Autism Spectrum Condition (ASC)
Autism is the generic term for the condition of having Autism Spectrum Condition (ASC). Autism is described as a 'spectrum disorder' because the condition affects people in many different ways and to varying degrees. This makes it difficult to diagnose. There are other difficulties in diagnosis, for instance, Autism shares a number of symptoms with developmental disorders such as Attention Deficit Hyperactive Disorder (ADHD), Dyslexia, Dyspraxia and many others. Furthermore, Autistics very frequently have one or more of these disorders to some degree alongside their Autism. Autistics suffer from higher rates of epilepsy; they also frequently have anxiety and depression as 'default settings'.
Until relatively recently, Autism was generally diagnosed when the individual was thought to have one of the disorders which were recognised as being on the Autistic Spectrum. There were a lot of them, new disorders being 'discovered' all the time. However, it was recognised that this is a misleading perception. What is actually being observed is that there are as many variations of clusters of symptoms and behaviours as there are Autistics. It is a frequently used saying that "no two Autistics are alike". Therefore it is not that there are many different disorders within the Autism Spectrum just many different manifestations of it. So people are now more likely to be simply diagnosed with Autism Spectrum Condition, if they demonstrate enough of the recognised 'markers' of Autism to make that diagnosis possible.
What Is Autism?
It is not an illness or disease, it is a lifelong developmental condition. It cannot be 'cured' or 'treated' and the Autistic person has to learn to accommodate to the handicaps it involves.
Advances in research and practice in the USA (where they take Autism seriously) have shown that what delineates the Autistic person are three things:
- They do not naturally develop the ability to understand the ‘rules’ and attributes of social interaction as most do, although they many learn simply by copying others. Autistic people are generally literalistic, which accounts for their poor ability to understand the nuances and implications that are fundamental to much of human social interaction.
- They are permanently over-stimulated by, for instance, crowds, sounds, colours, thoughts, expectations, taste, touch and so forth which leads to particular and personal hypersensitivities. Furthermore not being able to understand common social interactions imposes a stress which is also a form of over-stimulation.
- They suffer from ‘endogenous’ (‘hard-wired’) anxiety and commonly an attendant reactive depression. In fact this ‘anxiety’ is a barely-controlled primal terror. This accounts for the meltdowns, the need for order and routine and the inability to cope well with new or out-of-routine experiences.
There are also a number of common symptoms which are prevalent amongst Autistic people such as a measure of hypermobility and distinct ways of acting or moving.
Whereas the non-Autistic person (referred to as neuro-Typical or NT) is geared towards and learns through stimulation in one form or another, the Autistic has to constantly try to reduce stimulation or they risk, to use an old-fashioned phrase, ‘cerebral overload’. All of the behaviours common to those who have Autism, and by which it is identified, are carried out in order to reduce stimulation for that person. However it is easy to see only the behaviours and not appreciate that it is the core experiences which define the Autistic person: a) the inability to understand and effectively respond to common social interactions b) intense, psychologically painful over-stimulation and c) a chronic, underlying relentless anxiety. So it is obvious how the Autistic person does not fit easily into the world. Social settings, education, employment, personal interactions, communication all need to be completely different from the norm for the Autistic person.
What Causes Autism?
Thanks to advances in science (especially Magnetic Resonance Imagery or MRI) we are now sure that Autism is caused by a particular abnormality in the development of the brain. Various other causes have been suggested (the administration of the MMR vaccine being a recent example) but have proved to be false.
As a child grows, so does their brain. As they absorb knowledge and learn skills neural pathways are formed. Commonly, these trace a predictable pattern which includes the propensity to deal with mixing with other people in a socially acceptable way. For reasons that are not yet clear but most likely genetic, sometimes there develops a divergence from this pattern and the formation of the neural pathways takes a different turn. Neural pathways are formed that are different from the usual. Autism is the result of particular, alternative types of formation of these pathways. Besides a limitation to the social interaction areas of the brain, there are unusually extensive connections with areas to do with sensitivity to various stimuli.
How Does Autism Affect People?
For many years. when people mentioned Autism, they were actually referring to people at the 'severe' end of the Spectrum. People, and particularly children, who were completely unable to communicate in a meaningful way with others; they might incessantly rock backwards and forwards, perhaps hum to themselves over and over, have major tantrums or 'meltdowns' with little provocation, maybe bang their head or frequently strike themselves and such like. Eventually, however, it became clear that there were many people who were obviously Autistic but who did not have symptoms anything like as severe as these. They came to be described as 'High Functioning' Autistics. Almost of all of the people that Milestones finds itself helping come into the category of High Functioning.
