Autism Spectrum Disorder (Autism Spectrum Disorder) is a neurodevelopmental syndrome characterized by impairment to social communication adjoined by the presence of rigidity, restricted interests, and/or repetitive behaviors. Diagnosis of Autism Spectrum Disorder recently shifted from a series of pervasive developmental disorders recognized in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) to a single, comprehensive diagnosis in the 5th edition of the same manual (DSM-5; APA, 2013). To evaluate the appropriateness in this shift in diagnostic practice, the current study evaluates the consistency in symptom presentation amongst the previous DSM-IV-TR diagnoses. Additionally, this study identifies several novel considerations for Autism Spectrum Disorder symptom presentation in high ability youth. Thus, the current study addresses broad considerations for discrete versus continuous symptom presentation in Autism Spectrum Disorder, as well as contributes to the limited literature addressing Autism Spectrum Disorder symptom presentation features in high ability youth.
A review of literature on theory, conceptualization, and assessment of Autism Spectrum Disorder is provided, as well as a review of relevant literature for high ability youth diagnosed with Autism Spectrum Disorder. Progression of Autism Spectrum Disorder diagnosis is discussed, with emphasis upon the current debate regarding shifts from utilization of many diagnoses to a single, comprehensive diagnosis. Next, unique challenges associated with Autism Spectrum Disorder in high ability youth are identified, including current conceptualization, assessment, and treatment considerations. Due to identified gaps in consistent understanding of Autism Spectrum Disorder presentation, including Autism Spectrum Disorder in high ability youth, the author conducted two complementary studies. The first of these studies evaluated consistency in parent ratings on Autism Spectrum Disorder screening tools across previously used diagnostic labels (i.e., Autistic Disorder (AD), Asperger's Syndrome (AS), and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)) now subsumed under Autism Spectrum Disorder diagnostic criteria in the DSM-5. The second study analyzed Autism Spectrum Disorder symptoms reported by parents of high ability youth. Data collection for this latter study included a novel research measure intended for identifying symptoms associated with high ability Autism Spectrum Disorder. Items on this form were derived through a card sort of items included in current symptom screening tools completed by content area experts. Additionally, this novel research measure included an open-ended item for parents of high ability youth to report additional symptoms.
Results from the first study suggest that parents of children diagnosed with AD, AS, and Pervasive Developmental Disorder, Not Otherwise Specified do not differentially report symptoms on two current Autism Spectrum Disorder screening tools: (1) The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) and (2) the Autism Spectrum Screening Questionnaire (ASSQ; Ehlers, Gillberg, & Wing, 1999). Results from the second study provide evidence of parental perceptions of several nuances in symptom presentation associated with high ability youth with Autism Spectrum Disorder. Specifically, parents frequently endorsed impairment in development and maintenance of social relationships; however, insight into these weaknesses was not consistently reported as impaired. Additionally, restricted interests were acknowledged, with some parents identifying academic or pseudo-academic subjects as common areas of interest. The collective findings from these studies provide evidence of broad consistency in Autism Spectrum Disorder symptom presentation across previously used diagnoses, yet also unique symptom features for high ability youth. Implications for education, clinical practice, and research in both Autism Spectrum Disorder and twice-exceptionality are discussed.