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There are two main classification systems used by practitioners in the UK, the (ICD-10), which is a medical classification list by the World Health Organisation and the DSM-5 - the fifth version of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. In recent years the DSM-5 has removed some of the previous ‘classifications’ of autism and it is likely the UK will follow.


 

What are the types of autism?

In recent year, the DSM 5 (the diagnostic manual used by psychiatrists in the USA) has changed the classification names for autism spectrum disorder, removing terms such as ‘Asperger’s’.

As the UK manual (the ICD-10) normally follows the DSM 5, it is likely that ‘autism spectrum disorder’ will become the commonly given diagnostic term.

Currently, as of 2018, the following are subtypes of autism are recognised within the UK

  • Autistic spectrum disorder
  • Asperger’s syndrome
  • Pathological demand avoidance (PDA)
  • Childhood disintegrative disorder
  • Pervasive developmental disorder (not otherwise specified)

2.8
Million – the number of people in the UK for whom Autism is part of their daily life


Asperger’s Syndrome

In the previous classification, the diagnosis was given when there were the difficulties characteristic of autism, but without the delay in speech or cognitive development.

Asperger’s syndrome has been removed from the DSM 5 as a diagnostic category and is now included within the autism umbrella term. Whilst it still remains in the ICD-10 (the manual that UK psychiatrists use) there is general consensus that the term may be removed in the future.

The changing terminology is often confusing for autistic people and their families alike and can lead some to question what impact it will have on them, if any. The important thing to know is that autism is an umbrella term and considered to be a spectrum disorder (meaning severity of characteristics can vary between individuals).

triad of impairment

The central difficulty for children with PDA is an anxiety-driven need to be in control and avoid other people’s demands and expectations.


Pathological demand avoidance

PDA is a behavioural profile within autism and although there is some contention as to how it falls within the autism umbrella, those with pathological demand avoidance share many of the same characteristics of autism – social communication, interaction and repetitive and restricted behaviours.

Children with PDA have a deep anxiety about not being in control of a situation and having demands placed on them. Their anxiety will play out in their behaviours which can include:

  • Resisting every day demands of life
  • Deploying tactics to avoid having to do something
  • Lacking social understanding
  • Mood swings – anger, irritability
  • Procrastinating

Dr Krishnan went over and above to be able to support our child. She was very friendly and approachable, we felt completely at ease during the assessment and her report was very thorough.

Kiera, Leeds


The difference between girls vs boys

Over the years there has been a great deal of research about the prevalence of autism in girls versus boys – results ranging for boys being twice as likely to ten times as likely to have an autism diagnosis.

Part of this is due to historical reasons – initially it was only believed that boys could be autistic, but over time this belief has stopped and now it is understood that autism does not discriminate on gender.

That said, in general, girls are recognised as being naturally more able socially than boys and hence can mask their difficulties better. They also present more subtly and therefore can be more difficult to recognise. Below are some of the common areas that autistic girls and boys can differ on – but some symptoms are the same for both.

  • Autistic girls tend to be less aggressive than autistic boys, and get into trouble less, so can fly ‘under the radar’ which may mean their aren’t identified as readily as being autistic
  • Autistic girls tend to find it easier to follow nonverbal social clues
  • Autistic girls are more likely to have anxiety or depression
  • Autistic girls are more likely to adjust into social groups (often because girls take on a mentor role and may ‘sweep’ up an autistic girl into a friendship group)
  • Autistic girls may develop focused interests in more ‘socially acceptable’ or less stereotypically autistic interests; whereas boys may develop obsessional interest is ‘geeky’ topics like computer games or aeroplanes, girls may become very focused on TV programmes or pop groups.

We know that the autism symptoms change and develop over time and puberty can often be a very difficult time for autistic teenagers, as not only does a teenage brain develop at a fantastic rate, but a teenager’s body develops and changes, which can be hugely distressing for an autistic young person.

Finding a clinician who understands the complexities of autism and is aware that often symptoms can be different between the sexes is key to ensuring your daughter receives the right diagnosis. We can help.

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