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Severity of Autism Spectrum Disorders: Current Conceptualization, and Transition to DSM-5

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Abstract

Mirroring the evolution of the conceptualization of autism has been changes in the diagnostic process, including the most recent revisions to the DSM-5 and the addition of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. A review of recent literature indicates that in research stratifying individuals on the basis of autism severity, core ASD symptomology is the primary consideration. This conceptualization is disparate from the conceptualization put forth in DSM-5 in which severity determination is based on level of needed support, which is also impacted by cognitive, language, behavioral, and adaptive functioning. This paper reviews literature in this area and discusses possible instruments that may be useful to inform clinical judgment in determining ASD severity levels.

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References

  • Adams, J. B., Audhya, T., McDonough-Means, S., Rubin, R. A., Quig, D., Geis, E., Gehn, E., Lee, W. (2011). Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutrition & Metabolism, 8(1), 34–65.

  • Adams, J. B., Audhya, T., McDonough-Means, S., Rubin, R. A., Quig, D., Geis, E., et al. (2013). Toxicological status of children with autism vs. neurotypical children and the association with autism severity. Biological Trace Element Research, 151(2), 171–180.

    Article  PubMed  Google Scholar 

  • Adams, J. B., Baral, M., Geis, E., Mitchell, J., Ingram, J., Hensley, A., Zappia, I., El-Dahr, J. M. (2009). The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels. Journal of Toxicology. doi:10.1155/2009/532640.

  • Adams, J. B., Johansen, L. J., Powell, L. D., Quig, D., & Rubin, R. A. (2011b). Gastrointestinal flora and gastrointestinal status in children with autism – comparisons to typical children and correlation with autism severity. Bmc Gastroenterology, 11(1), 1–13.

    Article  Google Scholar 

  • Adams, H. L., Matson, J. L., Cervantes, P. E., & Goldin, R. L. (2014). The relationship between autism symptom severity and sleep problems: Should bidirectionality be considered? Research in Autism Spectrum Disorders, 8(3), 193–199.

    Article  Google Scholar 

  • Alabdali, A., Al-Ayadhi, L., & El-Ansary, A. (2014). A key role for an impaired detoxification mechanism in the etiology and severity of autism spectrum disorders. Behavioral and Brain Functions, 10. Retrieved from http://proxy.lib.ohio-state.edu/login?url=. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-25770-001&site=ehost-live

  • AL-ayadhi, L. Y., & Mostafa, G. A. (2011). Increased serum osteopontin levels in autistic children: Relation to the disease severity. Brain, Behavior, and Immunity, 25(7), 1393–1398.

    Article  PubMed  Google Scholar 

  • Allan, D. A., Steinberg, M., Dunn, M., Fein, D., Feinstein, C., Waterhouse, L., & Rapin, I. (2001). Autistic disorder versus other pervasive developmental disorders in young children: Same or different? European Child and Adolescent Psychiatry, 10, 67–78.

    Article  Google Scholar 

  • American Educational Research Association (AERA), American Psychological Association, National Council on Measurement in Education, and Joint Committee on Standards for Educational and Psychological Testing (U.S.). (2014). Standards for educational and psychological testing.

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Arnold, S. C., Riches, V. C., & Stancliffe, R. J. (2014). I-CAN: The classification and prediction of support needs. Journal of Applied Research in Intellectual Disabilities, 27(2), 97–111. doi:10.1111/jar.12055.

    Article  PubMed  Google Scholar 

  • Baghdadli, A., Picot, M. C., Pascal, C., Pry, R., & Aussilloux, C. (2003). Relationship between age of recognition of first disturbances and severity in young children with autism. European Child and Adolescent Psychiatry, 12(3), 122–127.

    Article  PubMed  Google Scholar 

  • Bavin, E. L., Kidd, E., Prendergast, L., Baker, E., Dissanayake, C., & Prior, M. (2014). Severity of autism is related to children’s language processing. Autism Research: Official Journal of the International Society for Autism Research, 7(6), 687–694.

