Is autism a disability? If it’s not a disability, what is autism? Is it a disorder? Or is it simply a different way of responding to people and the world around us? These are questions many parents ask, as well as people on the spectrum themselves. Unfortunately, the answers are far from straightforward.
According to the Centers for Disease Control and Prevention (CDC), autism spectrum disorder (ASD) is defined as a “developmental disability” while the National Institute of Mental Health, (NIMH) states that ASD is a “developmental disorder.”
Meanwhile, the Individuals with Disabilities Education Act (IDEA) has 13 categories for disabilities, and autism spectrum disorder is number three on the list, calling it a developmental disability that affects “social and communication skills” but can also have an “impact on behavior.”
What is considered a disability?
The Americans with Disabilities Act (ADA) gives the following as a legal definition of a disability: “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.” The Centers for Disease Control and Prevention gives the following medical definition of a disability: “any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions).”
If one wants to distinguish whether or not autism is a disability, one needs to look at the characteristics of autism. NIMH states that ASD is a developmental disorder, called this because symptoms usually occur during the first two years of development. It affects a child’s communication and behavior, and the types of symptoms span a wide range, some being more severe than others. ASD is the umbrella that includes autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome.
A child with autism could present with some of the following:
- Very little eye contact
- The child may not look at or listen to others.
- He/she may be disinterested in other people or in objects that are singled out, or he/she may be interested in others but be lacking the skills to socialize with them
- The child may not respond to someone who is trying to get his/her attention.
- The child may have difficulty with conversation exchanges
- The child may talk about a favorite topic to a heightened degree
- The child may have a flat vocal tone or facial expressions that don’t correspond with his/her words
- He/she may repeat words or phrases
- He/she may have trouble expressing his/her needs or their feelings
- He/she may hone in on parts of something and how they work
- He/she may be overly sensitive to sounds, lights, textures, or temperatures
- He/she may have sleep problems and irritability
- He/she may have had certain skills but then lost the ability to use those skills at a later time
What causes autism in children?
While there is no one definitive cause, scientists agree that genetics can be a factor in some cases. A child who has a sibling with autism has a higher risk. Also, a child born prematurely, having a low weight at birth, or having been exposed to lead can have a higher chance of developmental issues, and it is thought they should be screened for ASD.
There are a variety of developmental screenings for ASD. In some cases, a checklist of milestones may be used with input from parents, grandparents and early childhood caregivers. Also, the pediatrician should look for any delays at the child’s well-visit. The American Academy of Pediatrics (AAP) recommends doing a behavioral, as well as a developmental screening at 9, 18 and 30 months, while also doing a specific screening for ASD at 18 and 24 months.
If a child has any of the risk factors mentioned previously, or if a child shows any signs during the developmental screening, additional screening may be recommended. This could be an evaluation with a developmental pediatrician, a child psychologist or psychiatrist to check brain development and for behavioral issues, a neuropsychologist for any neurodevelopmental issues, and/or a speech language pathologist to see if there are any communication difficulties.
In the case of an older child whose parents and teachers are beginning to see signs of concern, a child study or special education team may do the testing and evaluation, with the team suggesting the child see a doctor for more evaluations.
The earlier a child is diagnosed, the better, since studies show that early intervention can provide help with communication and life-skills while building upon the strong qualities the child already has.
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Is autism a learning disability?
A person with autism doesn’t necessarily have an intellectual disability. Unfortunately, sometimes children with ASD who aren’t verbally communicating may be assumed to have an intellectual disability. During the 1980s, 69% of people with autism had a co-diagnosis of intellectual disability. When the research began to hone the criteria for diagnosing autism, the number of children having both diagnoses went down, and in 2014 was at 30%.
The misdiagnosis could be that the genes that cause autism also cause intellectual disabilities. While intellectual disabilities can include some social issues, autism doesn’t necessarily include intellectual disability. An IQ test at the time of an autism screening would help make that distinction, but there may be a need for a nonverbal intelligence test. One study in 2007 had 38 children with autism take a nonverbal intelligence test and a test for people with “typical verbal skills.” The children scored an average of 30 points higher on the nonverbal test.
Many children with autism spectrum disorder are able to learn and remember details, and they may excel in subjects such as math and science or in creative realms such as music and art.
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), supports research for autism spectrum disorder through the Autism Centers of Excellence (ACE) to find the causes and treatments for this. Some ACE centers are looking at the various risks and factors that occur during pregnancy and in the early stages of an infant’s life such as genetics, neurological components of brain development and performance, physical and even environmental facets. NINDS is also using some brain imaging studies to compare people with and without ASD in order to understand the differences in the nervous systems and possibly come up with helpful approaches or treatments.
Being able to distinguish between ASD and an intellectual disability, if one doesn’t co-exist with the other, is important in getting a child the correct type of help and support he/she needs.
Can people with autism receive disability benefits?
In the USA, under the Individuals with Disabilities Education Act (IDEA), a public school must provide services to a child who qualifies.
In order for a child with autism to qualify for disability benefits, according to the Social Security Administration (SSA), Section 112.10 of the Impairment Listing Manual called a “Blue Book,” the requirements from both Part A and Part B must apply.
In essence, Part A states that there needs to be deficiencies in communication, both verbal and nonverbal, as well as in social reciprocity. There would also need to be severely limiting repetitious traits that present in the child’s behavior or activities. These deficiencies and limits would need to have medical proof. Part B basically calls for an “extreme limitation” of one area or a “marked limitation” of two areas of cognition which include but are not limited to understanding, memory, social interaction, focus, and self-management. Check out the Impairment Listing Manual for more qualification and benefit information.
According to the Medicaid and CHIP (Children’s Health and Insurance Program) Payment and Access Commission (MACPAC), the number of people who are eligible for Medicaid because of a disability is over 10 million. Many qualifying for these benefits are under the age of 65 but have had a disability from the time they were born; or they developed some illness or received an injury or trauma which left them disabled. Some of those conditions include physical impairments, behavioral disorders, mental illness, and “intellectual or developmental disabilities.” Listed under this latter category is cerebral palsy, Down Syndrome, and autism.
Whether a child with autism spectrum disorder is considered to have a disorder or a disability, the most important factor is to get help and services as early as possible. With the right support, all children have the potential to offer something to the world around them in some capacity.