Autism refers refers to a wide range of challenges with social engagement, repetitive behaviors/"sameness" and sensory sensitivities. It is known as Autism Spectrum Disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text-Revision (DSM-V-TR). The older DSM-IV-TR separated autism into other categories such as autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. These categories no longer exist and are merge into one collective whole.
There is no one type of autism and each individual with autism shares varying strengths and challenges. Broadly speaking, individuals with autism are impacted in 3 main domains: social communication/interactions, repetitive behaviour and sensory sensitivities. The range, depth and scope of these challenges for each domain varies from individual to individual. Challenges in these areas do not mean that an autistic individual cannot perform, for example: an individual cannot make friends, cannot socialise and cannot make eye contact, however, what is impacted is the quality of it, an internal sense making.
Social communication/interactions Autistic people have difficulties with making sense of both verbal and non-verbal language like gestures or tone of voice. Some autistic individual are unable to speak or have limited speech while other autistic people have excellent language skills but struggle to understand sarcasm and jokes. Individuals with autism may take things literally and appearing quite matter of fact. Autistic individuals may struggle to 'read' and understand others or social cues, understand and recognized the intention and sometimes feelings of others and express their own feelings. These can make it hard to connect with others.
Repetitive behaviours Routines and repetition helps autistic people cope with the various social and life demands as it can be very confusing and scary. They may prefer to wear the same clothes, eat the same food, go to school or work the same way, have a strict sleeping pattern, etc. Autistic individuals may also repeat movements such as repeating hand movements, rocking/swaying, opening and closing doors, lining up things, having intense interest in things and hobbies, etc. Changes in these predictabilities can be very distressing and anxiety provoking. Autistic individuals not only do these things to calm themselves but they may actually find it enjoyable and fun.
Sensory sensitivities Autistic individuals experience the world in a different way. They may have under or over sensitivities to sensory input such and touch, sound, lights, smell, taste, temperature, pain, movement, etc. For example: Attending a concert may be difficult for an autistic individual as the lights may be too bright, the movement of the crowds too much and the sound being loud. Sensory sensitivities coupled with social communication challenges may make an autistic individual appear cold, uninterested or avoidant. However, this is not truly the case as an autistic individual may just be overwhelmed and that they have a different way in making sense of the world.
According to Autism Spectrum Australia, it is estimated that 1 in 70 Australian are on the autism spectrum. The Centre for Disease Control & Prevention (CDC), which is an arm of the American Health Department, reports that about 1 in 44 children have been identified with autistic. Autism is suggested to be more common in boys than girls, 1 to 4 ratio. However, there is current early evidence that suggests that girls are often under-reported due to cultural and role expectations. The current cause of autism is unknown, however, genetic factors have been identified. Siblings have a 35% higher chance of developing autism.
It is very normal for older children and adults to learn how to cope with autism, this is called “masking”. Masking is often an unintentional or subconscious coping mechanism. This is so that autistic individuals can appear to be 'normal' to others and be accepted - we all want to fit in, belong and be accepted. Individuals with autism will tell you that it is difficult, challenging, tiring and that “it [people or social engagements] just does not make sense” or “I just don’t get it”. Masking may look like: making eye contact, mimicking behavioural gestures, making smiles and facial expressions, hiding or minimising personal interest/passions, utilising well-rehearsed responses to difficult questions, having increased social interest in others – hyper-awareness of the feelings of others, hiding ‘stimming’* behaviours, pushing through intense sensory discomfort, etc. As you may have noticed, these appear to be normal social interactions. However, autistic individuals do genuinely struggle deep inside. It can be tiring, confusing and anxiety provoking.
*Stimming is short for self-stimulating. It is an emotional regulation mechanism, often unconscious. When someone with autism feels a sudden rush of feelings, that energy needs to go somewhere. Stimming provides an outlet for that energy.
Cultural and gender expectations may often “hide” the autistic challenges. For example, a 10-year-old Caucasian girl who has a very strong interest in unicorns and can name the different types of fictional unicorns can be seen as being passionate about unicorns and normal. This may not necessary be the case as it could be a form of masking to hide her strong interest for repetitive behaviour and ‘sameness’ in a socially and gender accepting way. She may not even be aware that she is hiding it due to gender expectations. She may struggle in other domains such as being poor in math (developmental delays are common co-occurring features in autism), does not like mashed potatoes (sensory to texture), “flips her lid” on weekends (non-routine from school), goes into a meltdown state when she is late for school (non-routine) and rocks herself when she is angry (stimming behaviour). She may have many friends and could tell you how Group A dislikes Group B and that she is actually friends with both groups. Again, this may be a form of masking by “flitting” between groups to hide the struggle to socially engage and connect in a meaningful way – she may be alone inside or not be aware that she is alone.
The above scenario could be seen as ‘growing up issues’ or 'childhood issues'. Autism may be missed as the problems described are not appearing to be distressing to the individual or not appearing to cause distress to others. Autistic individuals like these are sometimes called “high functioning autism” as they can still function quite well in society despite struggling with autism. However, the struggles and internal challenges are very real for these autistic indivduals. Their strengths and passion can elevate them to be very good at what they do due to their “strong interest” and “hyper-focusing”. However, they may struggle with an inner sense of restlessness as they may not understand how autism works - “I don’t get it why others are…..”, “Why do I keep doing these behaviours and routines…..”, “I feel no one gets me….”, etc. This coupled by the fatigue of masking often results in a higher prevalence of depression and anxiety challenges.
If you believe you or someone close to you are struggling with autism, it is important to talk about it. Hiding it often makes things worse. There is a growing movement and understanding called “neurodivergence” which reflects and encourages the acceptance of those struggling with neurological difference deserving the same rights, respect and acknowledgment. If you are concerned about yourself, please do reach out and speak to a professional who is well versed in autism.
AURE: Psychology, Counselling & Therapy currently provides autism assessment for children and adults.
* Person-first language puts the person before the factor/condition (e.g. individuals with autism), while identity-first language acknowledges and emphasizes the identity, factor or condition as a fundamental aspect of the person (e.g. autistic individuals). Both approaches aim to be respectful, and the choice between them often depends on individual preferences and the preferences of the communities involved. I have used an identity-first language as many people in the autism community prefer this as they view autism as a central and important part of their identity and would like to be proud about it.
Disclaimer: The material on this blog is not to be used by any commercial or personal entity without expressed written consent of the blog's author. The article above is an opinion of an individual clinician and should not be taken as full clinical advice. The statements on this blog are not intended to diagnose, treat, cure or prevent any mental health or mental illnesses. Always consult your doctor for medical advice or seek professional therapy.