2:29am July 12, 2014

Revised alternative autism criteria

This continues to be a side-project of mine. I sometimes really wish it was the 1800s and I could just up and declare myself a scientist and doctor and everyone would go with it. I’m planning to take these to my (autism-specialist) therapist tomorrow. I’ve done a bit of revising, added a few points, and clarified the impairment bit. Thoughts?

A. Differences in perception (at least 3)

1. Sensory defensiveness (ie, complaints or avoidance of any of the following: loud noises or places, bright lights, textures (food or object/clothing), tastes, smells, touch)

2. Sensory seeking (ie, stims or stimming behaviour such as rocking, flapping, finger flicking, hair twirling, spinning objects, etc or actively desiring any of the following: deep pressure or touch, vestibular sensation [swings, spinning in any context, etc], specific smells, tastes, or textures)

3. Auditory processing difficulties

4. Unusual, awkward, or delayed motor skills, or asymmetry between gross and fine motor skills (ie, clumsy but with strong fine motor skills, good gross motor skills with poor hand-writing or table skills, strong skills in a special-interest related area but poor overall [such as an ability to manipulate small objects but poor handwriting])

5. A reduced or lack of conscious awareness and/or use of allistic (not autistic) nonverbal behaviour and communication such as facial expression, gesture, and posture. This criterion should not exclude persons who have learnt to read or otherwise comprehend nonverbal behaviour by rote learning, particularly adults. Intentional learning to overcome an inherent difficulty in comprehension is supportive of this criterion. It should also not exclude persons who have been taught to use nonverbals to be less visibly different. In such cases, internal report of difficulty should take precedence over apparent behaviour.

B. Differences in cognition (at least 3, one of which must be 1 or 2)

1. Difficulty in beginning or ending (at least 1):

Perseverative thoughts or behaviours

Needing prompts (visual, verbal, hand-over-hand, etc) to begin or finish a task

Difficulties planning complex activities

Catatonia

Difficulty switching between activities

Lack of apparent startle response

Preference for sameness (same food, same clothes, same travel routes, etc)

2. Difficulty in using language (at least 1, not necessarily present at all times):

Problems with pronoun use that are developmentally inappropriate

A reduced or lack of awareness of tone in self (ie, speaks in a monotone, childish, or otherwise unusual manner) and/or others (ie, does not perceive sarcasm or follow implied prompts, responds to rhetorical statements and questions in earnest)

A reduced or lack of awareness of volume (ie, speaks too loud or too quietly for the situation)

No functional language use (includes sign, PECS, spoken, written, and any other communicative language regardless of form)

Echolalia

Mutism in some or all situations

Uses scripts instead of spontaneous language (these may also be delayed echolalic in nature)

3. At least one special interest in a topic that is unusual for any combination of intensity (ie, does not want to learn/talk about anything else, collects all information about the topic) or subject matter (ie, unusual, obscure, or not considered age appropriate). Topics may be age appropriate and/or common (such as a popular television show or book), but the intensity of interest and/or specific behaviour (such as collecting or organising information as the primary focus) should be taken into account.

4. Asymmetry of cognitive skills

5. Talents in any pattern recognition, including music, mathematics, specific language structures, puzzles, and art (any one meets this criterion, not all must be present)

6. A tendency to focus on details instead of the broader picture, across contexts.

C. These differences cause impairment and/or distress in at least one context (ie, school, work, home), which may be variable over time. Impairment or distress may be defined variably, including meltdowns, anxiety, depression, a pervasive sense of not fitting in, and compulsive behaviours. It is necessary to remember that while the symptoms are not necessarily disabling in themselves, the social response to these symptoms can be disabling. The impairment or distress may be historical, with appropriate evidence to support this claim (ie, a documented history of meltdowns as a child, and only mild anxiety as an adult), as distress may decrease over time and with education.

D. Symptoms should be present in early childhood, but may not be noticable until social demands outpace compensatory skills, at any age

I probably would have a lot of commentary on this. But one of my biggest ones is the focus on auditory processing difficulties above all other sensory processing difficulties.

Visual processing difficulties are extremely common in some parts of the spectrum. I have such severe visual processing difficulties that I’ve sometimes had doctors spontaneously describe me as ‘low vision’ even when my corrected acuity is close to perfect. I’ve wished I could learn cane travel because I sense things physically much better than I sense them visually, but I get so much shit already that I don’t want to add “sie uses a white cane even though sie doesn’t need one” to the list of BS people say about me (although honestly it would be helpful to pull out while crossing streets, because I can’t see when cars are about to hit me and that’s one valid use of them, as a warning). I can go actually completely functionally blind very easily, everything just turns into colors and shapes or even pixels. This is extremely common among some subsets of autistic people, some of whom have very good auditory processing. (I have auditory processing problems, it just doesn’t suck as bad as my visual processing.)

And there are other senses besides hearing and vision, too. I seem to be best at smell and tactile-kinesthetic feedback, followed by hearing, and vision is the worst. But in some cases I do better with visual things anyway because they stay still and let me examine them over and over, whereas auditory things vanish instantly. So I read better than I hear words, usually. (Except at times when I can’t read, but at those times I use a screenreader.)

At any rate… I don’t like the bias towards auditory processing difficulties because it feels like a bias towards one particular type of autistic person who just happen to be the most likely to be able to talk about what the problem is widely enough to get it recognized.

Still these are better alternative autism criteria than I’ve seen in awhile. I wouldn’t want them to be the official criteria, but I like them better than the official criteria anyway. It would be nice for there to be some kind of hybrid.

Notes: