Tag Archives: communication

What is autism? The diagnostic criteria explained

When you think about autism, you may, stereotypically, think of a boy, probably non-verbal, who may become violent at times. There is, however, also, the saying “when you’ve met 1 person with autism, you’ve met 1 person with autism”. That’s because Autism Spectrum Disorder (ASD) is so wide varying in how each individual experiences it.

The DSM V is the official American manual for assessment and diagnosis for mental disorders. ‘5’ refers to the number of iterations it has gone through to arrive at the current recommendations for the criteria needed in order to officially diagnose someone with each particular disorder.

Autism spectrum disorder (ASD) is not a mental disorder, it is a neurodevelopmental disorder, some prefer the word condition. The medical model of ASD speaks about the individual’s deficits (see each criterion below)—in future blogs I’m planning to address why this may help to diagnose someone but may be unhelpful when trying to live on the spectrum.

It is interesting to note that Asperger’s Syndrome was a separate diagnosis in the DSM IV, however inconsistencies were found between different diagnosticians—therefore, in the DSM V there’s one umbrella term. (Some people who were diagnosed with Asperger’s still use the term, they are not wrong to use it but it is not used for people diagnosed today.)

DSM V—Autism Spectrum Disorder

Criterion A—Persistent deficits in social communication and social interaction across contexts, manifest by 3 of 3 symptoms.

This means the individual will have difficulties making connections with people socially in all environments, with friends, family and strangers. All of the following 3 criteria have to be present:

A1. Social initiation and response

Deficits in social‐emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.

This covers a whole range of struggles; some people with autism do not speak while others may not understand how to start or end conversations. Other examples include: not sharing in another’s achievements, one sided conversations and difficulty sharing in social games.

A2. Non-verbal communication

Deficits in non-verbal communicative behaviors used for social interaction.

This represents the individuals difficulty with eye contact, understanding body language or gestures. Some individuals may talk with an unusual pitch, intonation, rate or volume of voice while others may not use facial expressions or struggle to coordinate verbal and non-verbal communication.

A3. Social awareness and insights + the broader concepts of social interactions

Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers).

Individuals have difficulty adjusting to different social contexts e.g. inappropriate questioning, laughing or limited understanding about other’s needs. Difficulties sharing imaginative play and making friends. Children may prefer to play with people much older or younger than themselves or to spend time on their own. Some individuals may appear to have a complete lack of interest in other people.

Criterion B—Restricted, repetitive patterns of behavior, interests, or activities, at least 2 of 4 symptoms:

B1. Atypical speech and body movements

Stereotyped or repetitive speech, motor movements, or use of objects.

Examples vary between individuals but could include: unusual speech such as pedantic, jargon, echolalia or neologisms; repetitive hand movements such as flapping or clapping, whole body movements, facial movements (grimacing) or excessive teeth grinding.

B2. Rituals and resistance to change

Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change.

While this may look like a need for control, individuals struggle with a need for routine and struggle with change. Even thinking patterns can be rigid such that there’s an inability to understand humour. Extreme distress will be observed if change is forced upon the individuals without any support.

B3. Preoccupations with objects or topics

Highly restricted, fixated interests that are abnormal in intensity or focus.

Overly perfectionist views with preoccupation in unusual inanimate objects or non-relevant, non-functioning parts of objects. Individuals may have incredibly interest in specific subjects—on face value it may not seem unusual until the depth of the interest is understood.

B4. Atypical sensory behaviours

Hyper‐or hypo‐reactivity to sensory input or unusual interest in sensory aspects of environment.

Individuals may find any kind of sensory input overwhelming or may not respond to it at all. An apparent indifference to pain/heat/cold may be observed. This may mean that they explore objects in unusual ways and seek out overt sensory input.

Criterion C—Symptoms must be present in early childhood

But may not become fully manifest until social demands exceed limited capacities.

Criterion D—Symptoms together limit and impair everyday functioning.

Although the individual may have learnt to mask from a young age, thus the impairment may appear subtle to the observer, within the individual, the impact of their symptoms will be profound.

Additional symptoms and co-morbid conditions

People diagnosed with autism may experience all sorts of other symptoms/difficulties. These many be related to their autism or may be a co-morbid condition. Symptoms that may be experienced/observed include (but certainly not limited to):

