Why is it possible for two children with the same diagnosis to display such different symptoms? Why doesn’t a boy with an Autistic Spectrum Disorder have the exact same symptoms that the doctor’s pamphlet lists? There’s a reason people have different versions of the same disorders. It’s called the spectrum disorder.
What is a Spectrum Disorder?
A spectrum disorder is a disorder that has ranges, rather than cut and dried symptoms. For example, when I’m told a student has Autism, there isn’t a cut and dried list I can rely on to tell me how that student will act while I’m working with him. Unlike a cold, where I can assume the child will have a runny nose and a sore throat, I can’t assum he’ll have any of the symptoms of other children on the spectrum. Instead, I’ll have to observe him and see where he falls.
For a disorder to have a spectrum, it needs multiple ways to be diagnosed. Sometimes, this is through severity. A spectrum disorder might have a spectrum based on how severe the typical symptoms of that disorder are. For example, here’s what the spectrum might look like when comparing 3 children wtih Tourettes.
Some spectrums, however, might not depend on severity, but rather which symptoms the individual has. Here’s an example using Bipolar Disorder.
At first glance, these might be confusing. The more you read about these disorders and their subcategories on the spectrums, however, the easier it might be to understand.
Some Spectrum Disorders
Auditory Neuropathy Spectrum Disorder (ANSD) – This is a fairly new diagnosable disorder, and now makes up 10-15% of hearing loss, according to KidsHealth. National Acoustic Laboratories describes ANSD as, “a relatively complex type of hearing loss that is believed to be due to abnormalities at the synapse of the inner hair cell and auditory nerve, and/or the auditory nerve itself.”
The reason it’s a spectrum disorder is because its effect on individuals can vary so widely in severity. People with this disorder can suffer from a basic hearing impairment, where sounds are delivered to the brain mildly distorted, to complete hearing loss. Cases have gone in different directions as well, as some people with the disorder improve, others stay the same, and some decline.
Fetal Alcohol Syndrome Spectrum Disorders (FASDs) – Fetal Alcohol Syndrome is one of the few disorders that has nothing to do with heredity. Fetal Alcohol Syndrome is caused by consumption of alcohol by the mother during pregnancy. The Center of Disease Control (CDC) gives a number of common symtpoms of FAS:
- Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
- Small head size
- Learning disabilities
- Difficulty paying attention
- Poor memory
- Sleep and sucking problems as a baby
- Intellectual disability or low IQ
- Poor reasoning and judgment skills
According to the Fetal Alcohol Spectrum Disorders Center for Excellence, there are 3 differnt kinds of spectrum disorders.
- Fetal Alcohol Syndrome (FAS) – This is the most severe of the spectrum disorders, and varies widely itself. Encompassing multiple symtpoms, FAS can have effects so wide they can range from infant death to learning struggles to facial abnormalities to vision or hearing impairment to kidney or bone defects to social problems.
- Alcohol-Related Neurodevelopmental Disorder (ARND) – Individuals with ARND might have learning problems, social struggles, poor decision making skills, or behavior problems.
- Alcohol-Related Birth Defects – This spectrum disorder has physical defects, such as problems with bones, kidneys, the heart, hearing, or a combination of these.
Bipolar Disorder (BD) – Bipolar Disorder isn’t nearly as simple as many think. It’s a spectrum disorder because it has multiple versions that show up in individuals, often with symptoms most people wouldn’t associate with BD, according to Psych Central:
Bipolar Disorder I – This is the more well-known version of Bipolar Disorder. Individuals on this part of the spectrum is characterized by manic episodes or cycles. Some individuals cycle quickly, going back and forth between their “normal” personalities and manic periods, often filled with delusions of grandeur. Depression often also occurs.
Bipolar Disorder II – While not marked by full cycles of mania, this version of the disorder has hypomanias, or milder versions of mania episodes. They can act out of character, but aren’t psychotic. They can also experience severe episodes of depression.
Cyclomythia / Bipolar NOS (Not Otherwise Specified) – Individuals with these disorders experience milder symptoms, but their symptoms and mood changes are nearly constant, as opposed to the periods of “healthy” time that someone with Bipolar I might experience.
Autistic Spectrum Disorders – Like Bipolar, there are multiple versions of Autism that lie on the spectrum, however, Autism has been classified into even more sections than Bipolar disorders or Fetal Alcohol Disorder. The Autistic Spectrum Disorders have recently been rewritten in the DSM-V (Diagnostic and Statistical Manual of Disorders 5).
In 2013, the manual grouped disorders, such as Autism and Asperger’s, thought before to be separate, but similar disorders, all onto the Autistic Spectrum. I’m going to refer to my article on Autistic Spectrum Disorders to explain the different parts of the spectrum here.
- Autism Disorder (Classic Autism) – This is the category of Autism that Raymond falls under in the movie, Rain Man. Even though it’s the most severe of the disorders, however, the individuals diagnosed with Classic Autism are on a spectrum of their own, meaning some have mild cases and some have more severe cases. As each of our brains are different, so are all cases of Autism.
