Autism

The State of the Art for Treating Autism

As we discuss in our page on Therapy for Autism, the main treatment paradigm for autism and, more broadly, autism spectrum disorder, is therapy, not medication. The main thrust of care designed to succeed is one-to-one, in person, supportive, child-centered care. For adults with autism, it’s person-centered care. Designing and executing an autism treatment plan almost always has a skilled, central physician leading the treatment team. That said, the treatment is usually done by a team working the treatment plan. Remarkable progress is the rule if the plan is designed for what’s best for the child. As soon as a problem is suspected it’s important to get solid confirmation of the diagnosis followed by a rapid move to start the therapies. If done appropriately there’s good reason for optimism. (We use “autism” to mean autism and autism spectrum disorders.)

One of our Wisconsin Readers Asked:

I’m 15 and do a lot of babysitting, so I know kids and how to help them have fun. We recently drove to visit an aunt and uncle we rarely see and they have three kids, the youngest is a five-year-old cute little girl. I was playing a board game with her and she suddenly got mad and started hitting and kicking me. She scratched my arms and bit my hand. I stayed away from her the rest of the visit. My aunt and uncle said she has autism, but, I mean, really, what’s wrong with her? They’ve got to do something for her.

We added this question sent to us by one of our readers because it “hits the nail on the head” on why medications need to be in the discussion when treating autism. Some autistic children have behaviors that are worse than just socially unacceptable. They’re dangerous. On the one hand it’s wrong to publicize this behavior as “autistic” because there are plenty of children with autism who show no behavior that could hurt anyone.

On the other hand there are some children with autism who have other medical diagnoses in addition to autism. (See reference here and below.) Examples of conditions that might be associated with problem behaviors are epilepsy, anxiety, attention deficit/hyperactivity disorder (ADHD), depression, obsessive-compulsive disorder (OCD), bipolar disorder, conduct disorder, and oppositional defiant disorder. For example, children with oppositional defiant disorder can have angry, argumentative outbursts and frequent disobedience. Usually this is toward parents and teachers but it can be toward playmates and brothers and sisters. Conduct disorder can be even worse in older children and adolescents with violent behavior, cruelty to others (including animals), and even criminal activity.

As These Examples Show, Medications Can Become Necessary in Autism

Whether from some second diagnosis in addition to autism or just with autism itself, we can, on occasion, see behaviors in autism that are far too over-the-top frightening, or even dangerous. Behaviors like breaking things, hurting oneself, or hurting others, sometimes badly, are too serious to ignore. And when such outbursts or temper tantrums or other problem actions occur, by the time someone says “medication” it’s usually already too late. The child has broken a window with glass flying everywhere, or injured herself, or hurt someone. It best, it’s safest, to think about the possible need for medications before they’re suddenly necessary. We hope you’ll agree, medications do have a place in the overall treatment plan.

Remember We’re Talking About the Brain

A neurologist in one of our training programs had a favorite phrase, a comment that he said all the time. “Bad behavior, bad brain.” Samuel Goldwyn, the movie mogul (you know, Metro-Goldwyn-Mayer, MGM) once said that, “Anyone going to see a psychiatrist should have his head examined.” Back then he meant it as a satirical joke, that you have to be crazy to see a psychiatrist. But these days, seen in another way, it’s medically true. If someone, especially a child, is troubled or has problem behavior it’s good medical care to get a brain scan. (See our page Your Mind and Your Brain.) Everyone has unique wrinkles in their brain and their behavior. Including people with autism. At times a brain can spark and fire off a behavior before other parts of the brain even have time to think about it.

Behavior, That Is, How We Behave.  Action in Action!

One autism item that comes up at times is aggression. You know, temper tantrums or outbursts that lead to things like hitting, kicking, scratching, or biting. Throwing things, sometimes heavy things. Such actions are dangerous even if the child is the only one in the room. And the bigger problem is, usually someone else, or several others, are also in the room. Other children, or parents, or teachers. Someone’s going to get hurt. Then there’s being overly-energetic with hyperactivity. A few more examples are repeating the same movements over and over; being remarkably and unexpectantly irritable and cranky; daydreaming and not paying attention at a time when attention is needed; being markedly nervous and anxious; and depression, either depression that socially isolates or angry depression, far more than just a down mood.

Who’s at Risk and Who’s at Fault?

