Some people think of autism like a swimming pool. You're either inside of it and wet, or you're outside of it and dry.
In reality, autism works on a spectrum of severity. Some people have immediately identifiable symptoms others can see, and others have subtle shifts in behavior that are harder to spot.
For medical professionals, the term mild autism refers to someone who has autism symptoms and needs help with everyday activities. For regular folks, mild autism could mean something much different.
Does someone with quirky behaviors qualify as mildly autistic? Does that person need help?
These are questions best answered in consultation with a mental health professional. But digging into common symptoms, challenges, and therapies could prompt you to make a screening appointment for yourself or someone you love.
Understand the Autism Spectrum
Autism is a neurological disorder that impacts a person's communication styles and behavior. Prior to 2013, doctors used many terms to describe disorders like this. Now, they are all grouped under the heading autism spectrum disorder (ASD).
Three levels exist within the autism spectrum.
- Level 1: This is the mildest version of autism, but people with this disorder still need help with social interactions, planning, organizing, or changes in routines.
- Level 2: This intermediate level of autism also comes with difficulties in communication, planning, and changes in routine. People at this level need more help than those with a milder form of autism.
- Level 3: This is the most severe type of autism, and people with this condition often require substantial help. Some never live independently, talk freely, or connect with strangers.
Within this formal framework, even people with so-called mild autism need support from family members, friends, and therapists to handle everyday life. Those who don't need assistance won't qualify for the diagnosis.
For some families, these rules are too restrictive. They know something is unusual about the way their loved one communicates or behaves, and they’d like more information to understand those differences. Some researchers agree with them.
Can People Have Undiagnosed Autism?
Researchers use something called an autism phenotype to describe people who have autism-like tendencies but don't qualify for a formal ASD diagnosis.
Researchers say someone in the autism phenotype has:
- Mild relationship problems. They struggle to join group activities. They can't always make close friends or develop romantic relationships. They may spend time with people much older or younger, or they may connect to pets instead.
- Unusual communication patterns. They may lean on digital tools, such as social media sites or internet chat rooms, to talk with others.
- Adaptive learning styles. They may have few friends or siblings to coach them on behavior and patterns, so they may research television programs or movies instead.
- Inappropriate social behavior. They may talk in an unusual manner that draws attention. Because they have poor social skills, they may be accused of inappropriate behavior.
- Obsessions. They may have favorite items or pieces of clothing that are worn from touches and hugs. They may be worried about order or perfection.
How many of these traits must a person have to qualify for the phenotype? Even experts say they're not sure. No specific diagnostic tests exist. Doctors can't hand out a survey or a list of questions, score it, and tell a person whether or not the term applies.
People with autism tend to have difficulties in three areas.
- Communication: They may find it hard to understand nonverbal speech, including jokes or puns or sarcasm. They may prefer to stick to topics they know and understand well, and natural give-and-take in a chat doesn't come easily to them.
- Relationships: They may prefer to fully control their own body, so they resist touches, hugs, or kisses. They may long to connect to other people, but are unsure how to make it happen. Some people with autism may not seem to care about other people at all.
- Rules: They might dislike sudden changes in the way things work, happen, or operate. They might like to eat the same food, wear the same clothes, and go to the same places each day. Changes bother them greatly.
In theory, a person could relate to a few of these categories and qualify for a very mild form of autism, even if their doctor doesn't formally recognize the self-diagnosis.
On the flip side, some children are diagnosed with mild forms of autism at an early age, and the issues seem to fade as they age. Some attribute this to a mild form of autism that miraculously disappears with experience. But some researchers say that misdiagnosis from doctors is to blame. Perhaps the kids didn’t have autism at all, they say.
Why Does a Diagnosis Matter?
It's easy to confuse the word mild with the word ignorable. If someone's troubles don't automatically qualify them for a formal autism spectrum disorder diagnosis from every doctor out there, why bother?
It's true that people must demonstrate difficulties with everyday functioning to merit an ASD diagnosis. But even people with cases doctors consider mild have very real difficulties.
Researchers say people with mild, but recognizable, autism can't always form close relationships. As they age, they're likely to deal with mental health challenges, including depression and anxiety.
It's reasonable to believe that people with a low level of autism, even if doctors don't recognize it, would also struggle.
First-person accounts written by people with autism describe days in which they try very hard to both fit in with the world around them and control their impulses so others will accept them. They describe feeling misunderstood, angry, and isolated. These feelings are real and they matter.
Knowing that you fit an autism phenotype could even help you protect your health later in life. Researchers say, for example, that people with ASD tend to develop signs of dementia earlier than people without ASD. If you're at risk, you could work with your doctor on techniques to preserve your mental acuity.
Help for Mild Autism
How do you know if you have formal autism or if you have a mild, subclinical case? A visit to the doctor starts the conversation.
In young children, diagnosis involves:
- Well-child checkups. Visits with pediatricians early in life should include screening tests. If those flag a problem, families move to the next diagnostic step.
- Team evaluations. Doctors and other health professionals assess a child's cognitive abilities, language skills, and ability to tackle daily tasks.
In adults, diagnosis involves:
- Doctors’ visits. Adults meet with their family doctors and ask for a referral to a specialist.
- Specialist screenings. A psychologist, psychiatrist, or another mental health expert conducts a screening involving social interactions, sensory issues, repeated behaviors, and interests.
Treatment for ASD typically involves applied behavior analysis (ABA) therapy. Mental health professionals work as coaches, helping their charges to tackle problems that hold them back.
For someone with Level 1 ASD, an ABA session might focus on communication. How do people open up conversations with strangers? How can they maintain eye contact? What should they do when lags in talking appear?
For someone with subclinical autism, that therapy may also be helpful. Everyone can benefit from working with a professional on distressing issues. For these clients, however, their sessions may not last as long. They may not need as many meetings with a professional as someone with Level 1 autism.
Everyone is different, and the help they need shifts too. Before you sign up for any therapy with a professional, talk with your doctor about symptoms, trajectories, and timelines. Together, you can craft a plan to make things better.
- Autism Diagnosis Criteria: DSM-5. Autism Speaks.
- What Does It Mean to Have Just a Hint of Autism? (December 2014). Interactive Autism Network at Kennedy Krieger Institute.
- From Asperger's Autistischen Psychopathen to DSM-5 Autism Spectrum Disorder and Beyond: A Subthreshold Autism Spectrum Model. (December 2016). Clinical Practice and Epidemiology in Mental Health: CP and EMH.
- Can Your Child's Autism Go Away? (November 2015). Cleveland Clinic.
- People With Milder Forms of Autism Struggle as Adults. (September 2011). Spectrum.
- Autscriptic: Mild Autism. (December 2017). Autism and Expectations.
- Behaviors Characteristic of Autism Spectrum Disorder in a Geriatric Cohort With Mild Cognitive Impairment or Early Dementia. (January 2020). Alzheimer Disease and Associated Disorders.
- Autism Spectrum Disorder. (March 2018). National Institute of Mental Health.
- Brief Report: Adults with Mild Autism Spectrum Disorders (ASD): Scores on the Autism Spectrum Quotient (AQ) and Comorbid Psychopathology. (January 2008). Journal of Autism and Developmental Disorders.
- Autism Spectrum Disorder Symptoms Among Children Enrolled in the Study to Explore Early Development (SEED). (October 2015). Journal of Autism and Developmental Disorders.
- Sensory Symptoms in Autism Spectrum Disorders. (March/April 2014). Harvard Review of Psychiatry.
- Some Children Can 'Recover' From Autism, but Problems Often Remain, Study Finds. (March 2019). Albert Einstein College of Medicine.