Tag: Atypical

Autism, which today is clinically known as Autism Spectrum Disorder (ASD), is one of the more complex and largely still unknown conditions in medical science today. It is a disorder with so many symptoms, in a broad range of intensities, that for centuries, it was not even properly recognized as a distinct condition. In past years, some forms of ASD were misdiagnosed as schizophrenia, because of some behavioral similarities and the fact that some ASD patients did respond positively to some schizophrenic treatments like prescribing antipsychotic medication.

Today, ASD understanding has improved, but the knowledge we have of the disorder is far from complete. Over the decades, many iterations of our understanding of ASD have come and gone. This has left some people confused as to the exact state of an ASD diagnosis since many are now outdated and no longer medically classified in such a way. All ASD patients today, for example, are diagnosed on “the spectrum.” There is no longer any distinct classification such as one ASD patient having Asperger’s Syndrome, while another has Childhood Disintegration Disorder.

One of these classifications that are no longer used is Atypical Autism, and there are many good reasons for that.

The Early Classifications

There is one medical document that is often considered a central source for global medical references, and that is the Diagnostic & Statistical Manual of Mental Disorders. The DSM, as it is more conveniently referred to, has been a touchstone of American mental health knowledge and reference since 1952. It is a “living document” in the sense that it is periodically updated to reflect discoveries, treatments and developments in the mental health medical space. So, the first edition of the text used is now referred to as “DSM-I.”

It was only in the 1980s, with the introduction of DSM-III, that ASD was given a distinct classification. However, unlike the current system, which defines ASD as one condition with a spectrum of different symptoms at different intensities, the DSM-III text created four different classifications for ASD and then tried to fit ASD patients into each of these categories. Atypical Autism was one of these four categories.

What Was Atypical Autism?

Atypical Autism, under DSM-III was not clinically referred to with this term. The technical term for it was Pervasive Developmental Disorder-Not Otherwise Specified, or PDD-NOS. As the name indicates, PDD-NOS was a “miscellaneous” category where those diagnosed with autism who didn’t fall into the other three categories would go. Asperger’s Syndrome was the first category and considered the “mildest and high functioning.”

The other categories, “Classic Autism” and “Childhood Disintegration Disorder,” were considered more severe. This meant people with ASD symptoms more severe than Asperger’s, but milder than Classic or CDD went into the PDD-NOS category, which quickly showed how inadequate a four-class category system was as more and more people failed to fit into the other three categories neatly.

The symptoms of people formerly classed as having PDD-NOS included:

Anomalous/Unusual Social Interactions

This was difficult to categorize since so many potential symptoms could be included, but in general, if a child experienced difficulty smoothly socializing with other children, and it was due to specific behaviors, such as unprovoked hostility, or unwillingness to speak, these fell into the category.

Linguistic/Communication Issues

Those with PDD-NOS in the past were also characterized by having communication deficits that made it difficult for them to be understood by others. This may have manifested as delayed communication development, or other anomalies, such as speaking without inflection and sounding like a robot.

Repeating Actions

Like other former categories of autism, PDD-NOS also included symptoms of repetitive motions or behaviors. Repeating certain gestures, actions, or words would often be a soothing activity in times of stress. However, there was little discretion about when these repeating behaviors would occur, which could be interpreted as inappropriate given the timing and circumstance.

Atypical Sensory Experience

This can be difficult to diagnose properly since an objective measurement is difficult. Atypical sensory experience means people formerly diagnosed with PDD-NOS may have apprehended their senses in ways that differ from those without the condition. Colors, for example, may look different, smells may be stronger or weaker, the sensation of touch may feel different.

The New Classification

By the 21^st century, it was apparent that trying to fit the huge variance of autism symptoms into four categories wasn’t working as accurately as envisioned. In 2013, with DSM-IV, the four categories of autism were discarded. We now operate on a single system of Autism Spectrum Disorder, where individuals are diagnosed as being “on the spectrum.” From there, a more in-depth diagnosis is made to catalog and diagnose the specific symptoms and then treat each person in a customized, personalized manner that suits their needs, rather than classing them as Category 1 or Category 4 and using only treatments specific to that category. ASD is far more complex than that and requires a nuanced treatment strategy.

