Examining the Validity of Autism Spectrum Disorder Subtypes

Abstract

The classification of autism spectrum disorders (ASDs) is a topic of debate among clinicians and researchers with many questioning the validity of the distinction among subtypes. This manuscript examines the validity of three ASD subtypes (Autism, Asperger’s, and PDDNOS) by reviewing 22 studies published between 1994 and 2006. We reviewed studies that examined differences between the subtypes in terms of clinical and demographic characteristics, neuropsychological profiles, comorbidity, and prognosis. Results largely did not support differences between autism and Asperger’s disorder based on current diagnostic criteria. Overall, the most salient group differences were noted when samples were categorized on IQ. Drawing definitive conclusions is difficult due to the inconsistent application of diagnostic criteria and circularity in methods.

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References

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington: American Psychiatric Association.

    Google Scholar 

  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revisions). Washington: American Psychiatric Association.

  4. Asperger, H. (1944). Die ‘Autistischen Psychopathen’ im Kindesalter. Archiv für Psychiatrie und Nervenkrankheiten, 117, 76–136.

    Article  Google Scholar 

  5. Billstedt, E., Gillberg, C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35, 351–360.

    PubMed  Article  Google Scholar 

  6. Borden, M. C., & Ollendick, T. H. (1994). An examination of the validity of social subtypes in autism. Journal of Autism and Developmental Disorders, 24, 23–37.

    PubMed  Article  Google Scholar 

  7. Buitelaar, J. K., Van der Gaag, R., Klin, A., & Volkmar, F. (1999). Exploring the boundaries of pervasive developmental disorder not otherwise specified: Analyses of data from the DSM-IV autistic disorder field trials. Journal of Autism and Developmental Disorders, 29, 33–43.

    PubMed  Article  Google Scholar 

  8. Cantwell, D. P. (1996). Classification of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 37, 3–12.

    PubMed  Article  Google Scholar 

  9. Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285, 3093–3099.

    PubMed  Article  Google Scholar 

  10. Chung, S. Y., Luk, S. L., & Lee, P. W. (1990). A follow-up study of infantile autism in Hong Kong. Journal of Autism and Developmental Disorders, 20, 221–232.

    PubMed  Article  Google Scholar 

  11. Clark, L. A., Watson, D., & Reynolds, S. (1995). Diagnosis and classification in psychopathology: Challenges to the current system and future directions. Annual Review of Psychology, 46, 121–153.

    PubMed  Article  Google Scholar 

  12. de Bruin, E. I., Verheij, F., & Ferdinand, R. F. (2006). WISC-R subtest but no overall VIQ-PIQ differences in Dutch children with PDD-NOS. Journal of Abnormal Child Psychology, 34, 254–262.

    Article  Google Scholar 

  13. Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2004). Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. Journal of Autism and Developmental Disorders, 34, 379–393.

    PubMed  Article  Google Scholar 

  14. Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism, 9, 392–415.

    PubMed  Article  Google Scholar 

  15. Ghaziuddin, M. (2005). A family history study of Asperger syndrome. Journal of Autism and Developmental Disorders, 35, 177–182.

    PubMed  Article  Google Scholar 

  16. Ghaziuddin, M., & Gerstein, L. (1996). Pedantic speaking style differentiates Asperger syndrome from high-functioning autism. Journal of Autism and Developmental Disorders, 26, 585–595.

    PubMed  Article  Google Scholar 

  17. Ghaziuddin, M., & Mountain-Kimchi, K. (2004). Defining the intellectual profile of Asperger Syndrome: Comparison with high-functioning autism. Journal of Autism and Developmental Disorders, 34, 279–284.

    PubMed  Article  Google Scholar 

  18. Gupta, A. R., & State, M. W. (2007). Recent advances in the genetics of autism. Biological Psychiatry, 61, 429–437.

    PubMed  Article  Google Scholar 

  19. Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four- to six-year follow-up. Journal of Autism and Developmental Disorders, 30, 137–142.

    PubMed  Article  Google Scholar 

  20. Howlin, P. (2003). Outcome in high-functioning adults with autism with and without early language delays: Implications for the differentiation between autism and Asperger Syndrome. Journal of Autism and Developmental Disorders, 33, 3–13.

