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March 8, 2011

Autism: What about that “spectrum” thing?

Written by Dr. Carosso
In the autism community, parents must sift through a host of confusing, murky, and contradictory words, terms,  and concepts. It’s no wonder there is frustration and misunderstanding.  Hopefully this post will help to clear the waters a bit.

In a prior posting (autism: facts and fallacies), I discussed that “autism” is not a diagnosis, but simply a term that represents the ‘autism spectrum’. However, that begs the question; what is the autism spectrum?

Okay, I suppose we’re all aware that the ‘spectrum’ reflects that any child with autism may ‘look’ quite different from another. One child may be nonverbal, while another may be fully conversational but with some social quirks.  However, how does that relate to the actual diagnosis any given child on the “spectrum” might get from a doctor?

Okay, here goes an explanation, for better or worse:)

The three most commonly used diagnoses for a child on the autism spectrum are:

Autistic Disorder………….Pervasive Developmental Disorder NOS………….Asperger’s Disorder
More Severe                                                                                                            Less Severe

I know it’s not perfect, and many of you will see shortcomings (as do I), but I find it helpful to view these three diagnoses as reflective of the “spectrum” we hear so much about.

At the far end of the spectrum is ‘Autistic Disorder’, which is how we tend to perceive classic ‘autism’ such as what was seen in the movie “Rain Man.”  These kids tend to have more significant social and language difficulties.

At the other end of the spectrum is ‘Asperger’s Disorder; kids who are conversational but have social problems and tend to obsess on things.

For those kiddos who do not meet the diagnostic criteria of those two extremes, we have the diagnosis of ‘Pervasive Developmental Disorder Not Otherwise Specified’, or PDDNOS, or simply PDD. These kids show signs of ‘autism’ but have strengths and differences that exclude an ‘Autistic Disorder’ or ‘Aspergers’ diagnosis.  For example, they may be quite social and talkative, but don’t always “know what to do” in social situations. These children may also speak mostly in short phrases, which precludes an Asperger’s diagnosis.

Clearly, PDD is the fastest growing diagnosis on the spectrum, likely for a bunch of reasons including we (professionals) are more aware of the condition than 10 years ago, and that the rates seem to be genuinely increasing for reasons we’re still exploring, e.g. vaccinations, genetics, toxins…

Understanding the ‘spectrum’ helps in many ways including appreciating the extent to which your child will improve and recover. For example, it’s not entirely uncommon for children at the upper PDD range, or upper Asperger’s range, to demonstrate wonderful progress and, down the line, recover and no longer need services.  In fact, I’ve seen two discharges from services in just the past month, which further reminds us of the potential for very positive outcomes:)

However, even kids who are diagnosed with Autistic Disorder can, and do, show lots of progress but it’s more likely they will have some ongoing deficits.

Well, hope that helped in understanding the ’spectrum’.  I know there are still lots of questions, so feel free to comment and I’ll follow-up. If you found this helpful, please forward to a friend. Thanks.

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