Defining the Different Types of Autism in Children & Adults

Defining the Different Types of Autism in Children & Adults
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There are five different types of autism found on the Autism Spectrum including Kanner’s or Classical Autistic Disorder, Asperger’s Disorder, Child Disintegrative Disorder, Rett’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (NOS). While these different kinds of disorder fall along the same scale and show similar symptoms, they range in severity and levels of functioning. So how can we tell the difference between each kind?

Kanner’s or Classical Autistic Disorder

This is the most commonly known kind of autism. There is some relation to mental retardation and this ranges from mild to profound according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (American Psychiatric Association, 2000). Also according to the DSM-IV manual the criteria is as follows to be diagnosed for Classical Autistic Disorder.

The individual must show six or more symptoms from the following three categories, with at least two in section one, at least one symptom in section two, and at least one symptom in section three.

Section 1: Social Interaction (At least two)

  1. Impairment in non-verbal cues such as with facial expression or eye-to-eye gaze.
  2. Inability to create social relationships with same age groups.
  3. Inability to share enjoyment in age appropriate interests.
  4. Inability to show reciprocity socially or emotionally.

Section 2: Communication (At least one)

  1. Underdeveloped spoken language
  2. Inability to maintain or start conversation
  3. Repetitive language; for example repetition of a line from a movie
  4. No variety seen in how the child plays

Section 3: Repetition (At least one)

  1. Preoccupied with one or more interests where the concentration or the actual focus is abnormal.
  2. Does not show flexibility with routines.
  3. Repetition with motor movements; for example hand flapping, finger flapping, or hand wringing.
  4. Constant fixation with items.

The child will also show a delay in either one or all of the following:

  • Social interaction
  • Pragmatic language such as how you use language socially
  • Imaginative play.

Asperger’s Disorder

Asperger’s Disorder occurs throughout life and is not normally diagnosed until after the child enters school. The child does not normally show any cognitive delay and can actually show above average intelligence. This can be a main reason why the diagnosis does not occur until after the child is of school age and becomes part of a “social circle”. This disorder mostly involves social inabilities and is not related to mental retardation as is other types of autism.

According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria is as follows to be diagnosed for Asperger’s Disorder (American Psychiatric Association, 2000):

Social Interaction Impairment (At least two):

  1. Impairment in non-verbal cues such as with facial expression or eye-to-eye gaze.
  2. Inability to create social relationships with same age groups.
  3. Inability to share enjoyment in age appropriate interests.
  4. Inability to show reciprocity socially or emotionally.

Repetition (At least one):

  1. Preoccupied with one or more interests where the concentration or the actual focus is abnormal.
  2. Does not show flexibility with routines.
  3. Repetition with motor movements; for example hand flapping, finger flapping, or hand wringing.
  4. Constant fixation with items.

This disorder causes a considerable impairment in areas of functioning such as social, academic, or occupational. There is no delay shown in cognitive or language abilities and the child develops normally in regards to self help skills.

Child Disintegrative Disorder

This type of autism is associated with severe mental retardation and the child develops normally for the first two years of his or her life. The child show appropriate development in areas such as verbal communication, non-verbal communication, social relationships, play, and adaptive behavior (American Psychiatric Association, 2000). The child will show a loss of these developed areas before the age of ten in at least two of the subsequent areas:

  1. Meaningful or friendly language
  2. Social Skills
  3. Bathroom control (bladder and bowels)
  4. Play
  5. Motor Skills

The child will also show impairment in at least two of the following areas:

  1. Social Interactions( such as with nonverbal behaviors)
  2. Communication (such as with spoken language)
  3. Repetitive behavior (limited interests and motor gestures)

This type of autism is diagnosed less often than Classical Autistic Disorder and is seen more often in males (American Psychiatric Association, 2000).

Rett’s Disorder

Similar to Child Disintegrative Disorder, children diagnosed with Rett’s Disorder develop normally at first and then show a significant loss of developed areas and delays. Rett’s Disorder is correlated with severe Mental Retardation, is less common than Classical Autistic Disorder, and is more common in females than in males. (American Psychiatric Association, 2000.)

To be diagnosed with Rett’s Disorder the child must show all of the following:

  1. Normal Prenatal development; normal perinatal development
  2. Normal psychological development up to five months after birth
  3. Head circumference is normal at birth

All of the following occurs after a period of normal development:

  1. Between the ages of 5 and 48 months the head growth slows down
  2. Hand skills such as grasping, etc. are lost between the ages of 5 and 30 months old. Repetitive hand movements such as hand wringing replaces functioning hand movements.
  3. Social interaction lost early on but may develop later.
  4. Uncoordinated gait and trunk movements.
  5. Profound psychomotor retardation; severe impairment of receptive and expressive language development.

(American Psychiatric Association, 2000)

Pervasive Development Disorder Not Otherwise Specified (NOS)

This disorder is diagnosed when it doesn’t fit the criteria of other types of autism, or Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder (American Psychiatric Association, 2000). A child with this diagnosis will show impairment in social interaction as they may have a delay in non-verbal or verbal communication. They may also show stereotyped behavior such as limited interests or activities, and hand movements such as flapping or hand wringing.

Evaluation and Intervention

Again, while these different types of autism show similarities there are some major differences among the physical characteristics of children with autism that a professional may only be able to notice.

If the child is younger than three, early interventions may be the choice for you. Other disorders do not appear until after school age such as Asperger’s Disorder, and there are certain evaluation teams available through the state. Such interventions may include Cognitive Behavioral Therapy or Play Therapy (Mastrangelo, 2009).

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

Mastrangelo, S. (2009). Play and the child with autism spectrum disorder: From possibilities to practice. International Journal of Play Therapy, 18(1); 13-30. DOI: 10.1037/a0013810.