Understanding Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is one of many disorders that have become more sensationalized than ever before thanks to social media. This has brought a lot of awareness, more acceptance, and at times, more misinformation or new stigma. Here, I will discuss the ways that the Diagnostic and Statistical Manual 5th edition, text revision (DSM-V TR) describes the criteria, in a more easily digested and comprehensible way, hopefully without the jargon and with helpful examples of each criteria. Additionally, in recent years, advocacy groups for Autism, disabilities, and neurodivergent communities have emphasized an approach moving away from the pathology and medical models, which is something I will attempt to emphasize here as well, while still acknowledging the needs for support, accommodations, and at times, treatment.

Criteria A: The Social Domain

Autism is often most visibly noticed in the social domain, at any level of diagnosis or support needs. The neurodiversity movement has brought attention to a new dichotomy, that rather than exclusively focusing on the social domain as consisting of deficits, that we can start to also view this domain as different instead. This should not be taken to ignore individuals with a higher level of communication challenges, delays, or other support needs relating to this domain. Here is how that might look:

Differences in "normal" social reciprocation. This might look like breaking from the usual social scripts, avoiding small talk, or differences in the typical rhythm. This may manifest as taking up more of the conversation time, staying silent or changing the subject when a response is expected, or missing social cues that others may easily catch and interpret. Social relationships may also be understood and interpreted differently, or there may be difficulties in understanding typical boundaries and expectations in general. Body language, eye-contact, and sharing of interests can all be exaggerated or reduced. Social anxiety or even social inhibition can be observed depending on the person, as well as eccentric behavior or reserved behavior.

At times, this domain can be difficult to interpret, as similar experiences and behavior can manifest in other disorders (social anxiety disorder, schizoid personality disorder, avoidant personality disorder, ADHD, etc.) and differences may simply be present due to personality, cultural, or upbringing differences. Seeking a trained professional is important to differentiate between disorders and simple differences!

Criteria B: Restricted or Repetitive Behaviors or Interests

This criteria involves the cognitive and behavioral, motivations/interests, and speech patterns. This domain is significantly impacted by differences in brain structure/functioning or sensory processing. This involves differences in brain development, which includes synaptic pruning (the process of brain development that removes certain connections in the brain and strengthens others) and differences in attention, executive function, and the brains ability to filter sensory information. Historically, behaviors associated with this domain was viewed as strange and as something to be fixed. With the neurodiversity affirming movement, they have framed associated behaviors with differences in processing, and as adaptive ways that the nervous system is coping with and making sense of an intense world.

This can involved a more intense and rigid set of interests, commonly described as special interests (or circumscribed interests in the DSM). Those with Autism can find themselves intensively interested in a small set of activities or areas of interest. Those who experience this describe an intense desire or passion to engage in these special interests, gather information, or gain mastery of these special interests. Special interests can serve the purpose of regulating and bringing joy or fulfillment to the Autistic persons life. This can also include a fixation on specific sensory input, such as an intense affinity toward a certain color or an intense appreciation to symmetry (and at times an aversion to things that are out of place).

At times related to a special interest, or other times more related to self-regulating behavior, an Autistic person may engage in repetitive behaviors. This can include repetitive body movements, such as fidgeting, rocking, swaying, rubbing body parts together, playing with hair, or even bodily focused repetitive behaviors (e.g. skin or hair picking). This can also include vocal behaviors, often described as echolalia. This can look like repeating certain lines, sounds, or speech of others. Another vocal behavior may involve something referred to as "vocal stims" which can be making non-speech sounds to self-regulate.

In times of intense distress, burnout, or a meltdown, repetitive behaviors may increase in frequency or intensity. This can be physically harmful self-injurious behaviors (head-banging), or increasing rigidity with an increase of frequency of the self-regulating behavior or speech.

This domain specifies a hypo-reactivity or a hyper-reactivity to external or internal stimuli. In any of the following areas, an individual may experience an abnormally intense or abnormally blunted response or awareness of the stimuli. This can include sounds, smells, lights, temperature, tastes, or textures for external stimuli. This can also include pain, hunger, arousal states, or awareness of other needs such as using the restroom. This list is far from exhaustive, and its extremely important to not invalidate an experience simply because it differs from our own.

Differential Diagnosis

The DSM specifies that these differences should be present or noticeable at an early developmental age. This is an important factor to consider, as it can help differentiate between trauma responses or other mood/personality disorders. The DSM also, as with every other diagnosis, emphasizes that these criteria should also result in difficulties or distress in coping with social or life demands. The severity of this is often encapsulated by the DSM's current approach to diagnosis, which includes a Level 1, 2, and 3 distinction, distinguishing by level of support needed. Finally, the DSM says that these symptoms should not be better described by an intellection disability or other developmental delay, but it is important to note that ASD and other developmental disabilities/delays commonly co-occur. All of this supports the need for seeking a comprehensive diagnosis and assessment process from a trained clinician, but also supports the need for clinicians to continue improving their awareness and competence in the nuances of this neurotype and the diversity of experiences and profiles that come with this.

Conclusion

Autism is a complicated phenomenon, with an extreme diversity of experiences and developmental differences. The autistic community continues to advocate for greater awareness, acceptance, and support of differences rather than stigmatization, stereotyping, and invalidation of experiences. It is extremely important to listen to trained professionals, but also giving space to the community and stakeholders. Autism is not something that can be "cured," and treatment typically includes goals of self-advocacy, self-awareness, skills training, and treatment of co-occurring challenges or diagnosis.