There Can Be Only One

As healthcare professionals we often find ourselves discussing our patients as a collective rather than as individuals. The same thing occurs in discussions about autism, and this has been highlighted with the recent changes in the way autism is medically defined and diagnosed.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism spectrum disorder (ASD) is a single neurodevelopmental disorder. ASD encompasses a range of disorders previously identified as separate and distinct sub-types that include autism, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). While social communication deficits are the hallmark of ASD, it is only diagnosed when the social deficits are accompanied by excessively repetitive behaviors, restricted interests, and a need for sameness.

The very term “spectrum” illustrates the broad range of conditions and behaviors that can manifest within an ASD diagnosis in an infinite number of patterns and combinations. Even though similarities exist, each individual who occupies space on the spectrum is separate and distinct from all others, and we must remember to treat them that way. We cannot make assumptions that what affects one effects all in the same manner.

It is true that grouping and classifying serve a purpose, but we must remember to single out the individual when it is time to develop a plan of care designed to meet that person’s specific needs.

Lia is unique. And it isn’t just because she has autism and Down syndrome, it’s everything about her including autism and Down syndrome. The autism has a tendency to be her squeaky wheel, but I constantly remind myself that she is a whole being and this is just one part of that being. I imagine that if she could, she would say:

There can be
Only one like me –
I am she.

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