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Cited by 267Autism Spectrum Disorder ResearchDown syndrome and intellectual disability researchChild Nutrition and Feeding Issues

State of the field: Differentiating intellectual disability from autism spectrum disorder

Open access
Thurm, Audrey, Farmer, Cristan, Salzman, Emma, Lord, Catherine, Bishop, Somer·2019·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2019.00526PMC PMC6683759
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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).

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  • DSM-5 classification of ID severity is based on adaptive functioning across conceptual, social, and practical domains, and the social ability expectations overlap with the social deficits that define ASD.

    “DSM-5 classification of ID severity is based on adaptive functioning across conceptual, social, and practical domains, and the social ability expectations overlap with the social deficits that define ASD.20,39”

    From Insufficient Evidence for “Autism-Specific” Genes (2020) · cites this paper as [39]

  • Many instruments developed for the assessment of social communication and interaction were developed primarily in populations without ID, and this complicates assessment of individuals with ID.

    “In addition, many instruments developed for the assessment of social communication and interaction were developed primarily in populations without ID, and this complicates assessment of individuals with ID.39,40”

    From Insufficient Evidence for “Autism-Specific” Genes (2020) · cites this paper as [39]

  • Many of the core social communication deficits that characterize ASD represent a failure to acquire developmentally expected skills and are therefore expected to be present to some extent in individuals with ID.

    “Many of the core social communication deficits that characterize ASD and are necessary for diagnosis represent a failure to acquire developmentally expected skills and, therefore, are expected to be present to some extent in individuals with ID.39”

    From Insufficient Evidence for “Autism-Specific” Genes (2020) · cites this paper as [39]

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Research works printed but not linked: 3

  1. [61]Lord C Rutter M DiLavore PC Risi S Gotham K Bishop SL Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Modules 1-4. Los Angeles, California: Western Psychological Services (2012).
  2. [63]Constantino JN Social Responsiveness Scale, 2nd edition manual. Los Angeles, CA: Western Psychological Services (2012).
  3. [85]Soorya L Leon J Trelles MP Thurm A Framework for assessing individuals with rare genetic disorders associated with profound intellectual and multiple disabilities (PIMD): the example of Phelan McDermid Syndrome. Clin Neuropsychol (2018), 32(7): 1226–55. 10.1080/13854046.2017.1413211 PMC6417924 29265961 · DOI

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Authors
Thurm, A., Farmer, C., Salzman, E., Lord, C., & Bishop, S.
Affiliations
  • National Institutes of Health (US)
  • University of California, San Francisco (US)
  • University of California, Los Angeles (US)
Corresponding author
Thurm, Audrey
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2019-07-30
Volume
10
Pages
526-526
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2019.00526
PMC
PMC6683759
OpenAlex
W2958993741
Cited by
267
References
92
Citations by year
2026: 29 · 2025: 32 · 2024: 48 · 2023: 38 · 2022: 44 · 2021: 51 · 2020: 22 · 2018: 1 · 2012: 1
FWCI
3.71
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • National Institute of Mental Health (ZICMH002961)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD093012)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
intellectual disability, autism spectrum disorder, idiopathic autism, diagnostic criteria, autism diagnosis, developmental delay, social communication deficits, differential diagnosis, autism etiology

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