While the general diagnosis of autism was first applied in 1911 to reference a suite of behavioral characteristics incorrectly associated with schizophrenia, mental health workers have since correctly used the term to individuals who exhibit behavioral and social difficulties. The autism spectrum was only incorporated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSMV, in 2013. The article below defines the new spectrum and explores the need for it as a more refined tool for diagnosis and treatment.
Related resource: Top 25 Online Master’s in Autism Spectrum Disorder (ASD)
Foundation and History of Autism
For many, the simple term conjures a static image of Dustin Hoffman’s character in Rain Man. This belies the complexity and variation of neurological disorders that fall within the category. Asperger’s Syndrome is a single manifestation of the spectrum of disorders, which has also been mischaracterized as “high-functioning” autism in the past.
At the end of the 19th century, Dr. Langdon Down described individuals with what was characterized as mental retardation or developmental slowness. This proved to be an incorrect assessment. However, the term coined in 1911 was also incorrectly applied and would continue to be misused until the 1940s, when it was finally associated with behavioral and social difficulties.
However, the diagnosis based on an observed suite of behavioral characteristics alone was the cause of continued misapplication and an entrenched misunderstanding of what caused the disorders such as Asperger’s. It was assumed as late as 1950 that autism was caused by cold or unloving parenting approaches by mothers, and was most likely to occur in the children of highly intellectual households. Of course, this was a sterling example of inherent bias and a complete misunderstanding of organic brain disorders.
It would be four decades before public schools chose to recognize verified symptoms of autism in children and offer services that tailored the educational experience. It would take nearly as long for medical professionals to form a better understanding of the array of disorders and practical guidelines for diagnosis in children. This shortfall is directly responsible for the low rate of diagnosis and the mishandling of care options offered to families or guardians of individuals with one of these disorders.
Because the medical field lacked a defined idea of what produced the observable behaviors associated with autism spectrum disorders (ASD), many practitioners published findings as new or previously undiscovered manifestations of these disorders. What the scientific consensus reveals today is that all ASDs share common neurological features. These include excessive gray matter in the cerebrum; reduced size of the cerebellum, amygdala, hippocampus, and the caudate nuclei; and increased size of ventricles.
Another system connected to the spectrum is the gastrointestinal region. Considering recent discoveries of a secondary or peripheral system of neurons running throughout the alimentary canal and the close ties of the gut microbiome with the production of serotonin and neurodegenerative disorders, this relationship seems less far-fetched than it once did.
According to an article published by the American Academy of Pediatrics, the diagnosis and treatment of such gastrointestinal disorders are frustrated by the patients’ difficulties with communication. As mentioned in the article, there has been little evidence-based study of the correlation, although many caregivers and medical practitioners observe the digestive and intestinal disorders.
Streamlining the multitude of individually identified ASD disorders is essential for another reason, beyond enabling researchers a better grasp on associated complaints and symptoms. To date, much of the publicly available reading on the subject includes outdated information and incorrect associations.
Lay material continues to characterize Childhood Disintegrative Disorder (CDD), to name only one example of this oversight. The cause of CDD is an unrelated genetic abnormality that impacts individuals in ways that may, at first, appear similar, but are unrelated to ASD. With better research parameters that are not dependent upon symptom-based assessment alone, will enable medical practitioners and researchers to better identify instances that appear autistic-like but are unrelated.
The Center for Disease Control (CDC) estimates that the actual rate of ASD incidence is still higher than successful diagnoses—as high as 1 in every 59 children may experience some form of autism. Because males exhibit a much higher rate than females, this translates to approximately one in every 37 boys and one in every 151 girls. And while school systems provide support for students with autism spectrum disorders, once these individuals age out of the system, they and their caregivers may be left to fend for themselves.
While it would be handy for medical practitioners if individuals with an ASD exhibited neatly defined, unvarying symptoms, this isn’t the way autism works. That’s also an excellent reason to switch to a spectrum approach, to enhance diagnosis and treatment options that work well for the individual. Such a spectrum also reflects individual variation—greater strengths and more intense challenges, which vary based on the person.
Some might wonder why this is important because much of Western society still functions in a frankly ableist framework. Why should medical science recognize the unique suite of capabilities and challenges represented in a single human being? The most straightforward and resounding answer is that such recognition permits better treatment and care, with fewer squandered resources.
Especially regarding applied behavior analysis (ABA) and related therapeutic approaches, understanding the individual allows the caregivers and therapists to work together, to enlist the help of the patient, and craft a therapy plan that leads to real progress. What’s not great about that? Because individuals with an ASD experience difficulty with social scenarios and also have challenges with learning and retention of essential social skills, according to the advocacy group Autism Speaks, ABA is one of the primary therapeutic approaches.
In addition to maximizing the benefit of these behavioral learning sessions, adopting the autism spectrum of disorders may also play a key role in future research. By helping individuals with severe ASD communicate their needs in a more precise way, researchers can document and tackle the most pressing problems and symptoms associated with the primarily brain-centered disorders. If researchers and medical practitioners have a clearer understanding of what they are studying, research advancement and treatment options expand.
Contrary to casual lay perception, the incidence of autistic disorders may not be any higher than it ever was, if the rate is adjusted for population growth and overall size. However, successful diagnosis and treatment of the neurological suite of disorders are higher, and this indicates that autism manifests in every culture, social stratum, and ethnicity in the world. This success is mainly due to the adoption of the autism spectrum of disorders, which leads to a more explicit understanding of the condition and a more refined medium of diagnosis.