Friday, December 27, 2013

Social (Pragmatic) Communication Disorder

The new Autism Spectrum Disorder diagnostic criteria state:  If have the social communication symptoms of ASD, but that's all (no stereotyped  behaviors, sensory issues), then the correct diagnosis for you might be:S(P)CD: Social (Pragmatic) Communication Disorder.  [Yep, that's formal, official diagnostic label, including the parenthesis.]

Controversy, or old news?
It has always been the case that you needed more than just social communication issues to be labeled with Autism or Asperger's; what's new in the DSM 5 is that if you do not meet the full criteria, there is now a new diagnostic option to consider.  

Implications for assessing ASD:  Find the RRBs and sensory issues
What does this mean for people with ASD fearing the loss of their diagnosis?  What is certain is that this will require people to assess more carefully for the category B symptoms of ASD, the restricted and repetitive patterns of behavior and sensory issues.  These may not be as prominent as the social and communication and theory of mind issues in ASD, but they may still be there. 

Not quite the same social/communication problems: 
    Notice in the criteria, pasted below, that the descriptions of social communication difficulties, though they overlap with the criteria for Autism Spectrum Disorder, are not quite the same.  My overall impression is that there is more emphasis here on language and communication rather than the ASD emphasis on theory of mind issues and other problems caused by difficulty managing complex streams of information (e.g. reading nonverbals and verbal simultaneously).  

Different populations, different origins, different brains?
This difference in the criteria suggests a different origin for similar behaviors. 
There may be kids out there who have some of the same social communication problems as a person with ASD but no general problems with coordinating sensory and perceptual and symbolic and motor information and action.  Instead, this may be a more focused language disability, caused by a problem with certain parts of the brain rather than caused by coordination problems among different areas of the brain as in ASD. 

Treatment/Support differences: The obvious

One of the functions of a diagnosis is to guide treatment/support. Kids with both S(P)CD, and ASD will often be helped by language pragmatics instruction (e.g. how to join a conversation without ending it).  With S(P)CD, based on the criteria, there may be many occasions of needing to explain idioms and sarcasm.  With either diagnosis, here may be social, mood, anxiety, and behavioral issues which will be helped by counseling, psychotherapy, coaching, and empathetic loved ones.  Kids with S(P)CD are not as likely to need occupational therapy/sensory integration work. 

Treatment/Support differences: The Speculative
If I am right that there are two populations with two different kinds of brain differences, then beyond the language social pragmatics instruction, the two groups might need different kinds of therapy, one focused on social and symbolic language and the other, with ASD, focused* more broadly on cognitive/emotional/motor/symbolic integration and adaptability *(at least in my model of ASD treatment and support... a subject for another post). 

Diagnostic Criteria for Social (Pragmatic) Communication Disorder

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context.
2. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation.)
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder. 

Tuesday, December 10, 2013

Diagnostic Criteria for ASD (now officially including Asperger's)

Since many people are posting the new diagnostic criteria for Autism Spectrum Disorder online, we may as well get it right.  Every version I've found online is from the DRAFT criteria; you can tell because there are only categories A,B,C,D, missing the 5th area which relates to Intellectual Disability.  I've got the full criteria summarized below, with some wording about examples and about severity ratings left out.

I am posting these now because the parents of a child with probable Asperger's/ASD today asked for online resources, and I linked them to my list of websites, but along with inviting them to dive into all of those links, I thought I'd provide some concrete starter information:  the criteria used by mental health professionals to make the diagnosis (assuming they've updated their methods this summer to account for the change in criteria in May, the first change in criteria in 19 years).

