On The Spectrum - A Discussion on Autism

By Aaron Olson

The use of the phrase “on the [autism] spectrum” is growing in both the medical literature and as a colloquial phrase used by maladroit people to describe a similarly socially inept co-worker. With that said, in light of autism awareness month, we thought it would be helpful to shed some light on autism and who, or more appropriately “what,” falls on the spectrum.

Autism is generally thought of as a bio-neurological developmental disability that appears before the age of 3 and impacts the development of areas in the brain responsible for social interaction, communication, and cognitive function. The disorder is also associated with several serious comorbid conditions such as digestive problems and impaired motor function. In short, most people, until recently, associated autism with a serious developmental disability.

So how did we go from the term “autism” to describe a serious developmental disorder to Autism Spectrum Disorder, which can include very mild disorders that can be associated with functioning (and even high functioning) members of society? The term autism was first used in 1908 to describe a subset of schizophrenic patients whose symptoms had many of the characteristics of what we today recognize as autism. In the mid-1940s autism started to be viewed as its own disorder and shortly thereafter Hans Asperger describes a “milder” form of autism, which came to be known as Asperger’s syndrome.

It wasn’t until 1987 that “autism disorder” was added to the DSM with a checklist of diagnostic criteria, and in 1988 the movie Rain Man was released starring Dustin Hoffman as an autistic savant, which helped draw public attention to the condition. Although Asperger’s syndrome was added to the DSM in 1994, relatively few changes were made until 2013 when the DSM combined all the autism subcategories into one general disorder known as autism spectrum disorder. As such Asperger’s is no longer considered a separate condition. ASD is now defined by two categories: 1) Impaired social communication and/or interaction. 2) Restricted and/or repetitive behaviors.

This definition has led to a number of misunderstandings, particularly with people who aren’t part of the autism community, about what it is to be autistic. While ASD is considered to be a spectrum disorder characterized by impaired social interaction, it does not mean that every person who fails to exhibit some degree of social grace is “on the spectrum.” Additionally, there are a number of other disorders that might impede a person’s ability to interact with others, such as ADHD and bipolar disorder, that don’t necessarily land someone on the spectrum either. The main takeaway from this should be there are hard minimum diagnostic characteristics associated with ASD and, even though the disorder exists on a spectrum, not every “autistic-like” behavior, in isolation, should be interpreted as a symptom of ASD.