Autism severity and its relationship to disability

Abstract

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological cooccurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay SummaryThe severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful subgroups of autistic individuals and could be useful in clinical care.

What Factors Predict Adaptive Functioning in Preschool Children with Autism Spectrum Disorder? A Longitudinal Study

“…These two sets of symptoms have a wide range of severity levels, which may be different for each child with ASD [ 2 ]. Hence, it is important to note that there is a wide range of heterogeneity within the autism spectrum, and individuals with ASD may have varying levels of adaptive functioning abilities [ 2 , 3 ]. Adaptive functioning refers to an individual’s ability to manage and adapt to the demands of everyday life, and includes skills such as socialization, communication, self-care, home living, and leisure and community participation.…”

Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood

“…Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by the presence of two core symptom domains: social-communication symptoms (SA) and restricted/repetitive behaviors (RRB) (American Psychiatric Association, 2013). Autism may also be associated with several additional mental health conditions; 70% of autistic individuals have at least one co-occurring condition and 41% have two or more (Simonoff et al, 2008), making mental health challenges a common part of autistic life (Waizbard-Bartov et al, 2023). The most common co-occurring mental health conditions experienced by autistic individuals are attention-deficit hyperactivity disorder (ADHD), anxiety disorders and disruptive, impulse-control, and conduct disorders (Lai et al, 2019; Mutluer et al, 2022).…”

“Profound autism”: The dire consequences of diagnostic overshadowing

“…This is highlighted in the use of co-occurring difficulties to create "profound autism." Waizbard-Bartov et al (2023) have added "severe" autism to the term, underscoring there is no consensus over what "profound autism" is. There is resistance against "profound autism," and its utility remains undemonstrated.…”