For many years when people spoke about autism they talked about a group of disorders called Pervasive Developmental Disorders. This category of disorders included Autism, Asperger Syndrome, Childhood Disintegrative Disorder, Rett Syndrome and Pervasive Developmental Disorders (Not Otherwise Specified). These are the categories discussed in the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (Text Revision) DSM-IV-TR. This manual is presently being rewritten and a Fifth Edition is to be published in the near future. Categories and names are certain to change, but, the underlying disorders will not. A new emphasis on the spectrum of presentation will likely be the focus. Underlying disorders that have autistic like features will be excluded and a new attention will be placed on children with social communication disorders.
The purpose of any diagnostic categorization is to facilitate treatment and understanding. Those writing and formulating the new edition are pursuing this goal. The intent is to allow each child with a spectrum disorder to be better understood and enhance our understanding of their developmental trajectory.
No matter what the new categories are underlying patterns seen in children with autism spectrum disorders (ASDs) will not change. These patterns fall into three basic categories. The first concerns social reciprocity and their ability to recognize, perceive and decipher the intent, purpose and meaning of others. The second issue concerns central coherence. Children with ASDs frequently are overfocused and fixated on various patterns of behaviors or responses. They lack the volume of qualitative responses that most children express when they are put in a new situation. They tend to see the “forest and not the trees”. They often miss the “big picture” and have difficulty with concept generalization where they are unable to abstract their responses from one situation to another. the third and final area concerns executive function and a pattern of special interests, behaviors or activities. Many issues including auditory processing difficulty and unmodulated or over modulated selective, shifting and sustained attention abnormalities are seen.
Children with ASDs are no different than any other child. Certainly, our challenge to understand and respond to their feelings, thoughts words and actions is much higher; but, with new understanding generated by recent neuroscience and genomic discoveries we are continuing to open the door to the best treatments of children with ASDs. As a parent or someone who knows or loves a child with an ASD the future is resoundingly bright as the drapes that previously obscured our view and understanding are released and collapse to the floor.