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Post No.: 0727difficulties


Furrywisepuppy says:


This is my last foreseeable post on the enlightening journey we’ve undertaken towards better understanding autism. We studied the possible causes of autism not long ago in Post No.: 0719. This time, we’ll take a look at what can be done to help autistic people, whether a diagnosis is always beneficial, and finally what we currently know we still don’t know about the condition.


Since the presentations and difficulties of those on the autism spectrum are highly individual – what can be done to help them will necessarily be individual too. But common things include predictability and structure – make reasonable adjustments to make spaces organised, predictable and consistent. Manage this across the different settings that they’ll be living in, working in or socialising in.


Manage the level of arousal in an environment – in most cases we’re not talking about removing all stimulation. Autistic people don’t want to be bored and, in fact, there are some things that people on the autism spectrum really like (e.g. some autistic people love the furry textures of some items or like the sensation of being held tightly, which leads them to specifically seek out those sensations). It’s about considering the person’s individual sensory sensitivities (e.g. light, sounds, smells) and making it softer for those senses. Reduce the level and amount of things in the room, and level and amount of things going on all at once.


For someone with communication problems and cannot apprehend others very well verbally, give them visual information – try diagrams, drawings, organised lists, symbols, colour coding, provide photographs and other visual supports. Use visual timetables that show them what’s going to happen in sequence; and when each event has passed or has been completed, perhaps remove it from the timetable. Alarms and alerts can also help. Stick to anything you already know works for the individual too.


Share this information about the specific autistic individual with others, such as teachers, employers and friends they might visit. Let everyone be aware of what strengths and difficulties the individual experiences. Anticipate what might be challenging and whether there are alternative strategies.


An autistic person might, for instance, have an intense interest in boats. If so, we could refer to these interests when teaching them other skills. So they could be encouraged to engage with reading, writing or mathematics problems by wrapping them in the context of boats, harbours and docks (e.g. by using analogies that involve tugboats and tankers, or problem sets that are about balancing the weight distribution when loading a ship rather than just a pair of scales). It might also give them more confidence to interact in classes. It might be a great way of meeting others who share the same interest too. Maybe their career can fit with their focused interest? Utilise their strengths while mitigating their weaknesses.


Many autistic people themselves find that they prefer to have everything planned in full detail to make the upcoming day more predictable. They will try to stick to a consistent routine and will hate changes, especially last-minute ones.


They also essentially already practise being more mindfully present when they’re focused tightly on a detail, which helps them to mentally block out surrounding, extraneous noise and thus helps to keep them calm.


Masking or trying to hide one’s symptoms can work. But a risk is that the enormous and persistent effort required to do this all of the time can eventually lead to burnout.


Anecdotally, autistic people find it easier to spot other autistic people – it’s the people they generally prefer to hang around with when given the choice. And when they hang around people who understand them, they feel more socially comfortable.


When it comes to whether or not seeking a diagnosis is always helpful – when we talk about ‘autism’, are we sure we’re talking about a single category (of classifications)? What’s the point of the ‘autism’ label when everyone who is autistic can be so individual?


Well, whatever future research and theories come up with – we are definitely talking about ‘something’, even if it might be hard to definitively pin down. There are common features like the difficulties with social communication and interaction, and the repetitive patterns of behaviour and interests. And it needs to have a diagnostic label, a diagnosis, in order for someone with the associated symptoms or difficulties to access services and support that other pupils in school or people in general don’t require (although it isn’t uncommon for people to say that receiving a diagnosis didn’t actually lead to anything in terms of services and support, when it should).


It’s not about the parents of autistic children. Yet if they voice their struggles when trying to raise their autistic children then it’s not appropriate to deny their experiences either. So the parents and family members of autistic people should receive education, help and support too.


A diagnosis helps the person, and others, to understand why they perceive the world as they do – to recognise they’re not useless, just different. It helps one to find the right school, get support at college or receive ‘reasonable adjustment’ at work. It can also be positive for helping one to find a group of similar peers, to share mutual experiences and learn from each other. So for autism, you could connect with other autistic people online and have easier communication with others who understand you – which could boost your confidence and self esteem.


Without an autism diagnosis (if a person of course has autism) – they’ll likely end up with another (usually unhelpful) primary diagnosis (e.g. anxiety without recognising the underlying reasons). This could lead to ineffective interventions and treatments.