    Article  Google Scholar 

  • Baxter, A. C., Lotspeich, L. J., Spiker, D., Martin, J. L., Grether, J. K., & Hallmayer, J. F. (2007). Brief report: Effect of maternal age on severity of autism. Journal of Autism and Developmental Disorders, 37(5), 976–982.

    Article  PubMed  Google Scholar 

  • Ben-Itzchak, E., & Zachor, D. A. (2007). The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism. Research in Developmental Disabilities, 28(3), 287–303.

    Article  PubMed  Google Scholar 

  • Benson, P. (2006). The impact of child symptom severity on depressed mood among parents of children with ASD: The mediating role of stress proliferation. Journal of Autism and Developmental Disorders, 36(5), 685–695.

    Article  PubMed  Google Scholar 

  • Bernier, R. (2012). How do we measure autism severity? SFARI Viewpoints. Retrieved September 2014 from http://sfari.org/news-and-opinion/viewpoint/2012/how-do-we-measure-autism-severity.

  • Beurkens, N. M., Hobson, J. A., & Hobson, R. P. (2013). Autism severity and qualities of parent–child relations. Journal of Autism and Developmental Disorders, 43(1), 168–178.

    Article  PubMed  Google Scholar 

  • Blaurock-Busch, E., Amin, O. R., Dessoki, H. H., & Rabah, T. (2012). Toxic metals and essential elements in hair and severity of symptoms among children with autism. Maedica - A Journal of Clinical Medicine, 7(1), 38–48.

  • Bodfish, J. W., Symons, F. W., & Lewis, M. H. (1999). The repetitive behavior scale. Western Carolina Center Research Reports.

  • Brandwein, A. B., Foxe, J. J., Butler, J. S., Frey, H.-P., Bates, J. C., Shulman, L. H., & Molholm, S. (2015). Neurophysiological indices of atypical auditory processing and multisensory integration are associated with symptom severity in autism. Journal of Autism and Developmental Disorders, 45(1), 230–244.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chang, C. L., Lung, F. W., Yen, C. F., & Yang, P. (2013). Adaptive behaviors in high-functioning Taiwanese children with autism spectrum disorders: An investigation of the mediating roles of symptom severity and cognitive ability. Journal of Autism and Developmental Disorders, 43(6), 1347–1355.

    Article  PubMed  Google Scholar 

  • Cohen, I. L., Liu, X., Lewis, M. E., Chudley, A., Forster-Gibson, C., Gonzalez, M., et al. (2011). Autism severity is associated with child and maternal MAOA genotypes. Clinical Genetics, 79(4), 355–362.

    Article  PubMed  Google Scholar 

  • Cohen, I. L., Liu, X., Schutz, C., White, B. N., Jenkins, E. C., Brown, W. T., & Holden, J. J. A. (2003). Association of autism severity with a monoamine oxidase: A functional polymorphism. Clinical Genetics, 64(3), 190–197.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale (2nd ed.). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Coutanche, M. N., Thompson-Schill, S. L., & Schultz, R. T. (2011). Multi-voxel pattern analysis of fMRI data predicts clinical symptom severity. Neuroimage, 57(1), 113–123.

    Article  PubMed  PubMed Central  Google Scholar 

  • Davis, J. M., Searles, V. B., Anderson, N., Keeney, J., Dumas, L., Sikela, J. M., & Foroud, T. (2014). DUF1220 Dosage is linearly associated with increasing severity of the three primary symptoms of autism. Plos Genetics, 10(3), 10:e1004241. doi:10.1371/journal.pgen.1004241.

  • Dereu, M., Roeyers, H., Raymaekers, R., Meirsschaut, M., & Warreyn, P. (2012). How useful are screening instruments for toddlers to predict outcome at age 4? General development, language skills, and symptom severity in children with a false positive screen for autism spectrum disorder. European Child and Adolescent Psychiatry, 21(10), 541–551.

