Autism and its effects on sleep: Part 2

The Bible, continued.

Let’s talk about levels of severity, about the behaviors you dear people might expect from one you love so much.

The DSM (described in the article just previous) has defined three distinct “levels of severity”, an indication of just how much support your loved one, diagnosed in general with ASD, might require.

Three levels apply. As here.

· Level 3: Those kiddos requiring very substantial support of all physical and emotional sorts – the sad, distant, clinical description of these Level 3 children: “severe deficits in verbal and nonverbal communication skills cause severe impairments in functioning, very limited initiation of social interactions and minimal response to social overtures from others.

· Level 2: Youngsters requiring substantial support – these glorious children with marked deficits in verbal and nonverbal social communication skills, with social impairments apparent even with supports in place, with limited initiation of social interactions and reduced or abnormal response to social overtures from others.

· Level 1: Little ones needing but some support. Of all kinds. The bible’s profile then: Without supports in place, deficits in social communication cause noticeable impairments, with difficulty in initiating social interactions. Also, demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to show, to feel, decreased interest in social interactions.

There’s the clinical analysis. Here’s the Hughes Brothers’.

Nothing special to do with us. But we do wonder about the fuzzy edges. About those undiagnosed, undiagnosable blurs of behaviors where ASD slips over into something else.

And who can say, which doctor can diagnose where one human behavior ends and another begins?

Most especially when the youngster – however we shall proclaim her diagnosis – is functioning, is functioning just fine, thank you. We Hughes Brothers mean, “It’s just terminology, folks. Just terminology. Might we please focus on this little human being crying out, right here in front of us all, for some relief?”

But here we go, brothers. Down into the rabbit hole. Down, down we go.


Alright, let’s trot out some more descriptors, some more diagnoses. And we Hughes Brothers present them to you not with any hope of therapy, of happy endings for you and your little child. It seems the medical, the psychiatric community is content with definitions, with no treatment, no response to the evermore closely defined set of behaviors that constitute the problem.

Any answer, medical and counseling professionals? Any hint of an answer here?

As we say, more descriptions of your child’s behavior.

With near as the Hughes Brothers, in our ignorance, can determine, not one bit, not one hint of a cure in sight.

“Cure,” way too strong. “Amelioration,” maybe. “A minute or two of relief” possibly.

We apologize, do John Howard, James, Joel, Curtis, Dave, and good old Mike. For the moment, we’re just reporting. But stay with us. Stay with us, please. We’ll find some answers for you long-suffering families. We will.


· Asperger syndrome: once thought of as the mildest of onsets of ASD. Fine. Kids and their elders with Asperger do not pick up on social cues. They are oh so sensitive to sensory stimuli of every sort – a distant cough, a squirrel there no there running in the treetops, a faint suggestion of coffee brewing. The Aspergers among us focus on a point of interest – calligraphy, stamp-collecting, marksmanship, kayaks – and they function so, so highly and completely in their knowledge of, their interest in, their overweening impulse to discuss calligraphy or stamp-collecting or target shooting or riding down those Class IV rapids in a boat of the child’s own devising.

· Here’s a brand new one, childhood disintegrative disorder, once thought of as the rarest and most savage from of autism. (Before the revision of DSM-5 – See the Hughes Brother’s immediately previous piece.) Suffice it to say that, now these blessed kids with CDD will most certainly manifest seizure disorders. Cold comfort, the Brothers worry, with your beautiful little Junior sitting there in his chair, minding his own business. His limited social, speech, and cognitive abilities.

· And hey, if that sweetheart eating Cheerios in her highchair hasn’t manifested any of the above untoward behaviors . . . well, let’s just call her an unfortunate suffering from pervasive development disorder, not otherwise specified.

The Hughes Brothers stand with the families somehow involved with all of the above. And, as with one voice, we ask.

Give me strength. Lord, give me strength.