Autism and Other Disorders
This is getting to be a big enough issue now that I felt it time to devote an article to this. I can't tell you the number of times over the past years that I've run into someone who I could swore was on the spectrum, only to have them tell me they had some other disorder. I've seen the opposite problem, too, children and adults diagnosed with autism that really apparently have a different disorder (William's Syndrome comes to mind).
Common Misdiagnoses
Here are some disorders which are often confused with autism, along with their DSM descriptions. Keep in mind, the confusion runs both ways. I'll include autism in this list for comparison purposes.
1. William's Syndrome
This probably wouldn't be anyone else's pick for a disorder commonly confused with autism, as it's supposedly the opposite of autism. In truth, it's not so opposite - people with Williams syndrome are very sociable, but that doesn't make them adept at social skills. Another factor that makes it easy to confuse is the fact that people with Williams syndrome have sensory sensitivities (to sounds and occasionally textures), and one of the comorbid disorders with autism is sensory integration dysfunction. I myself have seen it confused with autism twice now personally (the characteristic facial features, an 'elfin' look, confirmed it). Here are the diagnostic criteria, with the most important parts bolded.
Williams syndrome is a developmental disorder that affects many parts of the body. This condition is characterized by mild to moderate intellectual disability or learning problems, unique personality characteristics, distinctive facial features, and heart and blood vessel (cardiovascular) problems.
People with Williams syndrome typically have difficulty with visual-spatial tasks such as drawing and assembling puzzles, but they tend to do well on tasks that involve spoken language, music, and learning by repetition (rote memorization). Affected individuals have outgoing, engaging personalities and tend to take an extreme interest in other people. Attention deficit disorder (ADD), problems with anxiety, and phobias are common among people with this disorder.
Young children with Williams syndrome have distinctive facial features including a broad forehead, a short nose with a broad tip, full cheeks, and a wide mouth with full lips. Many affected people have dental problems such as small, widely spaced teeth and teeth that are crooked or missing. In older children and adults, the face appears longer and more gaunt.
A form of cardiovascular disease called supravalvular aortic stenosis (SVAS) occurs frequently in people with Williams syndrome. Supravalvular aortic stenosis is a narrowing of the large blood vessel that carries blood from the heart to the rest of the body (the aorta). If this condition is not treated, the aortic narrowing can lead to shortness of breath, chest pain, and heart failure. Other problems with the heart and blood vessels, including high blood pressure (hypertension), have also been reported in people with Williams syndrome.
Additional signs and symptoms of Williams syndrome include abnormalities of connective tissue (tissue that supports the body's joints and organs) such as joint problems and soft, loose skin. Affected people may also have increased calcium levels in the blood (hypercalcemia) in infancy, developmental delays, problems with coordination, and short stature. Medical problems involving the eyes and vision, the digestive tract, and the urinary system are also possible.
- Description taken from the National Library of Medicine
The nice thing about Williams syndrome is that there is a clear-cut test to diagnose it, along with distinct physical features it can be recognized by (although those are more subtle in younger children). You can learn more about Williams Syndrome here.
2. Schizophrenia
Though it may seem impossible to confuse with autism, schizophrenia and autism are more similar than they may seem. In fact, not so long ago, the label autism didn't exist; instead, autism was called 'childhood schizophrenia'.
Below are the three categories of symptoms - positive, negative, and cognitive - associated with schizophrenia. You'll note that you've probably heard of the positive symptoms before, but not the other two categories. I bolded those areas that could potentially be confused with autism.
Below are the three categories of symptoms - positive, negative, and cognitive - associated with schizophrenia. You'll note that you've probably heard of the positive symptoms before, but not the other two categories. I bolded those areas that could potentially be confused with autism.
POSITIVE SYMPTOMS
Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.
Delusions are false beliefs that do not change. The person believes delusions even after other people prove that the beliefs are not true or logical.
Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called "disorganized thinking." This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called "thought blocking." This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or "neologisms."
Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others.
NEGATIVE SYMPTOMS
Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene.
- - "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous voice)
- - Lack of pleasure in everyday life
- - Lack of ability to begin and sustain planned activities
- - Speaking little, even when forced to interact.
COGNITIVE SYMPTOMS
Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.
- - Poor "executive functioning" (the ability to understand information and use it to make decisions)
- - Trouble focusing or paying attention
- - Problems with "working memory" (the ability to use information immediately after learning it).
- Selection adapted from the National Institute of Mental Health
As you can see, the two share more characteristics than you might think.
3. Obsessive Compulsive Disorder (OCD)
Like the other disorders we discussed, obsessive compulsive disorder has symptoms that can be confused with those of autism, and more than one person on the spectrum has been diagnosed as only having OCD when they in fact (either additionally or separately) have autism.
People with OCD generally:
- Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
- Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again
- Can't control the unwanted thoughts and behaviors
- Don't get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause
- Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.
- Description adapted from the National Institute for Mental Health