Who’s at risk? Everyone. The child with autism. People, children and adults, who are in the room with him. What if you dodge (or worse, don’t dodge) a book he didn’t want to read so he throws it at you? Often such actions leave the child feeling awful about himself, the exact opposite of what such a child with autism needs in order to feel secure and to do well. Who’s at fault? Last of all the child. The child is not at fault. But what about the “adult in the room”. The adults in the room need to be prepared, to know what might happen, and to have any possibly needed medication ready and available. First of all to protect the child’s self-esteem, and also to stop self-injury, injury to others, property damage, and dangerous situations.

Making the Medication Decisions – Treating Autism with Medication

All the parts of the treatment plan, the various therapies and medication decisions, are made by the physician in the lead. A whole treatment team needs to be in place and working with the child (or adult) with autism. The goal has to be the best possible eventual outcome for the child. (See our page on Therapy for Autism.) Of course, the days of the “dictator doctor” were gone fifty years ago. This lead physician makes the decisions in consultation with the parents and the rest of the treatment team.

Understand That There Are No Medications For Autism

We’ve gone through all this explanation about medications to be used in autism but it’s important to understand that there are no medications to treat the autism itself. No medication has been discovered that can treat the autism. And there likely never will be. Autism is a way the hardwiring of the brain is set during pregnancy, through labor and delivery, and during the early months of life. It would be a wonderful miracle if a medication were actually found to repair that circuitry. If it does happen someday, however, it likely will not be soon.  

But There Are Medications That Can Help Avoid Disasters

Any medications that the physician says will help are medications to treat those problem behaviors we described above. They are behaviors that sometimes are just part of autism, the way an autistic brain is wired. It’s great for the child and for everyone around the child to provide safeguards against trouble. What’s more, it’s not always easy to find the best medication for any specific behavior. Any medication needs to be a good fit first of all for the child. A good fit meaning that will be useful in the child’s actual situation, and that actually helps the possible problem behavior. There is no “one-size-fits-all”. A medication that works great for one child’s anxiety might not help at all for anxiety in another child. There’s no one-size-fits-all for the child and no one-size-fits-all for the medications.

You Mean Children with Autism Can Be Irritable?

Hey, listen, everyone can be irritable. No surprise that a kid with autism can be irritable. And good news, the FDA has approved 2 medications for irritability in autism. One is risperidone (Risperdalâ) approved for ages 5 to 16 and the other is aripiprazole (Abilifyâ) for ages 6 to 17. As FDA-approved medications have gone through a lot of clinical studies. The FDA demands a lot of information and testing to approve a medication for such a specific medical reason

Other Medications That Are Good Need Not Be FDA-Approved

A medication can be known to be good and useful for the problems of autism and yet not have a government agency approval. Most medications that are known to work well for one or another problem in autism are used in line with what is called “community standards”. That is, these medications are known to be safe and to work well because physicians with skill and experience give them often to children with autism and usually find that they work well, and with few side effects.

Other Medication Choices Beyond risperidone and aripiprazole

Autism-useful Medications Originally Developed for Adult Depression

One example of this “community standards” way of choosing medications for autism is the use of medications developed to treat adults with depression. These medications were first made for treating major depression in teenagers and adults. Over a long period time physicians treating children with autism came to understand that these medications can lessen autism’s repetitive actions, anxiety, and irritated attitudes. The benefit these medications provide in autism have nothing to do with the child being depressed. They’re are not “depressed” in the same way that we think about depression in adults. At times these medications can lower the energy put into tantrums and lessen the force put into aggressive behavior. In addition, they can at times really help with better eye contact and more socializing and more typical socializing in an autistic child.

Medications for Anxiety and “Nervousness”

This situation is sort of like the situation above with medications for depression. Some medications that were made to treat anxiety or “nervousness” in adults also work in children with autism. Such medications can help lower an autistic child’s anxiety and even treat episodes that look much like panic attacks.

Medications That Work “Backwards” – “Stimulants” that Calm an Autistic Child

Unless you’ve been buried deep in the upset and worry of a child with autism and then seen these medications work, this idea might seem completely backwards. But, it’s real and at times it works. Some children with autism can feel calmer and better if given one of the medications that in adults would be considered “stimulants”. The medications actually seem to work much as they do in children with ADHD (attention deficit hyperactivity disorder). Take a child with ADHD that’s hyperactive and all-over-the-map and give the child a stimulant, and often he’s more calm. As odd as it might seem, it’s a real clinical effect.

