I can sort of see some commonalities between most ASDs, but the sheer variety of diagnosed people I’ve met (from normal, successful, but slightly quirky to literally unable to do anything on their own) has always struck me as odd.
What exactly are the criteria for a disorder to be associated with autism? As a complete amateur, it always seemed like a very artificial construct. It also makes me curious about how valid the ongoing controversy about its cause could be, given the enormous variety of ways it can present itself.
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So the first thing to note is that it’s not a gradient, but a spectrum. It’s not a scale from bad to worse, like with a lot of other afflictions. But instead it’s actually a whole bunch of different symptoms people with ASD may or may not have. And this results in different people with ASD to have vastly different experiences. Although there are commonalities like poor resistance to stress and difficulty communicating emotions with neurotypicals.
Autism is also very poorly understood. We don’t really know how it works or what’s causing it.
Another thing worth noting is that the symptoms(or at least their impact) can be somewhat reduced with a lot of effort. For example i have ASD, shit sucks. And when i was young it was really looking like i was going to need to do special ed.
But with a lot of councelling, therapy, good parenting and effort i managed to get a better grip on some of my symptoms and become what is called “high functioning”(which is a term i hate). This is an ongoing process. And now instead of special ed im doing a masters in mechanical engineering.
So you can learn to work around it a bit. This isn’t the same as masking, which is not recommended.
As a psychology student I would say very poorly. The DSM is made by physiologists. They are contaminated by a medical epistemology, a medical history and the scientific method that was invented to study a mechanistic world. The mind is symbolic, interconnected, dynamic, cumulative… It has rules and functions that goes beyond the reductionist mechanistic thinking.
It’s a relief that we have new epistemologies and methods of build knowledge like phenomenology and system thinking!
In physical medicine, most conditions and diseases can be defined by something objective and observable. Tuberculosis is a lung infection by a particular bacteria. Diabetes is recognized when blood sugar remains above normal levels for an extended period of time. Doctors might not always know the root cause of a condition or disease nor be able to predict its course with certainty, but at some point, there is a physical anomaly that can be tested and verified.
Not all physical conditions are like this. Chronic fatigue syndrome and fibromyalgia are examples of diagnoses based on patterns of symptoms and elimination of other explanations.
Psychiatrists and psychologists do not know how the brain works. It isn’t possible to examine brain waves, or MRI scans, or anything else, and say, “Ah! There’s the depression! And this guy… see, right there, that’s obsessive-compulsive disorder!” Aside from a couple things like traumatic brain injury, *all mental disorders are diagnosed by patterns of symptoms and elimination of a “better” explanation*.
So the closest we have to a definition of *Autism Spectrum Disorder* is the diagnostic criteria, published in the *Diagnostic and Statistical Manual of Mental Disorders* (DSM). I can’t link to the DSM, because it’s a book for which a hefty fee is charged ($129.56 at present for [the paperback edition on Amazon](https://www.amazon.com/dp/0890425760/)). However, the diagnostic criteria for autism spectrum disorder are listed on [this CDC web page](https://www.cdc.gov/autism/hcp/diagnosis/index.html#cdc_hcp_diagnosis_special-diagnostic-criteria-for-asd).
There is a long, complex and controversial history behind the decision to combine various previously recognized disorders (the most familiar being Asperger’s Syndrome and classic autism) into a single diagnosis of Autism Spectrum Disorder. The short explanation is that as different as these manifestations appear to be, there was no clear line between one of the autism-like disorders and another; and the current suspicion (we don’t yet have the technology to know for certain) is that they all have a common cause in something that goes wrong during early development of the brain.
Wikipedia explains what a [spectrum disorder](https://en.wikipedia.org/wiki/Spectrum_disorder) means in psychology. A particularly helpful quote from that page:
>The term spectrum was originally used in physics to indicate an apparent qualitative distinction arising from a quantitative continuum (i.e. a series of distinct colors experienced when a beam of white light is dispersed by a prism according to wavelength). Isaac Newton first used the word spectrum (Latin for “appearance” or “apparition”) in print in 1671, in describing his experiments in optics.
>The term was first used by analogy in psychiatry with a slightly different connotation, to identify a group of conditions that is qualitatively distinct in appearance but believed to be related from an underlying pathogenic point of view.
To ELI5 that: In a rainbow, there is no specific point where red turns to orange, orange turns to yellow, or yellow turns to green. Yet, when we look at red and then at green, they seem completely different. They’re all part of the same spectrum — color — because they all come from the same origin — wavelength of light — even though, if you take two colors at random, they appear to be unrelated.
There are some common “symptoms” that can be used to identify autism, but it’s generally how different symptoms come together that will lead to a diagnosis. So every autistic person is a unique cocktail of symptoms and struggles. In the most insultingly simple terms it’s a case of a psychiatrist going “yeah I’m pretty sure you’re autistic”.
Diagnosis involves a detailed interview with the person as to their present experiences as well as trying to find out if there were any signs during childhood (e.g. by speaking to parents).
There hasn’t been much detailed research on autism yet so there’s so much left to be discovered. We only relatively recently started commonly diagnosing it in women, for example, and we have discovered that women typically have very different symptoms to men. That’s why we transitioned to an image of a spectrum rather than a single cookie-cutter disorder. As more research is done it may be split into multiple disorders or even do away with the label all together.