    PubMed  Article  Google Scholar 

  21. Iwanaga, R., Kawasaki, C., Tsuchida, R. (2000). Brief report: Comparison of sensory-motor and cognitive functioning between autism and Asperger Syndrome in preschool children. Journal of Autism and Developmental Disorders, 30, 169–174.

    PubMed  Article  Google Scholar 

  22. Joseph, R. M., Tager-Flusberg, H., & Lord, C. (2002). Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 43, 807–821.

    PubMed  Article  Google Scholar 

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

    Google Scholar 

  24. Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.

    Article  Google Scholar 

  25. Klin, A., Pauls, D., Schultz, R., & Volkmar, F. (2005). Three diagnostic approaches to Asperger Syndrome: Implications for research. Journal of Autism and Developmental Disorders, 35, 221–234.

    PubMed  Article  Google Scholar 

  26. Klin, A., Volkmar, F. R., Sparrow, S. S., Cicchetti, D. V., & Rourke, B. P. (1995). Validity and neuropsychological characterization of Asperger Syndrome: Convergence with nonverbal learning disability syndrome. Journal of Child Psychology and Psychiatry, 36, 1127–1140.

    PubMed  Article  Google Scholar 

  27. Lecavalier, L. (2006). Behavior and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36, 1101–1114.

    PubMed  Article  Google Scholar 

  28. Lord, C., Leventhal, B. L., & Cook, E. H. (2001). Quantifying the phenotype in autism spectrum disorders. Neuropsychiatric Genetics, 105, 36–38.

    PubMed  Article  Google Scholar 

  29. Lord, C., Risi, S., DiLavore, P., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63, 694–701.

    PubMed  Article  Google Scholar 

  30. Lord, C., Risi, S., Lambrecht, L., Leventhal, B. L., DiLavore, P., Pickles, A., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

    PubMed  Article  Google Scholar 

  31. Macintosh, K., & Dissanayake, C. (2004). Annotation. The similarities and differences between autistic disorder and Asperger’s disorder: A review of the empirical evidence. Journal of Child Psychology and Psychiatry, 45, 421–434.

    PubMed  Article  Google Scholar 

  32. Mahoney, W. J., Szatmari, P., MacLean, J. E., Bryson, S. E., Jones, M. B., & Zwaigenbaum, L. (1998). Reliability and accuracy of differentiating pervasive developmental disorder subtypes. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 278–285.

    PubMed  Article  Google Scholar 

  33. Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviors in autistic disorder. Journal European Child & Adolescent Psychiatry, 11, 210–218.

    Article  Google Scholar 

  34. Miller, J. N., & Ozonoff, S. (2000). The external validity of Asperger disorder: Lack of evidence from the domain of neuropsychology. Journal of Abnormal Psychology, 109, 227–238.

    PubMed  Article  Google Scholar 

  35. Muhle, R., Trentacoste, S., & Rapin, I. (2004). The genetics of autism. Pediatrics, 113, 472–486.

    Article  Google Scholar 

  36. Ozonoff, S. (1998). Assessment and remediation of executive dysfunction in autism, Asperger syndrome. In E. Schopler & G. B. Mesibov (Eds.), Asperger syndrome or high-functioning autism? (pp. 11–28). New York: Plenum Press.

    Google Scholar 

  37. Ozonoff, S., South, M., & Miller, J. N. (2000). DSM-IV-defined Asperger syndrome: Cognitive, behavioral and early history differentiation from high-functioning autism. Autism, 4, 29–46.

    Google Scholar 

  38. Robins, E., & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983–987.

    PubMed  Google Scholar 

  39. Rutter, M. (1978). Diagnostic validity in child psychiatry. Advances in Biological Psychiatry, 2, 2–22.

    Google Scholar 

  40. Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised. Los Angeles: Western Psychological Services.

    Google Scholar 

  41. South, M., Ozonoff, S., & McMahon, W. M. (2005). Repetitive behavior profiles in Asperger syndrome and high-functioning autism. Journal of Autism and Developmental Disorders, 35, 145–158.