DSM-5 Thinking about Autism:   
no more strict age rules or limits on dual diagnosis, 
no more requirement for cognitive disability or language impairment, 
and 2 General categories of symptoms:
A. Social Impairment: Persistent deficits in social communication and social interaction

B. RRBs:  Restricted, repetitive patterns of behavior. 

Autism Spectrum Disorder, DSM-5 Diagnostic Criteria
 Must meet criteria A, B, C, D, and E:
A. Persistent deficits in social communication and social interaction across contexts, as manifested by the following examples, currently or by history:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following illustrative examples, currently or by history:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior, (e.g. extreme distress at small changes, difficulty with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (e.g. strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (e.g.apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or spinning objects).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E.  Symptoms are not better explained by Intellectual Disability or Global Developmental Delay.  à To diagnose ASD with ID or GDD, social communication ability must be below that expected for the intellectual/developmental level.

In case I get accused of copyright violation (taking away DSM-5 sales by giving you this information, and selling it myself):  I'll say that I get no money from this blog, and also that I'm happy to plug the DSM-5, since there are many more resources related to autism spectrum disorders besides the criteria itself, including a new set of standards for describing 3 severity levels in the two main symptom areas, plus information about prevalence, differential diagnosis, and more.

I'll be publishing more explanations and examples about some of the terms and symptoms listed above, and about some more intuitive ways of understanding the mind of someone with ASD, and of course some ideas about what to do with these understandings to help reduce relationship, educational, emotional, occupational, and other problems related to ASD.  But for now, I hope the criteria are a start at correctly diagnosing and, more importantly, a start at understanding.

Friday, December 6, 2013

Many incomplete views of the kid on the autism spectrum: a poem

You may have heard the story of the blind men who felt different parts of an elephant and proclaimed they knew for sure that this creature was a wall, a spear, a rope, a snake, a fan, or a tree.

Sometimes we can make this kind of mistake when viewing a person.

Below is the original poem, and something I wrote as a reminder that no matter how certain we are of our understanding, we may not have the full picture.

This poem was published in Autism Spectrum Quarterly in 2007.  My workshop participants in Cleveland this week participated in reading it (playing the role of the narrow minded clinicians, but my Wayne County workshop participants today missed this poem (though they saw more videos), and yet were very graciously appreciative of the day we spent together... so my thanks back to you is to give you a copy of this poem.

The original poem:

Six Blind Men & the Elephant: A Diagnostic Parable

Slightly modified (originally “A Hindu Parable” From John Godfrey Saxe (1816-1887)
It was six men of Indostan To learning much inclined,
Who went to see the Elephant (Though all of them were blind),
That each by observation Might satisfy his mind.
The First approached the Elephant, And happening to fall
Against his broad and sturdy side, At once began to bawl:
"God bless me! but the Elephant Is very like a wall!"
The Second, feeling of the tusk Cried, "Ho! what have we here,
So very round and smooth and sharp? To me 'tis mighty clear
This wonder of an Elephant Is very like a spear!"
The Third approached the animal, And happening to take
The squirming trunk within his hands, Thus boldly up he spake:
"I see," quoth he, "the Elephant Is very like a snake!"
The Fourth reached out an eager hand, And felt about the knee:
"What most this wondrous beast is like Is mighty plain," quoth he;
"'Tis clear enough the Elephant Is very like a tree!"
The Fifth, who chanced to touch the ear, Said: "E'en the blindest man
Can tell what this resembles most; Deny the fact who can,
This marvel of an Elephant Is very like a fan!"
The Sixth no sooner had begun About the beast to grope,
Than, seizing on the swinging tail That fell within his scope.
"I see," quoth he, "the Elephant Is very like a rope!"
And so these men of Indostan Disputed loud and long,
Each in his own opinion Exceeding stiff and strong,
Though each was partly in the right, And all were in the wrong!
So oft in diagnostic* wars, The disputants, I ween,
Rail on in utter ignorance Of what each other mean,
And prate about an Elephant Not one of them has seen.

*originally “theologic” wars

My satire on this poem:

The 16 Narrow-minded diagnosticians
and the kid with an Autism Spectrum Disorder
with apologies to John Godfrey Saxe

by James Foley, MSW, LISW-S

A rag-tag band of clinicians
Diagnostically inclined
Once came to know a special child
Though each was of narrow mind.

