Autism – Good to know

According to the current classification systems, autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by qualitative impairments in social and communicative development as well as restricted behaviors, interests and activities (DSM-5, American Psychiatric Association, 2013; ICD-11, see Freitag, 2011). It is currently assumed that autism has a neurobiological basis and a strong genetic component.

Why are autism disorders on a “spectrum”?

Autism is described as a spectrum because autistic people are very different from one another. It ranges from people with less autistic characteristics in their behavior and experience to people who are more severely affected. But the focus of autistic symptoms, their difficulties and strengths, are also very different. Some have particular sensory difficulties, others require particular routines. No two autisms are the same. It is also important to note that there is a wide range of intellectual and linguistic abilities on the autism spectrum. They should therefore also be taken into account in the diagnosis according to ICD-11. Some people with autism function well in many areas of life through exceptional effort, so their difficulties may not be obvious to others. However, the symptoms usually lead to significant impairments in important areas of life, such as personal, educational or professional development. (Happé & Frith, 2020)

When can autism be diagnosed?

Symptoms must begin at early stages of development, but often only become apparent when the demands of the environment exceed the compensatory abilities of the person affected. Autism can be detected by qualified clinical professionals in children as young as 18 months of age, and a reliable diagnosis can be made at around 30 months of age (Gillberg et al., 1996). Early signs of the disorder, such as reduced eye contact, can appear as early as the first year of life (Jones & Klein, 2013). In recent years, the importance of early diagnosis and intervention has been highlighted by the availability of early diagnostic tools such as the M-Chat (Modified Checklist for Autism in Toddlers) or the CARS (Childhood Autism Rating Scale), as well as checklists for parents offered by autism organizations (e.g. Autismus e.V.).

What criteria must be met for a diagnosis?

For an autism diagnosis, special features must be present in the three symptom areas of communication, social interaction and repetitive-stereotypical behavior. In the areas of communication and social interaction, the characteristics often manifest themselves in the form of reduced social-emotional reciprocity. For example, there is not necessarily a normally regulated back-and-forth conversation; emotions or affects may be shown or communicated differently; initiation or response to social interactions may fail.

Communication may focus more on immediacy and less on content conveyed through idioms. There may also be less evidence of non-verbal communication (e.g. less or no eye contact and no body language or limitations in understanding and using gestures and facial expressions). In addition, people with ASD may have difficulty developing, maintaining and understanding relationships (e.g. when it comes to participating in fantasy play or adapting behavior to different social contexts). In addition, there may be difficulties in making and keeping friends, or a seemingly general lack of interest in peers.

What behavioral patterns can occur?

The final symptom area of restricted behaviour patterns, interests and activities is characterized by repetitive movements, use of objects or language (e.g. rocking the upper body forwards and backwards; lining up toys or turning objects over; echolalia; idiosyncratic phrases such as “hot rain” instead of “steam”). In addition, there may be a desire for or insistence on repetition, sameness, or ritualized patterns of behavior (e.g., the need to walk the same route or eat the same food every day), along with highly restricted, fixated interests that are unusual in their intensity and orientation (e.g., strong attachment to unusual objects; overly restricted interests). In some cases, those affected acquire unusual knowledge or skills. There may also be hyper- or hyporeactivity to sensory stimuli (e.g. apparent indifference to pain/temperature; negative reaction to certain sounds and textures) and unusual interests in sensory aspects of the environment (e.g. excessive smelling or touching of objects; visual fascination with lights or movement).

Neurodiversity

It is important to note that the long-held assumption that behavioral features of autism indicate a lack of social interest or social motivation lacks consistent empirical support and should be abandoned - at least in its general form (Jaswal & Akhtar, 2019). Rather than focusing on a disorder-based perspective that interprets autistic behavior as negative due to its deviation from a norm, we are currently seeing and actively promoting a paradigm shift in autism research to better address the shortcomings of the traditional deficit-based model. In particular, there is an increasing amount of research that focuses on neurodiversity in the context of an individual differences perspective (Pellicano & den Houting, 2022) and on problems arising from the frequent misperceptions of autistic people's social behavior by neurotypical people (Mitchell et al., 2021). Overall, these considerations support the focus on reciprocity and mutual social interactions that we are pursuing in the Social Potentials in Autism research group.