The increase in autism prevalence doesn’t necessarily indicate how more frequent autism has actually become over the recent decades – like with ADHD, the rising rate of diagnoses is at least partly down to changes in diagnosis criteria and an increased awareness of the condition, rather than necessarily down to recent changes in the environment, or of course the human gene pool. Some school districts also receive extra funding per child with an established diagnosis, hence an incentive for schools and parents to push for diagnoses for children in those geographical areas.


There’s no objective blood test or brain scan to diagnose autism – it’s based on a clinician’s subjective assessment of the social and other difficulties an individual faces (many of which can also overlap with other diagnostic categories). The assessment process is detailed and normally involves an interview with someone who has known the person from early childhood, along with an observational task, and possibly a set of cognitive assessments.


A diagnosis and classification needs to see the whole person, and a dimensional rather than categorical view. So it needs to break down and take into separate account the extent to which social communication difficulties and restricted and repetitive behaviours are causing the person functional difficulties. Other factors will of course play a role here because whether or not they experience these difficulties depends very much on things like how much their environment mitigates the difficulties they encounter (e.g. the amount of predictability, structure, clear rules and boundaries, and control over social contact, they have in their workplace).


It is normally a lifelong diagnosis, yet medical professionals are often asked to diagnose during childhood. So should we be applying a lifelong label when we don’t know what’s going to happen to the individual when they’re older? And unless the wider culture changes enough, the label can be quite stigmatising. Some worry that a diagnosis would lead others to question their ability to have a relationship, to parent, care for others, or secure a job.


We should also be aware of something called ‘inspiration porn’ – where someone, with any kind of disability, will be called ‘inspirational’ or similar just because of their disability, and for doing normal, everyday things. Many find it patronising. Many are told, “You should be extremely proud of yourself” or, “You seem so normal.” This is insulting because it suggests that, because they don’t appear to fit the preconceptions of a ‘disabled stereotype’, they must not be disabled, which is quite dismissive of a person’s difficulties and experiences. It also suggests that ‘normal’ is the standard to which everyone should aspire to appear, act or sound like – and that ‘normalisation’ should be the ultimate goal of therapies and treatments for people with ASD and other conditions.


There’s still so much to learn about autism so, in the future, knowledge of the condition may greatly update and refine as we collectively learn more over the years (like for many other mental health conditions too). We’ve not yet found a simple explanation for why some people are autistic, whether it’s to do with neurology, cognition, genetics, the environment or whatever? The more we’ve investigated these areas – the more diverse and complex the picture appears. We’ve not yet honed what makes good fluffy service provision either? We still need to collectively reduce social stigma and self-stigma and focus on people’s strengths too.


But progress is being made. One of the major steps forward in recent years is listening more to the voices of autistic people themselves; although it remains a challenge to access the subjectivities of less verbal autistic people precisely because of their communication difficulties.


…Speaking more generally, psychological health can be described as the absence of mental illness. (Physical health can likewise be described as the absence of somatic illness.) Other descriptions of psychological health include being able to function at or near one’s personal best, or simply being happy, satisfied with life, having self-esteem and other such traits. Others yet relate to measures of stress, secure attachment, and the ability to socially connect with other people.


Rather than mental disorders or conditions existing as all-or-nothing clear-cut entities, most exist on a spectrum and often have many different causes, just like most physical injuries or maladies can come in a range of severities and can have many different causes for the same apparent symptoms (e.g. headaches, itchiness, stomach pain). This acknowledges the variability between patients and the fact that not all people who are, for example, schizophrenic, autistic, depressed or anxious, will necessarily have the same causes or symptoms for their conditions (e.g. anxiety can be caused by stressor events such as the loss of a job, divorce or the death of a loved one, the chronic use of drugs like cocaine, taking too much caffeine or an overactive thyroid, for instance – and each case will likely require different kinds of interventions or treatments).


Because most, or really all, mental disorders are yet to be perfectly and fully understood, the current latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disorders (ICD) aren’t really books of concrete facts and answers so much as a starting point for treating patients – a sort of general guidance for treating large numbers of patients who present with diverse symptoms and histories based on what we currently think we understand about their ailments. The field of mental health is still relatively in its infancy I would say, with many classifications of disorders still potentially shifting and refining. That’s why both the DSM and ICD will continue to evolve through new updates and editions.


Woof. And that’s why we all need to keep staying abreast with the latest mental health research and understanding. I know that Fluffystealthkitten and I will be trying our very best. Let us know if you will be too by replying to the tweet linked to the Twitter comment button below!


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