    Article  PubMed  Google Scholar 

  • Di Rezze, B., Rosenbaum, P., & Zwaigenbaum, L. (2012). What attributes determine severity of function in autism? A web-based survey of stakeholders. Focus on Autism and Other Developmental Disabilities, 27(1), 39–41.

    Article  Google Scholar 

  • Dickerson, A. S., Pearson, D. A., Loveland, K. A., Rahbar, M. H., & Filipek, P. A. (2014). Role of parental occupation in autism spectrum disorder diagnosis and severity. Research in Autism Spectrum Disorders, 8(9), 997–1007.

    Article  PubMed  PubMed Central  Google Scholar 

  • Doyle-Thomas, K. A. R., Kushki, A., Duerden, E. G., Taylor, M. J., Lerch, J. P., Soorya, L. V., & Anagnostou, E. (2013). The effect of diagnosis, age, and symptom severity on cortical surface area in the cingulate cortex and insula in autism spectrum disorders. Journal of Child Neurology, 28(6), 729–736.

    Article  Google Scholar 

  • Dudova, I., & Hrdlicka, M. (2013). Olfactory functions are not associated with autism severity in autism spectrum disorders. Neuropsychiatric Disease and Treatment, 9. Retrieved from http://proxy.lib.ohio-state.edu/login?url=. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-00665-001&site=ehost-live

  • Eussen, M. L., Bruin, E. I., Gool, A. R., Louwerse, A., Ende, J., Verheij, F., et al. (2015). Formal thought disorder in autism spectrum disorder predicts future symptom severity, but not psychosis prodrome. European Child and Adolescent Psychiatry, 24(2), 163–172.

    Article  PubMed  Google Scholar 

  • Eussen, M. L. J. M., Van Gool, A. R., Verheij, F., De Nijs, P. F. A., Verhulst, F. C., & Greaves-Lord, K. (2013). The association of quality of social relations, symptom severity and intelligence with anxiety in children with autism spectrum disorders. Autism, 17(6), 723–735.

    Article  PubMed  Google Scholar 

  • Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J., & Eng, C. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 28–40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gadow, K. D., DeVincent, C. J., Olvet, D. M., Pisarevskaya, V., & Hatchwell, E. (2010). Association of DRD4 polymorphism with severity of oppositional defiant disorder, separation anxiety disorder and repetitive behaviors in children with autism spectrum disorder. European Journal of Neuroscience, 32(6), 1058–1065.

    Article  PubMed  Google Scholar 

  • Geier, D. A., Hooker, B. S., Kern, J. K., Sykes, L. K., & Geier, M. R. (2014). An evaluation of the effect of increasing parental age on the phenotypic severity of autism spectrum disorder. Journal of Child Neurology, 1–6. doi:10.1177/0883073814541478.

  • Geier, D. A., Kern, J. K., & Geier, M. R. (2009a). A prospective blinded evaluation of urinary porphyrins verses the clinical severity of autism spectrum disorders. Journal of Toxicology and Environmental Health. Part A, 72(24), 1585–1591.

    Article  PubMed  Google Scholar 

  • Geier, D. A., Kern, J. K., & Geier, M. R. (2009b). A prospective study of prenatal mercury exposure from maternal dental amalgams and autism severity. Acta Neurobiologiae Experimentalis, 69(2), 189–197.

    PubMed  Google Scholar 

  • Geier, D., Kern, J., King, P., Sykes, L., & Geier, M. (2012). Hair toxic metal concentrations and autism spectrum disorder severity in young children. International Journal of Environmental Research and Public Health, 9(12), 4486–4497.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gibbard, C. R., Ren, J., Seunarine, K. K., Clayden, J. D., Skuse, D. H., & Clark, C. A. (2013). White matter microstructure correlates with autism trait severity in a combined clinical-control sample of high-functioning adults. Neuroimage Clinical, 3, 106–114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goldin, R. L., Matson, J. L., Beighley, J. S., & Jang, J. (2014). Autism spectrum disorder severity as a predictor of battelle developmental inventory—second edition (BDI-2) scores in toddlers. Developmental Neurorehabilitation, 17(1), 39–43.

