Autism classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Classification

DSM 5 categorized autism under autistic spectrum disorders/pervasive developmental disorders (PDD). Autistic spectrum of disorders are characterized by widespread abnormalities of social interactions, communication associated with severely restricted interests and repetitive behavior.[1][2][3]

 
 
 
 
 
 
 
 
 
Autistic spectrum disorder
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Autistic disorder
 
Retts disorder
 
Childhood disintegrative disorder
 
Pervasive developmental disorder
 
Asperger's disorder
 
 

Based on the degree of severity and level of support ASD are classified into 3 types[2][4][5]

Severity level Social communication Restricted, repetitive behaviors
Level 3 Requiring very substantial support
  • Sever deficits in verbal and non-verbal communication skills
  • Sever impairment in functioning
Level 2 Requiring substantial support
Level 1 Requiring support

The terminology of autism can be bewildering, with autism, Asperger's and PDD-NOS often called the autism spectrum disorders (ASD) or sometimes the autistic disorders,[4] whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the classic autistic disorder, while other sources sometimes use autism or the autisms to refer to ASD, or equate ASD with PDD. ASD, in turn, is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.[2]

The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to less impaired individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication.[6] Sometimes the syndrome is divided into low-, medium- and high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds, or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial. Autism can also be divided into syndromal and non-syndromal autism, where the former is associated with severe or profound mental retardation or a congenital syndrome with physical symptoms, such as tuberous sclerosis.[3] Although individuals with Asperger's tend to perform better cognitively than those with autism, the extent of the overlap between Asperger's, HFA, and non-syndromal autism is unclear.[7]

Some studies have reported diagnoses of autism in children due to a loss of language or social skills after 14 months of age, as opposed to a failure to make progress. Several terms are used for this phenomenon, including regressive autism, setback autism, and developmental stagnation. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype.[8]

The inability to identify biologically meaningful subpopulations has hampered research into causes.[9] It has been proposed to classify autism using genetics as well as behavior, with the name Type 1 autism denoting rare autism cases that test positive for a mutation in the gene contactin associated protein-like 2 (CNTNAP2).

References

  1. Geschwind DH, Levitt P (2007). "Autism spectrum disorders: developmental disconnection syndromes". Curr Opin Neurobiol. 17 (1): 103–11. doi:10.1016/j.conb.2007.01.009. PMID 17275283.
  2. 2.0 2.1 2.2 Piven J, Palmer P, Jacobi D, Childress D, Arndt S (1997). "Broader autism phenotype: evidence from a family history study of multiple-incidence autism families" (PDF). Am J Psychiatry. 154 (2): 185–90. PMID 9016266.
  3. 3.0 3.1 Cohen D, Pichard N, Tordjman S; et al. (2005). "Specific genetic disorders and autism: clinical contribution towards their identification". J Autism Dev Disord. 35 (1): 103–16. doi:10.1007/s10803-004-1038-2. PMID 15796126.
  4. 4.0 4.1 Freitag CM (2007). "The genetics of autistic disorders and its clinical relevance: a review of the literature". Mol Psychiatry. 12 (1): 2–22. doi:10.1038/sj.mp.4001896. PMID 17033636.
  5. Stephan DA (2008). "Unraveling autism". Am J Hum Genet. 82 (1): 7–9. doi:10.1016/j.ajhg.2007.12.003. PMID 18179879.
  6. Happé F (1999). "Understanding assets and deficits in autism: why success is more interesting than failure" (PDF). Psychologist. 12 (11): 540–7.
  7. Validity of ASD subtypes:
  8. Volkmar F, Chawarska K, Klin A (2005). "Autism in infancy and early childhood". Annu Rev Psychol. 56: 315–36. doi:10.1146/annurev.psych.56.091103.070159. PMID 15709938. A partial update is in: Volkmar FR, Chawarska K (2008). "Autism in infants: an update". World Psychiatry. 7 (1): 19–21. PMC 2366821. PMID 18458791.
  9. Altevogt BM, Hanson SL, Leshner AI (2008). "Autism and the environment: challenges and opportunities for research". Pediatrics. 121 (6): 1225–9. doi:10.1542/peds.2007-3000. PMID 18519493.

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