As the name implies, ASD, or autism spectrum disorder, is a condition that lies along a broad range of different symptoms and degrees of severity. Someone that is diagnosed as being in the “mild” end of the spectrum may be able to function more or less normally, and only be considered by others to be a little introverted or maybe eccentric in some habits.

On the other end of the spectrum, symptoms can be so severe that someone diagnosed with ASD can be unresponsive and experience great difficulty interacting with others and performing normal, daily activities without significant challenges. Today, regardless of where along this spectrum a person diagnosed with ASD is, that person is said to have ASD.

However, this was not always the case. As recently as six years ago, there was another form of diagnosis used, primarily in American medical circles, to evaluate ASD. The system used different grades of the spectrum, and it had a specific class of ASD called “Atypical Autism.”

So what was Atypical Autism, and how would someone be diagnosed with it?

All In The Book

Between 1994 and 2013, a specific edition of a document known as the Diagnostic & Statistical Manual of Mental Disorders was used as the textbook reference for medical professionals when diagnosing, identifying, and classifying mental disorders.  There have been five editions of this book, known as DSM since it first started publication in 1952. It was not until the 1980s, with DSM-III that autism was even acknowledged as a unique condition. Before DSM-III children with ASD were diagnosed as schizophrenic and received treatment for such.

After the publication of DSM-III, autism got much more specific examination from medical professionals and had treatments tailor-made for those diagnosed, rather than assuming schizophrenia, which was not an effective treatment and in some cases, even harmful. From this new understanding came the idea that there were different types and “grades” of autism, and one of these was known as Atypical Autism or Pervasive Developmental Disorder-Not Otherwise Specified, also known as PDD-NOS.

What Is It?

The other types of autism were considered Pervasive Developmental Disorders, or PDDs, and fell under five categories; autism, Asperger’s syndrome, childhood disintegration disorder (CDD) and Rett’s Syndrome. The fifth, Atypical Autism, or PDD-NOS, was a “miscellaneous” category for people diagnosed with some autism characteristics who didn’t fit into the other four existing PDD categories.

In effect, atypical autism was an admission that a person being diagnosed had traits of autism, but not “enough” in any one of the four categories to conclusively “drop that person into a box.” In some respects, it is because of the organic, nebulous nature of autism symptoms, and their varying degrees, that when DSM-V eventually came out, the five categories were abandoned, and atypical autism got folded into the others.

What Are The Symptoms?

Atypical autism, when it was still being referred to as such, as had a mix of different symptoms. In the DSM-III and DSM-IV era, Asperger’s Syndrome was considered the “highest functioning” form of autism, with some of those diagnosed with it able to function without any special medical treatment, while those diagnosed with other autism, such as CDD, required more intensive attention and treatment.

Atypical Autism was, in terms of severity, considered somewhere between Asperger’s and typical CDD autism, a “mild” form that didn’t require serious treatment or therapeutic intervention for those diagnosed to have a normal, productive life. The symptoms of atypical autism included:

Atypical/Unusual Social Behavior

This was another broad “umbrella term” that includes potentially everything from delayed responses, to an inability to maintain eye contact. The only consistent thing was that, compared to other people within that culture, the behavior was considered abnormal.

Language/Communication Deficit

Another very broad range of behaviors that could even fall under unusual social behavior. Atypical autism has characteristics such as communication difficulty. This could manifest in delayed communication acquisition, taking much longer to learn to speak, or in unusual speech patterns, such as speaking in a flat monotone, like a “robot,” having never learned to use tone or voice inflection to add nuance to words.

Repetitive Motions/Behaviors

Atypical autism could be characterized by a focus on ritual and repetition. The AA patient would fall back on repeating certain actions or rituals over and over again, either as a way to relax or to feel a sense of control in stressful situations.

Atypical Sensory Experience

Someone diagnosed with atypical autism could have a sensory experience that was different from others, either more intense or less. For example, some could have a much more sensitive experience with touch, reacting much more strongly and negatively to changes in temperature. On the other hand, that sensory stimuli could also be much less refined, such as an atypical autism child have little or no sense of smell, and unable to participate meaningfully in smell-based activities.

Because of this large range of differences, it was eventually decided in 2013 to eliminate the different autism categories. ASD or Autism Spectrum Disorder is now the sole diagnostic category.