    Article  PubMed  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2012). Trajectories of autism severity in children using standardized ADOS scores. Pediatrics, 130(5), e1278–e1284.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hamza, R. T., Hewedi, D. H., & Sallam, M. T. (2013). Iodine deficiency in egyptian autistic children and their mothers: Relation to disease severity. Archives of Medical Research, 44(7), 555–561.

    Article  PubMed  Google Scholar 

  • Heine, S., Quackenbush, J., Lee, N., Frank, B., & Hu, V. (2006). Gene expression profiling of lymphoblastoid cell lines from monozygotic twins discordant in severity of autism reveals differential regulation of neurologically relevant genes. BMC Genomics, 7(1), 1–18.

    Article  Google Scholar 

  • Hilton, C. L., Harper, J. D., Kueker, R. H., Lang, A. R., Abbacchi, A. M., Todorov, A., & LaVesser, P. D. (2010). Sensory responsiveness as a predictor of social severity in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(8), 937–945.

    Article  PubMed  Google Scholar 

  • Hilton, C., Wente, L., LaVesser, P., Ito, M., Reed, C., & Herzberg, G. (2007). Relationship between motor skill impairment and severity in children with Asperger syndrome. Research in Autism Spectrum Disorders, 1(4), 339–349.

    Article  Google Scholar 

  • Hock, R., & Ahmedani, B. K. (2012). Parent perceptions of autism severity: Exploring the social ecological context. Disability and Health Journal, 5(4), 298–304.

    Article  PubMed  Google Scholar 

  • Hollander, E., Soorya, L., Chaplin, W., Anagnostou, E., Taylor, B. P., Ferretti, C. J., & Settipani, C. (2012). A double-blind placebo-controlled trial of fluoxetine for repetitive behaviors and global severity in adult autism spectrum disorders. The American Journal of Psychiatry, 169(3), 292–299.

    Article  PubMed  Google Scholar 

  • Hrdlička, M., Komárek, V., Faladová, L., Zumrová, A., Beranová, I., Dudová, I., & Urbánek, T. (2004). EEG abnormalities are not associated with symptom severity in childhood autism. Studia Psychologica, 46(3), 229–234.

    Google Scholar 

  • Hus, V., Gotham, K., & Lord, C. (2014). Standardizing ADOS domain scores: Separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders, 44(10), 2400–2412.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ingersoll, B., & Hambrick, D. Z. (2011). The relationship between the broader autism phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 337–344.

    Article  Google Scholar 

  • Ismail, M., Hewedi, D., & Hamza, R. (2010). Basal and adrenocorticotropic hormone stimulated plasma cortisol levels among Egyptian autistic children: Relation to disease severity. Italian Journal of Pediatrics, 36(1), 1–6.

    Article  Google Scholar 

  • Jang, J., Dixon, D. R., Tarbox, J., & Granpeesheh, D. (2011). Symptom severity and challenging behavior in children with ASD. Research in Autism Spectrum Disorders, 5(3), 1028–1032.

    Article  Google Scholar 

  • Jiao, Y., Chen, R., Ke, X., Cheng, L., Chu, K., Lu, Z., & Herskovits, E. H. (2012). Single nucleotide polymorphisms predict symptom severity of autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(6), 971–983.

    Article  PubMed  PubMed Central  Google Scholar 

  • Joseph, R. M., & Tager-Flusberg, H. (2004). The relationship of theory of mind and executive functions to symptom type and severity in children with autism. Development and Psychopathology, 16(1), 137–155.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanne, S., Abbacchi, A., & Constantino, J. (2009). Multi-informant ratings of psychiatric symptom severity in children with autism spectrum disorders: the importance of environmental context. Journal of Autism and Developmental Disorders, 39(6), 856–864. doi:10.1007/s10803-009-0694-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.

