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Dr Geeta Krishnan

Author: Dr Geeta KrishnanConsultant Child & Adolescent Psychiatrist

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 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 ASD, 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 ASD 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 those with ASD 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 ASD 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 ASD and although there is some contention as to how it falls within the ASD umbrella, those with pathological demand avoidance share many of the same characteristics of ASD – 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 is girls versus boys – results ranging for boys being twice as likely to ten times a likely to have autism.

Part of this is due to historical reasons – initially it was only believed that boys could develop ASD, but over time this belief has stopped and now it is understood that ASD 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 hence can be more difficult to recognise. Below are some of the common areas that girls and boys with ASD can differ – but symptoms are the same for both.

  • Girls with autism tend to be less aggressive than boys with ASD, and get into trouble less, so can fly ‘under the radar’ which may mean their aren’t identified as readily as having ASD
  • Girls with ASD tend to find it easier to follow nonverbal social clues
  • Girls with autism are more likely to have anxiety or depression
  • Girls with autism are more likely to adjust into social groups (often because girls take on a mentor role and may ‘sweep’ up a girl with ASD into a friendship group)
  • Girls with ASD may develop focused interests in more ‘socially acceptable’ or less stereotypically ASD 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 those with ASD, 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 someone with autism.

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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