A Seizure Medication for a Child with Autism Who Does Not Have Seizures

Medications for seizures were made and are used to prevent seizures and to treat seizure disorders like epilepsy. There are children with autism who also have seizures, and for these kids it makes sense to use a medication to prevent seizures. However, these same medications can also be useful for children with autism who don’t have seizures or any seizure disorder. They can help in some certain situations. One example is a child being upset in an “out-of-control” kind of way. We don’t mean just distressed or agitated. We mean really OUT – OF – CONTROL. These medications for seizures can keep things from getting out of control.

So, There, You Have It – Good News or Bad?

So, that’s the story on treating autism with medication. We wish it didn’t upset anyone but we know some people, good and conscientious people, just don’t “believe” in medication for children with supposed “behavior” problems, including children with autism. But medically, clinically, for the benefit of the child and everyone around the child, there are times when a medication helps, a medication keeps trouble from happening, or a medication stops trouble like nothing else can. We’re talking about the brain here, a bodily organ like a heart or stomach or a lung. It’s a brain, and at times it doesn’t work as well as is needed, and at times a medication can help.

Helpful Links:

National Institute of Child Health What are the treatments for autism?

PubMed Central Treatment of Autism Spectrum Disorder

PubMed Central Pharmacologic treatments for autism

Centers for Disease Control Treatment for Autism

Autism Speaks Treatments for Autism

Mayo Clinic on Autism Spectrum Disorder

Therapy for Autism is the Heart & Soul of Treatment

For autism, the “heart and soul” of treatment is one-to-one, in person, supportive, child-centered care. For adults with autism, person-centered care. The large body of scientific work in the area of autism supports this viewpoint. The whole care plan needs to be focused on the child, the person, with autism. What’s best for him and what works best in his world? There is usually remarkable and often rewarding progress. With early diagnosis, solid confirmation of the diagnosis, and a rapid move to start the progress of therapy, there is good reason for optimism.

The Therapist in the Therapy for Autism

The key individual in this care plan is then the therapist. A whole team of skilled professionals then backs up this one-on-one central therapist, each adding a specific skill set and experience. Having said all of this, it’s important to understand that no therapy we have can reliably, consistently, and effectively make the core symptoms of autism just disappear.

A Reader Asks:

Why can’t a kid just take a pill to treat autism like other problems?

Wishing For a Medication to Cure Autism

A great question, and don’t we all wish there was such a medication. One has to realize the medical situation with autism. The brain’s wiring is such that the child experiences the world in an unusual way. She’s responding to the world as best possible. It’s brain hardwiring that’s at the center of the situation. Though in computer terms, a better term might be the brain’s “firmware”. Medical neuroscience does not yet have a pill to correct brain’s firmware circuit wiring. Maybe someday. So the best we can do is modulate the circuitry with a variety of educational and therapeutic treatments. And often this approach works remarkably well. There are a few specific medications that might help for certain times in a person with autism.

Medication and Therapy for Autism

This statement of medication and therapy is an either/or. It’s not one vs. the other. The main thrust for treating autism is a therapy of one sort or another. We talk about medications and autism on our page Treating Autism with Medicine. At times specific behaviors might need some medication. Behaviors that might possibly cause injury. But medication is not center stage to treat autism, and is barely on the stage at all.

Dozens of Therapies When Discussing Therapy for Autism

Here’s a good question. Is the broad choice of therapies for autism a rich collection of help, or, is it a situation with too many cooks spoiling the broth? Autism can be very individual. It can look like many different conditions. And, there’s no one, simple, cut-and-dried way to treat it. This situation can create an absolute mess. Every Tom, Dick, and Harry, (or Jane, Mary, and Suzie) claims to have “THE magic bullet” treatment. Whether noted, famous doctors or plain money-hungry bums, they’re all in the mix. And sadly, too often, those with the loudest voices show up with the least good treatments. How does one decide? We hope the information below will help. As discussed more below, Applied Behavioral Analysis has been and remains the “gold standard” for a good treatment that works for autism.

More Emphasis on One-to-One Therapy for Autism

The idea of a one-to-one therapist with the child is important and too often overlooked. Parents of a child with autism are often anxious and upset, maybe even in crisis. So one-to-one therapy can be overlooked just because there are not enough people, not enough help, to do the best for every child. The parents seek help and those who guide them toward help often offer what’s readily available rather than what’s best. The only true way to say if a therapy works is to answer the question, does it work for this one child, the child in front of you.