    Google Scholar 

  • Keown, C. L., Shih, P., Nair, A., Peterson, N., Mulvey, M. E., & Müller, R. A. (2013). Local functional overconnectivity in posterior brain regions is associated with symptom severity in autism spectrum disorders. Cell Reports, 5(3), 567–572.

    Article  PubMed  Google Scholar 

  • Kern, J. K., Geier, D. A., Adams, J. B., Troutman, M. R., Davis, G., King, P. G., & Geier, M. R. (2011). Autism severity and muscle strength: A correlation analysis. Research in Autism Spectrum Disorders, 5(3), 1011–1015.

    Article  Google Scholar 

  • Khakzad, M. R., Javanbakht, M., Shayegan, M. R., Kianoush, S., Omid, F., Hojati, M., & Meshkat, M. (2012). The complementary role of high sensitivity C-reactive protein in the diagnosis and severity assessment of autism. Research in Autism Spectrum Disorders, 6(3), 1032–1037.

    Article  Google Scholar 

  • Kjellmer, L., Hedvall, Å., Fernell, E., Gillberg, C., & Norrelgen, F. (2012). Language and communication skills in preschool children with autism spectrum disorders: Contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability. Research in Developmental Disabilities, 33(1), 172–180.

    Article  PubMed  Google Scholar 

  • Konstantareas, M. M., & Papageorgiou, V. (2006). Effects of temperament, symptom severity and level of functioning on maternal stress in Greek children and youth with ASD. Autism : the International Journal of Research and Practice, 10(6), 593–607.

    Article  Google Scholar 

  • Le Couteur, A., Lord, C., and Rutter, M. (2003). Autism diagnostic interview-revised (ADI-R) Los Angeles: Western Psychological Services.

  • Lin, J.-D., Sung, C.-L., Lin, L.-P., Hsu, S.-W., Chien, W.-C., Su, S.-L., & Wu, J.-L. (2011). Ten-year trend analysis of autism severity: A nationwide population-based register study. Research in Autism Spectrum Disorders, 5(1), 570–574.

    Article  Google Scholar 

  • Llewellyn, G., Riches, V. C., Hindmarsh, G. J., Parmenter, T. R., & Chan, J. (2005). I-CAN: Instrument to classify support needs for people with disability. Sydney: The Faculty of Health Sciences.

    Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • MacDonald, M., Lord, C., & Ulrich, D. A. (2014). Motor skills and calibrated autism severity in young children with autism spectrum disorder. Adapted Physical Activity Quarterly, 31(2), 95–105.

    Article  PubMed  Google Scholar 

  • Mandy, W. P. L., Charman, T., & Skuse, D. H. (2012). Testing the construct validity of proposed criteria for DSM-5 autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 41–50.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Goldin, R. L. (2014). What is the future of assessment for autism spectrum disorders: Short and long term. Research in Autism Spectrum Disorders, 8(3), 209–213.

    Article  Google Scholar 

  • Matson, J. L., & Rivet, T. T. (2008). The effects of severity of autism and PDD-NOS symptoms on challenging behaviors in adults with intellectual disabilities. Journal of Developmental and Physical Disabilities, 20(1), 41–51.

    Article  Google Scholar 

  • Matson, J. L., Wilkins, J., & Macken, J. (2009). The relationship of challenging behaviors to severity and symptoms of autism spectrum disorders. Journal of Mental Health Research in Intellectual Disabilities, 2(1), 29–44.

    Article  Google Scholar 

  • Matson, J. L., Worley, J. A., Neal, D., Mahan, S., & Fodstad, J. C. (2010). The effects of inattention/impulsivity and ASD symptom severity on social skills in toddlers. Developmental Neurorehabilitation, 13(6), 408–412.

  • McStay, R. L., Dissanayake, C., Scheeren, A., Koot, H. M., & Begeer, S. (2014). Parenting stress and autism: The role of age, autism severity, quality of life and problem behaviour of children and adolescents with autism. Autism, 18(5), 502–510.