- Childhood Disintegrative Disorder – The U.S. Library of Medicine defines Childhood Disintegrative Disorder as, “a condition in which children develop normally through age 3 or 4. Then, over a few months, children lose language, motor, social, and other skills that they already learned.” This condition is reported to be similar to Classic Autism, but generally in the more severe form. Intervention is generally similar to that of Classic Autism as well.
- Asperger Syndrome – This syndrome is more like Classic Autism than any of the others, however, it’s considered a less severe diagnosis. WebMD says, “…children with Asperger’s syndrome generally have normal intelligence and near-normal language development, although they may develop problems communicating as they get older.” Once again, this is a spectrum disorder, meaning some individuals will display more severe symptoms than others.
- Rett Syndrome – The Mayo Clinic says Rett Syndrome is, “a rare genetic disorder that affects the way the brain develops.” Found mostly in girls, most symptoms of Rett Syndrome appear around or after children reach six months of age. Some of these symptoms are slowed growth, decreases in coordination, communication, and thinking abilities, unusual hand and eye movements, abnormal breathing, irritability, seizures, and strange, unexpected behaviors. Although this is technically a genetic disorder, it displays traits that are largely Autistic in nature.
- Pervasive Developmental Disorder-Not Otherwise Specified (PDD- NOS) – The Child Study Center of Yale defines PDD-NOS as, “a ‘subthreshold’ condition in which some – but not all – features of autism or another explicitly identified Pervasive Developmental Disorder are identified.” Basically, this is when an individual is labeled with certain symptoms of Autism, but not enough to be fully diagnosed with it. This is probably the mildest of the disorders that are categorized under ASD.
Obsessive Compulsive Disorder Spectrum (OCD) – Obsessive Compulsive Disorder is often thought to be expressed through counting or people who are ultra-clean. While these can be parts of OCD, the OCD spectrum covers more than just specific traits. There are three different types of OCD, and someone on the OCD spectrum can .
- Obsessions – This is where the individual experiences unwanted, intrusive thoughts. They can influence compulsions, but they remain in the mind.
- Compulsions – This is when a person feels obligated to act in a certain way. Again, these can be connected to the complusions, but don’t necessarily need compulsions to be present.
- Simulataneous Obsessions and Compulsions – This mix is the most common expression of OCD. For example, when I was little, I would obsess over saying prayers right. The continual thoughts about prayer made up the obsession. Actually saying the endings of my prayers 3 times at the end of each prayer was the compulsion.
Tourette Syndrome – This disorder has two main expressions, tic disorders and Tourettes Syndrome. (It’s also near and dear to my heart, as I have Tourette Syndrome.) Characterized by tics, sudden, repetitive movements or sounds, Tourettes varies in everyone who has it.
To begin with, people on the Tourettes spectrum have different tics, as well as differing numbers of tics. While some are more common, such as blinking, grimacing, throat clearing, or shrugging, just about any motion can be a tic. (For example, I have a tic where I curl my thumb and touch it to my mouth and move it around.)
Tourette Syndrome Plus says, “Tic conditions represent a spectrum ranging from a simple tics that lasts only weeks or a few months to situations in which there are many tics that change in their anatomic location and frequency over time and tics are present for more than a year. Within each type of tic condition, there is also a range of severity from mild and infrequent to severe and frequent.” Here are the specific labels for the severity of the disorders on the spectrum, according to WebMD:
- Transient Tic Disorder – This is where an individual (usually a child) has at least one tic for more than a month, but less than a year. People are always diagnosed with this first, even if they have one of the other forms of the disorder, as the doctor has to document the presence of the tics for at least a year for them to qualify for the other disorders.
- Chronic Tic Disorder – This is where motor and/or vocal tics are present for more than one year.
- Tourette Syndrome – This is the most severe form of the disorder on the spectrum. According to Kids Health, to qualify for Tourette Syndrome, an individual must have more than one motor tic and at least one vocal tic. Even people with Tourettes vary greatly in their severity, however. I have a milder form of Tourettes, and I have 4 to 5 to 8 or more tics at any given time. There are individuals, such as author of World’s Strongest Librarian, Josh Hanagarne, (a fantastic memoir about life with Tourettes, by the way) who have more obvious tics that occur more often.
One More Thing
This list isn’t by any means exclusive. There are other disorders that range in severity and symptom, such as Attention Deficit Hyperactive Disorder (ADHD), and I’m sure others that I’m not aware of. these are some of the more commonly known spectrum disorders. The important thing to remember when considering a spectrum disorder is that anything dealing with the brain will appear differently in different people. As I always say, each human is wired differently, which is a good thing. It forces us to focus a little more, however, when we look at how these disorders affect people from case to case.
The key is going in with an open mind. When someone you know is diagnosed with a spectrum disorder, instead of assuming he’ll have every single symptom listed in the doctor’s pamphlet, it’s healthy to observe. What symptoms does he really exhibit? Are there typical signs of the disorder that he lacks? If he doesn’t match the pamphlet exactly…it’s okay! The pamphlet is just there to give you a place to start.
Your job, really the job of everyone who loves that individual, is to be there for him. Pray for him, encourage him, and love him for who God made him, not who you wish he was. I can tell you from personal experience that love like that can transform someone’s life.