The truth about autism
It was World Autism Day this week, and it set me thinking about how we all see autism. A few years ago, if people had heard of autism, it was courtesy of Dustin Hoffman's Oscar-winning portrayal in the 1988 film Rain Man. While Hoffman's portrayal is remarkably accurate, there is a vast spectrum of symptoms and no one person fits them all. Raymond may be a maths genius, but by no means all people with autism have a 'special gift' in one area. These days, the success of the book and play 'The curious incident of the dog in the night time' has also done much to further public understanding of autism - but even this is not the whole picture.
Autism comes in a huge variety of shapes and forms - that's why it's often referred to as the autistic spectrum disorder. At one end of the spectrum are people with very severe autism - their disability is usually obvious, because their behaviour is completely at odds with what society considers 'normal' or 'acceptable'. They may have limited speech or no speech at all, learning disability, and may get aggressive if they feel threatened.
At the other end are people with milder forms of autistic spectrum disorder, sometimes known as Asperger's syndrome. In the past, they were often not diagnosed - they were just the socially awkward kid that the cool kids were embarrassed to be seen with. People with Asperger's syndrome don't have learning disabilities - in fact, they often have above-average intelligence. But they still have difficulty with reading and responding to social cues.
Autism can affect three main areas:
- Social communication
- Social interaction
- Behaviours and interests, such as very rigid, fixed patterns of behaviour that are often repetitive.
Most of us take social cues for granted. We 'read' other people's behaviour - if someone is friendly, or irritated, teasing or being sarcastic. We understand jokes (well, mostly) or when someone wants us to back off or offer them comfort. People with autism find it difficult or impossible to do any of these things. As a result, they might invade someone's personal space when they're standing with them; talk about inappropriate subjects; or seem to have no sympathy when others are having problems.
This means that often people with autism have problems making and keeping friends (or jobs). People with Asperger's often desperately want to fit in, but just don't 'get' why others avoid them. This can be very distressing for them.
People with autism describe routine as being very comforting and find any change from their routine upsetting. If they have been taught that a certain way is the 'right' way to do something, they may believe this is the only way to do it. Dustin Hoffman's character in Rain Man had to watch the same TV show every day, and go to bed at the same time. I have a patient who cannot bear to see cups and plates out of alignment. He will go up to strangers in a coffee shop and try to 'tidy up' their table. Children with autism may spend hours lining their toys up, but have no idea of how to play 'let's pretend' with them.
People with Asperger's syndrome may not have obvious repetitive patterns of behaviour, but they struggle with social imagination. They may have no problems with maths and logic, which have very definite rules. On the other hand, they might find it impossible to come up with possibilities for what might happen next in a certain situation - blue sky thinking is a completely alien concept.
Because they find interpreting the world around them so difficult, they can often feel overwhelmed or anxious. They may suddenly go off on their own, or cover their hands with their ears. They may also be over-sensitive to sounds, touch or sights.
Autism is common - about one in 100 people in the UK are affected. Boys are diagnosed far more often than girls, but it's not clear if this is, in part, because it's more easily spotted in boys. Certainly at least part of the increase in diagnosis in recent years is down to more awareness and better detection.
While autism can't be cured, there are lots of therapies that may help with development and learning. In the meantime, we can all do our bit. It could be as simple as stopping to ask yourself why that person is behaving 'oddly'. Could you have a bit of patience with them, rather than dismissing them or steering clear? If we all stop to think, maybe we could be part of the solution rather than part of the problem.