Autism + Neurodiversity

Question 1

What are the traditional ways of thinking of autism in the medical diagnostic sense?

Answer 1

1) Difficulties in social interaction e.g. limited eye contact
2) Difficulties in (social) communication e.g. difficulty understanding verbal humour
3) Restricted interests or repetitive behaviours

These characteristics may be considered autistic but what makes them autistic is the pattern or combination they are present in the individual

Question 2

What are some confusing terms for ASD?

Answer 2

Classical autism: tends to be associated with very limited communication
Asperger syndrome: no history of any difficulty with language
High functioning autism: can be a history of language difficulty, but there is no difficulty at that point in time
PDD-NOS (pervasive developmental disorder not otherwise specified)

Question 3

Describe one area of diagnostic criteria for autistic disorder

Answer 3

• Social + communication characteristics are considered as one clinical aspect
  Persistent deficits in social communication + social interaction, across multiple contexts, as manifested by deficits in the following:
  1) Social-emotional reciprocity
  2) Nonverbal communication
  3) Developing, maintaining, and understanding relationships

Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning

Question 4

What are examples of deficits in social-emotional reciprocity?

Answer 4

e.g. abnormal social approach + failure of normal back and forth conversation
e.g. reduced sharing of interests + emotions
e.g. failure to initiate or respond to social interactions

Question 5

What are examples of deficits in nonverbal communication?

Answer 5

e.g. poorly integrated verbal + nonverbal communication
e.g.abnormalities in eye contact + body language or deficits in understanding + use of gestures
e.g. total lack of facial expressions + nonverbal communication

Question 6

What are examples of deficits in developing, maintaining + understanding relationships?

Answer 6

e.g. difficulties adjusting behaviour to suit various social contexts
e.g. difficulties in sharing imaginative play or in making friends
e.g. absence of interest in peers

Question 7

Describe another area of diagnostic criteria for autistic disorder

Answer 7

Restricted, repetitive patterns of behaviour, interests + activities, as manifested by at least TWO of the following:
1) Stereotyped motor or verbal behaviours or unusual sensory behaviours
2) Excessive adherence to routines + ritualised patterns of behaviour
3) Restricted, fixated interests
4) Abnormal responses to sensory stimuli

Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

Question 8

What are examples of stereotyped motor or verbal behaviours, or unusual sensory behaviours?

Answer 8

Stereotyped motor behaviours: e.g. hand flapping, lining up toys or flipping objects, echolalia

Unusual sensory behaviours: e.g. hypo or hyper accuses i.e. high or low sensitivity to noises, lighting, smells

Question 9

What are examples of excessive adherence to routines + ritualised patterns of behaviour?

Answer 9

Finding it difficult if routines or ritualised patterns of behaviour are disrupted
e.g. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day

Question 10

What are examples of restricted, fixated interests?

Answer 10

e.g. strong attachment to or preoccupation with unusual objects, excessively circumscribed or preservative interest

Question 11

What are examples of abnormal responses to sensory stimuli?

Answer 11

Hyper- or hyporeactivity to sensory input of unusual interests in sensory aspects of the environment
e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement

Question 12

What evidence is there that ASD is not linked to MMR vaccines?

Answer 12

Gerber & Offit (2009): Studies that fail to show association of MMR + ASD

Jain et al (2015)
- Retrospective study of 95,727 children in USA, all with older siblings
- Of those with older siblings with ASD, 134 had ASD vs 860 children with unaffected siblings
Receiving the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD - suggests that ASD isn’t caused by genetic sensitivity to MMR vaccines

Question 13

What is the autism spectrum?

Answer 13

Autism characteristics are also seen in the neurotypical population (Constantino & Todd, 2003)
- If you are high in autistic traits, there is a separate distinct subpopulation
vs
- Everyone is somewhere on the curve and its just the far end of the curve that is still continuous with the rest of the population - that is the model we follow now

Question 14

How many people are autistic?

Answer 14

Incidence: true rate (how many people are autistic in a population)
Prevalence: recorded rate (may be an overestimate or underestimate)

• There was a 787% prevalence exponential increase in prevalence of autism diagnoses in the UK between 1988 + 2018 (Russell et al., 2021), with estimates ranging from roughly 1% to 2% in England (O’Nions, 2023)

Question 15

Why is there more people with autism?