    PubMed  Article  Google Scholar 

  42. Sponheim, E., & Skejeldal, O. (1998). Autism and related disorders: Epidemiological findings in a Norwegian study using ICD-10 diagnostic criteria. Journal of Autism and Developmental Disorders, 28, 217–227.

    PubMed  Article  Google Scholar 

  43. Szatmari, P., Archer, L., Fisman, S., Streiner, D. L., & Wilson, F. (1995). Asperger’s syndrome and autism: Differences in behavior, cognition, and adaptive functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1662–1671.

    PubMed  Article  Google Scholar 

  44. Szatmari, P., Bryson, S. E., Streiner, D. L., Wilson, F., Archer, L., & Ryerse, C. (2000a). Two-year outcome of preschool children with autism of Asperger’s disorder. American Journal of Psychiatry, 157, 1980–1987.

    PubMed  Article  Google Scholar 

  45. Szatmari, P., Merette, C., Bryson, S. E., Thivierge, J., Roy, M., Cayer, M., & Maziade, M. (2000b). Quantifying dimensions in autism: A factor-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 467–474.

    Article  Google Scholar 

  46. Tonge, B. J., Brereton, A. V., Gray, K. M., & Einfeld, S. L. (1999). Behavioural and emotional disturbance in high-functioning autism and Asperger syndrome. Autism, 3, 117–130.

    Article  Google Scholar 

  47. Towbin, K. E. (2005). Pervasive developmental disorder not otherwise specified. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders Vol. 1: Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 165–200). Hoboken: Wiley.

    Google Scholar 

  48. Verte, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., & Sergeant, J. A. (2006a). Executive functioning in children with an autism spectrum disorder: Can we differentiate within the spectrum? Journal of Autism and Developmental Disorder, 36, 351–372.

    Article  Google Scholar 

  49. Verte, S., Geurts, H. M., Roeyers, H., Rosseel, Y., Oosterlaan, J., & Sergeant, J. A. (2006b). Can the children’s communication checklist differentiate autism spectrum subtypes? Autism, 10, 266–287.

    PubMed  Article  Google Scholar 

  50. Volkmar, F. R. (1998). Categorical approaches to the diagnosis of autism. Autism, 2, 45–49.

    Article  Google Scholar 

  51. Volkmar, F. R., & Klin, A. (2005). Issues in the classification of autism, related conditions. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders Vol. 1: Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 5–41). Hoboken: Wiley.

    Google Scholar 

  52. Volkmar, F. R., Klin, A., Siegel, B., Szatmari, P., Lord, C., Campbell, M., et al. (1994). Field trial for autistic disorder in DSM-IV. American Journal of Psychiatry, 151, 1361–1367.

    PubMed  Google Scholar 

  53. Volkmar, F. R., Lord, C., Bailey, A., Schultz, R. T., & Klin, A. (2004). Autism and pervasive developmental disorders. Journal of Child Psychology and Psychiatry, 45, 135–170.

    PubMed  Article  Google Scholar 

  54. Walker, D. R., Thompson, A., Zwaigenbaum, L., Goldberg, J., Bryson, S., Mahoney, W. J., Strawbridge, C. P., & Szatmari, P. (2004). Specifying PDD-NOS: A comparison of PDD-NOS, Asperger syndrome, and autism. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 172–180.

    PubMed  Article  Google Scholar 

  55. Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.

    PubMed  Article  Google Scholar 

  56. Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11, 115–129.

    PubMed  Article  Google Scholar 

  57. Wing, L. (1998). The history of Asperger syndrome. In E. Schopler & G. B. Mesibov (Eds.), Asperger syndrome or high-functioning autism? (pp. 11–28). New York: Plenum Press.

    Google Scholar 

  58. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. Geneva: World Health Organization.

    Google Scholar 

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Correspondence to Luc Lecavalier.

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Witwer, A.N., Lecavalier, L. Examining the Validity of Autism Spectrum Disorder Subtypes. J Autism Dev Disord 38, 1611–1624 (2008). https://doi.org/10.1007/s10803-008-0541-2

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Keywords

  • Validity
  • Subtype
  • Autism
  • Pervasive developmental disorder
  • Autism spectrum disorder