“This child needs things a particular way,
Disorder to him is repulsive,
He repeats actions over and over,
This child is Obsessive-Compulsive.”

“But this child is so easily angered,
So easily, wildly perturbed,
The child would do best in a classroom
For the Emotionally Disturbed.”

“But the reason for any disturbance
As is obvious to even a gerbil,
Is the stress and misinterpretations
From a Disability in reading Nonverbals.”

“You’re close, but the social problems
Include verbal errors, sometimes dramatic,
with irrelevance, cues, chatting, and tact;
The deficit is Semantic-Pragmatic.

Ignores loud noise, yet hates some small sounds,
Mishears conversation and oratory,
The child thus struggles in class and peer groups,
Due to problems in processing (Central Auditory).

“You’re missing the hyperreactions
Which literally cause a Sensation
Light touch, not just sounds, can set this child off
The problem is Sensory Integration.”

“Hello, you are speaking in negatives,
You all need your consciousness lifted
This child has special talents and interests
Can’t you notice? This child is Gifted.”

“You’re missing the problems with fine motor skills,
Note the stumbling to his destination
This child has problems in the area of
Developmental Coordination.”

“He doesn’t talk about feelings?
He’s kinda rough with his toys?
He’s rude and he’s crude, only eats certain foods,
Hello! This child is a boy!”

“The child is wild, then is down, has tantrums,
Screams! like you pulled out a molar!
Has moods that don’t fit the situation
It is possible:  this child is bipolar.”

Have you heard of executive function?
The odd movements, and odd impulsivity
The lack of focus on relevant topics,
Is Attention Deficit, with Hyperactivity.

“But notice the tics! I’ll place my bets:
The child has a case of mild Tourette’s.”

“This child, (face the Eventuality),
will develop schizoid personality.”

“Your mind is like a closed hatch:
 this child just will not attach.”

“Look, can’t you see? Confess!
You know it’s PDD! (NOS).”

“I looked at the facts and I checked ‘em,

This child’s on the autism spectrum.”

Monday, December 2, 2013

ASD up to date website list

I am presenting two full-day workshops this week on Autism Spectrum Disorders.  As part of my prep, I updated my list of websites with information helpful to people on the spectrum and those who care about them or are seeking more information.  I recommend each of these.
Every site below is one I have visited in November 2013, so they should be up to date, so I can guarantee no dead links if you're seeing this post in 2013, and if you comment below on any broken links or new sites for me to recommend, I'll keep it updated.  These are in the order I came across them this month, not any order of priority.
I originally posted this at my general mental health blog,, but I have so much ASD material, it may be more useful to collect it here.  --trainings, conferences, resources for professionals, also lists of professionals with expertise  --parent resources, material on lifestyle issues such as safety and hygiene, focused on younger and more severe cases but material on Asperger’s too.  --descriptions, forums, although site is currently being rebuilt, only basic articles available. --Northern Ohio-based organization for families of people on the spectrum; offers social activities, empowerment network for parents, teen and adult services, and an annual conference in Cleveland in mid-June (I have not attended).  -- News from a foundation supporting research on autism causes and treatment.  Alternative to Autism Speaks. -- supports autism research with the hope of curing autism.   Not as sympathetic to the idea of autism as an alternative mind structure that can be part of a happy life.  Sympathetic to parents, in fact sees autism as a terrible tragedy affecting parents.  But it’s evolving, adding information for helping adults with autism. --Autism Spectrum quarterly, a “Magajournal” of personal stories, promotional pieces for treatment programs, and digested research information.  --News, especially science and policies  --general information and questions Widely trusted source, WebMD, assembling research information on autism, brain, and body. --Sponsored by the Autism Society of North Carolina, but has resources for everyone, is up to date, easy to use, with many topical categories, listing new items and sale items.  Much easier to use for searching than Amazon, which includes tons of self-published e-books as 80% of search results. --blog related to ASDs, lots of common sense advice to parents and teachers and clinicians. 
National Institutes of Health, under their National Institute of Neurological Disorders and Stroke:
Recommended at the above website:
Autism Network International (ANI)
Autism National Committee (AUTCOM)
Autism Research Institute (ARI)
Autism Science Foundation
Autism Society of America 
    --links and to local resources, serves   clients, family members, professionals, advocates
Association for Science in Autism Treatment
--online practice in reading emotions by just looking at the eyes. Interactive Autism Network
   --  Opportunities to participate in research, link to researchers
   -- participate in an online community of families of people with autism  --by Lee Wilkinson, clinician and author of a lot of articles which aid in the undestanding and treatment of ASD

