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Autism Spectrum Condition And What You Need To Know
Disclaimer: The terms ‘autistic person’ and ‘person with autism’ are hotly debated. For the purposes of this article, as an autistic adult, I will be using identity first language, i.e., the term ‘autistic’. Language is very conflicted around autism from the issue of identity first vs person first to the terms neurodiverse and neurotypical, terms I will also be using as well as Autism Spectrum Condition rather than Autism Spectrum Disorder. Please do not interpret this as indicating a lack of acceptance of other terms, merely my personal preference.
Autism Spectrum Condition (ASC), sometimes referred to as Autism Spectrum Disorder (ASD), is a lifelong condition that occurs from birth, although it is often picked up later in life, from early childhood through adulthood. It is characterised by difficulties with social skills, communication difficulties, and self-regulation difficulties. Although it is not a mental health related condition it is described in the Diagnostic and Statistical Manual of Mental Disorders Vol. 5 (DSM-5), which describes it as “persistent differences in communication, interpersonal relationships, and social interactions across different environments
For a person to be diagnosed with ASC they must meet three criteria. This is known as “The Triad of Impairments”. People have different levels of difficulty within the triad, but it is described as
- difficulties with social interaction – finding it hard to understand, communicate and recognise how other people are feeling.
- difficulties with social communication – struggling with verbal and non-verbal language.
- difficulties with social imagination – finding it hard to imagine what others are thinking or alternatives to their own routines.
The result of this triad of impairment is that autistic people have difficulty with social engagement such as knowing when to speak, when to laugh and when to empathise.
The important thing to note is that autism is a spectrum with different autistic people having differing degrees of difficulty within each of the triad’s elements. No two autistic people are different, the saying goes that “Once you have met one autistic person you have met one autistic person”. One autistic person might be able to empathise and be verbal but have difficulties with changing routines, whilst another might be nonverbal with 24/7 care needs. Each element of autism exists along a spectrum. Whilst people think this indicates a straight line from ‘high functioning’ to ‘low functioning’ this is not the case and functioning labels can cause difficulty as a ‘high functioning’ person may be perceived as only having mild care needs and a ‘low functioning’ non-verbal autistic person may be perceived as having no ability to communicate and of limited, and little abilities. In both instances this may not be the case and, as such, functioning labels can be harmful in understanding autism and autistic people.
It is easier to think of the autism spectrum as a circle with segmented pieces describing areas of difficulty, you can plot a person’s abilities by looking at these segments to better understand their needs and abilities. An example is provided below
Each segment is marked with the different difficulties faced by autistic people. Motor skills refers to abilities to do anything from gross motor skills – walking, standing, holding things, to fine motor skills – doing up buttons, using a pencil. Language refers to being verbal or nonverbal – the ability to speak and communicate either through speech, sign language or writing. It also refers to ‘expressive’ and ‘receptive’ communication – the ability to both express and understand language.
Sensory difficulties are those experienced by the senses – not only the five most people understand: sight, hearing, touch, taste, and smell, but also problems with the vestibular sense: balance and body movement, the proprioceptive system: our sense of where our body is in relation to the world around us, and our sense of temperature. A person may experience difficulties with any of these 9 senses. Scientists are still of the consensus we may have more senses than this but for the purposes of this article sensory corresponds to these nine senses.
Executive function is the cognitive processes that help us regulate, control, and manage our thoughts and actions. It includes planning, working memory, attention, problem solving, verbal reasoning, inhibition, cognitive flexibility, initiation of actions and monitoring of actions.
The last segment is perception which refers to the ability to participate in social interactions such as knowing when to speak, as well as understanding idioms and humour.
By plotting points in each of these segments leads to a more complete picture of a persons need as shown in the diagram below
Understanding that this picture looks different for every person gives more understanding of how being on the autism spectrum affects that person.
The effects of these needs on the autistic person can be quite wide ranging and diverse. Social communication difficulties may include an inability to detect sarcasm or everyday idioms such as ‘raining cats and dogs. It may also result in echolalia – a pattern of repetitive speech that a person hears, either in conversation or from media sources such as films or music (scripting). The autistic person may also need additional time to process what is being said to them and provide an answer. A neurodiverse person may appear socially inappropriate – maybe brusque, tactless, or rude, or can be overly affectionate or appear strange or eccentric. Owing to this they may find it difficult to form or maintain friendships.
An autistic person can be easily overwhelmed by the world around them, it can appear unpredictable and confusing. They may deal with this through rigid or repetitive routines, or intense specialised interests, appearing almost obsessive, all these techniques allowing them a measure of control over their environment, the loss of which can be immensely overwhelming. They may experience over, or under, sensitivity to sensory input such as a dislike of being touched, the need to wear ear defenders or headphones to block out sound, a need to use weighted blankets or tight compressive clothing or conversely loose clothing without seams or tight waistbands and necklines.
Again, every autistic person is unique in their needs but in general adjustments can be made to aid their ability to adjust such as lowered lighting and music levels in a shopping centre or not forcing them to engage in affectionate behaviours such as hugging. Autistic people have a high comorbidity of anxiety and this, combined with a need to self-regulate, means they can often engage in ‘stimming’, or self-stimulatory behaviours such as flapping, spinning, or repetitive use of an object such as a fidget toy which enables the autistic person to self regulate. This can be from anxiety, but also from enjoyment.
It is important to note that neurotypical people also engage in stimming without realising it.
Of final note, if the demands on an autistic person become too great, they may go into meltdown or shutdown. These are intense and exhausting experiences. A meltdown is a loss of behavioural control and can be verbal (screaming, or shouting), or physical (kicking, lashing out). Meltdowns in autistic children particularly can be mistaken for a temper tantrum and subject to judgement and disapproval from less understanding members of the public, especially when this occurs in public. A shutdown occurs when a person is so overwhelmed, they stop engaging and may appear passive or ‘quiet’ or even ‘switching off’ entirely. This is an equally exhausting experience. 
The subject of autism is a vast one and this blog, despite being a long read, has merely scratched the surface in explaining the very basics, and I will be including more blogs on many of the aspects mentioned today plus more so please take a moment to subscribe below.
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