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They started talking about the symptoms of autism long before the term itself appeared: it was introduced in 1911 by the Swiss doctor Eugen Bleiler (we owe the term “schizophrenia” to him), but similar cases were described by Martin Luther in the XNUMXth century. How did the definition of this disorder and the criteria for its diagnosis change, and what forms of the disease are now isolated?
What features of the patient’s behavior will allow the doctor to diagnose him with autism or autism spectrum disorder? Over time, these criteria have changed – as well as the types of diagnoses. The easiest way to track these changes is in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the main guideline for diagnosing mental illness in the United States.
The previous fourth edition listed four disorders:
- autistic disorder,
- Asperger Syndrome,
- pervasive developmental disorder not otherwise specified (PDD-NOS),
- childhood disintegrative disorder.
In the current edition, the DSM-5, all four diagnoses have been combined into one: Autism Spectrum Disorder (ASD). Why did it happen? Researchers realized that all four disorders exhibit similar behavioral patterns, but in varying degrees of severity. Because of this, doctors began to view autism as a spectrum.
The main criteria for diagnosing ASD are difficulties in social communication, limited interests, and a tendency to repetitive actions. At the same time, doctors separately distinguish social communication disorder – it is in many ways similar to ASD, such patients experience serious problems with communication and social skills, but other symptoms are much less pronounced.
Autism Spectrum Disorders by Severity
In addition to consolidating diagnoses, the fifth edition of the DSM added the concept of severity of autism disorder: on a scale of 1 to 3 (where 1 is the mildest manifestations, 3 is the most severe), each of the symptoms is assessed. This allows physicians to distinguish between three forms of ASD.
RAS 1: the patient needs help
This is the mildest form of autistic disorder. Patients with this diagnosis may experience difficulties in social situations and certain problems due to limited interests and a tendency to repetitive actions, but they need minimal support to function normally in everyday life.
In most cases, they are quite capable of verbal communication, and can often maintain relationships with other people. At the same time, they may have difficulty maintaining a normal dialogue, it is much more difficult for them to find friends and maintain relationships.
Often, those diagnosed with ASD 1 prefer to stick to a certain daily routine, unexpected events and changes in the usual rhythm of life can cause them discomfort. They prefer to do things their own way.
RAS 2: the patient requires significant assistance
Such people need more help and support than people with ASD 1. They have more pronounced problems with social skills, and the difficulties they experience in social situations are more visible to others.
Not everyone who has an ASD 2 diagnosis is capable of verbal communication. Some may only keep very short conversations or speak on strictly limited topics. They may need significant support to participate in social life.
Their non-verbal behavior also differs significantly: often they do not look at the interlocutor or in his eyes at all. Many of them fail to express emotions in tone of voice or facial expressions in the way that most people do.
Limited interests and a tendency to repetitive behavior is a significant problem for such people. Often they feel that they must adhere to a strictly defined routine or follow a familiar rhythm, and with any changes or violations of the established way of life, they experience severe discomfort.
RAS 3: the patient needs very substantial help
People with ASD 3 experience significant social interaction difficulties, and their limited interests and repetitive behaviors are so severe that they interfere with daily activities on their own.
Many people with ASD 3 are unable to speak. Any unexpected or unusual events cause them great difficulties. They may be too sensitive or, on the contrary, not sensitive enough to certain stimuli. Often they are completely absorbed by any repetitive rituals: such people sway, repeat the same words, rotate objects.
Those who have this diagnosis require very significant help and support to learn the skills needed in daily life.