Autism: One or many spectrums?

Abstract

Our conceptualisation of autism spectrum disorder has changed over time, with recent classifications reflecting a heterogeneous clinical presentation now regularly encountered in routine general paediatric practice. As the prevalence of autism and associated demands for services have increased so has research into understanding the cause and trials aimed at providing best care and intervention. However, the heterogeneity of autism has meant that no single aetiology can account for all differences in presentation, and not all children benefit from broad‐based interventions. Now is the time to rethink how best to understand individual differences in order to focus research efforts and take steps towards more sophisticated strategies that go beyond the behaviours we look for when making an autism diagnosis. We suggest adopting a dimensional approach to autism assessment, with the consideration of eight spectrums of abilities, ways of thinking and behaviour. This eight‐spectrum approach will assist clinicians to consider each individual's strengths and needs and personalise interventions and support accordingly. Profiling individual skills across these dimensions may also provide researchers with a greater capacity to link causal pathways with specific phenotypes, which is needed to develop precision medicine for autism.

Automated recognition of spontaneous facial expression in individuals with autism spectrum disorder: parsing response variability

“…Our results support the notion of multiple dimensions of observable behavior that contribute to the autism phenotype [37], and the need to look at behaviors that go beyond the diagnostic criterion to consider profiles of skills across dimensions [38]. This could lead to personalization of interventions and an increased ability to link casual pathways to ASD phenotypes [39].…”

The Feedback Session of an Autism Assessment: A Scoping Review of Clinical Practice Guideline Recommendations

“…Considering a child’s strengths as well as their weaknesses across all areas of functioning could lead to more informed interventions and a more balanced understanding of the child. Providing a tailored feedback session, and addressing all functioning rather than just autism symptomatology, could also potentially lead to more individualised intervention and support (Ure et al, 2018 ).…”

Autism and mood disorders

“…Nevertheless, to best inform diagnostic and intervention approaches, it is also critical to investigate individual variability in the presentation and risk factors for mood problems in autism, which has rarely been reported in previous studies. Acknowledging individual variability is of primary importance for developing more individualised, needs-based (as opposed to diagnosis-based) detection and intervention approaches for mood problemsidentifying who may benefit most from specific interventions and minimising unwanted side effects and disruption to compensatory mechanisms (Ure et al, 2018).…”