![]() The underlying assumption is that the way neurotypical individuals seek out, initiate and maintain social interactions represents a basic human behavior, and lack of interest or ability to participate in this behavior is considered to be a disability. These can range from engaging in repetitive movements, such as hand flapping, to having an intense preoccupation with highly specific objects or topics. The second core domain is the presence of restricted or repetitive patterns of behavior and interests (RRBs). These can manifest, for instance, in failure to use eye contact to initiate communication with others, as well as in social interactions that lack a natural, “back and forth” reciprocal quality. The first domain comprises deficits in social and communication abilities (social affect). Based on current DSM5 criteria ( APA, 2013), autism includes three levels of severity ranging from “requiring support” to “requiring very substantial support.” Judgments of severity are based solely on the characteristics of the two core domains that make up the diagnostic criteria. 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.Īutism has historically been considered an impairing condition. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person’s life. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. 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. This approach was recently taken by The 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. In order to truly understand how a person’s autism impacts their life, both core symptoms as well as other challenges should be considered. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring 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. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. 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. ![]()
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