This article provides an overview of autism. Over the last decade, autism has has increased visibility in the media and the general public, and as such, it is very important to understand what it is. Because autism is so variable, it is somewhat difficult to define and describe; I am very careful to emphasize that not each of these characteristics affects every autistic person.
What causes autism?
The exact cause of autism is not precisely understood and continues to be researched. As with many things, the symptoms of autism can be traced to the brain. We know that an autistic brain, compared to a neurotypical brain, has a different arrangement of the synapses – connections and pathways. This leads to processing information differently. Additionally, other sections of the brain are formed differently – such as a larger sensory processing center and a weaker balance and coordination center. But, take all this with a grain of salt, because none of this is definitive yet.
It is usually thought that the origin of autism is a mix of genetic and environmental factors. Autism usually runs in families, and it is common for autistic parents to have autistic children.
How is autism diagnosed?
Autism is diagnosed by observation of behavior. A person might receive an autism diagnosis if their behavior closely matches the actions and symptoms associated with autism. The testing materials vary by age. A test usually includes a formal IQ test, an autism-specific test, and/or a developmental interview. In the autism-specific test, it can involve creative activities, play, or a verbal or written interview about how the client responds to situations and interactions. The developmental interview is meant for the parents to discuss early childhood milestones and development.
Because it is based on observation, autism diagnoses are subjective. Some people self-diagnose with autism if they believe the autism symptoms describe them. Autism can be diagnosed as early as 18 months, and has been diagnosed as late as 50s and 60s. The age at which symptoms emerge varies by person.
What are the core symptoms of autism?
First, autism is difficult to pin down. There are core symptoms experienced by nearly every autistic, and other symptoms that are common but not universal. Any of these symptoms, and the intensity, varies greatly from person to person. I can speak with some generalities, but every person is different.
One of the core symptoms, and probably the most well-known aspect of autism, is social interaction. Autistics usually do not know how to instinctively carry and hold conversations and social activities. Neurotypical people (non-autistics) intuitively learn the unspoken rules and norms of social interaction, but autistics do not. Autistics will find it difficult to engage in small talk, nonverbal communication, and group settings. They can find it challenging to form and keep friendships, and usually need to prepare scripts for social interactions. The meaning and purpose of the rules for social interaction need to be explicitly explained and might feel unnatural to an autistic. It is relatively common that an autistic person will hold values, opinions, goals, preferences, and interests that differ from that of the general population. Sometimes an autistic is indifferent to ongoing social interaction, and other times they feel lonely in a world that is confusing.
Another core symptom is sensory needs. Sensual elements will be either too strong or too weak. This can mean that sensory stimulation—visuals, audio, smells, tastes, and touch—will be overwhelming and more intense than for the average person. Autistics will commonly have specific preferences for the things they like or don’t like. Loud sounds, harsh smells, particular fabrics and human touch are often disliked. Due to these acute senses, autistics might be adept at detecting nuances in flavors, sounds, aesthetic patterns, and the like.
The last core symptom is self-stimulation, or “stimming”. Everyone stims to some extent – these are the self-soothing behaviors such as biting your nails, tapping your fingers or feet, crossing your arms, or brushing your face. Autistics are more prone to stimming as a natural reaction to overwhelming external or internal stimuli, serving to provide or negate sensory input, or evoke pleasure through motion. Autistic stimming is characteristically hand flapping or shaking, moving the head, rocking the body, or fidgeting. Stimming can also be verbal tics, like noises, laughter or crying. But it can be anything! Small plush toys or devices such as the fidget spinner or the fidget cube are very helpful in assisting the stimming response. As long as stimming isn’t harmful to the body, it is very important that an autistic be permitted to stim. Stimming is a physical feature of processing input and emotions differently.
What is meant by “autism spectrum”?
Autism is referred to as a “spectrum”, meaning that it has much variation. Our understanding of this has changed over the years. We used to describe people as high, medium or low-functioning. Additionally, the diagnosis Asperger’s Syndrome described a very high-functioning condition related to autism, but that has now been collapsed into the autism spectrum (some people choose to still use the term). We’ve been phasing out of these terms, because they don’t accurately reflect the autistic experience. It would imply that the severity of all autism symptoms was directly correlated with where you fell on the spectrum and your behavior and personality would be predictable. In reality, the mixture of symptoms and their severity is unique to each autistic. That is the true spectrum.
What are the other symptoms of autism?
These other symptoms are common to autism, but not universal. An autistic might experience these to a great degree, or not at all.
