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High-Functioning Autism refers to a condition where individuals do not have any learning or intellectual disability but do exhibit other common features of autism. The main characteristics may include difficulties with social interaction and communication. They are unable to read facial expressions and social cues of conversations making it difficult to make friends. Along with high emotional sensitivity, individuals with this condition exhibit strong reactions to physical sensations like light or noise. Individuals with high-functioning autism have limited social skills and may have problems maintaining eye contact. They have repetitive habits and obsessions that may interfere with their social interactions and negatively affect their day-to-day life.
Asperger´s syndrome is generally considered as a mild type of Autistic Spectrum Condition and hence, people with Asperger´s may have good language and cognitive skills with no language delays. The characteristics of Asperger´s differ in different individuals depending on how it impacts their practical lives. Although there is no language delay, people with Asperger´s do face difficulties in communicating and interacting with other people. Making or keeping friends is a challenge. They may find sarcasm, humor, or the general nature of the conversation difficult to understand. Some people with Asperger´s may experience a delay in motor skills development and might lack coordination. Moreover, similar to people with classic autism, individuals with Asperger´s also engage in repetitive patterns of behaviors and interests.
The term neurodiverse is not only used in the context of autism spectrum conditions, but also includes other neurological, learning, and developmental conditions. It defines how people differ in their thinking and behavior.
All individuals have distinct ways in which they behave, contemplate things, and learn. The term encompasses this variation and encourages a nonjudgmental and rather more inclusive attitude towards people classified as neurodiverse, ensuring they receive the same treatment from the rest of society as other non-neurodiverse people.
The term neurotypical generally refers to those individuals who do not fall under the category of autism spectrum conditions or other neurological or developmental disorders. It means those people whose thoughts, actions, and behaviors are considered standard or typical of mainstream society.
The main signs and symptoms of autism comprise the following:
- Difficulties with social interaction. Examples may include avoiding or finding it hard to maintain eye contact. People with autism find it difficult to relate to other people or understand the social norms and general rules of society.
- Communication difficulties. It is extremely hard for people with autism to communicate how they feel or verbalize their thoughts and emotions. Even if they are verbal, they struggle with conversation building and if non-verbal, their use of body language and gestures is restricted. For example, children with autism may not wave goodbye or point to things of interest or they may have no facial expressions to show if they are happy, sad, or angry.
- Sensory Processing Disorder. People with autism may have unusual reactions to certain physical sensations like loud noise, bright light, or temperature changes. They may be highly sensitive to the extent of experiencing physical pain when exposed to such stimulus, while others may inadequately respond to the same, putting themselves at risk of injury example eating inappropriate foods or touching too hot or cold surfaces.
- Problems in interpreting emotions. Individuals with autism may not understand if people around them are happy or sad or what others think or feel.
- Literalism and linguistic rigidity. People with autism interpret language in a literal way and may not understand phrases, humor, or irony in any conversation. For example, the phrase itâs raining cats and dogs´, would be taken in its actual literal way and not in the figurative way.
- Echolalia. Autistic individuals repeat phrases or sounds they hear around them from other people. For example, when asked if they want water, they will repeat the question rather than answer yes or no.
- Obsessive behavior. People with autism have an intense obsessive interest in a particular thing or subject which may keep them occupied throughout the day. For example, children with autism may be obsessed with certain toys or tv characters. They would be focused on gathering information about their obsessions and always talking about them.
- Stimming. People with autism display repetitive compulsive behavior like flapping hands, rocking, spinning in circles, flipping fingers, lining up toys or objects, and getting upset if the order is changed. They follow a certain routine and may play with toys the same way every time.
Autism is a spectrum condition and there are limitless ways in which it affects different individuals. This diversity in the signs and symptoms can be seen in the reference scenarios.
Rashid and Josh, both are 16 years of age with a diagnosis of autism. Both have the same condition but experience it differently. Talking first about communication and social skills, Rashid seems to be more affected by limited verbal communication and hence the need for a special school. He is socially withdrawn and does not interact with peers. On the contrary, Josh communicates verbally and has a good vocabulary. Even though he does struggle with literalism, it is seen in the scenario that he has friends and interacts with them to share his interests. This functioning aspect has enabled him to attend mainstream secondary school.
Secondly, both have different sensory processing traits. Rashid is hypersensitive to touch and needs his clothes´ labels to be cut out, whilst Josh is hypersensitive to noise and needs a sensory room to calm himself when overwhelmed.
Moreover, both have a varying degree of obsessive and repetitive behavior. Rashid prefers a routine and becomes upset if there is a change in order. He displays the stimming trait and spends a significant time pacing around one small section of the classroom. Josh, on the other hand, has an obsessive interest in computers and is keen to talk about his interest with his peers. He also has problems interpreting emotions and may not understand whether his friends wish to talk about the same subject.
The Triad of impairments refers to the three main areas of difficulty faced by autistic individuals, though each individual may be affected by any trait of the triad in a varying way. The three traits are also used as a diagnostic criterion for different types of autism. They briefly include:
- Difficulties with social communication. Individuals show varying manifestations of this trait. Some may have unaffected speech but with literalism and linguistic rigidity while others may use a limited vocabulary but exhibit echolalia. They are also some with no speech who vocalize or make sounds to communicate.
- Difficulties with social interaction. Unable to understand and recognize other people’s thoughts and emotions. They avoid making eye contact and feel distressed in noisy and unfamiliar situations.
