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Review
. 2019 Jul 30:10:526.
doi: 10.3389/fpsyt.2019.00526. eCollection 2019.

State of the Field: Differentiating Intellectual Disability From Autism Spectrum Disorder

Audrey Thurm  1 , Cristan Farmer  1 , Emma Salzman  2 , Catherine Lord  3 , Somer Bishop  2
Affiliations
Review

State of the Field: Differentiating Intellectual Disability From Autism Spectrum Disorder

Audrey Thurm et al. Front Psychiatry. .

Abstract

The topic of this special issue on secondary versus idiopathic autism allows for discussion of how different groups may come to manifest autism spectrum disorder (ASD) or ASD-like symptoms despite important etiological differences. A related issue is that, because many of the social communication deficits that define ASD represent a failure to acquire developmentally expected skills, these same deficits would be expected to occur to some extent in all individuals with intellectual disability (ID). Thus, regardless of etiology, ASD symptoms may appear across groups of individuals with vastly different profiles of underlying deficits and strengths. In this focused review, we consider the impact of ID on the diagnosis of ASD. We discuss behavioral distinctions between ID and ASD, in light of the diagnostic criterion mandating that ASD should not be diagnosed if symptoms are accounted for by ID or general developmental delay. We review the evolution of the autism diagnosis and ASD diagnostic tools to understand how this distinction has been conceptualized previously. We then consider ways that operationalized criteria may be beneficial for making the clinical distinction between ID with and without ASD. Finally, we consider the impact of the blurred diagnostic boundaries between ID and ASD on the study of secondary versus idiopathic ASD. Especially pertinent to this discussion are findings that a diagnosis of ID in the context of an ASD diagnosis may be one of the strongest indicators that an associated condition or specific etiological factor is present (i.e., secondary autism).

Keywords: DSM-5; autism spectrum disorder; developmental delay; differential diagnosis; intellectual disability.

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Figures

Figure 1
Figure 1
Number of students (in thousands) in the US who receive special education services pursuant to the Individuals with Disabilities Education Act, adapted from a previous publication (6). Numbers are plotted by the beginning of academic year (X-axis) and by diagnostic group, which are mutually exclusive. Other diagnoses not explicitly labeled include deaf-blindness, developmental delay, emotional disturbance, hearing impairment, multiple disabilities, and orthopedic impairment. The most common diagnoses, specific learning disabilities (in 2014, n = 2,278), and speech or language impairment (in 2014, n = 1,332) are not shown. Figure produced from data obtained from the U.S. Department of Education (7).
See this image and copyright information in PMC

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