Autism refers to a broad range of conditions and is not a one-size-fits-all disorder. Autism spectrum disorders (ASD) are generally considered to be linked to atypical neurodevelopment and are therefore innate. Autism affects people their whole lives, although ASD manifestations can look different among individuals diagnosed, depending on their age, skills and environmental factors. Autism spectrum disorders are a diverse group of conditions and can vary according to e.g. symptoms and age of onset. This diversity is sometimes referred to as “autism spectrum”.
The autism spectrum is an umbrella term which attempts to describe the diversity of autism. For instance, the term “diagnostic criteria for autism spectrum disorder” is commonly used, and it is based on the international classification system in use at any given time. Today, account is taken of ICD-10 diagnostic criteria (international classification system), with ICD-11 soon to be implemented here in Iceland. With that change, diagnostic criteria for autism spectrum disorder will change considerably. Many countries use the DSM-5 classification system, in which autism definitions are considerably different from the ones outlined in the ICD-10 system. Furthermore, the autism spectrum sometimes refers to how it is perceived by autistic people themselves, describing their own symptoms and experiences. This spectrum is made up of numerous symptoms, perceptions and experiences, which cannot be explained with an image like a line, but rather with a wheel or clock face, similar to the colour cycle. ASD manifestations are like fingerprints – no two are the same, just like no two persons are the same.
Autism diagnosis is comprehensive, and it is important that it is conducted by an interdisciplinary team of qualified experts in autism. On diagnosis, the developmental history of the individual is reviewed, from birth to the present. Cognitive skills and language development must be mapped, and it must be ensured that accepted assessment tools for autism are used. A medical examination should be performed by a medical specialist, naturally followed by an interview with both the person who is undergoing the diagnostic process and his or her family (usually parents or partners). The diagnosis takes account of all data on development and well-being. The international classification systems in use at any given time must also be taken into account. Furthermore, it is important to be mindful of differential diagnoses and correlation because behavioural comorbidities are highly common in autistic individuals. Other behavioural disorders with high rates comorbid with autism are ADHD and anxiety.
The characteristics of autism can be best detected in social interactions and communications. Autistic and non-autistic individuals can have different communication styles, which can prove challenging. Non-autistic individuals seem to follow many unwritten social rules that autistic individuals do not have the skills for. A good example of this is the social skill of maintaining a conversation. Many factors play a role in conversations, e.g. body language, turn taking, correction of misunderstandings and deciding the subjects to discuss. Non-autistic individuals often discuss daily life, face the person they are speaking to and maintain eye contact meanwhile. However, autistic individuals are perhaps less likely to seek eye contact and are more interested in discussing facts, lists or special interests. There are also many autistic individuals in Iceland who choose to think and speak in English. Furthermore, autistic individuals often repeat their words and choose certain phrases or scripts they picture in their minds (known as “echolalia”). The voice tone of many autistic individuals can be nontraditional, at times with peculiar stresses or a monotonous voice. Individuals with autism can take the meaning of words literally and be inflexible in the way they think, affecting both understanding and expression. It can cause a misunderstanding in communications, especially when sarcasm is used. Many autistic individuals see and think in pictures; therefore, using illustrations, pictures and visual cues as a form of communication is often more successful than using spoken or written language. Whereas autistic individuals have nontraditional or blank facial expressions, exhibit atypical gestures and have a reduced ability to read other people’s body language, non-verbal communication can be a challenge. Eye contact is another example of non-verbal communication that autistic individuals sometimes use in a nontraditional way, either by limiting it or by staring into the other person’s eyes. A common denominator for many people with autism is that they struggle to make friends and maintain friendships. Unfortunately, victimisation is a common phenomenon and can result in mental health difficulties. It is clear that the protocol for autistic individuals is different from that of others, keeping in mind that it is not inferior in any way. Tolerance and understanding therefore play a critical role.
