Autism, or autism spectrum disorder (ASD), is classified into several types according to their characteristics. This article explains the types of autism according to DSM-IV and DSM-5, and how they differ. This information is key to a better understanding of autism and its treatment.
Key Points
- Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects social communication and behaviour, manifesting as early as infancy and often persisting into adulthood.
- The classification of autism has evolved significantly from DSM-IV, which identified five distinct types of disorders, to DSM-5, which unified all categories under the term ASD and emphasised a continuum with varying degrees of severity.
- Early detection and proper diagnosis of autism is essential for effective early intervention, significantly improving the prognosis of people with ASD and their long-term quality of life.
Definition of autism
Autism, also known as autism spectrum disorder (ASD), is a group of diverse conditions related to brain development. This neurodevelopmental disorder of neurobiological origin manifests itself from infancy and primarily affects social communication and behaviour. Individuals with autism often exhibit repetitive and restricted behaviours and interests, as well as significant difficulties in social interaction and communication.
The overall prevalence of autism is remarkable, affecting approximately one in every 100 children. This high prevalence highlights the need for in-depth understanding and early intervention to improve the quality of life of people with autism. The difficulties faced by these individuals are not limited to childhood, as autism can extend into adulthood, impacting several areas of daily life.
People with autism often have difficulty interpreting social cues and may show atypical patterns of behaviour. These difficulties in social interaction and communication, along with repetitive behaviours, are the main characteristics of the autism spectrum. In addition, it is common for individuals with ASD to experience significant levels of anxiety due to the rigidity and predictability of their routines.
The World Health Assembly has recognised the importance of addressing autism spectrum disorders, adopting a resolution in 2014 that calls for closer collaboration between the World Health Organization (WHO) and Member States to improve the lives of people with autism. This international effort underscores the need for comprehensive strategies for diagnosis, treatment and ongoing support.
Classification of autism: From DSM-IV to DSM-5
The classification of autism has evolved significantly over time, reflecting a better understanding of its complexity. In 1994, DSM-IV was the first edition to recognise autism as a spectrum of conditions, categorising five distinct types of spectrum disorders. However, in 2013, the publication of DSM-5 brought about fundamental changes in the way autism was categorised.
DSM-5 unified the previous categories under the term Autism Spectrum Disorder (ASD), encompassing a wide range of manifestations and levels of severity. This new classification focuses on two main clusters of features: impairment in communication and social interaction, and repetitive patterns of behaviour. This significant change aims to provide a more consistent and flexible approach to the diagnosis of autism.
What is the DSM?
The Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, is a crucial tool for health professionals. It is used to diagnose and classify mental disorders, including autism. This guide is updated periodically to reflect advances in research and understanding of mental conditions.
In its evolution, the DSM has redefined how autism is perceived. For example, the second edition of the DSM in 1952 defined autism as a form of childhood schizophrenia characterised by a detachment from reality. It was in 1980, with the third edition of the DSM, that autism was established as an independent diagnosis, distinct from schizophrenia.
Changes in the classification of autism
The DSM-5 adopted the idea of a continuum of autism, a decision driven by the difficulty of associating specific genes exclusively with autism. This new perspective seeks to capture the diversity of manifestations and severities within the autism spectrum, offering a more inclusive and accurate framework for diagnosis.
With the publication of the DSM-5, previous diagnoses such as Asperger's syndrome and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) were eliminated. Instead, DSM-5 introduced specifiers that indicate whether ASD is associated with medical conditions, genetic conditions, or other developmental disorders. This change aims to provide greater consistency in diagnoses between different professionals and clinics.
In addition, the DSM-5 established stricter criteria to address the lack of consistency in diagnoses, ensuring that the autism spectrum is assessed uniformly and accurately. These changes reflect a continued effort to improve the accuracy and utility of diagnostic tools, benefiting both health professionals and individuals with autism.
Types of autism according to DSM-IV
The DSM-IV, published in 1994, classified autism into five different types, each with its own characteristics and manifestations. There are several types of autism spectrum disorders, such as:
- Kanner's autism
- Asperger's Syndrome
- Childhood Disintegrative Disorder (CDD)
- Rett Syndrome
- Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).
Each of them has different characteristics.
Each of these types was part of the Pervasive Developmental Disorders, characterised by severe and pervasive disturbances in social skills, communication and stereotyped behaviours. In the following, we will explore each of these types in detail.
