Month: May 2020

What is Autism?

The autism spectrum is a set of complex neurodevelopmental disorders that until recently included autistic disorder (AD); high functioning autism (HFA); Asperger’s Syndrome (AS), and pervasive developmental disorder not otherwise specified (PDD-NOS). Controversy and confusion have surrounded the diagnosis of AS and whether it is distinct from, similar to, or identical to a diagnosis of HFA. Following the 2013 release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the replacement of these subdivisions into a single diagnosis of Autism Spectrum Disorder has created considerable worldwide disagreement, especially in regard to the integration of AS (Posar, Resca, & Visconti, 2015). Autism Spectrum Disorder is now more commonly referred to as Autism Spectrum Condition (ASC).

The term autism is derived from the Greek for “self” and signifies persons living in their own world rather than the world of others (Tantam, 2012) . Current psychoanalytic theorists of autism deem the defining feature to be a lack of social and emotional reciprocity resulting in the “objectification” of other people, who are treated essentially as the means by which the individual’s needs may be met. This disconnection from social interaction; an isolated self, is a characteristic of all ASC, which is quite distinct from other disorders (Tantam, 2012).

While the ASCs were considered rare just two decades ago, autism is now known to be relatively common, affecting the lives of millions of people across the world (Pellicano, 2014) . Understanding of the autism spectrum has undergone numerous adaptations since being first formally identified early in the twentieth century. However, autism existed long before it attracted a label. Autism Spectrum Conditions are found worldwide, with considerable evidence to indicate their existence throughout human history (Deisinger, 2011). Characterised by early-onset difficulties with social interaction, social communication, and imagination, and together with rigid and repetitive patterns of interests and behaviours, ASC exist from very early life and have life-long effects that influence how the brain processes information. The ASCs are conditions in which there are no sharp distinction between normality and pathology with a range of functioning ability that varies in combination and severity, between and within individuals. People with autism have atypical cognitive profiles, such as atypical social cognition and perception, executive dysfunction, together with atypical perceptual and information processing (Lai, Lombardo, & Baron-Cohen, 2014). Although each person on the autism spectrum shares similar difficulties, the degree, extent, and quantity of these difficulties influences how well, or not so well, any person adapts, functions, and interacts with others. Individuals on the spectrum who have high intellect and proficient capabilities in some areas of life, will always have noticeable social impairment together with profound egocentricity, which will affect their abilities to interact with others. The apparent inability to reflect on their own thinking and the thinking of others; known as mind-blindness (Baron-Cohen, 1997), is seen to contribute to impairments in social interaction, communication, and imagination. Mind-blindness is lacking the ability to put oneself into someone else’s shoes, to imagine their thoughts and feelings. Without this ability, it can be difficult to understand how to respond in any given situation.

Since research continues to focus heavily on children, autism is still largely undiagnosed in adults. Few people have a concept of how autism manifests in adults. Mental-health professionals often lack the skills or experience to distinguish autism in adults, from diagnosed disorders with which they are more familiar (Lehnhardt et al., 2013). Consequently, many adults on the autism spectrum have spent much of their lives struggling to fit in without knowing why, with the wrong diagnosis, consigned to psychiatric institutions, or overmedicated for disorders that were non-existent (Wright, 2015). These and other aspects, such as inadequate services and insufficient professional assistance and information (Hagland, 2009), has meant that whether an adult suspects that they may have an ASC, or whether a diagnosis is gained or not, many adults with ASC may not achieve the understanding or specialised help that they require. The result is that they and their families are often obligated to bear the responsibility of this lack of awareness.

Dr. Bronwyn Wilson

Baron-Cohen, S. (1997). Mindblindness. An essay on autism and theory of mind. London: The MIT Press.

Deisinger, J. A. (2011). Chapter 10 History of autism spectrum disorders. In A. Rotatori (Ed.), History of Special Education (Vol. 21, pp. 237-267): Emerald Group Publishing Limited.

Hagland, C. (2009). Getting to grips with Asperger Syndrome: Understanding adults on the autism spectrum: Jessica Kingsley Publishers.

Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. The Lancet, 383(9920), 896-910. doi:10.1038/mp.2012.106.http://dx.doi.org/10.1016/S0140-6736(13)61539-1

Lehnhardt, F.-G., Gawronski, A., Pfeiffer, K., Kockler, H., Schilbach, L., & Vogeley, K. (2013). The investigation and differential diagnosis of Asperger Syndrome in adults. Deutsches Ärzteblatt International, 110(45), 755-763. doi:10.3238/arztebl.2013.0755

Pellicano, E. (2014). A future made together: New directions in the ethics of autism research. Paper presented at the A future made together: New directions in the ethics of autism research, Social Sciences Lecture Theatre  UWA Perth.

Posar, A., Resca, F., & Visconti, P. (2015). Autism according to diagnostic and statistical manual of mental disorders 5 th edition: The need for further improvements. Journal of Pediatric Neurosciences, 10(2), 146-148. doi:10.4103/1817-1745.159195

Tantam, D. (2012). Autism Spectrum Disorders through the life span London Jessica Kingsley Publishers.

Wright, J. (2015). Autism’s lost generation. Retrieved from LinkedIn: http://www.theatlantic.com/health/archive/2015/12/the-lost-adults-with-autism/419511/?utm_source=yahoo

What is Autism in Adulthood?

People do not grow out of autism. Autistic children become autistic adults. However, research continues to focus heavily on children, and as a result, few people have a concept of how autism manifests in adults. Recent population-based studies estimate that 40% of primary-school age children who need to be diagnosed with autism go unrecognised, resulting in many reaching adulthood without a diagnosis (Lehnhardt et al., 2013). Mental-health professionals often lack the skills or experience to distinguish autism in adults from diagnosed disorders with which they are more familiar (Lehnhardt et al., 2013). Therefore, many adults on the autism spectrum grow up without understanding their “difference.”  A distinct feature of that difference is that many adults with autism have a higher intellectual capacity together with a lower social capacity (Deisinger, 2011).  Consequently, they have spent much of their lives struggling to fit in without knowing why, with the wrong diagnosis, consigned to psychiatric institutions, or overmedicated for disorders that were non-existent (Wright, 2015). These and other aspects, such as inadequate services and insufficient professional assistance and information (Hagland, 2009), have meant that whether an adult suspects that they may have an Autism Spectrum Condition (ASC), or whether a diagnosis is gained or not, many adults with ASC may not achieve the understanding or specialised help that they require. The result is that they, and their families, are often obligated to bear the responsibility of this lack of awareness.

There is also considerable evidence to indicate that autism has existed throughout human history (Deisinger, 2011). It has been said that many famous historical figures would probably have been diagnosed with an ASC if they had lived today. Albert Einstein, Amadeus Mozart, Sir Isaac Newton, Charles Darwin, and Michelangelo are among many celebrated and brilliant figures who have exhibited considerable behaviours suggestive of autism (Elder & Thomas, 2006; James, 2005). Therefore, there are most likely countless adults with an ASC throughout the world, of all ages, who largely continue to be unknown.

Adults with moderate to high intellect are not only more likely to have partners and children, but are also more proficient at hiding their symptoms (Attwood, 2015). Often, adults with ASC have learnt from an early age to compensate for their underlying difficulties by camouflaging, that is modifying their behaviour in order to blend in, or appear neurotypical, by using their intellect to mask deficiencies in public (Livingston, Colvert, Bolton, & Happé, 2019). The verbal IQ abilities of many adults on the spectrum have meant that they are often able to mask their deficits in social communication, to some extent, by learning social rules and scripts, in order to suppress autistic behaviours (Lehnhardt et al., 2013; Livingston et al., 2019). An appearance of being socially skilled can hide impairments, to a degree (Lingsom, 2008). The special abilities, talents, and interests that adults with ASC often display, means that they have the potential to do well in their vocational pursuits and frequently rise to the top of their field (Howlin, 2000).

