Many people think that Autism is a single disorder when in fact it is a collection of them. Think of Autism as an umbrella that covers Autism, Aspergers and Pervasive Development Disorder (PDD). As an umbrella term, Autism has a wide variety of characteristics and symptoms. Not every person has every symptom and not every symptom is as severe as the others.
The distinguishing factor most people use to describe Autism isn’t even part of Autism. When we talk about the formerly diagnosed condition “Aspergers”, “High Functioning” or “Mild Autism” vs. “Severe Autism” we are not actually talking about Autism at all–what we are talking about is cognitive functioning.
The Autism Spectrum Disorder criteria in the DSM-5 does not address the ability to use spoken language, self-feeding, toileting, or holding a job, yet those are the symptoms the majority of people consider when they are classifying a person with Autism. Even the DSM-5 “level of support” classification system is not truly addressing Autism symptoms but instead focusing on the ability to live independently, which is more dependent on cognitive ability than on Autism symptoms.
Autism in and of itself is based on social-communication, social interaction, and restricted or repetitive patterns of behavior, interests or activities. Cognitive functioning is based on attention, memory, reasoning and language that directly leads to gaining information.Therefore the deficits many people, myself included, are using to describe their loved ones as non-speaking or having trouble learning new skills is actually their cognitive functioning and not Autism at all.
Cognitive Functioning
If a person with Autism has high cognitive functioning they usually speak, can pay attention to social skills that are constantly being taught, remember previous learning experiences and can logically reason how they should respond to a social situation even if it does not come natural to them. Meanwhile, someone without those abilities is not able to respond appropriately. As you can imagine, these two situations are going to be “judged” very differently by society who then labels one “high functioning autism” and the other “severe autism” but in reality they both have the same social deficits–one just learned to adapt and the other was not able to due to brain abnormalities.
The ability to adapt has huge implications for treatment. A person with high cognitive abilities may only need 10 trials to learn a new skill while a person with low cognitive abilities may need 80 trials to learn that same skill. Essentially, the first person is learning 8 times as many skills as the second person learned one skill which snowballs over the lifespan. This allows people with high cognitive functioning who were considered to have “Mild Autism” to catch up while those who have low cognitive functioning and considered to have “Severe Autism” to fall further and further behind their peers.
Causes of Cognitive Differences
One contributing factor to cognitive functioning is oxygen deprivation before, during or shortly after birth. There can be multiple ways that this occurs: the mother’s blood may not have had enough oxygen, the mother’s blood pressure may have been too high or too low, the placenta could have separated too early, the mother may have had a very long or difficult delivery, the umbilical cord may have been compressed or wrapped around the baby’s neck, a serious infection could have occurred, the baby’s airway could be blocked or have a malformation, or the baby may have anemia and not carry enough oxygen. Whatever the cause, Seattle Children’s explains “without oxygen, cells cannot work properly. Waste products build up in the cells and cause temporary or permanent damage”.
Conservative numbers estimate that 15-30% of people with Autism also have seizures, many of which often cause some brain damage. Additionally, a genetic condition named Fragile X Syndrome, is the most common cause of inherited intellectual disability and it also is associated with nearly 10% of Autism cases.
Proper Terminology
So the next time you go to say “High Functioning Autism”, “Mild Autism” or “Severe Autism” please take a second to consider if you are attempting to describe language, attention, memory or reasoning skills because those are not Autism symptoms–they are cognitive abilities/deficits and would be more accurately labeled: “Autism without any Intellectual Disability”, “Autism with Global Developmental Delay” or “Autism with Intellectual Disability” because Autism acceptance starts with each of us labeling symptoms correctly.