Kanner's Autism
Kanner's Autism, also known as Autistic Disorder, is considered the classic form of autism. It is characterised by poor social interaction and communication, along with repetitive and restricted behaviours. People with Kanner's autism often show a lack of social reciprocity and serious communication problems, which significantly affects their ability to relate to others.
In addition, they may show indifference to the reactions of others, which makes their social interactions even more difficult. The symptoms of this disorder are often more severe, severely affecting social relationships, cognition and language.
Asperger Syndrome
Asperger's Syndrome is distinguished by:
- Difficulties in social interaction
- Repetitive behaviours
- No noticeable delays in language and intelligence development.
- People with Asperger Syndrome tend to have very specific interests and may talk at length about them, which can sometimes be perceived as a lack of reciprocity in conversations.
Despite their difficulties in social and behavioural skills, people with Asperger Syndrome can lead relatively independent and successful lives, especially with appropriate support and accommodations. Their ability to develop advanced verbal and cognitive skills allows them to function well in certain contexts, although social interactions remain a challenge.
Childhood Disintegrative Disorder (CDD)
Childhood Disintegrative Disorder (CDD) is one of the most severe and least common types of autism spectrum disorders. This disorder manifests after at least two years of normal development, followed by a significant loss of acquired skills, including language, social functions and motor skills.
Children with IDD experience significant regression, which can be devastating for families. The loss of social, communication and motor skills can be abrupt and profound, severely affecting the child's quality of life and requiring intensive, specialised support.
Rett Syndrome
Rett syndrome is an identified genetic disorder that mainly affects girls. This syndrome includes symptoms such as loss of purposeful hand use, repetitive hand-washing movements, and coordination and gait problems. Unlike other autism spectrum disorders, Rett syndrome has a specific genetic basis, which makes it easier to diagnose.
Girls with Rett syndrome often develop skills normally during the first few months of life, but then experience significant regression in motor and communication skills. This disorder requires a specialised approach to treatment and ongoing support due to the complexity of its symptoms.
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) was used to categorise cases that did not fully meet the criteria of the other specific autistic spectrum disorders. This diagnosis was applied to children who showed symptoms of autism, but in a less defined or atypical way, allowing them to receive the necessary support without a specific classification.
Introduced in the revised DSM-III in 1987, the concept of NT-DDD allowed for the inclusion of children who needed support but did not meet all the criteria for autism. This underlines the need for a flexible and adaptive understanding of the autistic spectrum, which can encompass a variety of manifestations.
Grades of autism according to DSM-5
The classification of autism in DSM-5 focuses on degrees of severity, providing a more dynamic and accurate framework for assessing the needs of individuals with autism. ASD is presented in several grades, with three main levels: Grade 1 (needs help), Grade 2 (needs significant help) and Grade 3 (needs very significant help).
Each grade reflects the intensity of symptoms and support needs, considering both social communication and repetitive behaviour patterns. This classification allows professionals to tailor their interventions more specifically and effectively, ensuring that each person receives the appropriate level of support.
Grade 1 autism
Grade 1 autism is considered the mildest grade on the spectrum, also known as mild or high-functioning autism. It is characterised by less pronounced symptoms compared to other grades. People with this type of autism present:
- Significant difficulties in social communication
- Repetitive patterns of behaviour
- Developed verbal and cognitive abilities to function independently in daily life with some supports.
These individuals may have problems with planning and organisation, which can affect their performance in social and work situations. However, with appropriate support, they can lead relatively independent and successful lives, highlighting the importance of early and ongoing intervention.
Grade 2 autism
Grade 2 autism is characterised by:
- A more severe level of impairment in social relationships, as well as in verbal and non-verbal communication.
- Repetitive patterns of behaviour.
- Limitations in initiating social interactions and exhibit apparent social impairment even with support.
- Inflexibility in behaviours and difficulties with change or repetitive behaviours.
These individuals need specific adjustments in the environment to improve functional adaptation and require significant supports to manage their daily difficulties. Appropriate intervention can make a significant difference to their quality of life.
Grade 3 autism
Grade 3 autism is characterised by severe communication difficulties and repetitive patterns of behaviour. Individuals with this grade of autism have very limited or no language and require a significant level of support and supervision in multiple areas of daily life.
Their ability to interact socially is severely impaired, requiring intensive and personalised interventions to help them develop basic skills and improve their quality of life. This degree of autism presents the most significant challenges for both affected individuals and their families.
