As an update to a previous BLOG that was written (pre-ICD-11), we have updated the info on the diagnostic criteria for ASCs (Autism Spectrum Conditions) or ASDs (Autism Spectrum Disorders) as follows:
Despite many training providers, resource materials, clinicians and families referring to the OLD methodology of using the autism diagnoses: ‘severe’, ‘high functioning,’ and ‘Asperger’s Syndrome’, these terms NO LONGER fall within current diagnostic guidelines.
The OLD ICD-10, (ICD being short for: ‘International Statistical Classification of Diseases and Health Related Problems’, the most commonly-used diagnostic manual in the UK), listed Childhood Autism, Autistic Disorder, Atypical Autism, Asperger Syndrome & ‘Pervasive developmental disorder, not otherwise specified’, as the main autistic categories. However this too is now out of date.
With the launch of the latest ICD-11 in summer 2018, only ‘Autism Spectrum Disorder‘ is stated, with varying sub-descriptions – see graphic. These are the terms that diagnosing clinicians should use. (It’s possible that some may continue to use the older terms, until their own continued professional development has caught up with the new guidelines).
In America, within the DSM-5 diagnostic manual, clinicians are also advised to also use the broad term Autism Spectrum Disorder, but with a numerical note of severity, and / or the additions of ‘With or without accompanying intellectual / language impairment,’ dividing the ‘severities’ from 3 to 1. (e.g ‘Autism Spectrum Disorder level 1’ is seemingly akin to an Asperger’s-type diagnosis, under the ‘older’ system).
But what if you were diagnosed with an older autism spectrum diagnostic term, e.g. Asperger’s – do you still keep that diagnosis? The answer is emphatically, yes. Autists identifying as having Asperger Syndrome often feel comfortable with their own diagnostic ‘label’, and the term ‘Aspie’ is widely used and liked (by many autists).
And WHY do resources like this one keep using the phrase ‘Autism Spectrum Disorder’ instead of Autism Spectrum Condition, which is obviously preferable? It is because anyone researching autism spectrum conditions needs to use the correct terms to inform their searches, and currently, the diagnostic guidelines use ‘Disorder’, and not ‘Condition’. We may not like the term Disorder, and we may choose to use ‘Condition’ personally, but diagnostically and from a research and clinical point of view, ‘Disorder’ is used, and informs our research.
Finally, what about Hans Asperger’s links with the Nazis? Briefly, we advise reading author Steve Silberman’s ‘Neurotribes‘ book, for a well-written piece of autism back-history. (You can read an article here summarising the recent ‘Asperger’ revelations. “Asperger it seems was playing a very complicated game of appearing to be anti-Nazi, but meanwhile signing… death warrants,” Silberman has said.) Do #actuallyautistic individuals want a moniker associated with the Nazi regime? That’s an interesting debate for us to tackle at ‘Spectra.blog’ another day!
A little disclaimer – here at Spectra.blog we don’t claim to be experts about Autism Spectrum Conditions / Disorders; the information we post here is based purely on our own exposure and experiences.
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Them V Us – disparity in the autism spectrum condition ranks (ASD/ASC/Asperger’s)
It’s the 21st-century – 2017 to be precise. I have told my friends and family that I am gay; I only realised myself, relatively recently – their responses run along a similar vein. They are generally a mixture of ambivalent, surprised and somewhat perplexed; and more than once, I am told ‘well you are obviously only mildly gay’, and ‘well we’re all a little bit gay aren’t we?’
Despite my protestations to the contrary on both of those counts, the friends and family remain unconvinced, and in most cases, the subject is barely brought up again. Within the wider family, any hint of conversation around the subject of my ‘gayness’, or anyone else’s for that matter, feels like it’s swiftly dropped. (‘We don’t talk about that in these circles, you know’. seems the inference. ‘It’s too awkward. We’d have to look back on the heterosexual challenges you have faced in life, with the hindsight that you are and have always been gay; and maybe if we look too closely, we would feel awkward that no-one noticed your struggles. Or that we closed our eyes to it, or put it down to your quirkiness. ‘Cause we’re all a little bit quirky, right?’
This story is not quite true. I have substituted the word autistic for gay, for the sake of comparison.
In the 21st-century, such responses (like those detailed above) to one’s inner coding, one’s DNA, one’s hard wired neurology, seem so dated and cold, do they not? Do they seem dismissive too?
To make another comparison…. is one mildly pregnant? Are we ‘all a little bit pregnant’? Of course not. Sometimes we share traits with pregnant women, but that doesn’t make us mildly pregnant.
The aforementioned story is an interesting and arresting comparison, in any case.
Let’s talk about autism spectrum conditions (ASCs). Autism is autism. Yes, some individuals need less (or even zero) support in place to function fairly successfully in a neurotypical world than others. The label ‘high functioning’ would likely be hung around their metaphorical necks.
“What if autists have autism running through their core, like Brighton rock?”
Other autists with increased support needs, and co-morbid conditions such as learning difficulties, would likely be labelled ‘low functioning’ or, depending on their perceived communication abilities and health challenges, the dreaded ‘extremely autistic’. What if we stopped thinking about mild or severe, and high or low functioning? What if autists have autism running through their core, like Brighton rock, and their co-morbid conditions, health issues, sensory and social challenges simply accessorise or populate their condition, and make it more or less debilitating, and ‘dis-abling’? (Because, yes, autism is classed diagnostically as a disability.) This ‘frame’ makes the modern way of looking at autism (without functioning labels and even without the diagnostic term ‘Asperger Syndrome’, for so-called high functioning autists who did not have learning delays present in infancy) seem infinitely sensible.
But back to our early opening story – why is it hard for friends and families to grasp the idea that a loved one is autistic – and the author of this blog is musing specifically about late autism diagnosis (including the decreasingly given ‘Asperger’s’ profile) – e.g autism diagnosis in adulthood. (Read our post on confusion in diagnoses of autism HERE).
It’s important to clarify that questioning HOW autistic someone is (‘Aspergers? Oh, I see, just MILDLY autistic…’), dismisses the autist’s struggles.
And it’s important to emphasise that pedalling the old chestnut ‘We’re all a little bit autistic’ is patronising (and untrue.)
We need to realise that autism is widespread – everyone knows people who are autistic, including family members, friends, work colleagues (and yes, even those quirky celebrities we’re all fascinated by) – even though the individual may not (yet) know themselves that they have autism.
So to conclude – when your loved one tells you they’re autistic, it is important to give the disclosure the respect and acceptance it deserves.
(You may like to check out our blog about what to expect during your adult autism diagnosis HERE. And also our blog on ‘what next?’ after autism diagnosis, HERE).
A little disclaimer – here at Spectra.blog we don’t claim to be experts about Autism Spectrum Conditions; the information we post here is based purely on our own exposure and experiences.