Autism Spectrum Disorder, or ASD, is a neurophysiological condition that can affect both the behavior and the physical health of the person with the condition. The most obvious symptoms of ASD are the behavioral ones, such as communication difficulties.
However, as the name suggests, ASD falls along a spectrum, meaning that someone diagnosed with this condition can have a few symptoms from a very long list, and those symptoms can be at varying levels of severity, from mild and barely noticeable to crippling in intensity. As a result, it is very important to get people diagnosed if there’s any suspicion of ASD, to assess the severity and what the appropriate treatment should be.
This requires extensive individual assessment and observation, and it’s important to remember that the current methods of diagnosis and classification we currently work with are very recent; only six years old!
The Way It Used To Be
For people living in the 21st century, it can be quite shocking to learn that less than 50 years ago, ASD didn’t even “exist” in the eyes of the medical community. A standard text reference of diagnosing and classifying behavioral disorders in American medicine is the Diagnostic & Statistical Manual of Mental Disorders, which has been in publication since 1952. Every few years, a new, revised edition is released which reflects the knowledge acquired and new treatment methods that have surfaced since the previous edition came out.
Before the 1980s, the DSM, as it was called, did not recognize ASD. Instead, any child or adult that, today, would be diagnosed with autism, would, before the 1980s, have been diagnosed as schizophrenic! It’s very disturbing today to think that a child with mild ASD might be evaluated as potentially psychotic, but until DSM-III came out in the 1980s, finally recognizing ASD, that’s exactly what happened to children.
The Categories Arise
From the 1980s until 2013, autism was “graded” into five categories or types, that were classified according to the severity. They went from Asperger’s Syndrome to “classic autism” that included Pervasive Developmental Disorders (PDDs) such as childhood disintegration disorder (CDD) and Rett’s Syndrome. The fifth, Atypical Autism, or PDD-NOS, was a “miscellaneous” category used for any behavior that was clearly autism but didn’t fall neatly into one of the other categories.
As a result, autism assessment began to fall along certain lines of seriousness, with Asperger’s considered the mildest and in terms of severity, the most “desirable,” sometimes even being regarded as a sign of eccentric genius, while the others were regarded as more serious and harmful.
The Cracks Show
In 2013, however, DSM-V came out, and with this new edition, the various categories of autism were done away with, and what is used now is, simply, Autism Spectrum Disorder, or ASD. The reason for this decision was because the insistence on “grading’” autism into strict categories often didn’t match with more “messy,” organic characteristics of different autism symptoms.
There was also a question of correct interpretations and cultural or even class biases, were white, middle or upper-class children would be diagnosed as having Asperger’s Syndrome while black, lower-class children with identical symptoms would be diagnosed more severely, and thus receive very different treatments and therapies.
Now, the entire collection of symptoms and behaviors is classed into a single condition, ASD, with individual symptoms evaluated across the spectrum, taking each one into account, for a more individualized diagnosis that can lead to better treatment.
The most important thing to keep in mind when it comes to assessing someone for ASD is that while this is a medical evaluation, it is one of behavioral analytics based on professional opinion. It is not as cut and dried as a blood test, for example, where an evaluation is conducted based on established standards. The youngest that a child may be assessed for autism is about a year and a half after birth, or 18 months, though if a parent wishes, a child can be brought in for an assessment at any age.
The first step is a testing process known as Developmental Screening. There is a “checklist” available to doctors that shows the average rates of development in key areas, such as reflexes, communication ability, perception, and other characteristics. If a child is already showing signs of ASD at the developmental screening stage or is not meeting average expectations, another stage begins.
The second stage is known as comprehensive diagnostic evaluation, a much more intensive assessment. Now, instead of basic tests, in-depth neurological examinations may be conducted, parents will be interviewed, and a variety of different tests applied to see what the exact symptoms are, and where along the spectrum they lie in order to evaluate the child’s particular expression of ASD and then decide how best to move forward to treat and manage it. This part of the test will have different results for every child.