  • Shutdowns – someone who can usually speak/communicate well, becomes uncommunicative/has trouble communicating due to excessive stress linked to all of traits A, B2 and B4.
  • Meltdowns – each individual will experience these differently, from excessive crying to extreme outbursts of anger/aggression. In children, this may look like tantrums; adults may feel them coming on and try desperately to suppress them for as long as possible (weeks-months sometimes) but they are a sign of extreme overwhelm and are particularly linked to traits B2 and B4 above.
  • High levels of anxiety – due to the world being set up for neurotypicals, it can be incredibly daunting for an autistic to attempt navigation. When communication doesn’t go to plan, sensations are overwhelming or routines are disrupted, feelings can become hard to bear.
  • Taking longer to process events/trauma – a particular event may not cause any problems for a neurotypical person but an autistic individual may struggle to process what has happened. This is linked to traits B4 and the A above, no matter how well the autistic person works to overcome their difficulties, managing the sensory input and processing it will always be difficult.
  • Difficulties managing physical health problems – this may be due to an inability to recognise signals from the body or having a higher or lower pain tolerance than the neurotypical population. This can lead to individuals becoming very ill before seeking help or taking longer to recover from illnesses. Some individuals with autism struggle with knowing when their body is hungry, satiated or when they need the toilet.
  • Loneliness – people with autism still have the same human needs to be loved and to love but communicate in a different way. They may not know that their desires stem from standard human instincts and require support.
  • Self-harm and suicidal behaviour – due to severe stress individuals with autism can be driven to extremely dangerous coping mechanisms. See previous blog in “mental health for all”.

Co-morbid conditions include:

  • Learning Disability
  • Depression
  • Anxiety
  • Eating Disorders
  • Attention Deficit Hyperactive Disorder
  • Conduct Disorder
  • Personality Disorder

Please look out for future blogs when I’ll be explaining more about my experience, including why females are more likely to be diagnosed later than males, whether a formal diagnosis is necessary for support and why there’s such a link between eating disorders and autism.

Are we doomed to divorce?!

These are strange times! I’m aware I have readers from all over the world and each country is dealing with the coronavirus pandemic differently, restricting movement of people to varying degrees.

Lockdown, quarantine, self-isolation, restricted movement, stay at home, social distancing, flatten the curve, work from home, slow down the spread, protect the NHS – these words are all now common parlance!

Since the epicenter was in China, we may be able to gauge where we’re heading by what’s happening there…China are seeing a significant spike in divorce applications from couples coming out of isolation.

Steve, my husband and I, obviously, love each other but like any couple, have our ups and downs! We prefer not to have blazing rows but we’re capable of a few harsh words. We’re struggling with this situation for different reasons but we know we’re going to get through it together because we work at our relationship.

I’m writing this blog because it would be sad to follow China’s lead, relationships don’t need to be doomed. Some of these suggestions may seem common sense but I think it’s fair to say in these uncertain times people are acting out of character and we can all do with a bit of reminding that sometimes the simple things are the best things:

Hold onto the things that are the same

Some people are working from home, try to home school children and/or manage an unusual living situation, these things will feel destabilising but there will be some things that are the same. Can you eat meals together? Is your morning or bedtime routine the same? Is there a TV programme you both like to watch together? Anything that anchors your relationship will help you feel stable.

Date times

You may think “but we’re spending too much time together, that’s the problem”. But date time is special time. If you have other people in the house it might be difficult but it’s important to set time aside, even if it’s just 10-15 minutes for a coffee together (but the longer the better!) to set technology aside and focus on each other. If you’re fortunate to have more time alone, you could play a board game or give each other a massage.

Self care

If you’re giving to other people all the time, you’re strung out and exhausted, you can’t pour from an empty cup! Your relationship’s going to suffer because we always take our frustrations out on those closest to us. Living on top of each other can be difficult. Don’t underestimate how beneficial going outside for fresh air is, whether it’s onto a balcony, the back garden or for a walk if permitted. You take this opportunity to learn a new hobby, crafting or reading may not have previously been your thing but maybe give it a go!

Give and take

With so many routines changing it might be difficult to stay on top of the household chores or you might find yourselves bit more messy than usual. As the situation changes people might need change the responsibilities they have. I don’t envy the parents suddenly home schooling and those who’ve never worked from home suddenly have to adapt. Sometimes, stepping back from the situation and writing a list or a timetable for who does what when might stop the situation from getting out of hand.

Communication – I’ve left the most important ‘til last!

Understanding what each other need is so important and this is only going to come if you talk to each other! This next part is so important – no one can mind read! If you’re feeling grumpy, fed-up, overwhelmed, sad or pissed off just say so. If you’re not sure how you feel and you’re not sure why, just say so! If you want to be left alone, say so. If you want to have a cry, say so.

Talk to each other about what you need! Are you an introvert or an extrovert? I’m an introvert, so managing the isolation fairly well. My husband is an extrovert so the aspect that’s hit him hardest is not being able to see his friends. My husband uses technology every day whereas getting to grips with multiple platforms (to stay connected with various people) quickly has been overwhelming for me. As genuinely fantastic as technology is, I’ve found large WhatsApp groups intrusive and long video conference calls exhausting!

I don’t need to remind you the most important part of communication is the listening part! Most people listen to reply – don’t be most people, listen so that you understand your partner.