Autism classification: Difference between revisions

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{{Autism}}
{{Autism}}
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{{CMG}} ; {{AE}} {{ADG}}
 
== Overview ==
[[DSM|DSM 5]] categorized autism under autistic spectrum disorders/[[pervasive developmental disorder]]s (PDD). Autistic spectrum of disorders are characterized by widespread abnormalities of social interactions, communication associated with severely restricted interests and repetitive behavior and can be classified into 5 types.


==Classification==
==Classification==
Autism is a brain development disorder that first gives signs during infancy or childhood and follows a steady course without [[Remission (medicine)|remission]] or [[relapse]]. Impairments result from maturation-related changes in various systems of the brain. Autism is one of the five [[pervasive developmental disorder]]s (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior.
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'',<ref name=Freitag>{{cite journal |author=Freitag CM |title= The genetics of autistic disorders and its clinical relevance: a review of the literature |journal= Mol Psychiatry |volume=12 |issue=1 |pages=2–22 |date=2007 |doi=10.1038/sj.mp.4001896 |pmid=17033636}}</ref> 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,<ref>{{cite journal |journal= Curr Opin Neurobiol |date=2007 |volume=17 |issue=1 |pages=103–11 |title= Autism spectrum disorders: developmental disconnection syndromes |author= Geschwind DH, Levitt P |doi=10.1016/j.conb.2007.01.009 |pmid=17275283}}</ref> 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 [[Trait (biology)|traits]], such as avoiding eye contact.<ref>{{cite journal |author= Piven J, Palmer P, Jacobi D, Childress D, Arndt S |title= Broader autism phenotype: evidence from a family history study of multiple-incidence autism families |journal= Am J Psychiatry |date=1997 |volume=154 |issue=2 |pages=185–90 |pmid=9016266 |url=http://ajp.psychiatryonline.org/cgi/reprint/154/2/185.pdf |format=PDF}}</ref>


The manifestations of autism cover a wide [[Spectrum disorder|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.<ref>{{cite journal |author=Happé F |title= Understanding assets and deficits in autism: why success is more interesting than failure |journal=Psychologist |volume=12 |issue=11 |pages=540–7 |date=1999 |url=http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_12-editionID_46-ArticleID_133-getfile_getPDF/thepsychologist/psy_11_99_p540-547_happe.pdf |format=PDF}}</ref> 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 [[syndrome|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]].<ref name=Cohen>{{cite journal |journal= J Autism Dev Disord |date=2005 |volume=35 |issue=1 |pages=103–16 |title= Specific genetic disorders and autism: clinical contribution towards their identification |author= Cohen D, Pichard N, Tordjman S ''et al.'' |doi=10.1007/s10803-004-1038-2 |pmid=15796126}}</ref> Although individuals with Asperger's tend to perform better cognitively than those with autism, the extent of the [[Diagnosis of Asperger syndrome#Differences from high-functioning autism|overlap between Asperger's, HFA, and non-syndromal autism]] is unclear.<ref>Validity of ASD subtypes:
=== Classification according to DSM V criteria ===
*{{cite journal |journal= Rev Bras Psiquiatr |year=2006 |volume=28 |issue= suppl 1 |pages=S3–S11 |title= Autism and Asperger syndrome: an overview |author= Klin A |doi=10.1590/S1516-44462006000500002 |pmid=16791390 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&lng=en&nrm=iso&tlng=en}}
DSM 5 categorized autism under autistic spectrum disorders/[[pervasive developmental disorder]]s (PDD). Autistic spectrum of disorders are characterized by widespread abnormalities of social interactions, communication associated with severely restricted interests and repetitive behavior.<ref>{{cite journal |journal= Curr Opin Neurobiol |date=2007 |volume=17 |issue=1 |pages=103–11 |title= Autism spectrum disorders: developmental disconnection syndromes |author= Geschwind DH, Levitt P |doi=10.1016/j.conb.2007.01.009 |pmid=17275283}}</ref><ref name=":0">{{cite journal |author= Piven J, Palmer P, Jacobi D, Childress D, Arndt S |title= Broader autism phenotype: evidence from a family history study of multiple-incidence autism families |journal= Am J Psychiatry |date=1997 |volume=154 |issue=2 |pages=185–90 |pmid=9016266 |url=http://ajp.psychiatryonline.org/cgi/reprint/154/2/185.pdf |format=PDF}}</ref><ref name="Cohen">{{cite journal |journal= J Autism Dev Disord |date=2005 |volume=35 |issue=1 |pages=103–16 |title= Specific genetic disorders and autism: clinical contribution towards their identification |author= Cohen D, Pichard N, Tordjman S ''et al.'' |doi=10.1007/s10803-004-1038-2 |pmid=15796126}}</ref>
*{{cite journal |journal= J Autism Dev Disord |date=2008 |title= Examining the validity of autism spectrum disorder subtypes |author= Witwer AN, Lecavalier L |doi=10.1007/s10803-008-0541-2 |pmid=18327636}}</ref>
{{family tree/start}}
{{family tree | | | | | | | | | | A01 | | | | | | | | | |A01= Autistic spectrum disorder}}
{{family tree | | | | | | | | | | |!| | | | | | | | | | | |}}
{{family tree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | | |}}  
{{family tree | | B01 | | B02 | | B03 | | B04 | | B05 | | | B01=Autistic disorder| B02=Retts disorder| B03=Childhood disintegrative disorder| B04= Pervasive developmental disorder|B05= Asperger's disorder }}
{{family tree/end}}


