Conditions Related to Autism
Author: Dr. Anna Kaplan
Autism is a pervasive developmental disorder. This means that autism can affect every aspect of a child's development and functioning. Not every child with autism has the same symptoms.
Autism is a spectrum disorder, which means that individuals with autism can be severely affected or have the same problems, but of much less severity.
Autism is related to Asperger's Disorder, also called Asperger's Syndrome, or AS. Asperger's Syndrome is often thought of as autism with high functioning. Children (and adults) with this diagnosis can be very successful. Parents, as well as older children, may prefer the Asperger's diagnosis. Many people feel that it has less of a stigma attached to it than autism. However, they are both pervasive developmental disorders according to the American Psychiatric Association. The diagnosis of a disease like autism is guided by the American Psychiatric Association and the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision), its most recent manual with diagnostic criteria for psychiatric disorders. There are five "pervasive developmental disorders" in this manual, with the two most common being autism and Asperger's Disorder.
There are many similarities between the two diagnoses. Both demonstrate what is called "a qualitative impairment in social interaction." This can be demonstrated in a number of ways. A child with autism or AS will not make eye contact or other nonverbal communication with others. He will not share emotions or share enjoyment. This has been described as delayed or absent "joint attention." A second area describes repetitive and stereotyped behavior that is persistent. This can include preoccupation with one area of interest, repetitive movements such as spinning or arm flapping, and inflexible routines.
However, there are differences between the two disorders. Children with AS have normal verbal skills. Their difficulty in communication is not due to language delay. Autistic children have significant language delays, sometimes to the point of not speaking. If they do speak, they have trouble communicating with others and may have stereotyped and repetitive language. They also do not engage in play like others of their age.
While Asperger's Syndrome causes significant social impairment, there is no speech delay or delay in cognitive development or learning, except in the areas of social interaction. In fact, children with AS may be quite advanced in certain areas, knowing all about trains or dinosaurs. Autistic children must display a delay or lack of language development. However, they too can have exceptional gifts like perfect pitch or the ability to relate to animals.
There are high-functioning people with Asperger's and low-functioning people with Asperger's. The same is true about autism. High-functioning autistic teenagers may appear to be no different than teenagers with Asperger's. In one family, there may be a child with autism and another child with Asperger's. As is often pointed out, many with the diagnosis of Asperger's actually do meet the criteria for autism. They are all on part of the spectrum of autism. For these reasons, among others, the next edition of the DSM manual, the DSM-V, which is expected in 2012 or 2013, will probably reclassify Asperger's as part of autism. There will be one diagnosis called "Autism Spectrum Disorder" accompanied by an estimate of how severe the dysfunction is. This change has caused much concern in the autism and Asperger's community. Many parents who have a child with each disorder say that they cannot be the same condition. Others are upset that their children may need to be reevaluated and re-diagnosed to get the correct help at school, if Asperger's as a condition will no longer exist.
Since no one knows exactly what causes these disorders, or what is happening in the brain, psychiatrists are linking similar behaviors and symptoms that they believe are related. The current thinking seems to be that Autism Spectrum Disorder may be the best way to look at the affected children, adolescents, and adults. Although some people are not happy with this idea, others look at is as a way to bring together ideas, resources, and research.
The other disorders in the group with autism and Asperger's are rare. Probably only one of them, Pervasive Developmental Disorder Not Otherwise Specified (not quite autism, not quite Asperger's) will probably be brought under the autism umbrella.
While the community of people with autism and Asperger's Syndrome and their families are preparing themselves for the upcoming change, many are noting that until the cause of these disorders is known, groupings for the sake of diagnosis are somewhat arbitrary, and may be changed again by the time of the DSM-VI in the more distant future.
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