    Article  PubMed  Google Scholar 

  • Meresse, I. G., Zilbovicius, M., Boddaert, N., Robel, L., Philippe, A., Sfaello, I., & Chabane, N. (2005). Autism severity and temporal lobe functional abnormalities. Annals of Neurology, 58(3), 466–469.

    Article  Google Scholar 

  • Mostafa, G. A., & AL-ayadhi, L. Y. (2011). Increased serum levels of anti-ganglioside M1 auto-antibodies in autistic children: relation to the disease severity. Journal of Neuroinflammation, 8(1), 39–44.

  • Mostafa, G. A., & Al-Ayadhi, L. Y. (2012). The relationship between the increased frequency of serum antineuronal antibodies and the severity of autism in children. European Journal of Paediatric Neurology: Ejpn: Official Journal of the European Paediatric Neurology Society, 16(5), 464–468.

    Article  Google Scholar 

  • Movsas, T. Z., & Paneth, N. (2012). The effect of gestational age on symptom severity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(11), 2431–2439.

    Article  PubMed  Google Scholar 

  • Nagar, S. H., Weizman, A., Yoran, R. H., & Raviv, A. (2012). Theory of mind, severity of autistic symptoms and parental correlates in children and adolescents with Asperger syndrome. Psychiatry Research, 197, 1–2.

    Article  Google Scholar 

  • Nicholas, J. S., Charles, J. M., Carpenter, L. A., King, L. B., Jenner, W., & Sprat, E. G. (2008). Prevalence and characteristics of children with autism-spectrum disorders. Annals of Epidemiology, 18, 130–136.

    Article  PubMed  Google Scholar 

  • Parks, L. K., Hill, D. E., Thoma, R. J., Euler, M. J., Lewine, J. D., & Yeo, R. A. (2009). Neural correlates of communication skill and symptom severity in Autism: A voxel-based morphometry study. Research in Autism Spectrum Disorders, 3(2), 444–454.

    Article  Google Scholar 

  • Poustka, L., Jennen-Steinmetz, C., Henze, R., Vomstein, K., Haffner, J., & Sieltjes, B. (2012). Fronto-temporal disconnectivity and symptom severity in children with autism spectrum disorder. The World Journal of Biological Psychiatry, 13(4), 269–280.

    Article  PubMed  Google Scholar 

  • Pry, R., Guillain, A., Aussilloux, C., & Baghdadli, A. (2004). Severity of the autistic disorder and organization of socio-cognitive skills: Differentiation or dissociation. European Review of Applied Psychology/Revue Européenne de Psychologie Appliquée, 54(3), 157–163.

    Article  Google Scholar 

  • Rao, P. A., & Landa, R. J. (2014). Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism, 18(3), 272–280.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ring, H., Woodbury-Smith, M., Watson, P., Wheelwright, S., & Baron-Cohen, S. (2008). Clinical heterogeneity among people with high functioning autism spectrum conditions: Evidence favouring a continuous severity gradient. Behavioral and Brain Functions, 4. Retrieved from http://proxy.lib.ohio-state.edu/login?url=. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2008-11887-001&site=ehost-live

  • Robinson, E. B., Samocha, K. E., Kosmicki, J. A., McGrath, L., Neale, B. M., Perlis, R. H., & Daly, M. J. (2014). Autism spectrum disorder severity reflects the average contribution of de novo and familial influences. PNAS Proceedings of the National Academy of Sciences of the United States of America, 111(42), 15161–15165.

    Article  Google Scholar 

  • Russo, A. (2014a). Decreased mitogen inducible gene 6 (MIG-6) associated with symptom severity in children with autism. Biomarker Insights, 9, 85–89.