However, social communication difficulties are not the only characteristics of autism. It is also common for autistic individuals to have special or intense interests, exhibit repetitive behaviours and, commonly, struggle with sensory processing. The interests of autistic individuals can sometimes be age inappropriate; however, this is not always the case. A characteristic of the interests of autistic individuals is that they play a large role in their lives and seem to carry more weight than interests of non-autistic individuals. The personal strengths of individuals with ASD can generally be best identified in their interests. It is important that autistic individuals are given the opportunities to cultivate their interests; this can help them develop a positive self-esteem. Some individuals with autism often repeat certain behaviours; these can be simple behaviours, such as rocking back and forth or producing sound. These can also be more complicated longer term behaviours that interrupt daily life to a greater extent. This is sometimes referred to as “stimming”, a behaviour which many individuals with ASD describe as their way to calm or reset themselves. Autistic individuals tend to have a high need for sameness, and some changes can therefore be uncomfortable. It is important to use visual clues to prepare for the changes that are considered to cause interruption.
Many autistic individuals seek sensory stimulus, such as watching objects from a side angle, touching objects with certain textures or being drawn to a particular smell. Furthermore, many are hypersensitive to certain stimulus, particularly noise. Autistic individuals often describe this experience as painful, something which can have significant effects on their daily lives. Sensory processing can interrupt eating habits, this can mean both that the texture of the food can feel unpleasant and/or that the individual can fixate on one type of food. The diet of autistic individuals can thus be very monotonous. It is important to monitor the appropriate intake of vitamins and nutrition, approaching it with respect and understanding for sensory processing issues, and to find suitable solutions. Exposure to overwhelming stimulus can result in meltdowns, reactions to not being able to handle a situation. Much can be done to prevent dysphoria in autistic individuals, with understanding and tolerance for autism playing a crucial part. Various assistive devices are available, such as noise-cancelling headphones, weighted blankets, stress balls and much more.
As with other neurological disorders, autism is mostly an invisible disability. Many people with autism experience themselves as somewhat invisible or even intolerant of their own symptoms of autism. They therefore attempt to pass as neurotypical. Many refer to the act of “wearing a mask” as a way to better blend into the crowd, something which requires a great amount of energy and can encourage social isolation. Everybody needs to adjust their behaviours to environmental factors and to identify social situations in order to recognise the appropriate behaviour at any given time. In this respect, we are all trying to fit in and respond in certain ways. It can prove difficult, even impossible at times, for autistic individuals to identify situations. This is associated with a skill referred to as “theory of mind”, a theory which is considered by some to be the foundational cognitive component in autism. The ability to identify other people’s feelings and well-being is namely an important criterion for effective communication and being aware of surroundings. Autistic individuals have a hard time reading responses and realising that other people’s opinions and attitude can vary from that of their own. This is part of why communicating can be testing, and autistics experience this as though they emptied their energy supplies by trying to fit in. Attempting to hide the symptoms of autism tends to be more common for those with an IQ score around or above average and for women. Autistic women often see a direct link between hiding their symptoms of autism and experiencing anxiety or even burnout. Preventative measures should take account of this and promote understanding that people are free to be who they are.
Autistic individuals’ ability levels in strengths can often vary, depending on their skills and circumstances. They can excel in some areas, while not excelling in others. Sometimes, these areas relate to their interests, in which many immerse themselves, while they might have no interest at all in other things. Some consider that this relates to deficits in executive functions in the brain. It is believed that the prefrontal cortex is linked to cognitive control functions, such as self-control, cognitive flexibility and working memory. Executive function appears to be an underlying factor of many neurodevelopmental disorders, and it is yet to be examined more closely whether this sheds light on the different ability levels in strengths of autistic individuals. Central coherence is another cognitive theory that is believed to explain the ability levels in strengths of autism and the fact that autistic individuals are often experts in analysing details but lack an overall view. However, autistic individuals themselves have pointed out that the overall view is not an absolute truth, and thus it can be argued that while different, both perspectives are essential. Therefore, this is why there is no one theory existing today that can explain the complex condition of autism. It is important to focus on the strengths that many autistic individuals have and to examine whether the challenges that people with autism often face in society result from a lack of tolerance and understanding of human diversity.