In brief
“Spectrum” means that there is no single uniform form of autism. The 2016 guideline stated that, at no level examined (clinical, neurobiological, cognitive), can reliable subgroups be distinguished within the autism spectrum; the earlier diagnoses of early childhood autism, Asperger syndrome and atypical autism are therefore now combined into one category, autism spectrum disorder. [4, Ch. A.2.3, Rec. 1] The picture also changes over a lifetime. [4, Ch. A.2.1] And the need for support differs greatly.
This English translation was produced with AI assistance and has not yet been independently reviewed.
Status of the guideline: This article uses the S3 guideline on diagnosis (text version 2016, valid “until 4 April 2021” according to the DGKJP, and therefore expired). [1]
No fixed subgroups
According to the guideline, there is a categorical difference between autism spectrum disorders and other disorders, but within the spectrum the features are distributed along a continuum (hybrid model). [4, Ch. A.2.3] The consensus-based statement was: subgroups of the kind proposed by ICD-10 cannot be reliably separated. [4, Rec. 1] On the old terms: Asperger syndrome and Early childhood autism.
Shared core areas, different expression
According to the classification, all people on the spectrum share two core areas: social communication and interaction, and repetitive patterns of behaviour, interests or activities. [3] How strongly and in what form they appear differs. The 2024 expert overview describes that the symptom focus in children with delayed language development lies more on nonverbal communication, whereas in adolescents and adults with fluent speech it is more abstract (for example social insight and empathy). [3] More: Social communication and interaction, Repetitive behaviour and special interests, Sensory processing.
Change over a lifetime
The clinical picture changes considerably from toddlerhood through school age and puberty to independent adult life; each stage of life makes different demands. [4, Ch. A.2.1] People without intellectual disability can develop compensation strategies that mask features. [4, Ch. A.2.1] This is why two people with the same diagnosis often look very different.
Need for support and terms such as “high-functioning”
In therapy and support, the 2021 guideline distinguished between people with and without intellectual disability. DSM-5 also provides for a division into clinical severity levels. [4, Rec. 1] Drawing on older studies, the 2016 guideline stated that about half of people on the spectrum also have an intellectual disability; this figure is probably outdated, and we have not read current numbers. [4, Ch. A.2.2] Terms such as “high-functioning” or “low-functioning” are disputed in the community: in a US survey, terms for subgroups and functioning labels were described as controversial. [2] We use them only as quotations. More: Language and terms and Autism and intellectual disability.
What do we know – what is still open?
Finding (guideline 2016, expert consensus based on studies): no reliable subgroups within the spectrum; change over a lifetime. [4, Rec. 1, Ch. A.2.1]
Open:
- Why people on the spectrum are so different from one another is not conclusively explained by any of the sources we read.
- How best to describe this diversity (dimensions instead of categories) continues to be discussed in research; we have not read more recent work.
What else you should know
- Comparisons help little: What suits one person on the spectrum does not suit another. The guideline provided that individual skills and needs be taken into account. [5, Rec. 3]
- Basics: What is autism?.
Note: This article provides general information. It is not a substitute for diagnosis or advice.
Sources and literature
- DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
- Dwyer P, Williams ZJ, Magnuson JE, Woynaroski TG. English-Language Autism Terminology Preferences of Autistic People and their Parents in the United States: Clustering Illuminates Diverse Views. Autism 2026. https://doi.org/10.1177/13623613261475023 – Survey
- Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie 2024;(4+5):27–32. – Expert overview (in German)
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Textstand 23.02.2016. – Guideline (in German) (expired; according to the document note under revision)
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021. – Guideline (in German); expired on 23 March 2026
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