However, within relationships, it is a different story. Due to their camouflaging abilities, first impressions of the communication abilities of adults with ASC often can be inaccurate (Aston, 2003). Many are quite articulate, especially when they are talking about their work or interests and since they do not disclose their difficulties, the courtship stage may not provide an indication of actual communication problems (Aston, 2003; Attwood, 2015). After a relationship moves to a deeper level, whereby compensatory strategies cannot be maintained over time (Attwood, 2015; Lingsom, 2008), difficulties with social interaction, social reciprocity, and social imagination (American Psychiatric Association, 2013), may impact on the capability to do well within the everyday interaction requirements of close relationships. Due to the hidden nature of adults with ASC, regularly others do not see the struggles, they, and their families confront. Consequently, these difficulties impact on the quality of life for those with ASC, and their significant others (Pallathra et al., 2018). As a result of the lack of awareness or understanding of the particular difficulties associated with ASC for adults, the responsibility to cope is placed on the adults with ASC, and their significant others (Attwood, 2015; Hendrickx, 2009; Mendes, 2015).

Dr. Bronwyn Wilson

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington, VA: APA.

Aston, M. (2003). Aspergers in love. Couple relationships and family affairs. London and Philadelphia: Jessica Kingsley Publishers.

Attwood, T. (2015). The complete guide to Asperger’s Syndrome (Revised ed.). London and Philadelphia: Jessica Kingsley Publishers.

Deisinger, J. A. (2011). Chapter 10 History of autism spectrum disorders. In A. Rotatori (Ed.), History of Special Education (Vol. 21, pp. 237-267): Emerald Group Publishing Limited.

Elder, J., & Thomas, M. (2006). Different like me: my book of autism heroes. London: Jessica Kingsley.

Hagland, C. (2009). Getting to grips with Asperger Syndrome: Understanding adults on the autism spectrum: Jessica Kingsley Publishers.

Hendrickx, S. (2009). The adolescent and adult neuro-diversity handbook: Asperger syndrome, ADHD, dyslexia, dyspraxia, and related conditions. London;Philadelphia;: Jessica Kingsley Publishers.

Howlin, P. (2000). Outcome in adult life for more able individuals with autism or Asperger syndrome. Autism, 4(1), 63-79. doi:10.1177/1362361300004001005

James, I. (2005). Asperger’s Syndrome and high achievement : Some very remarkable people [1 online resource (226 pages)]. Retrieved from https://ebookcentral.proquest.com/lib/ECU/detail.action?docID=290867

Lehnhardt, F.-G., Gawronski, A., Pfeiffer, K., Kockler, H., Schilbach, L., & Vogeley, K. (2013). The investigation and differential diagnosis of Asperger Syndrome in adults. Deutsches Ärzteblatt International, 110(45), 755-763. doi:10.3238/arztebl.2013.0755

Lingsom, S. (2008). Invisible impairments: Dilemmas of concealment and disclosure. SCANDINAVIAN JOURNAL OF DISABILITY RESEARCH, 10(1), 2-16. doi:http://doi.org/10.1080/15017410701391567

Livingston, L. A., Colvert, E., Bolton, P., & Happé, F. (2019). Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 60(1), 102-110. doi:10.1111/jcpp.12886

Mendes, E. (2015). Marriage and lasting relationships with Asperger’s Syndrome (Autism Spectrum Disorder): Successful strategies for couples or counselors. London, UK: Jessica Kingsley Publishers.

Pallathra, A. A., Calkins, M. E., Parish-Morris, J., Maddox, B. B., Perez, L. S., Miller, J., . . . Brodkin, E. S. (2018). Defining behavioral components of social functioning in adults with autism spectrum disorder as targets for treatment. Autism Research, 11(3), 488-502. doi:10.1002/aur.1910

Wright, J. (2015). Autism’s lost generation. Retrieved from LinkedIn: http://www.theatlantic.com/health/archive/2015/12/the-lost-adults-with-autism/419511/?utm_source=yahoo

What is a Neurodiverse Relationship

Relationships that involve people with an Autism Spectrum Condition (ASC) are often described as neurodiverse. Neurodiverse relationships can include either, both people who have an ASC, or else one person with an ASC and one person without an ASC (i.e., a person who is considered neurotypical). Neurodiverse relationships that include one person with an ASC and one person who is neurotypical (NT) may encounter considerable challenges, given that autism is a condition that impacts on an individual’s communication and social abilities, whereas people who are NT tend to have instinctive social skills. The giving and receiving of emotional support through reciprocity is a fundamental component of interpersonal interaction for NT individuals in their relationships. However, the opposite is usually the case for autistic people. They can experience a great deal of stress and anxiety when faced with the conventional expectancies of engaging in social interaction and reciprocity in close relationships. Thus, the different interaction capacities and requirements between autistic and NT individuals, when integrated in one relationship, may be an extensive source of miscommunication.

