2:06pm August 21, 2014

"Autism is a spectrum"

Whenever I write posts about autism, someone will reblog with a comment along the lines of “you have to remember that autism is a spectrum, ranging from extreme cases to mild Aspergers.” Here is a recent example.

It’s true that autism is a spectrum, but it’s not a spectrum of severity from low functioning to very mild. Autism is much more complicated than that.

There are a number of things that go into autism. It’s a combination of impairments in cognition, communication, sensory perception, and movement. These impairments combine in different ways. And “high functioning” and “low functioning” don’t accurately describe any of them.

All autistic people are disabled in significant ways, and it’s not always obvious how. There are a lot of stereotypes, and they’re misleading.

When Aspergers syndrome and autistic disorder where separate diagnoses, the primary difference was whether someone developed expressive language before or after the age of three. That doesn’t tell you anything important about their abilities. (Which is one reason they’ve been combined into Autism Spectrum Disorder into the DSM-V.)

One way stereotypes can be misleading: some nonspeaking autistic people have significantly better language comprehension than some autistic people who speak. (And you can’t tell from affect either: A student who spends all day rocking in a corner might be understanding significantly more than a student who spends all day sitting still at a desk.)

Autistic impairments can also change over time, or in times of stress.

Someone you think has “very mild Aspergers” may well have no ability to understand language when they’re upset. They may have severe auditory processing problems and be unable to watch TV without captions. They may be physically incapable of walking across a crowded room. They may have very little voluntary motion and be dependent on prompts in their environment. They might not be able to initiate interactions or independently tell you that they are injured or sick.

Not all autistic people do the thing I described in my post on noticing when repetition is communication. (And not all autistic repetition is for this reason). But it has nothing to do with severity. When an autistic person repeats the same thing over and over in a conversation with you, it’s very important to consider the possibility that they’re trying to communicate something but don’t currently have the words to get you to understand. This is true even if they live alone and five minutes ago they gave a complicated lecture on physics.

tl;dr Autism is a spectrum, but it’s not a simple severity spectrum.