Collect Information and Judge Over Time

As you need to or want to, try different therapies and therapists and keep careful records, such as you would in a diary. Which therapists helped, which therapy approaches worked, and which ones did not? Both the parents and the treatment team members can work on this diary of help, helpers, and careful notes about progress. It’s needed to have solid information on what has helped this specific child.

Therapy for Autism – Therapist Qualities

The weighing and deciding go beyond which types of therapies to try. It’s possible that a good, quality, conscientious therapist using a supposedly so-so form of therapy could provide good progress in the child’s well-being and success. On the other hand, a lackadaisical therapist, even if performing therapy in the model of the gold-standard of care, might be of little help to the child, with little progress.

Should I Wait Before Starting Therapy to See What Happens?

In a word, no. In several words, no, no, no, no, and no. Once the diagnosis is made, start with therapy absolutely as soon as possible. The sooner treatment is started after the diagnosis of autism is made, the better everything will go for the child for years to come. But, make sure the diagnosis is real and correct. That is, if there’s any question, get a second opinion that the diagnosis IS autism from a really capable doctor, and get that opinion right away.

What Therapy for Autism Can Do

Treatment can make all the difference in the world. The first step will be looking at where the child is now. What is he able to do? What can he do really well, that is, what are his strengths, strengths upon which a therapist can build? In what areas does he not do well? That is, find those areas that are not as strong. The information from this thorough look gives the therapy team the ability to reward strengths. And, to work gently on less strong areas to gradually build balance in abilities over time.

Meet the Treatment Team Around the One Central Therapist

The Doctor

• Most important and at the top of the list, 1 or 2 experienced, highly-trained, top-level doctors. Perhaps a psychiatrist or a neurologist, maybe a pediatrician or an internist.

An Occupational Therapist

• An occupational therapist. This individual knows play behavior, social skills, and daily living skills (like eating and personal hygiene). In an adult this therapist knows work skills.

A Speech Therapist

• Speech therapist. Some people with autism are not that great at speaking, at conversation, at getting their ideas across. A person who cannot explain to others what he needs or wants will not do well in life. Speech therapists train and improve speaking ability, practice on talking back and forth with others, and improve a child’s learning ability.

The Care Manager

• Care manager. The coach and coordinator. A central, super-necessary person. The care manager or case manager follows the treatment plan and keeps track of everything and everyone. The case manager functions like a coach on a sports team. In this situation the “sports team” consists of the person with autism, the members of the treatment team, and the friends, relatives, and other helpers for the person with autism. The case manager is like the center hub of a wheel holding the spokes of the wheel in place.

The Therapist and The Care Manager

• The child’s therapist might or might not be able to function as the care manager. Case management takes a lot of talking to people, tracking interactions, and coordinating across home, school, work, and/or social settings. That is, it takes a lot of time. The central therapist’s time might be better spent working with the child. A therapist and a case manager working in tandem as a team can put experience and skills where they’re needed.

Comments on a Few Behavioral Therapies

Applied Behavioral Analysis

Some call Applied Behavioral Analysis the “gold standard” for a treatment for autism that works. Applied Behavioral Analysis is, no surprise, based on an analysis of the child’s behavior and known treatment strategies in psychology. Behaviors that one wants to make more frequent are rewarded. Actions that one wants to make happen less often, to extinguish, are ignored. For example, reward school skills like reading and arithmetic, reward social actions like playing with others and talking to others, and reward living skills such as paying attention to calendars, days, and schedules.

Cognitive Behavioral Therapies

Cognitive behavioral therapies are learning-based treatment. That is, they’re teaching. For this approach to work the autistic child has to be able to understand and to work with the teacher/therapist. Some children can understand and work with this type of a therapist and some cannot. As therapies in other areas are put in place and progress is seen, understanding might improve over time. Changing how you yourself think and paying attention to how a you behave is hard for anyone. Truly starting to think differently and changing your behavior is even harder. (Truth is, most mature adults can’t do it.)

Therapy for Autism – Exercise Therapies

Exercise therapy is the one that most parents use with most children. It can help some autistic children. It starts with getting the child going in some form of exercise. If the child can do it, it helps with muscle movement training, coordination when active, and general physical fitness. And, as a side benefit, the time spent in a good exercise program leaves less time for a problem behavior to start.

