An Exploratory Study of a Dimensional Assessment of the Diagnostic Criteria for Autism
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An Exploratory Study of a Dimensional Assessment of the Diagnostic Criteria for Autism Mark Brosnan1
© The Author(s) 2020
Abstract Prevalence rates of autism based upon child samples have shown a consistent increase over the past three decades, suggesting that many autistic adults are undiagnosed. Adult diagnostic pathways typically are initiated with measures of autistic-like traits. Whilst autistic-like traits represent a continuous dimension across the general population, autism is a categorical diagnosis and the relationship between the two is unclear. A self-report dimensional reflection upon the two diagnostic criteria for autism was developed and reflected upon by 1076 participants embedded within two online surveys. Those with an informal (self) diagnosis of autism self-reported comparable social difficulties but fewer restricted and repetitive behaviour difficulties than those with a formal diagnosis of autism. The new items also significantly correlated with autistic-like traits. Keywords Autism assessment · Diagnostic criteria · Autistic-like traits
Introduction Autism Spectrum Disorder (hereafter autism) is a neurodevelopmental condition defined by persistent difficulties across multiple contexts within two distinct domains: (1) social communication and interaction and (2) restricted and repetitive patterns of behaviours, activities or interests (APA 2013; WHO 2018). Studies in Asia, Europe, and North America have identified an average prevalence of autism of between 1 and 2% (Baio et al. 2018). In the USA, substantial increases in prevalence have been identified over the past three decades, which have been attributed to greater autism awareness and changing diagnostic criteria, which have reduced the number of missed cases (see Baio et al. 2018; Christensen et al. 2018). As these prevalence estimates are based upon child populations, this would suggest that there are a number of adults on the autism spectrum who are undiagnosed, which is compounded by a lack of adult-focused autism research (see Camm-Crosbie et al. 2019; Cashin et al. 2016; Pellicano et al. 2014; Milton and Bracher 2013; Warner et al. 2019).
* Mark Brosnan [email protected] 1
Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath BA2 7AY, UK
Whilst a diagnosis of autism is categorical, either a diagnosis is present or it is not, people have reported an autism social identity, some of whom do not have a formal diagnosis of autism (Cooper et al. 2017). Cooper et al. report that around one fifth of their sample identifying as autistic did not have a formal diagnosis from a professional, rather they perceived themselves to be ‘autistic-like’. Autistic-like traits refer to behavioural traits such as social imperviousness, directness in conversation, lack of imagination, affinity for solitude, and difficulty displaying emotions (Gernsbacher et al. 2017). Autistic-like traits are argued to vary continuously across the general population, with studies reporting that groups with a f
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