Support for autism related difficulties

‍Neurodivergence Terminology

Firstly, it is important to acknowledge the controversies around the term Autism Spectrum Disorder and the preferred language around the topic of neurodivergence for autistic individuals.

For individuals with mental illness, the preferred terminology is person-first language. For example;

- Replacing “I’m Bipolar” with “I have bipolar”

- Replacing “I’m Anorexic” with “I suffer from anorexia”

In contrast, for neurodivergence, the preferred terminology is identity-first language. So;

- “I’m autistic” is generally preferred over “I have autism”

- “Jane is autistic”  is generally preferred over “Jane has Autism”

- “Autistic individuals”  is generally preferred over “Individuals with ASD”

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The term Autism Spectrum Disorder (ASD) or referring to autism as disability is considered offensive to some due to the meaning implied in the words disorder and disability. Although it is in the Diagnostic Statistical Manual (DSM), autism is not a mental illness, it is the normal functioning of a differently structured brain. That said, autistic individuals have higher rates of depression, anxiety, and other difficulties. 

It is also worth acknowledging that for some, the use of ‘Autism Spectrum Disorder’ is preferred over ‘autistic,’ and the use of the term disability in relation to it is welcome.

In this article, we will use the term autism instead of ASD as it is the generally more preferred term in the autistic community, but we acknowledge that this is not everyone’s preferred term. Similar to using preferred pronouns, it is important to use the preferred language of the individual when talking to them. 

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Autism

Autism is when the brain develops in a unique way, affecting the way a person interacts, communicates, feels, and behaves. It is referred to as a "spectrum" because it encompasses a wide range of symptoms and abilities, which can vary greatly from one person to another. Autism has been referred to as a different kind of brilliant. 

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What about Asperger's?

Asperger’s (also known as Aspergers Syndrome) was dropped in the medical community in 2013 due to its similarity autism. Previously, Asperger's was used to describe high functioning autism. 

The medical community now house Asperger's  and autism under the label ASD, where there is:

1. High functioning autism (ASD level I)
2. Moderate functioning autism (ASD level II)
3. Low functioning autism (ASD level III)

What level a person is ‘diagnosed’ with has significance as only level II and above are considered a disability and therefore eligible for support through the National Disability Insurance Scheme (NDIS).

The autistic community (and many health professionals working with the autistic community) generally see this medical model as inaccurate and over simplistic, preferring the Autism Wheel over the Spectrum. The Autism Wheel reflects the varying autistic traits and levels of functioning in a neurotypical world. 

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The Autism Wheel

Image credit @LauraFMcConnel 

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Autistic Characteristics

Autistic characteristics typically become apparent during early childhood, usually before the age of three. The main areas of difference for autistic individuals are in the areas of social interaction, communication, and behaviours, but the presentations of autistic traits vary greatly, as shown in the image below.

Autism and Women 

Initially, autism was believed to be significantly more common in males than females, with autistic males outnumbering females by a ratio of of 4 to 1. However, there is a growing body of research to indicate that there has been a diagnostic bias towards males, leading autistic girls and women being misdiagnosed, under diagnosed, or diagnosed late in life. In fact, recent research indicates that about 80% of autistic females are undiagnosed by age 18 ( footnote 1).

There is a number of factors that could contribute to autism being missed in females. Autistic females tend to engage in a lot of masking (camouflaging/concealing autistic tendencies) and overcompensating (mimicking neurotypical tendencies) behaviours. This has been speculated to be due to:

• The importance of communication skills and social relationships in female friendships
• The modeling of communication skills and social relationships of women in popular culture 
• The mother daughter relationship may be useful for the modelling of and teaching communication and relationship skills 

Some argue that autistic special interests are more fitting with female gender norms (such as an obsession with horses or a teen boy band) and may be particularly more socially acceptable in adolescent females rather than males.

It is also believed that the rigid and inflexible thinking associated with autism, may (in females) present as:

• Perfectionism
• Anxiety
• Depression
• Disordered eating 

And therefore be diagnosed as such.

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What Causes Neurodivergence?

According to the Ecological Model, neurodiversity occurs as a result of natural biodiversity. In the words of Dr Nick Walker in her book Neuroqueer Heresies, "Neurodiversity is a natural, healthy, and important form biodiversity - a fundamental and vital characteristic of the species, a crucial source of evolutionary and creative potential."

Viewing neurodiversity through a biodiversity lens helps explain the increasing frequency of people identifying as neurodiverse. Additionally, as a society we are getting better at understanding the internal neurodivergent experience, and therefore are identifying people who mask well that would have previously been missed.

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Assessment and Diagnosis

Identifying an autistic neurotype is a complex process that may take several appointments. Selected psychologists at Exhale Psychology Centre can provide comprehensive diagnostic assessments for neurotype.

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Support for Autistic Individuals

Therapy can offer support for autistic individuals in the form of:

• Psychoeducation around autism
• Support to identify sensory aversions (strong sensory dislikes) and sensory preferences
• Environment modification to reduce sensory triggers
• Sensorimotor Psychotherapy skills to as a way to use sensory tools to support emotion regulation
• Dialectical Behaviour Therapy skills to support emotional regulation
• Communication skills to support the individual to express individual preferences and to improve relationships

Autistic individuals may also benefit from support groups, finding like minded individuals in special interest groups, and targeted therapy and/or medication to help co-occuring symptoms such as anxiety or depression.

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1. McCrossin, R. (2022). Finding the True Number of Females with Autism Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. Children (Basel). Feb 17;9(2):272.

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Exhale Psychology now provides autism assessments. Book your initial appointment or learn more.