Although a common misconception is that adults on the autism spectrum do not want romantic relationships (Moreno, Wheeler, & Parkinson, 2012), many autistic adults are usually as interested in such relationships as NT adults. Consequently, many adults with ASC initiate romantic interest, form romantic attachments, progress along the relationship continuum, and enter into long-term relationships (Henault, 2006; Moreno et al., 2012). Not only are the higher functioning adults with ASC likely to have partners and children, but they are often proficient at hiding their symptoms (Attwood, 2007, 2015). By using their intellect to mask deficiencies in public, the coping skills of these adults can contribute to the hidden quality of many adults with ASC (Attwood, 2007, 2015).

While forming healthy, loving relationships is cultivated through the ability to give and receive healthy reciprocal interaction, individuals with ASC have difficulties with the social aspects of life, such as social interaction abilities and social functioning. Therefore, they have social impairments that can interfere with their capacity to engage in, contribute to, and persevere with, the ongoing reciprocal interaction necessary to sustain relationship health. The day-to-day reality of living with high skills in certain areas coupled with low skills in others may cause unseen turmoil behind closed doors. Edwards (2008) reports that, “all people with ASD have problems with communication…[often] giving a false impression of their comprehension” (p. 52). Consequently, many extremely able autistic adults may commonly struggle with day-to-day life skills (Edwards, 2008). Given that adults with ASC can often feel most comfortable within the intimate relationships of a family, they may exhibit more of their ASC characteristics in private. An outcome of this unseen aspect is that, others outside the confines of the home regularly do not observe the resulting struggles that they, and their families confront. At the same time, their special abilities, talents, and interests can help them to rise to the top of their field (Howlin, 2000). While this often means that they do well in their vocational pursuits, their struggles within the home environment with seemingly simple instructions, and their inabilities to perform what is generally viewed as straightforward mundane tasks, can perpetuate the hidden quality of ASC (Bresnahan, Li, & Susser, 2009; Edwards, 2008; Elichaoff, 2015; Howlin, 2000). The result is a divide between the public and private manifestations of neurodiverse relationships, with the healthy reciprocal interaction that NT adults usually expect, challenging to achieve in these relationships.

Dr. Bronwyn Wilson

Attwood, T. (2007). The complete guide to Asperger’s Syndrome. London and Philadelphia: Jessica Kingsley Publishers.

Attwood, T. (2015). The complete guide to Asperger’s Syndrome (Revised ed.). London and Philadelphia: Jessica Kingsley Publishers.

Bresnahan, M., Li, G., & Susser, E. (2009). Hidden in plain sight. International Journal of Epidemiology, 38(5), 1172-1174. doi:10.1093/ije/dyp293

Edwards, D. (2008). Providing practical support for people with autism spectrum disorder: supported living in the community [1 online resource (192 pages) : illustrations]. Retrieved from https://ebookcentral.proquest.com/lib/ECU/detail.action?docID=350373

Elichaoff, F. (2015). What’s it like being you? Growing old(er) with Autism Spectrum Conditions – A Scoping Study. The European Journal of Social & Behavioural Sciences, 13(2), 1851-1864. Retrieved from http://search.proquest.com.ezproxy.ecu.edu.au/docview/1682443834?OpenUrlRefId=info:xri/sid:summon&accountid=10675

Henault, I. (2006). Asperger’s Syndrome and sexuality. From adolescence through adulthood. London and Philadelphia: Jessica Kingsley Publishers.

Howlin, P. (2000). Outcome in adult life for more able individuals with autism or Asperger syndrome. Autism, 4(1), 63-79. doi:10.1177/1362361300004001005

Moreno, S. J., Wheeler, M., & Parkinson, K. (2012). The partner’s guide to Asperger Syndrome. London: Jessica Kingsley.