Early detection of autism
Early detection of autism is crucial to initiate early treatment that can guide neurodevelopment towards normalisation and prevent progression to autistic symptomatology. The earlier the signs of ASD are identified, the greater the chances of effective intervention, significantly improving the long-term prognosis.
Research is currently focusing on aspects of the infant's gaze to aid in the early detection of ASD, although its routine use is not yet possible. Screening tools such as the M-CHAT R/F and CHAT are useful for early detection, although they do not diagnose ASD on their own.
Diagnosis and treatment of autism
The diagnosis of ASD is complex and relies initially on the detection of delays in neurodevelopmental items. Professionals trained to perform a developmental assessment for ASD include:
- Developmental paediatricians
- Paediatric neurologists
- Child psychologists
- Child and adolescent psychiatrists
It is essential that these professionals are trained in the use of diagnostic tools and studies to ensure a systematic and structured assessment.
Complex assessment tests such as the ADI-R and ADOS-2, which are widely recognised and validated for the diagnosis of autism, are used to confirm a diagnosis of ASD.
Treatment of autism includes a combination of behavioural, educational and, in some cases, medication therapies to manage specific symptoms and improve the individual's quality of life.
Autism in women
Autism in women presents unique challenges, as they tend to receive their diagnosis later and often as adults, due to more male-oriented diagnostic frameworks. Many women with autism go undiagnosed or are misdiagnosed because they have fewer restrictive and repetitive attitudes and are better able to ‘camouflage’ symptoms by mimicking social behaviours of other children their age.
Common characteristics in autistic females include:
- Avoiding eye contact
- Using imitative gestures in communication
- Being aware of the need to act socially
- Having one or two friends in primary school
In addition, a 2016 study in Poland found that women with autism may be better at non-verbal communication than men.
Symptom camouflage in autistic women is associated with worse mental health outcomes, including an increased risk of developing anxiety, depression and sleep disorders. It is crucial for health professionals to be aware of these differences in order to provide appropriate diagnosis and treatment for women with ASD.
In addition, women with ASD tend to be better at masking their symptoms to meet social expectations, known as symptom camouflage. This camouflage can lead to late diagnosis and greater difficulty in receiving the necessary support at the right time.
Education and support for children with ASD
Providing appropriate education and support for children with ASD is essential for their development. Structuring the environment helps children with ASD to understand and participate in activities, keeping them motivated. Implementing a daily activity schedule with pictures can help adjust their expectations and reduce anxiety.
Teamwork between parents, caregivers and teachers is essential to manage behaviour and promote socialisation. Strategies such as using visual aids and anticipating changes in activities can facilitate learning and communication in children with ASD, improving their quality of life and adaptability.
Summary
In summary, autism is a neurodevelopmental disorder with a wide range of manifestations and levels of severity. From the classification in DSM-IV to the significant changes in DSM-5, we have seen how the understanding of the autism spectrum has evolved to offer a more inclusive and accurate approach. Early detection, appropriate diagnosis and early treatment are essential to improve the quality of life of people with autism.
It is essential to continue to research and develop effective support strategies for people with ASD. By increasing awareness and understanding of autism, we can create a more inclusive and supportive environment for all. Let's continue to learn and work together to make a meaningful difference in the lives of people with autism.
Frequently Asked Questions
What is autism?
Autism is a neurodevelopmental disorder that affects social communication and behaviour, with symptoms varying in severity and manifestations.
What are the DSM-IV types of autism?
The types of autism according to DSM-IV are: Kanner's Autism, Asperger's Syndrome, Childhood Disintegrative Disorder (CDD), Rett Syndrome and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). These are the five recognised types.
What changes did the DSM-5 make to the classification of autism?
DSM-5 unified previous categories into Autism Spectrum Disorder (ASD), eliminating diagnoses such as Asperger syndrome and PDD-NOS, and introduced specifiers to indicate associations with medical, genetic or developmental conditions. This change simplifies the classification and allows for a broader view of autism.
Why is early detection of autism important?
Early detection of autism is critical because it allows for early treatment that can significantly improve the long-term prognosis. Do not underestimate the importance of detecting autism early.
How does autism manifest itself in women?
Autism in females manifests with later diagnosis, less restrictive and repetitive attitudes, avoiding eye contact and using imitative gestures in communication. This may be associated with poorer mental health outcomes.
