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What is autism? Who and how many does it affect? What are its symptoms? What are its early indicators? What does it mean, to be ‘on the spectrum’? What treatments are there? What benefits can autism bring? What causes autism? What do we know about it? What do we not know? What does autism tell us about the brain and how it functions?
What is autism? That simple question masks huge complexity.
Whatever it is impacts four to five times as many males as females, and is experienced by around one in 100 people. ‘Autism’ covers such a wide range of behaviours that any one definition seems utterly meaningless – some kind of working definition is necessary. Here it goes: ‘Autism is the word used to label behaviours that are outside the “normal range”, in social interaction and communication.’
Other definitions are available. For instance, this is from the National Autistic Society in the UK: ‘Autism is a lifelong developmental disability which affects how people communicate and interact with the world.’
What are the symptoms and early indicators of autism?
In babies, autism, is ascribed after the observation of several negative symptoms – the absence of expected behaviours at certain age milestones, such as: no reaction to eye gaze, or name by six months old, an absence of gesturing and babbling at 12 months, single words are not present by 16 months, and a paucity of double word phrases at 24 months.
People of all ages are given the label ‘autistic’ when there appears to be abnormal social interaction, and communication with others. It appears that autistic people either don’t process social signals, or process them differently from the rest of the population. It seems they do not read or respond to social cues. They are less emotionally responsive.
One of the many difficulties in understanding autism is disentangling it from the background of variance in cultural behaviours. For instance, Americans find British people to be emotionally unresponsive, but would probably not argue that all Brits are exhibiting autistic behaviours.
Autistic behaviour can also include: taking the statements of others literally and appearing not to understand abstract concepts. Here, too, there are problems. Young children typically take things literally, but seem not to be autistic. Brits often (falsely) note that Americans don’t get irony, (caused by taking an ironic statement literally) but no-one is saying that all Americans are autistic.
Some apparently autistic people repeat everything that is said to them. Here lies another problem: mental health professionals are trained to do exactly that; it is called ‘reflective listening’. Yet no-one is suggesting that all mental health workers are autistic.
Autistic people want to be alone when they feel overwhelmed by others. That also characterises introverts, those who prefer their own company, and do not put themselves forward in social situations.
Another supposedly ‘autistic behaviour’ which makes it difficult to separate what is going on from typical human variation is: not seeking support or comfort from others. That also characterises mavericks and other independent spirits.
Engaging in repetitive behaviour, that the autistic person finds comforting or calming, is something we all do. “We are creatures of habit” became a cliché because for so many of us, it is true; our habits, our repetitive behaviours give us comfort.
Some autistic people find change deeply upsetting. Have you ever seen any proposed change that many people didn’t complain bitterly about?
Another ‘symptom’ of autism is sensitivity to noise or light, or its opposite, lack of sensitivity to sound or light. Which of us has not been in an environment that we find distressing because ‘it is too loud’ or ‘too quiet for my liking’?
Anyone who achieves at an extraordinary level is highly focussed on their passion, hobby or area of expertise. That can also characterise autism.
Anxiety in unfamiliar situations, or in contexts that are not understood, also, is deemed to characterise autism. Again, that is common to most people.
Have you ever seen someone having a ‘meltdown’? Perhaps you have seen a sports star ‘losing it’, by way of shouting and screaming at a colleague, an opposing team member, or an umpire. Meltdowns are a relatively normal reaction to overwhelming frustration. Perhaps autistic people are just like everyone else, in their reaction to whatever internal challenges they face.
Almost everyone has experience another behaviour often associated with autism; the ‘shutdown’; being so overwhelmed that the person “freezes.” Again, it is so common that a cliché exists to describe it. ‘They froze’.
The point of comparing the behaviours used to diagnose autism to the behaviour of others, is that, in context, almost all of the behaviours that are used to diagnose autism, fall within the normal range.
It is behaviour that is not appropriate to the social and communication context that seems to indicate a different way of functioning.
It could be that many of the behaviours used to diagnose autism are entirely normal reactions to a different way of processing the world.
Earlier in this article you may have spotted the definitional problem: even specialists in the field can’t define autism in way that differentiates “it” from learning challenges, or long-term mental fitness difficulties. (That applies to my definition, too.) Indeed, where there are learning impairments or mental health challenges AND apparent autism, understanding what is happening is even more difficult.
Despite those definitional, and symptom differentiation problems, there does appear to be a pattern of behaviour with sufficient commonalities to justify the theory that we are looking at a discrete ‘injury‘ of some kind.
Even the use of the word injury is controversial when it comes to theories of the cause or causes of autism.
Are the differences labelled ‘autism’, actually an evolutionary adaptation? Perhaps autism is a product of epigenetics? Epigenetic theory suggests that the environment alters our genes in such a way as to pass on genetic benefit to the next generation.
The logical question, then: is autism a genetic variation passed on epigenetically? We don’t know. Is autism genetic? If so, is it directly inherited? We don’t know. Is it a rare genetic mutation? Or, is a multi-gene interaction of common genes? We don’t know. Is it cause by chemical injury during fetal development?
Many such possible chemical causes have been connected to autism, but again, we don’t have enough information to know. There is not enough evidence of the triggers for autism, yet, to say whether epigenetics, or indeed, any other theory, can accurately explain or partly explain autism, (whatever “autism” may be).
Frankly, we know more about what we don’t know. We don’t know if autism is structural, (connected to unusual brain structures), or process driven. That is, the brain structure is normal but the way the systems are working is different in some way, such as synaptic functioning. Could autism be based in some chemical imbalance?
Again, we just don’t know.
We have a closed loop knowledge deficit: we don’t understand enough about the effective functioning of the brain to be able to identify what is different in autism (if anything). And we don’t understand enough about autism to draw any inferences about the workings of the brain.
We do know this. For some people, whatever autism is (if it is one “thing”), it can be utterly debilitating; rendering someone unable to function in society.
What treatments are there? The idea of ‘treatment’ on a challenge whose causes and mechanics we don’t understand, seems more than a little ambitious. Any ‘treatments’, by necessity, are based on unproven theories. That does not mean they are completely ineffective, although evidence for efficacy is scant at best. Most “treatments” are based on teaching coping strategies to those who experience autism, and those who live with, or care for, those with autism.
What benefits can autism bring? Some people who are labelled as having a challenge ‘on the spectrum’ (colloquially meaning, they are thought to have mild characteristics of autism on the ASD – autism spectrum disorder), have extraordinary talents, that can and have improved the world. The cliched ‘computer geek’ or ‘maths genius’ are perhaps the most widely known of such ‘high functioning’ cases of suspected autism.
Autism, in its ‘high functioning’ forms can be an asset of huge value. Here are some of the people who have impacted ALL our lives who are thought to have had, or have publicly admitted having, some form of autism: Albert Einstein, Charles Darwin, Nikola Tesla, Leonardo da Vinci, Vincent van Gogh, Thomas Edison, Mozart, Beethoven, Jane Austen, Henry Ford, and Alexander Graham Bell. Elon Musk has reportedly stated that he has a form of autism, as it seems has Sir Anthony Hopkins.
If you do have some form of high functioning autism, you are in very good company.
Neuro-diversity, like most forms of diversity, seems to be part of the evolutionary spectrum, and even though it is clear that we do not understand autism, we can seek to include, accept and harness it.
What do you think of this prediction? If we can understand autism, we will be well on the road to solving that most intractable of all problems in science: understanding consciousness itself.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.