On a Dutch autism forum, someone asks what “mild” autism means. There are several possible answers to this:
- Mild autism means Asperger’s Syndrome. This was the definition the person opening the thread referred to. She had a problem with this definition, because, even though she has an Asperger’s diagnosis, she is quite severely impaired by her autism. The only reason she got the Asperger’s label, is that she didn’t have a speech delay. In fact, this is the only significant difference within DSM-IV between autistic disorder and Asperger’s, if the person has an IQ above 70 – I recently learned that the expanded text of the DSM-IV uses other methods for differential diagnosis, like “active but odd” vs. “passive” social behavior, and technically you don’t need a speech delay for an autism diagnosis (it is enough if you have one feature from the “communication” criterion), but these are not universally applied rules. Besides, most of the differential diagnostic criteria between autistic disorder and Asperger’s, are based on early development, so what does this say about adult functioning?
- Mild autism means the person has an IQ above 70 (or 85, in some cases). This doesn’t say anything about one’s autism, but about the presence or absence of comorbid mental retardation. Why would the severity of one disorder be defined solely by the existence of another disorder?
- Mild autism means the person meets fewer DSM-IV criteria. Relatively speaking, then, again, Asperger’s can be considered to be milder than autism, because for an Asperger’s diagnosis, you need to meet only three criteria (out of eight), whereas you need six (out of twelve) for an autism diagnosis. I could be considered to have moderate Asperger’s, because I meet five criteria (as I walk myself through the DSM-IV right now, I forgot how many I met during my diagnostic interview). However, most people with an Asperger’s diagnosis will in fact meet some criteria from the “communication” set that isn’t included with their diagnosis, but less obviously than those with an autism label (I for one have periods when I use a lot of repetitive language, but am generally judged to have normal communication). Also, some people experience more trouble due to one area of impairment (eg. repetitive behaviors) than another, and may therefore meet fewer criteria but still be equally severely impaired. And, of course, I’m not even speaking about those autism symptoms that haven’t made it into the DSM-IV, like sensory processing differences, executive dysfunction, etc. I for one find these particularly impairing.
- Mild autism means few behavioral problems, like aggression or self-injury. Even though this is often assumed to be a logical determiner of severity, these problems aren’t anywhere in the DSM-IV as far as I know.
- Mild autism means the person can live independently, keep a job, etc. This may in fact be the most accurate determiner of functioning, and it has made it into the DSM as one’s axis V GAF (global assessment of functioning) score. The problem with this very raw guess about one’s ability to function in daily life, is that of course someone may function alright in one area and not function at all in another. For example, I am at this point unemployable for reasons related to my autism (of course I am unemployable for reasons related to my lack of education, too, but that is not the point) and cannot live independently, but I can be in a romantic relationship.
These are only the determiners of severity that have any merit at all. The ability to write coherently on the Internet, the lack of desire for a cure, etc., are just nonsense, and I won’t waste my and my readers’ time and WordPress’ webspace to comment on these.