Disorder, with 3 levels of severity according to DSM- 5. Autism is ranked as level 1, 2 or 3, depending on how severe it is and how much support the person needs. However, many psychologists, psychiatrists, parents, and organizations continue to use the other terms, except the Rett Syndrome.
Level 1 Autism
They have noticeable issues and problems with communication and socializing skills. They can have a conversation but it might be difficult to maintain back-and-forth. They can have a problem with making new friends.
People with level 1 autism require support and with the help of support, they can maintain a high quality of life. They have decreased interest and have lived through difficulties initiating in social interactions. They have trouble adapting to changes in routines. They are not good at making plans and organizations.
Level 2 Autism
It requires substantial support. Even with this support, they may have a hard time. They may feel alone. The symptoms show themselves in communication and daily life activities. They are not good at verbal and nonverbal communication. They have problems coping with daily life. There are some behavior issues severe enough to be observed even to the casual observer. They have an unusual response to social cues or social interactions, or maybe even no response.
Level 3 Autism
It is the most severe level of autism. These individuals need very substantial support. Especially they may need a caregiver. These people can help them basically to survive in daily routine. In addition to a more severe lack of verbal and nonverbal communication and socialization skills, individuals with level 3 autism display repetitive and restricted behaviors.
They are not good at adaptation. When somehting has changed in their lives, it can cause great stress, they may have trouble to focus or pay attention. They have narrow interests in very specific topics. They have mostly a preference for being alone. Compare to other levels, people with level 3 autism may also benefit from medication in order to reduce co-occurring disorders’ symptoms such as depression.
Autistic Disorder (Classic Autism / Typical Autism)
This is what most people think of when they hear the word “autism”. Individuals with typical autism symptoms, symptoms that when you think about autism come to your mind, are in this category. This type, in general, refers to problems and challenges with social interactions, communication and imaginative play in children who are younger than 3 years. Many people with autistic disorder also can have intellectual disabilities.
In other respect, there may not be intelligent related problems with these children. It means they may not have mental retardation. They can show the same developmental level as the same time as their peers. However, unlike their peers, communication problems and behavioral problems are observed. It is not true that children with these symptoms have Asperger syndrome.
Even though the term and the diagnosis removed from the diagnostic manual (DSM -5) in 2013, every professional in the autism community still continue to use the term. Because it is very useful in describing a very specific group of people.
Asperger syndrome is a problem that begins in childhood and causes problems in social interaction. The most important symptoms are being excessively introverted, communication problem, and skill weakness. Symptoms are similar to autism, in general. Just like autistic disorder, Asperger syndrome is a condition that is completely unknown and affects a lifetime.
Asperger syndrome is usually diagnosed between 4 and 11 years of age. Children are observed in different environments. Their learning style, motor development, strengths, weaknesses, challenges, problems, and independent living skills are examined by the professionals. It is more difficult for adults to get diagnosed with Asperger syndrome. Early diagnosis is very important in Asperger syndrome as in autistic disorder.
Asperger syndrome describes the individuals at the highest functioning end of the autism spectrum. People with it usually have milder symptoms of autistic disorder. They might have social challenges, unusual behaviors, and unusual interests, but they typically do not have problems with language or intellectual disability.
In individuals with Asperger syndrome, there is no intelligence or intelligence-related problem. People, who are able to learn at the same time as their peers, can receive the same training and education with them. Whereas children with autistic disorder have difficulties with even in small talks, children with Asperger syndrome can establish very long sentences.
These individuals do not have a problem with language. People with Asperger syndrome generally develop spoken language in the same way as typically developing children but have a tough time with social communication. These difficulties become more obvious as they get older and social expectations increase.
People with Asperger syndrome tend to score in the average or above-average range on the intelligence test. They are often very intelligent but quirky. They still have the same social problems and limited scope of interest as children with autistic disorder. Because of this reason, the disorder is sometimes nicknamed “geek syndrome” or “little professor syndrome.”
It was and is still often used to describe people with high functioning autism. Most of them are of normal or above intelligence with strong verbal skills and significant difficulties with social communication. Also, many of them can have significant sensory challenges. After DSM-5 published, people with the symptoms of Asperger syndrome are considered to have Level 1 Autism Spectrum Disorder.
Pervasive Developmental Disorder – Not Otherwise Specified (Atypical Autism)
The diagnosis given to children who have symptoms of autism but do not meet enough criteria to be diagnosed is called atypical autism. It is a “catchall” for disorders with autism-like symptoms that didn’t fit the full criteria for. There is no way to define exact symptoms of atypical autism, which may range from very mild to very severe.
Individuals who were diagnosed with atypical autism (PDD) prior to the DSM-5, will now have an Autism Spectrum Disorder diagnosis and may be diagnosed at Level 1, 2 or 3 depending on how severe the symptoms.