High Functioning Autistics, whilst they may have the usual difficulties with social interactions and of suffering from continuous over-stimulation from various sources have formed other pathways and (it will surprise many) that give them abilities that are more advanced than NTs. Here are some examples. They have:
- The ability to perceive order, patterns and structures that others cannot
- A genius for seeing and creating order and harmony out of the apparently random or chaotic.
- A special aptitude for spotting minor or obscure differences or aberrations in patterns and structures.
- A proclivity to think in a very unrestrained way, thus making them remarkable problem solvers (someone said that they do not have to think 'out of the box' as they have no 'box' to think out of!).
- Immense powers of concentration.
- An extraordinary attention to detail.
- An emphasis on precision (which can make them a little hard to live with!).
- The capability to gather, inwardly collate and retain vast and detailed amounts of knowledge about subjects in which they gain an interest.
- Total three-dimensional visualisation, that is they can make an image created in their mind move smoothly in any direction, without needing to make a series of stops to change the angle of view, in much the same way as a 3-D computer graphic can be moved (try it sometime!).
- An enhanced intuitive capacity.
That High Functioning Autistics have this last capacity is not generally known even by the Autistics themselves. This is simply because the people who assess and help them are generally not Autistic themselves so have no notion of its existence.
All of the above advanced characteristics have led to Autism no longer being referred to as a 'disorder'; but, more accurately as a condition.
However, in the High Functioning range of Autism, there are two Syndromes that are referred to as 'diagnostic subtypes' of ASC. These are Asperger's Syndrome and, increasingly, Pathological Demand Avoidance Syndrome.
Asperger's Syndrome (AS)
AS was named after the Austrian paediatrician Hans Asperger who identified what he termed as ‘autistic psychosis’. His work went relatively undiscovered until a psychiatrist, Lorna Wing, brought it back into public attention and gave it its name. It recognised that some people, who were clearly Autistic, also displayed other characteristics that were somewhat out of the ordinary for an Autistic. These are as follows:
- Unlike other Autistic people they are less self-focussed and can learn how to interact more 'normally' with the world.
- They are able to understand that they have a condition that makes them see things differently to others.
- They frequently have fewer problems with speech than those 'further along' on the Spectrum although it is common for them to begin speaking a little later than average.
- They do not usually have the learning disabilities associated with the other forms of Autism, although they may have in some part learning difficulties such as dyslexia and, of course, that they learn in a different way from NTs.
People with AS can hold down a job, look after themselves and generally take their place in society, albeit at some psychological and emotional cost to themselves. It is why many people often seek a diagnosis only later in life, because, despite their suffering, they have managed to go about their lives as everyone else does. Most often they have blamed themselves, unfortunately and erroneously, for their difficulties and awkwardness in social situations and their feeling of general alienation from other people.
Pathological Demand Avoidance Syndrome (PDA)
(with acknowledgement to Priory Educational and Childrens' Services)
PDA until recently was regarded as not being on the Autistic Spectrum. It is a pervasive developmental condition (meaning it affects all areas of development) first identified by Elizabeth Newson in 2003. It's main characteristics are:
- A need to resist normal, everyday demands made by others
- That this resistance appears to be a way of managing acute anxiety
- Unlike those with other forms of Autism, they are comfortable with playing 'pretend' games and have less difficulty in using social skills. Hence the doubt that they are truly on the Autistic Spectrum. However, they will tend to use these skills to manipulate others and these skills are rather at a functional and logical level rather than at a deeper emotional level.
- They are able to create and 'act out' a character who is entirely credible as a normal, even especially socially skilled and well-behaved person. It is true that many of those with Asperger's Syndrome can do this but they are not so skilled as the person with PDA and find it exhausting, which does not appear such an issue to those with PDA.
Although it is still not currently recognised in some diagnostic criteria for Autism, gradually it is being regarded, as with AS, as a diagnostic subtype of Autism.
Now the good news...
- It is not possible to tell that someone is Autistic by looking at them.
- Many people who are 'High Functioning' Autistics do learn how to socially interact and are able to take their place in society without seeming 'out of place'.
- Having ASC is not a 'life sentence'. There are many accomplished and successful people with Autism living in the world.
Beware! There is still a great deal of out-of-date information on Autism available on the internet. One major example is the now completely debunked idea that Autism is more commonly found in males than in females. Women and girls seem to be more adept at hiding it!
The easiest way I can describe having ASC is that it is like spending your life living on an alien planet.