Autism is a neurological disorder that we’ve only just started to begin to understand in the last thirty years. While classic Autism was first recognized by Dr. Leo Kanner in 1942, it had a very narrow scope. Dr. Kanner’s first description of autism is about people being aloof and distant, but there is much more to it according to Dr. Raja Mukherjee, who is the Adult Autism and ADHD clinical lead for SABP NHS Foundation Trust:
“When we talk about Aspergers and Autism it is based on studies that are now 30 years old. Then there is a whole nother chunk of 20-30 years worth of research/studies that show that it doesn’t make sense to say that there is Aspergers or infantile autism or atypical autism. This is because you have a bit of A, B, and C but don’t have D and F and it all kind of merges together. Everyone is all sort of interlinked and it’s messy. However, in order to have autism you must have the 3 core components that people originally talked about in terms of autism; that being restricting repetitive patterns, behaviors, and social communication.”
When Dr. Mukherjee was first trained he was taught that 70% of people with autism would have an IQ below 70, 50% would have an IQ below 50, and anything above that was a minority group.
“Now we know that this is actually probably the other way around. Whilst the more intellectually disabled you are, that is – the more brain damaged you are, your social communication aspects of your brain and the pathways are interfered with and you are more likely to have a social communication disorder. When it’s of a certain nature and degree you will be autistic. We know that the more brain damaged you are the more likely you are to be autistic. The difficulty is, the more intelligent you are, the harder it is because you find ways of dealing with life. You find ways to mask or camouflage your symptoms.”
Dr. Mukherjee
By definition, high functioning individuals are highly intelligent. They are usually able to imitate those around them so that they fit in, even if they don’t realize they’re doing it. This makes them chameleons of a sort. This is how Ashton Nicholls, who is now 17 years old, wasn’t diagnosed until he was 13. Ashton was extremely good at mimicking other people’s behaviors. However, the unwritten social rules, invisible context, thoughts and feelings of others, are lost on these individuals. They don’t understand the intent behind these behaviors unless they’re blatantly obvious. People on the spectrum have trouble reading “social contexts” that help you to understand a behavior and why someone is doing what they are doing.
Why does social interaction exhaust those with autism spectrum disorder? This is because social communication is a core deficit for those with autism. They really struggle with reciprocal interaction.
“ Reciprocal interaction – the way I describe it – is like a coffeeshop, pub, or just an enjoyable evening with somebody – if you can do that and it’s pleasurable and you’re not constantly thinking about what to do and it’s two-way about a whole load of stuff – that’s a reciprocal conversation.
If you go somewhere and you talk about Liverpool FC and that is all that you can talk about that’s not reciprocal. You need to talk about COVID, you need to talk about life, employment, you need to talk about a whole range of stuff and it goes from one to another and you have a conversation and it’s pleasurable.
If you’ve had friends over and you say I really had a good night tonight I really enjoy that, it is highly unlikely that you’re autistic – unless of course you were sitting there thinking what’s the next question? How do I answer that? Why is that person looking like that? If you are constantly thinking and doing it cognitively, that is not natural, that is not a typical way in which people process information.
So if you are having to do that and constantly thinking what’s the next thing how do I look and you’re using your brain and intelligence to do it – that’s your high functioning bit – that isn’t a typical approach. It is not truly reciprocal. If you talk to most typically functioning individuals if they go out and meet some friends and have an evening together they say that was enjoyable and I relaxed doing that – but someone with autism will go home and say wow, that was exhausting I really had to think through everything.”
Dr. Mukherjee
People with Autism are constantly having to cognitively think much more than the average person. They do not read body language in a typical manner. They have to consciously dissect what a person’s doing, what they’ve said, how they’ve moved, and what it could all possibly mean. They have to cognitively think about all those things versus a natural emotional empathetic understanding of how or why a person looks or is acting a certain way. Because they have to use their brains so much more and constantly think through everything by the time they get home at the end of the day they are utterly exhausted. That’s the nature of the beast.
What can you do to help someone with autism and create lasting relationships? You have to be willing to adapt. Because individuals with HFA do function a little better, people expect more of them. You have to remember that they are still autistic and they are working much harder than the average person to get by. You have to understand each individual’s autism and make the adjustments that they need, because at the end of the day they are still unique individuals.
“People with autism do have relationships. It’s just that the other person has to make accommodations for them. You have to be willing to make enough adjustments that you are able to bring out the best out of the other person. If you are looking for someone who is going to be totally empathic and get you without having to be told, forget it. But if you tell them explicitly I need you to do this, they often get it done. It’s about how you adjust to the other person. Is it high functioning vs low functioning? I think it’s about understanding the person with autism as an individual and each person is different.”
Dr. Mukherjee
Dr. Mukherjee also added,
“If there was one thing I would say about anyone who is autistic is that they are all their own different individual. You can take some general approaches but then you have to adapt it to that individual. You need to think “what it is that person does and needs?” If they struggle with something then you have to adapt to that need. If they need to be warned the day before an event, you remind them. Similarly, if someone can deal with some change but not the anticipation, then you do not tell them. It’s about that individual person and how they function best. Understanding that if someone is overstimulated and has socialized a lot, they may need that hour alone to decompress when they get home. Let them have that hour, who cares. That’s the kind of accommodation and adjustments that we’re talking about. This is a reasonable adjustment. You have to understand the person and how they function, and then you adapt to it to allow them to function at their best. It’s like someone who is diabetic. You wouldn’t say to them, “actually I’m not going to let you have your insulin now because I think you need to go out and do this first.” You would never do that because it’s physical health, nobody ever questions it. But because autism is neurological and you cannot see it people think “why can’t you do it like everybody else does?” It’s because they are not the same as everyone else. You cannot see their disability. It’s hidden. Families need to understand you and your autism and adapt to it.”
Under My Skin 