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.<ref name=Volkmar>{{cite journal |author= Volkmar F, Chawarska K, Klin A |title= Autism in infancy and early childhood |journal= Annu Rev Psychol |date=2005 |volume=56 |pages=315–36 |doi=10.1146/annurev.psych.56.091103.070159 |pmid=15709938}} A partial update is in: {{cite journal |journal= World Psychiatry |date=2008 |volume=7 |issue=1 |pages=19–21 |title= Autism in infants: an update |author= Volkmar FR, Chawarska K |pmid=18458791 |pmc=2366821}}</ref>
=== Classification according to severity level ===
Based on the degree of severity and level of support ASD are classified into 3 types<ref name=":0" /><ref name="Freitag">{{cite journal |author=Freitag CM |title= The genetics of autistic disorders and its clinical relevance: a review of the literature |journal= Mol Psychiatry |volume=12 |issue=1 |pages=2–22 |date=2007 |doi=10.1038/sj.mp.4001896 |pmid=17033636}}</ref><ref>{{cite journal |journal= Am J Hum Genet |date=2008 |volume=82 |issue=1 |pages=7–9 |title= Unraveling autism |author= Stephan DA |doi=10.1016/j.ajhg.2007.12.003 |pmid=18179879}}</ref>


The inability to identify biologically meaningful subpopulations has hampered research into causes.<ref>{{cite journal |journal=Pediatrics |date=2008 |volume=121 |issue=6 |pages=1225–9 |title= Autism and the environment: challenges and opportunities for research |author= Altevogt BM, Hanson SL, Leshner AI |doi=10.1542/peds.2007-3000 |pmid=18519493}}</ref> 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).<ref>{{cite journal |journal= Am J Hum Genet |date=2008 |volume=82 |issue=1 |pages=7–9 |title= Unraveling autism |author= Stephan DA |doi=10.1016/j.ajhg.2007.12.003 |pmid=18179879}}</ref>
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Severity level
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Social communication
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Restricted, repetitive behaviors
|-
|Level 3
|Requiring very substantial support
|
* Severe deficits in verbal and non-verbal communication skills
* Severe impairment in functioning
* Very limited initiation of social interactions
* Minimal response to social overtures from others
|
* Inflexibility of behavior
* Extreme difficulty in coping with change
* Repeated behavior markedly interferes with functioning in all spheres
* Great distress/difficulty changing focus or action
|-
|Level 2
|Requiring substantial support
|
* Marked deficits in verbal and non-verbal communication skills
* Marked impairment in functioning
* Limited initiation of social interactions
|
* Difficulty in coping with change
* Distress/difficulty changing focus or action
* Repetitive behaviors occur frequently
|-
|Level 1
|Requiring support
|
* Without support, deficits in verbal and non-verbal communication skills
* Atypical and unusual social responses
|
* Interference with functioning in one or more context
* Problems of organization and planning hamper independence
|}


==References==
==References==

Latest revision as of 13:47, 2 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

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 and can be classified into 5 types.

Classification

Classification according to DSM V criteria

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
 
 

Classification according to severity level

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
  • Severe deficits in verbal and non-verbal communication skills
  • Severe impairment in functioning
  • Very limited initiation of social interactions
  • Minimal response to social overtures from others
  • Inflexibility of behavior
  • Extreme difficulty in coping with change
  • Repeated behavior markedly interferes with functioning in all spheres
  • Great distress/difficulty changing focus or action
Level 2 Requiring substantial support
  • Marked deficits in verbal and non-verbal communication skills
  • Marked impairment in functioning
  • Limited initiation of social interactions
  • Difficulty in coping with change
  • Distress/difficulty changing focus or action
  • Repetitive behaviors occur frequently
Level 1 Requiring support
  • Without support, deficits in verbal and non-verbal communication skills
  • Atypical and unusual social responses
  • Interference with functioning in one or more context
  • Problems of organization and planning hamper independence

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 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. ↑ 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. ↑ 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.

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