It’s not like a virus or even some mental health issues where you have it and you need curing. If you’re experiencing certain difficulties an autism diagnosis can help you make adjustments and find support to make your life easier. For example, I used to get overwhelmed in loud, busy places and I never understood why. I just assumed that I was overreacting and powered through it, at great harm to my mental health. Now I have a diagnosis I know not to put myself in those situations and I no longer feel bad about it. I also have a reason that people will actually listen to (most of the time) so I get less hassle from it.
TLDR: there is no exclusive definition for the autism spectrum, but maybe this is for the best because we’re discovering more and more that rigid diagnostic criteria aren’t actually helpful.
Autism isn’t one thing. Like USA is a bunch of countries (states) in a trenchcoat, pretending to be one, autism is a bunch of different conditions with vaguely similar symptoms. There’s a number of genetic markers correlated with it, but we really don’t know much about it, because it’s not a single entity. “It” is 80%+ heritable, though. (So when looking for prognosis for an ASD kid, you are best off looking at family member experiences).
Source: have had traits of the stuff in the family for 4+ generations, though my kid was the first to be formally diagnosed.
The autism spectrum is a way of understanding that people with autism can be very different from each other. Some might be really good at certain things, but find socializing tricky, while others might need help with everyday tasks. They all have some common challenges, like understanding social cues, communicating, or dealing with changes, but how much these things affect them can vary a lot. So, it’s called a “spectrum” because people can have mild or more severe symptoms, just like how a rainbow has many different colors but is still a rainbow.
Now, let’s dive deeper into your question:
**How is the autism spectrum defined?**
Autism Spectrum Disorder (ASD) is diagnosed based on a set of criteria that focus on two main areas:
1. **Social communication and interaction difficulties**: This can range from having trouble understanding social cues (like body language or tone of voice), to finding it hard to build relationships, or even being non-verbal. Some people might appear “quirky” or struggle with small talk, while others might not speak at all.
2. **Restricted, repetitive behaviors, interests, or activities**: This could mean doing things like repeating the same action over and over, having very specific routines or interests, or being highly sensitive to things like sounds, textures, or lights.
The wide variety you’ve noticed comes from the fact that people can experience these symptoms to different degrees. Some people with autism might need very little support and be quite independent (this used to be called “high-functioning” autism), while others might need a lot of help with daily tasks (what was once labeled “severe” autism). But they all share difficulties in those two key areas.
**Why does it seem so broad?**
Autism is a spectrum because no two people with autism are the same. Think of it as having common “ingredients” but in different amounts for each person. Some may have lots of social difficulties but not many repetitive behaviors, while others may show the opposite pattern. This variety can make autism seem like a very broad or “artificial” construct, but it reflects the complexity of how the brain works.
**Why is there controversy about the causes?**
The cause of autism is still being studied, and there’s debate partly because autism looks so different in different people. Some researchers believe that autism is influenced by a mix of genetic and environmental factors, but because the symptoms can vary so much, it’s hard to pin down a single cause. The controversy comes from people trying to figure out if autism is one thing with many forms or a collection of different conditions that look similar.
So, while autism can appear very differently from person to person, the core features of social and communication challenges, along with repetitive behaviors, tie them together under the spectrum. Does that help clarify things?
People are not identical – even two people you’d consider to be “perfectly normal” will have some differences in how they function as a person. In most cases, those differences are small enough to not have major impact on their lives – some people are slightly better or worse at reading emotions, expressing themselves (verbally and non-verbally) or have some quirky behaviours (compulsively playing with pen?) that don’t impact their lives at all.
Autism spectrum starts where those differences become big enough to impact ones life – ICD-10 (international classification for diseases) criteria specifically considers three different categories of issues (impaired social interaction, abnormal communication, restricted/repetetive behaviour) and requires each of them to be problematic enough to classify.
Specific criteria (by ICD-10) are as follows: at least 6 specific symptoms of impairment in social interactions, abnormalities in communication and restrictive repetetive patterns of behaviour – none being explained by other disorders; in a way that makes autism spectrum a catch-all for specific severe social interaction deficiencies that don’t fit anything more specific.
Simply put – autism spectrum is all people that are far out of norm enough in those specific criteria that it has negative impact. Now, nothing says how far past “it’s enough for diagnosis” they can go, and in which criteria – which is where “spectrum” term comes and why there are so many different people under same label. By parallel – there’s only one way to perfectly slice bread and any bread sliced well enough will look similar, but there are so many different ways to slice a bread wrong.
To make it even more complicated – autism spectrum doesn’t have to come with impaired mental abilities (if anything, Aspergers diagnosis criteria explicitly rules out cognitive abilities below norm) and people are able to learn how to deal with their issues. That’s where the “quirky, but otherwise normal” people come from – in large part those are people who learned how to make do with their issues and navigate around them, putting concious effort to not stand out negatively. My therapist liked to compare it to hearing impairment – just because someone uses hearing aid, learned how to read lips and pays more attention to movement rather than sounds doesn’t make them no longer hearing impaired. Common term here is “high-functioning”, I find “well-trained” to be a better fit – simply not standing out too much can still require a lot of constant concious effort.
For a TL;DR: every autistic person has same set of problems that significantly impact their lives, but how far those problems go exactly and what aspects are worse than others will differ from person to person by a lot.
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