    Article  PubMed  PubMed Central  Google Scholar 

  • Russo, A. J. (2014b). Increased epidermal growth factor receptor (EGFR) associated with hepatocyte growth factor (HGF) and symptom severity in children with autism spectrum disorders (ASDs). Journal of Central Nervous System Disease, 6, 79–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Russo, A. J., Bazin, A. P., Bigega, R., Carlson, R. S., Cole, M. G., Contreras, D. C., et al. (2012). Plasma copper and zinc concentration in individuals with autism correlate with selected symptom severity. Nutrition and Metabolic Insights, 5, 41–47.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rutter, M. L. (2011). Progress in understanding autism: 2007-2010. Journal of Autism and Developmental Disabilities, 41, 395–404.

    Article  Google Scholar 

  • Schopler, E., Van Bourgondien, M., Wellman, G., & Love, S. (2010). Childhood Autism Rating Scale (2nd ed.). Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Schumann, C. M., Barnes, C. C., Lord, C., & Courchesne, E. (2009). Amygdala enlargement in toddlers with autism related to severity of social and communication impairments. Biological Psychiatry, 66(10), 942–949.

    Article  PubMed  PubMed Central  Google Scholar 

  • South, M., Larson, M. J., White, S. E., Dana, J., & Crowley, M. J. (2011). Better fear conditioning is associated with reduced symptom severity in autism spectrum disorders. Autism Research, 4(6), 412–421.

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Balla, D. A., Cicchetti, D. V., Doll, E. A., & American Guidance Service. (2005). Vineland adaptive behavior scales (2nd ed.). Bloomington, MN: NCS Pearson.

    Google Scholar 

  • Spiker, D., Lotspeich, L. J., Dimiceli, S., Myers, R. M., & Risch, N. (2002). Behavioral phenotypic variation in autism multiplex families: Evidence for a continuous severity gradient. American Journal of Medical Genetics, 114(2), 129–136.

    Article  PubMed  Google Scholar 

  • Sprenger, L., Bühler, E., Poustka, L., Bach, C., Heinzel-Gutenbrunner, M., Kamp-Becker, I., & Bachmann, C. (2013). Impact of ADHD symptoms on autism spectrum disorder symptom severity. Research in Developmental Disabilities, 34(10), 3545–3552.

    Article  PubMed  Google Scholar 

  • Thompson, J. R., Bryant, B. L., Campbell, E. M., Craig, E. M., Hughes, C. M., Rotholz, D. A., & Wehmeyer, M. L. (2004). Supports intensity scale. Washington, DC: American Association on Intellectual and Developmental Disabilities.

    Google Scholar 

  • Thompson, J., Hughes, C., Schalock, R., Silverman, W., Tassé, M. J., Bryant, B., et al. (2002). Integrating supports into assessment and planning. Mental Retardation, 40, 390–405.

    Article  PubMed  Google Scholar 

  • Thurm, A., Manwaring, S. S., Swineford, L., & Farmer, C. (2015). Longitudinal study of symptom severity and language in minimally verbal children with autism. Journal of Child Psychology and Psychiatry, 56(1), 97–104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Travers, B. G., Powell, P. S., Klinger, L. G., & Klinger, M. R. (2013). Motor difficulties in autism spectrum disorder: Linking symptom severity and postural stability. Journal of Autism and Developmental Disorders, 43(7), 1568–1583.

    Article  PubMed  Google Scholar 

  • Tsatsanis, K. D., Dartnall, N., Cicchetti, D., Sparrow, S. S., Klin, A., & Volkmar, F. R. (2003). Concurrent validity and classification accuracy of the Leiter and Leiter-R in low-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 23–30.

    Article  PubMed  Google Scholar 

  • Tudor, M. E., Hoffman, C. D., & Sweeney, D. P. (2012). Children with autism: Sleep problems and symptom severity. Focus on Autism and Other Developmental Disabilities, 27(4), 254–262.

    Article  Google Scholar 

  • Tureck, K., Matson, J. L., Cervantes, P., & Turygin, N. (2015). Autism severity as a predictor of inattention and impulsivity in toddlers. Developmental Neurorehabilitation, 18, 285–289.