Other Types of Therapy

Educational Therapies

Educational therapies are in a setting familiar to everyone, a classroom with a teacher. For an autistic child these classes have a fairly firm behavioral focus. The information or material to be learned must be put together to serve the needs of the one specific child. As one might imagine, doing this is hard. Even with just a few children you need a team of skilled people who really know what they’re doing. There’s a classroom with children but each individual child needs attention focused on him or her. Daycare age children and kindergarten age, if they can do it, often show good progress. They’re then better able to enter elementary school grades with the hope of success. One example of an educational therapy is called Early Intensive Behavioral Intervention, or EIBI.

Training Parents – Giving Parents Tools and Skills

Parents. They’re in trouble, too. They’re often hit with several grief-like reactions as they discover the diagnosis of autism in their child. Their internal struggle can cycle through all of the usual grief stages, early denial, realization anger, hopeful bargaining, and upset depression. Finally, they get to the acceptance stage and the desire to move forward sets in, but not usually with a calm clear-mindedness. There’s still anxiety, and overtones of a crisis. Given all of this it’s little wonder that working with the parents is helpful and needed. How to play with their child, how to talk, watch, and encourage in a way that adds to progress and growing. And one needs to let parents know that as troubled waters of new behaviors come up, they have a place to get help.

No Evidence for Complementary and Alternative Medicine Therapies

For reasons that are not clear except that the label is trendy right now, Complementary and Alternative Medicine (CAM) therapies for autism are popular. CAM treatment includes things like herbal supplements, vitamin supplements, probiotics, “chelation” therapies, acupuncture, message therapies, yoga, hyperbaric oxygen, dietary manipulations, and others. Lumped under the CAM approaches are music therapies and other auditory training, drama therapies, dance therapies, pet therapy, and “sensory integration” therapies. Even chiropractic treatment is listed in this mix. Unfortunately, based on a large expert review by the Italian researcher Dr. Natascia Brondino and her collaborators (Complementary and Alternative Therapies for Autism Spectrum Disorder) there is no conclusive evidence, none, zero, zip, that CAM therapies work for autism or autism spectrum disorder. You see, everything is tried based on hope when nothing works and a child is in distress.

Helpful Links:

Autism Society – Autism Intervention and Therapy Options

Autism Speaks – Sensory Integration Therapy

Mayo Clinic – Autism Spectrum Disorder

NIH PubMed Central – Complementary and Alternative Therapies for Autism Spectrum Disorder

Autism – The Sorrows and Joys

Autism. It’s a medical diagnosis that parents both welcome and dread hearing. As those early months roll by and the doctor’s milestones are delayed, the fear arises, is something wrong. So the testing starts, and when the tests results come back autism… At first it can be a heartbreak for parents. But there is a huge relief of sorts to know what it is, to know that somebody knows what it is, and maybe can do something to help. It’s a major medical and cultural concern. Yes, parents are challenged. But the more they learn the more they realize that there’s almost always a way for their child to win. Autism is common and most everyone knows what it is. Much more is known about the condition and more is learned with each passing year.

The Autism Diagnosis

It’s now possible for most individuals with autism to have childhood go well. And, for that matter, to have adolescence, adult life, and life generally go well. Understandably, many parents are not sure at first. If you’re not sure but you think your child might have autism, talk to a trusted and experienced doctor. Get the testing done and get the diagnosis as soon as possible. Shop carefully for the pediatrician and autism care team. Your child needs the best possible evaluation and you have to have the correct diagnosis.

Do It Now – We’re Serious, Don’t Wait, Don’t Dally

Here’s why you, the parents, need to do this now and not later. The sooner the diagnosis is made and the therapies is started, the better. The earlier the therapeutic team starts their work the more they will be able to make the situation medically right. This means that the sooner the therapies start the better the eventual outcome for your child to grow up well and live life well. If the diagnosis is autism, your doctor will pull a whole autism treatment team together. Then your child can be surrounded and helped by this enriched environment of trained professionals.