- Behavioral challenges. Individuals exhibit obsessive, highly focused interests in varying subjects be it art, music, Tv characters, technology, or automobiles; and compulsive repetitive behavior which may include hand flapping, rocking, spinning in circles, and flicking fingers.
Autism is a lifelong condition and individuals can neither grow out of it nor treat it medically. A professional diagnosis of the condition is detrimental in ensuring the individuals not only get the required help, support, and assistance in managing their day-to-day activities but also in a broader spectrum, the rights and a sense of equality as enjoyed by the other neurotypical group of people.
With reference to the scenario given, it is apparent that Alisha has struggled with her condition in school life and even in her adult life, her parents are not willing for a professional diagnosis. Had Alisha gone for a professional diagnosis of autism early, her life might have been a bit easier. The signs mentioned in the scenario hint that Alisha was probably not on the severe end of the spectrum. She has been verbal, has attended school, and is now working. Has she been diagnosed early, she would have had access to support mechanisms and psychological help at school to help her deal with the anxiety and distress she faced as a result of social isolation. People would have been more understanding of her situation. Given her interest in animals, certain learning programs could have been tailored for her so that she may pursue it as a profession. An early diagnosis not only helps the affected individual in giving a name to their differences but also helps people around them to be more willing to accept those differences and then to together devise strategies to overcome them. It gives a justifiable reason for their challenging adverse behaviors so that their peers could be more empathetic and tolerant and deal with the situations with kindness and compassion. The establishment of a formal diagnosis also paves the way for a much healthier and stress-free professional life where employers can make adjustments to the working environment to suit the needs of autistic individuals. All these factors not only help contribute towards a society more embracing of this neurodiversity but more importantly contributes to the self-acceptance of autistic individuals to promote their self-esteem and gain a better understanding of their reactions and behaviors to certain situations. Thus, a formal professional diagnosis of autism is pivotal in ensuring the well-being, growth, and development of autistic individuals so that they may lead healthy independent lives.
Even though it is established that early diagnosis of autism is key in ensuring affected individuals have access to the required support, help, and care, the diagnostic process still faces a lot of challenges.
The scenario given highlights the reaction of Alisha´s parents to the mere idea of getting her diagnosed. It is the social stigma attached to the term, that many families are resistant to accept and embrace it. Parents are concerned about their children being labeled as different or those with special needs as it might affect their future life and deny them learning and working opportunities. It is the feeling of fear and uncertainty, that shadows their will to learn about the condition, understand it and then provide their children with the support they rightfully need. Moreover, the diagnosis of autism is a complex process. It needs a team of professional individuals including clinicians, behavioral and educational psychologists, and also teachers and social care workers. The process takes time and there may be a long waiting period. There may be funding issues as well. The whole process daunts the bare thought of going for a professional diagnosis. The lack of awareness about the help available leads them to question the benefits of a diagnosis or of having a label for their condition. Also, they believe that having a label might involve a lot of work from their end. As given in the scenario, Alisha is reluctant to get the diagnosis because she believes it will involve a lot of verbal and written explanations by her, something which she has struggled with throughout her life.
Autism being a spectrum condition is presented in varying degrees in different individuals. Certain mental health conditions and learning disabilities can either overcome the symptoms of autism, exacerbate its features, or even mask its characteristics, making a timely formal diagnosis exceedingly difficult. For those individuals who are on the severe end of the spectrum with significantly serious communication, social and sensory difficulties, the diagnosis can be quick to reach considering the apparent nature of the condition. Conditions such as High Functioning autism or Asperger´s pose a greater challenge in reaching a formal diagnosis as their features may give a false impression as being those of a mental health condition or personality disorder.
There are many conditions that co-occur with autism making its formal diagnosis a huge challenge. Certain mental health conditions and learning disabilities share overlapping characteristics with autism with varying manifestations. The co-occurring conditions can either exacerbate the features of autism or mask its symptoms making a delay in its timely diagnosis. Vice versa, an established diagnosis of autism can also shadow the search for any other underlying mental health condition, timely treatment of which could ultimately help in improving the quality of life for autistic people. For example, in autistic individuals with communication difficulties, underlying mood disorders and behavioral disorders would be very difficult to detect. There is an increased likelihood of anxiety and depression as a result of frustration in not being able to make themselves understood or as a reaction to unmet emotional needs. According to Autistica, 7 out of 10 autistic people have a mental health condition. The diagnosis of these is extremely important so that timely support and care can be given to these individuals in helping them develop coping skills. Autism co-occurring with sensory processing disorder poses a challenge in maintaining a healthy nutritional and hydration status of autistic individuals. Obsessive Compulsive Disorder coexisting with autism can heighten the already existing risk of anxiety and other obsessive behaviors leading to more stress and social exclusion. Autistic individuals already struggle with communication difficulties, added on by other learning disabilities can seriously affect their progress in developing their functional skills.
Certain mental health conditions like OCD and ADHD can not only co-occur with autism, but people with autism can also develop these conditions as a reaction to unmet emotional needs.
All in all, in my opinion, the biggest challenge is in the diagnosis of other conditions alongside autism because it is only after proper diagnosis, that steps can be taken to improve the quality of their lives. Treating other related conditions like epilepsy can in fact, also ease autism traits and help to somewhat lessen the cognitive and behavioral challenges that autistic individuals face in their daily lives.
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