Autistics range in intelligence—some can be highly intelligent, others will have intellectual disability, and everything in between. Autistics have been noted for cognitive tendencies to observe and analyze patterns and fine details, owing to their sensorial processing. Sometimes they can be visual learners and think more in pictures than words (but I have met many who do not). Similarly, they can have an exceptional capacity for memory. They use these features toward their interests, which are commonly obscure or unusual. Autistics become passionate about their “special interests”, a source of satisfaction and fulfillment for them.
Some autistics are non-verbal, in that they cannot speak. It is important to note that this does not mean they have low intelligence or cognitive abilities necessarily—they can write, for example. These autistics use means to communicate such as technology aids, sign languages, or a system known as augmentative and alternative communication (AAC). While non-verbal means they don’t use words, they can use sounds and noises.
Autistics often have a blunt communication style, and struggle with telling lies or dishonesty. They are described as “literal-minded”. This “literal-mindedness” is more complicated than it might sound. It is portrayed as taking statements meant sarcastically or tongue-in-cheek seriously, or figures of speech as their literal meaning. It can mean that. But more specifically, it refers to defaulting to literal over symbolic descriptions. Example: I was in a circle where for an introduction, we were asked to use one word to describe our feelings. Some of the participants used words such as “elevation” or “receptive”. I said tired. I was thinking about how I had been feeling that day and my activities for the day.
This also means speech will be direct about perceptions and emotions, with less implied or idiomatic meanings. If an autistic learns symbolic speech, it can very well be understood or even used, especially if metaphors are helpful for visualizing what is difficult to describe. Likewise, autistics struggle with communication layered with hidden meaning or statements that express the opposite of the speaker’s real intent (e.g., “I’d love to hang out with you!” when you have no such desire).
Autistics usually prefer to have routines and structure in their lives, and expectations about what will happen or what they will do. Interruptions in those routines and unexpected changes can cause distress and overwhelm the brain. While autistics do not know most rules of social interaction naturally, they can be learned and applied well with practice. However, all this learning, methodical planning, and focus required of autistics to function, is very energy-consuming.
As stated before, autism usually comes with various behavioral quirks and perceptions. Some examples of how this can manifest: an autistic person might prefer friendships and relationships outside of their expected gender or age range. Young autistic children might display specific and unusual play patterns, such as repeated activities (lining up the same toys over and over), more solitary play and less imaginative play. Autistics usually struggle greatly with making and maintaining eye contact. The rhythm of speech and body movement might flow differently. They might struggle with understanding social concepts such as keeping obligations or maintaining cultural traditions, and motivated more by their interests than by social bonding.
Autism can sometimes affect physical health and physiology, too. This can mean poor motor coordination and muscle tone and low stamina. They are more prone to food allergies and intolerances such as gluten or casein. Autism very often co-exists with mental health or developmental issues such as depression, anxiety, OCD, ADHD, or selective mutism.
How do autistics live?
Autistics are very diverse, and some people go their whole lives without knowing they are autistic! Some autistics will always need care and supervision, either with a live-in aid, from their family members, or living in a group home. They need assistance with activities of daily living and communicate very minimally. In the past, this type of autism was the best-known, but this only represents some autistics.
Many autistics are capable of graduating high school and attending college, including earning doctoral degrees. They can live independently, or with roommates, and care for themselves. They can hold driver’s licenses and own cars. They can be employed. They can be married and have children. They can travel, including overseas and solo. However, I will note that while all these things are possible for autistics, they are still often challenging: many autistics do not drive, struggle with dating and sex, have difficulty with school, are unemployed or underemployed.
Having autism also means a greater degree of adjustment for daily living, such as clothing selection, food preferences, planning for social interactions, and devices for managing stimuli like loud sounds (e.g., noise-cancelling headphones) and the tendency to stim (e.g., fidget spinners, fidget cubes, stuffed animals). It is common for them to refrain from alcohol or other drugs and to avoid crowded and loud gatherings like parties, nightclubs, and concerts.
Demographically, autistics come from all backgrounds. They can be of any ethnic background, male or female, LGBT, and the whole range of political or religious affiliations.
How is autism treated clinically?
Not all autistics receive clinical therapy. For those that do, especially if they are young children, the most common has been Applied Behavioral Analysis (ABA). ABA takes place in one-on-one sessions with a clinician and in simplest terms, involves the repetition and performance of tasks by the autistic client through direct instruction and reinforcement to encourage compliance. For most autistic children who undergo ABA, it is frequent and intensive. ABA is very controversial in the autism community.
Alternatives to ABA available include the floortime method of play therapy developed by Stanley Greenspan. They attend social skills training classes or vocational training. They often have Individualized Educational Programs (IEPs) in school. They also use traditional therapeutic methods of CBT-based talk therapy or medications. The little-known Davis Autism Approach, the first autism therapy developed by an autistic man, will hopefully gain more traction in the coming years.