To many clinicians (myself included) autism is the far end of the ADD/ADHD continuum.   Many of the same symptoms may occur with autistic kids as with ADD/ADHD kids, and additional symptoms are probable.   Again, individuals are different and there is no set of exact autistic symptoms.   Like ADD/ADHD, the diagnosis of autism is difficult to distinguish from ADD/ADHD with many differing symptoms common to both.  The diagnostic autistism "guidelines" used by psychiatrists and psychologists are mainly for insurance purposes, and can be wildly different between clinicians.

A new and very useful test has recently come to my attention.   This test was designed to measure ongoing improvement for Autism primarily, but might also be used in serious ADD/ADHD cases.    It's called the Autism Treatment Evaluation Checklist (ATEC), and it's available free at: ATEC.   Clicking on this takes you off this site, so be sure to bookmark, or use the return arrow if you use it.

There's also a test developed by Psychologist Simon Baron-Cohen and his colleagues at Cambridge's Autism Research Centre.   It's the Autism-Spectrum Quotient, or AQ, as a measure of the extent of autistim traits in adults.  In the first major trial using the test, the average score in the control group was 16.4. Eighty percent of those diagnosed with autism or a related disorder scored 32 or higher.   The test is not a good means for making an autistic diagnosis, however, and many who score above 32 and even meet the diagnostic criteria for mild autism or Asperger's report no difficulty functioning in their everyday lives .

Originally, the term autistic meant that the child could not communicate to others.   They were in a world of their own.   But, this term wasn't enough, as there were individual variations here as well. Some could communicate, but not well.

So, 15-20 years ago, somebody coined another new term "semantic pragmatic disorder".   It was used to describe those children that were not strictly autistic.   The symptoms it included were:

• delayed language development


• learning to talk by memorizing phrases, instead of putting words together freely


• repeating phrases out of context, especially snippets remembered from television programmes


• muddling up 'I' and 'you'


• problems with understanding questions, particularly questions involving 'how' and 'why'


• difficulty following conversations


• Children with this disorder have problems understanding the meaning of what other people say, and they do not understand how to use speech appropriately themselves.

Before much longer, research and practical experience yielded two important discoveries:

• Many people who definitely are autistic have this kind of language disorder (Dustin Hoffman's character Raymond in the film 'Rainman' being a typical example).
• Most of the children diagnosed as having semantic pragmatic disorder do also have some mild autistic features.   For example, they usually have difficulty understanding social situations and expectations, they like to stick fairly rigidly to routines, and they lack imaginative play.

For a while some language therapists maintained there was still an important difference between children with semantic pragmatic disorder and children who were truly autistic.   They believed the autistic features seen in children with semantic pragmatic disorder were only a result of their difficulty with language.

However, further research has shown that there is probably a single underlying cognitive impairment which produces both the autistic features and the semantic pragmatic disorder.   The fact that children with semantic pragmatic disorder have problems understanding the meaning and significance of events, as well the meaning and significance of speech, seems to bear this out.

Eventually the idea of an autistic continuum was used to explain the situation.   All the children on the continuum have semantic pragmatic difficulties, but the degree of their other autistic impairments can be severe or moderate or mild.   This parallels the autistic continuum relating Asperger syndrome, where all the children have a marked social impairment but those with Asperger syndrome have only a relatively mild and subtle language impairment.

It seems that children who are diagnosed as having a semantic pragmatic disorder might more accurately be described as high-functioning autistic.   Clinicians tend to give all autistic children who have good intelligence the label Asperger syndrome, even if a child actually has very limited speech.   But there are important differences between bright autistic children with semantic pragmatic difficulties and bright autistic children with Asperger syndrome.   Children with semantic pragmatic difficulties have usually learnt to talk late, whereas (according to diagnostic guidelines) children with Asperger syndrome were able to talk in sentences by the age of three.   Also children with semantic pragmatic difficulties do better on performance IQ tests than verbal IQ tests, whereas with children with Asperger syndrome the results tend to be the other way round.   However, if a child with semantic pragmatic difficulties eventually becomes a fluent talker, the difference between the labels 'high functioning autistic' and ' Asperger syndrome' becomes fairly academic.

There is another aspect to the issue of labelling which is altogether more emotive.  Many parents feel much more able to cope with the idea of their child having semantic pragmatic language disorder than with the idea of their child being a high functioning autistic.   But many other parents find the label semantic pragmatic disorder frustrating and baffling, as they only begin to really understand their child's behaviour when they realise he or she has a form of autism.

Yet another issue is the provision of resources.   It is a sad truth that many high functioning autistic children are denied the kind of educational language provision they desperately need, purely because of the word 'autism'.   These children are more likely to be accepted into language units and schools when they have the label of semantic pragmatic language disorder.   Perhaps the only real solution is to educate the educators, so they begin to understand the wide continuum of autistic disorders, and to forget dated stereotypes.   Even better, perhaps they could learn to look beyond the label and to see the child.

There are a large number of organizations that have info on autism and related subjects.  One of the best sources for info of all types is Autism.com. (If you go there, be sure to bookmark this site). For a list of many others go to the Resources Page

Lately, many clinicians refer to "Brain Damaged" as "Brain Injured" (another example of "selling with language").  The term "damaged" seems to mean something permanent, whereas "injured" holds the hope of cure.

In either case, the disorder constitutes another continuum, ranging from relatively minor problems to drastic brain malfunctioning.  Causes may be from a variety of things:

• Physical injury from an accident.
• Injury to mother during pregnancy.
• Damage during baby delivery.
• Poor nutrition by the mother during pregnancy.
• Drug or alcohol abuse by mother during pregnancy.
• Allergy/sensitivity of mother.
• Allergy/sensitivity of child.

There are even more causes of brain damage, and most of these will be unknown, although many mothers will have guilt complexes.  In very few cases is there actual guilt, even with accidents causing brain injury.

The range of symptoms can be from simpler ADD/ADHD to very severe impairment of speech and other malfunctions.  EEG Biofeedback has been shown to be very effective in greatly improving all such cases in a much shorter time than other means.  In all such cases, if EEG BF improves symptoms, so does the Bate Neuroliminal Training.

The human brain is amazing, and tends to be self-fixing of all brain problems, if given a chance.

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