Newly found ASD books, not categorized yet

For the benefit of my workshop participants:  here are the books that didn't make it yet into the categorized listing of books in my bibliography.  Sorry that the formatting is also not complete, with dates and authors often in the wrong places.

Lois Jean Brady, America X Gonzalez, Maciej Zawadzki and Corinda Presley (2012).  Speak, Move, Play and Learn with Children on the Autism Spectrum:  Activities to Boost Communication Skills, Sensory Integration and Coordination Using Simple Ideas from Speech and Language Pathology and Occupational Therapy.  Jessica Kingsley Publishers.
22 Things a Woman with Asperger's Syndrome Wants Her Partner to Know. Jessica Kingsley Pub.   Rudy Simone (2012)
Exploring Bullying with Adults with Autism and Asperger Syndrome:  A Photocopiable Workbook. Jessica Kingsley Pub.  (2013)
Siblings and Autism: Stories Spanning Generations and Cultures. Jessica Kingsley Pub.   Edited by Debra L. Cumberland and Bruce E. Mills (2010)
A Practical Guide for Teachers of Students with an Autism Spectrum Disorder in Secondary Education. Jessica Kingsley Pub.   Debra Costley, Elaine Keane, Trevor Clark and Kathleen Lane (2012)
Parenting Girls on the Autism Spectrum:  Overcoming the Challenges and Celebrating the Gifts. Jessica Kingsley Pub.   Eileen Riley-Hall (2012)
Helping Children with Autism Spectrum Conditions through Everyday Transitions: Small Changes - Big Challenges. Jessica Kingsley Pub.   John Smith, Jane Donlan and Bob Smith (2012)
Teaching Theory of Mind: A Curriculum for Children with High Functioning Autism, Asperger's Syndrome, and Related Social Challenges.  Kirstina Ordetx (2012)
Lee Wilkinson, (2010). A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. Jessica Kingsley Pub.  
Life and Love: Positive Strategies for Autistic Adults.  Zosia Zaks (2006) Autism Asperger Publishing Co.
Kevin B. Hull (2013)  Group Therapy Techniques with Children, Adolescents, and Adults on the Autism Spectrum: Growth and Connection for All Ages. Jason Aronson, Inc.
Brenda Boyd (2013) Parenting a Teen or Young Adult with Asperger Syndrome (Autism Spectrum Disorder): 325 Ideas, Insights, Tips and Strategies Jessica Kingsley
Scott Bellini (2006). Building Social Relationships: A Systematic Approach to Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorders and Other Social Difficulties. Souls: Beneath & Beyond Autism by Sharon Rosenbloom and Thomas Balsamo (Jan 21, 2003)
Khalid Karim (2013) A Practical Guide to Mental Health Problems in Children With Autistic Spectrum: It's Not Just Their Autism! Jessica Kingsley Pub.
Davida Hartman (2013) Sexuality and Relationship Education for Children and Adolescents With Autism Spectrum Disorders. Jessica Kingsley Pub
Vincent Mark Durand (2013) Autism Spectrum Disorder: A Clinical Guide for General Practitioners American Psychological Association (APA); 1 edition
Susan P., Sherkow, Alexandra M., M.D. Harrison and William M., M.D. Singletary (Nov 15, 2013) Autism Spectrum Disorder: Perspectives from Psychoanalysis and Neuroscience. Jason Aronson, Inc.
Andy Bondy and Mary Jane Weiss ( 2013). Teaching Social Skills to People with Autism: Best Practices in Individualizing Interventions. Woodbine House.
Trevor Pacelli (Nov 13, 2013). Six-Word Lessons on Growing Up Autistic-100 Lessons to Understand How Autistic People See Life. Leading on the Edge International.
Katharina Boser Ph.D (2013). Technology Tools for Students With Autism.  Brooks Publishing
Pamela LePage and Susan Courey (2013). Teaching Children with High-Level Autism: Evidence from Families. Routledge.
Matt Dolphin, Angela Byers, Alison Goldsmith and Ruth Jones (2013).  Psychodynamic Art Therapy Practice with People on the Autistic Spectrum. Routledge.
Maureen A. Flanagan (2008).  Improving Speech and Eating Skills in Children with Autism Spectrum Disorders - An Oral Motor Program for Home and School. Autism Asperger Publishing Company