  • Uddin, L. Q., Supekar, K., Lynch, C. J., Khouzam, A., Phillips, J., Feinstein, C., & Menon, V. (2013). Salience network–based classification and prediction of symptom severity in children with autism. JAMA Psychiatry, 70(8), 869–879.

    Article  PubMed  PubMed Central  Google Scholar 

  • Venker, C. E., Ray-Subramanian, C. E., Bolt, D. M., & Weismer, S. E. (2014). Trajectories of autism severity in early childhood. Journal of Autism and Developmental Disorders, 44(3), 546–563.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wallace, A. E., Anderson, G. M., & Dubrow, R. (2008). Obstetric and parental psychiatric variables as potential predictors of autism severity. Journal of Autism and Developmental Disorders, 38(8), 1542–1554.

    Article  PubMed  Google Scholar 

  • Weil, T. N. & Inglehart, M. R. (2012). Three- to 21-year-old patients with autism spectrum disorders: parents’ perceptions of severity of symptoms, oral health, and oral health-related behavior. Pediatric Dentistry, 34(7), 473–479.

  • Weitlauf, A. S., Gotham, K. O., Vehorn, A. C., & Warren, Z. E. (2014). Brief report: DSM-5 “levels of support:” A comment on discrepant conceptualizations of severity in ASD. Journal of Autism and Developmental Disorders, 44(2), 471–476.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wells, K., Condillac, R., Perry, A., & Factor, D. C. (2009). A comparison of three adaptive behaviour measures in relation to cognitive level and severity of autism. Journal on Developmental Disabilities, 15(3), 55–63.

    Google Scholar 

  • White, S. W., Schry, A. R., Miyazaki, Y., Ollendick, T. H., & Scahill, L. (2015). Effects of verbal ability and severity of autism on anxiety in adolescents with ASD: One-year follow-up after cognitive behavioral therapy. Journal of Clinical Child and Adolescent Psychology, 44, 839–845.

  • Williams, B. T., & Gray, K. M. (2013). Are emotion recognition skills related to autism symptom severity in children with autism? International Journal of Developmental Disabilities, 59(2), 118–133.

    Article  Google Scholar 

  • Wisessathorn, M., Chanuantong, T., & Fisher, E. B. (2013). The impact of child’s severity on quality-of-life among parents of children with autism spectrum disorder: the mediating role of optimism. Journal of the Medical Association of Thailand Chotmaihet Thangphaet, 96(10), 1313–1318.

    PubMed  Google Scholar 

  • Wood, J. J., Fujii, C., Renno, P., & Dyke, M. (2014). Impact of cognitive behavioral therapy on observed autism symptom severity during school recess: A preliminary randomized, controlled trial. Journal of Autism and Developmental Disorders, 44(9), 2264–2276.

    PubMed  Google Scholar 

  • Zachor, D. A., Ilanit, T., & Itzchak, E. B. (2010). Autism severity and motor abilities correlates of imitation situations in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 4(3), 438–443.

    Article  Google Scholar 

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Author Contributions

MHM & MJT conceived of the study; MHM developed the design, conducted the literature review, analyses and summarization of data, and wrote the draft and revisions of the manuscript; MJT participated in the discussion of the results, and participated in revisions of the drafts of the manuscript. Both authors read and approved the final manuscript.

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  1. Nisonger Center, The Ohio State University, McCampbell Hall Room 279, 1581 Dodd Dr, Columbus, OH, 43210, USA

    Margaret H. Mehling & Marc J. Tassé

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  1. Margaret H. Mehling
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  2. Marc J. Tassé
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Correspondence to Margaret H. Mehling.

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Mehling, M.H., Tassé, M.J. Severity of Autism Spectrum Disorders: Current Conceptualization, and Transition to DSM-5. J Autism Dev Disord 46, 2000–2016 (2016). https://doi.org/10.1007/s10803-016-2731-7

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