Since children with PDD exhibit mild autism, they are often confused with typical autism and Asperger syndrome. Atypical autism and typical autism basically share the same problems, however, the level of persistence is higher as problems and disorders are deeper in typical autism.
Atypical autism has difficulties in language and in communication, as well as other types on the spectrum, delays in development, repetitive speech and behaviors, problems with socialization. However, these symptoms may appear in later ages instead of childhood period or may be seen to be less likely to prevent having a full diagnosis.
The most important feature that differentiates atypical autism from other types of autism is the ability to overcome speech and communication problems experienced by individuals through early diagnosis and correct treatment methods.
The impact of early diagnosis is enormous when it comes to overcoming the problems and continuing the normal life of the individual like normally developed individuals.
Therefore, parents should observe their children’s movements and development, be sensitive about doctor controls, and follow children’s developmental stages with the help of healthy communication with their children. If the child has symptoms of atypical autism, he/she should immediately consult an expert and the treatment process should be started quickly.
It should be kept in mind that the group that responds best to the treatment process in Autism Spectrum Disorder is the group with atypical autism disorder. If the families in the treatment process show despair and psychologically negative reactions, it may adversely affect the child and the child may refuse treatment. Therefore, parents should support their children and the children should feel this support during the treatment process.
Childhood Disintegrative Disorder
It is an extremely rare disorder that is categorized under Autism Spectrum Disorder. There is a debate among many mental health professionals about childhood disintegrative disorder’s existence as a separate condition.
These children develop symptoms normally in 2 years of their lives. It can be the first 2 years or unexpected 2 years. Then, they start to lose some skills and have problems with sociability. This condition has a relatively late-onset.
Childhood disintegrative disorder is characterized by regression of previously reached skills. It means they have the ability to do everything, they have learned to do everything, but suddenly disruption happened. The cause is unknown, even in the 20th century, and it is often seen that children who have this disorder are very successful to reach to normal developmental milestones compared to their peers before the regression of skills.
Age is something varies in this case. I t can be observed at any age. However, it is typically observed after 3 years of reaching normal milestones, on the contrary to typical autism. The regression can be so fast that the child may be mindful of it. Even in the beginning, they can try to give meaning and cant understand. It causes psychological problems as well. Even if the most common and distinct characteristics of this disorder is that the attained skills are gone. In more severe cases, some children may appear to be responding to hallucinations and delusions.
It is not an unofficial diagnosis in order to easier to diagnose and for treatment. Severe autism is usually diagnosed as Level 3 Autism Spectrum Disorder. Simply it describes the most significant and severe symptoms that someone has.
Level 3 Autism Spectrum Disorder means that individuals on that level need support for everything in their lives, from basic things to most complicated ones. They require 7/24 support, supervision, and care. Sometimes institutionalization would be a good idea for those people because it is very difficult for their families as well.
People with severe autism are often non-verbal and intellectually disabled, and they may have very challenging behaviors. It has extremely challenging behaviors compared to mild forms such as self-injury, aggression, and anti-social behaviors, wandering, and eloping. Eloping means they may run away with no obvious cause and no particular destination from the environment.
Individuals with severe autism never gain the ability to speak meaningfully. Even though it is hard, they may gain the ability to communicate through signs, cards or pictures.
It is not an official diagnosis. The term is used for individuals whose symptoms fit a spectrum, but they mostly don’t have problems in verbal skills and behavioral skills. However, those individuals with mild autism may exhibit severe problems with sociability and communication.
They may have problems with sensorial inputs. They may have trouble coping with them. For example, let’s say they cannot go to weddings because the music is so loud, there are so many people and blight are probably so bright fro them. That wedding is a kind of torture for them. The symptoms could be difficult to recognize and understand until people with mild autism are under stress or coping with complex situations.
Mild autism and Asperger syndrome are identical or essentially similar, we can say. Individuals with mild autism are considered to have Level 1 Autism Spectrum Disorder, according to DSM-5.
High Functioning Autism
It is a made-up term by professionals and became commonly used in time. It is similar to Asperger syndrome. It would be termed Level 1 Autism Spectrum Disorder.
Like Asperger syndrome, people with high-functioning autism show more or less the same symptoms. On the other hand, unlike people with Asperger syndrome, people with high functioning autism start to talk very late, very slow, and idiosyncratically.
Until 2013, it was one of the disorders that included Autism Spectrum Disorder. After publishing DSM- 5, it is excluded from the diagnostic criteria. It means it is no longer part of the Autism Spectrum Disorder.
It is a genetic disorder that can be medically diagnosed. It surprisingly affects only girls. They develop severe symptoms including the hallmark social communication challenges of autism. In addition, after some time, they lose the ability to use their hands. All the girls with Rett syndrome look more or less the same.