Barbara Sher (2009). Early Intervention Games: Fun, Joyful Ways to Develop Social and Motor Skills in Children with Autism Spectrum or Sensory Processing Disorders
Mark J. Palmieri and Kristen M. Powers (2013).  Feeding Your Child with Autism: A Family-Centered Guide to Meeting the Challenge. Woodbine House.
Ashley Stanford (2013). Troubleshooting Relationships on the Autism Spectrum: A User's Guide to Resolving Relationship Problem.  Jessica Kingsley Pub.
Lisa Rogers (2103). Visual Supports for Visual Thinkers: Practical Ideas for Students With Autism Spectrum Disorders and Other Special Education Needs. Jessica Kingsley Pub.
Simon Baron-Cohen, Michael Lombardo and Helen Tager-Flusberg (2013):  Understanding Other Minds: Perspectives from developmental social neuroscience. Oxford University Press.
The Science of Making Friends, (w/DVD): Helping Socially Challenged Teens and Young Adults by Elizabeth Laugeson and John Elder Robison (Sep 10, 2013) Jossey-Bass
The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism (2013). Naoki Higashida  (Author) , KA Yoshida (Translator) , David Mitchell (Translator). Random House
Teach Me With Pictures: 40 Fun Picture Scripts to Develop Play and Communication Skills in Children on the Autism... by Simone Griffin, Ruth Harris and Linda Hogdon (2013). Jessica Kingsley
Assimilation System Dysfunction: Guide to Understanding the Autistic Spectrum of Disorders from A First Hand Point of View (2013). by Mr Jeff Williams 
How Can I Talk If My Lips Don't Move?: Inside My Autistic Mind  (2011)Tito Rajarshi Mukhopadhyay
Embracing Autism: Connecting and Communicating with Children in the Autism Spectrum. Robert Parish (2008). Jossey-Bass.
Chicken Soup for the Soul: Raising Kids on the Spectrum: 101 Inspirational Stories for Parents of Children with... by Rebecca Dr. Landa, Mary Beth Marsden, Nancy Burrows and Amy Newmark (Apr 2, 2013) Chicken Soup for the Soul
Ido in Autismland: Climbing Out of Autism's Silent Prison Paperback Ido Kedar, Sharon Kedar (2012)
The Autistic Brain: Thinking Across the Spectrum by Temple Grandin and Richard Panek (Apr 30, 2013)Houghton Mifflin Harcourt
Look Me in the Eye: My Life with Asperger's by John Elder Robison (2008)  Three Rivers Press
Carly's Voice: Breaking Through Autism by Arthur Fleischmann and Carly Fleischmann (2012)
Ethan's Story; My Life With Autism by Ethan Rice and Crystal Ord (2012) Anchor Group kid’s book
The Way I See It: A Personal Look at Autism and Asperger's by Temple Grandin and Ruth Sullivan (2008) Future Horizons
Inside Asperger's Looking Out by Kathy Hoopmann (2012).  Jessica Kingsley Pub
Far From the Tree: Parents, Children and the Search for Identity by Andrew Solomon (2012). Scribner
Applied Behavior Analysis (2nd Edition) by John O. Cooper, Timothy E. Heron and William L. Heward (2007) Pearson.
Making Sense of Autistic Spectrum Disorders: Create the Brightest Future for Your Child with the Best Treatment... by James Coplan M.D. (2010).  Bantam
An Unexpected Life: A Mother and Son's Story of Love, Determination, Autism, and Art by Debra Chwast, Seth Chwast and Seymour Chwast (2011) Sterling
National Research Council, Committee on Educational Interventions for Children with Autism (2001).  Educating Children with Autism.  National Academy Press.
Super Silly Sayings That Are Over Your Head: A Children's Illustrated Book of Idioms. Catherine S. Snodgrass (2004)
An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn... by Sally J. Rogers PhD, Geraldine Dawson PhD and Laurie A. Vismara PhD (2012). The Guilford Press
Engaging Autism: Helping Children Relate, Communicate and Think with the DIR Floortime Approach (Merloyd Lawrence... by Greenspan, Stanley I. and Wieder, Serena (2007). Da Capo Press
Mozart and the Whale: An Asperger's Love Story by Newport, Jerry, Newport, Mary and Dodd, Johnny (2007). Touchstone
Tacos Anyone? An Autism Story (2005 Barbara Jordan Media Award) (English and Spanish Text) (Spanish and English... by Marvie Ellis and Jenny Loehr (2005). Speech Kids Texas Press, Inc