Answer 15

In one figure, incidence is constant but prevalence increases
- Better diagnosis?
- Change in diagnosis?
- Broader diagnostic criteria?

In another figure, incidence increases and prevalence also increases
- Something in the environment is making children have autism
- Prenatal injury / disease - vaccines / MMR?

Question 16

Is autism seen as a difference, disability or disorder?

Answer 16

• 2% of all people in the UK have a learning disability (PHE, 2023)
• 60-70% of autistic people in the UK may have a learning disability (NHS, 2012), although some advocacy groups provide lower figures
• 29% of people with learning disability in the UK are autistic (autistica.org.uk)

Question 17

Why should autism not be considered a disorder?

Answer 17

• More people with autism spectrum conditions are promoting the view that autism characteristics are just differences rather than deficits
• Differences include avoiding eye-contact, preference for being alone, insistence on sameness, repetitive play, restricted interests
  None of these need be considered a disorder!

Question 18

What is the difference between a disability and a disorder?

Answer 18

Equality Act 2010: Disability is a ‘physical or mental impairment that has a ‘substantial’ + ‘long-term’ negative effect on your ability to do normal daily activities’

• ‘substantial’ -> more than minor e.g. takes longer to complete a daily task
• ‘long-term’ -> 12 months or more e.g. breathing condition that develops as a result of a lung infection

APA: Disorder is ‘a group of symptoms involving abnormal behaviours or psychological conditions, persistent or intense distress, or a disruption of physiological functioning

No obvious meaningful distinction here

Question 19

What are the downsides to autism?

Answer 19

• Some people with ASD feel alienated + misunderstood. Can feel frustrated by the barrier that their condition puts between themselves + neurotypicals
• Its common for children with ASD to be bullied, as bullies often single out children who are different (Cappadocia et al., 2012)
• People with ASD feel frustrated + upset daily, especially when routines are broken or expectations are not met

Question 20

What is the medical model and the social model?

Answer 20

Medical model: things are going wrong because the autistic person is behaving or feeling differently

Social model: things are going wrong because the people around the autistic person are behaving in a way that is not well-matched to the needs of the autistic person

To understand autism in a more holistic way, we should consider both

Question 21

How does improving communication consider both medical + social models?

Answer 21

• 25th October 2016, study (by Pickles et al., 2016) of 152 children with ASD, aged 2 to 4 years
• Twice a month for 6 months, parents watched videos of their interactions with their children. A therapist paused the video periodically to discuss methods the parents could use to better engage their children + boost their communication skills
• 6 years later, among those in the intervention group, 46% were considered to have “severe” autism. That proportion was 63% in a control group

Its training the parents, not the kids. The intervention is on the parents. Its about helping them to be sensitive to the needs of their children who are autistic

Question 22

How does peer-mediated programs consider both medical + social models?

Answer 22

Interventions where the intention is to change the autistic people but they are doing it via changing the behaviours of their peers by the social context - the intention is to change the system as a whole, both the individuals + their friends

Watkins et al., (2015): Reviewed many peer-mediated interventions in fostering social interactions between autistic + non-autistic students in inclusive settings

Findings:
- improved social skills: Non-autistic peers who received training showed improved communication + social engagement with autistic classmates
- Increased social inclusion: Autistic students reported reduced isolation + a greater sense of belonging in classrooms where peer interventions were implemented
- Long-term impact: Positive social interactions continued beyond the intervention period, with changes in peer dynamics sustained over time

Study doesn’t look at the impact of peer training on academic performance

Question 23

How does peer sensitivity training consider both medical + social models?

Answer 23

Intention is to just change the behaviours of the people around the autistic people - not trying to change the behaviour of the autistic people at all

Roberts & Simpson (2016): Paper reviewed many peer awareness interventions + their effectiveness in increasing understanding + acceptance of autistic students in schools

Findings:
- Positive impact on social interaction: Programs that involved interactive learning e.g. roleplaying, empathy-building exercises, showed greater success in fostering positive peer relationships + improving social inclusion of autistic students
- Reduced stigma: Increased likelihood of autistic students being included in group activities + social interactions
- Varied program effectiveness: Ongoing programs have a greater long-term impact