Now that I’ve given the reasons why the current, “we can’t distinguish Autistic Disorder and Asperger’s Syndrome empirically, so instead we’ll just lump all autistics together into one diagnosis called Autism Spectrum Disorder” is faulty, from both a personal and research perspective, I thought I would offer my take on a possible solution. Instead of lumping even more, we should instead swing the opposite way and split further.
I don’t think the current AS/AD split is working. The two categories manage to be simulatenously far too similar, leading to struggles over who to put into which, and yet also so different, such that the terms “Asperger’s” and “Autistic” connote two very different presentations. But I don’t think the solution is to give up on trying to categorize the types of autism. Instead, common sense needs to be utilized to determine a practical way to distinguish different forms of autism from each other.
Here are some ways we can split:
- Family History: it seems pretty clear to me, at least, that some families can trace spectrum traits up the family line. It is possible that in these cases, the individual who finally fits enough criteria to get an autism diagnosis, might not have any other root cause of disorder exhibition than inherited traits. For example, my grandmother has sensory issues, food issues, limited interests and poor social skills. My father has a “special interest”, food issues, impulse control and anger management issues. My brother and I have ASD diagnoses. I think in these cases, it might only be a matter of how extreme each “symptom” is. However, in other situations, an autistic child is born into a family with no history of spectrum traits. These are likely two different forms of autism.
- Age of symptom onset: Many individuals with autism were clearly autistic from birth. Seemingly from when they left the womb, they didn’t want to be touched, cried all the time, and didn’t seem interested in faces or people in general. Others seemed neurotypical until between fourteen and twenty-four months, when spectrum traits began to appear and then never left. These two different situations can even occur in the same family such as with the twins vs. the younger son at Everyday Adventures. Autistic from birth vs. later-onset are likely two different forms of autism.
- Presence or Absence of Food issues: I do not endorse the notion of “leaky-gut” which anti-vaccinists are quite fond of. But it seems clear to me that there are some autistic individuals who cannot tolerate gluten, casein, lactose, or food additives, or for whom the presence of these ingredients can cause erratic behavior. There are many autistic indivuals, however, that have no issues with food, who have regular bowel movements and whose behavior is totally unaffected by diet. These characteristics might be indicative of different forms of autism.
- Speech Capablities: Some autistics have no issue creating new, spontaneous phrasing, but cannot participate in a typical conversation. Some use scripting and echolalia to communicate but can stay fully on topic. And some produce no speech at all. Perhaps these differences are also indicative of different forms of autism.
There are probably hundreds of other ways to divide individuals on the spectrum into different groups. These were just the first four which immediately sprang to mind. What makes these divisions better is that they can be practically utilized. Interventions which will help autistic individuals with no speech will likely be unhelpful for individuals with full speech capabilities but poor social skills, who will need interventions that won’t help those with scripted on-topic speech as much as another therapy geared specifically for them. So how nice would it be to find a center which is specifically geared to help with your (or your child’s) particular communication issues, rather than a particular nearly-arbitrary diagnostic category?
Maybe this is what the board of the DSM is thinking. They tend to go through cyclical periods of splitting and lumping. Perhaps this revision is re-lumping so that the next edition can re-split along practical lines. And perhaps once the re-split occurs, we will have the technology needed to begin to sort autism out a bit better- a way to examine brain physiology and say, for example, “Individuals with and without a family history of autistic traits have a similar presentation and therefore should not be categorized separately” (or the opposite might be found. We really have no possible way of knowing at the moment).
Once we know how many distinct forms of autism there are, and what the hallmark of each of the separate types are, we can begin to formulate specific interventions which are geared to helping the members of each particular group live up to their full potential.