What a Child with Autism Looks Like Behaviorally

As an overview (not specific on every detail) here’s the picture of a child with autism. Your child might be very interested in something, though not necessarily interested in what’s immediately around him. He might do the same thing over and over again in a way that, at least to you, does not seem to make sense. You talk with him in plain, simple child’s language and you’re still not sure that what you’re saying is what he’s hearing. Clearly, at times, he wants or needs something in an emotionally intense way, but it’s far from clear what that something is. On the playground he has a mind of his own, and might or might not connect with the other kids all the time.

Three Important Aspects of Autism

There are three centrally-important areas of behavior in a child with autism:

(1) Doesn’t not play well.
(2) Doesn’t speak well, that is, can’t say what they need or what they mean.
(3) Performs the same action or makes the same sounds over and over.

How the Doctor Makes the Diagnosis of Autism

To make a diagnosis of autism the doctor looks at how your child behaves and at “developmental milestones”, things a child usually does at a certain age. Some additional specific testing might be needed. A skilled and experienced doctor can make the diagnosis. Because the doctor has to get the diagnosis right, it’s not quick and easy. She needs to pull together a lot of information. Each child can be a bit different from others with autism. Each of the three important behavioral areas above can exist as mild-to-severe, giving the medical condition a different appearance.

Signs of Larger Challenges

The doctor might see some behaviors that show that a child might have some larger hurdles to overcome. Examples are: times of moderate-to-severe irritability, throwing full-blown tantrums, loud outbursts with fighting, and hurting himself/herself.

Autism Touches Every Neighborhood

Autism is an “equal opportunity” medical condition. It’s seen in all neighborhoods. Children in the nicer part of town, in the disadvantaged part of town, and all through that big, middle-class (whatever that really is) area. It can be found in every geographic area around the world and affects every ethnicity, white, black, brown, Native American, everyone. We’re all in this together.

Autism Doesn’t Just Go Away

There’s a peculiar saying that makes a point, “The only thing that will go away if you ignore it is your teeth.” Autism doesn’t just go away, and absolutely does not go away if one ignores it. Children go not automatically grow out of autism. Autism is about how the brain within the body is put together. It’s a lifelong condition.

Treatment Helps a Lot

The therapies that are used to treat autism help. Based on the needs of each specific child a treatment program is designed. When the treatment program is carried out the improvement can be remarkable. And the earlier in the child’s life that the therapies start, the more they help. A treatment program needs to be individually designed because the therapies need to be the correct therapies, the best therapies. The best therapy for each child has to be designed as a treatment plan made just for that child. The right therapy started early can make the child’s entire life go better. More on this in the pages: Therapy for Autism and Treating Autism with Medication.

Helpful links:

National Institute of Neurological Disorders and Stroke on Autism

The National Institute of Mental Health on Autism Spectrum Disorder

US National Library of Medicine’s Medline Plus on Autism Spectrum Disorder

Centers for Disease Control and Prevention on Autism Spectrum Disorder

Autism Society on Autism

Autism Speaks on Autism

Creating a Sensory Friendly Home for Autism (recommended by WonderMoms.org)

And Now a Bit of Medical History… 

The concept of autism seems to have started in 1911 with German psychiatrist Eugen Bleuler. He invented the term “autism” to name a symptom he saw in severe cases of schizophrenia. He had previously invented the term “schizophrenia” in 1908. The symptom of autism didn’t make sense to him. The children had normal intelligence, often a good memory, yet odd behavior. In 1943 the physician Leo Kramer decided this syndrome was “psychiatric” in nature, a type of childhood schizophrenia (which was wrong). In the 1950s and 60s cold, unemotional mothers were believed to be the cause of these “childhood schizophrenias”. Many twisted concepts and theories were developed about autism in the 1960s and 70s (most of them wrong) with much professional conflict and debate. Old ideas were thrown out as fast as new ideas were thought up. Finally it became more clear as a medical disorder, a biological brain-based condition. To get away from this wrong idea of schizophrenia it was given a new name, pervasive developmental disorder. As time went by doctors realized that this medical condition was not always “pervasive” but could be far less severe. In the late 1980s and 1990s doctors began to think of a range from mild to severe and started saying there was a spectrum of illness. Then started the term “Autism Spectrum Disorder”. This “spectrum” had terms for some of the categories. Asperger’s disorder was considered to be mild. Childhood Disintegrative Disorder was severe. It all became rather loose in interpretation, lacking the rigor needed to make a good, clear diagnosis. To this day most doctors remain unhappy with the situation. “Autism” refers to many poorly understood conditions.