Point to Happy: For Children on the Autism Spectrum by Afton Fraser, Miriam Smith, Margo Smithwick and Toni Giannone (2011)Workman Publishing Company 

Sunday, December 1, 2013

DSM-5 ASD Specifiers: Intelligence and language become side issues

My inspiration for the name of this blog, Autism "Spectra" name was the underlined sentence in the material I wrote below for one of my workshops.  If you need to diagnose ASD (Autism Spectrum Disorder) with the DSM-5, the material below might be useful.  These are not the core of the diagnostic criteria, but it is a newly required component of the diagnostic procedure for ASD.  All three types of specifiers explained below have interesting implications about the DSM's new way of thinking about the Autism spectrum... or, with all of its variety, including people with Asperger's, the Autism Spectra.
      Let me know in the comments if the "side issues" title of this post is not clear after reading the last two parts below.
Diagnosing:  Severity and other specifiers
Severity:  For each of the two symptom areas there are descriptive guides in the DSM for rating the level of current severity based on the impact on functioning (not based on number of symptoms; this is the DSM-5 move toward a dimensional, rather than categorical, diagnosis) and whether the person requires some support (Level 1), substantial support (Level 2) or VERY substantial support (Severity: Level 3). 

Do severity ratings create the spectrum?  No.
 “Spectrum” does not mean “varying in only one dimension (severity)” This means that the severity rating does NOT simply place you on a scale from “high functioning” or “Aspergers” to “Autistic Disorder.” People on this spectrum may have fewer RRB symptoms, or more, and differ also in the specifiers below:
Specify: With or Without accompanying Intellectual Impairment, separating intellectual disability completely from autism, as coexisting rather than coextensive conditions. Still, some people mistakingly think that social impairments are merely a function of intellectual disability.
Specify: With or Without accompanying language Impairment, again making this symptom another dimension on which people can vary, independent of how they vary in severity of autistic symptoms or severity of intellectual impairment.

Introduction: Why Autism "Spectra."

I have a "Mental Health Knowledge" blog, but thanks to my preparations for two full-day workshops on Autism Spectrum Disorders, I have enough information to fill blog posts for a long time, maybe write some articles too (it's been a while).
My inspiration for the name "Spectra" is that it I was just writing that it is a mistake to think that the new DSM-5 diagnosis of "Autism Spectrum Disorder" means that there is just one dimension along which people on the spectrum vary; they can vary in as many ways as neurotypicals can, and in several major ways that are relevant to autism.
So, if you think of a spectrum as being like the EM Spectrum with just one scale, then I'll make a point of saying that in ASD, there is not just one Spectrum:  there are Spectra.