But I feel a bit like that too, does that mean I am Autistic?

Being Autistic is being human.

Every human will understand and experience Autistic traits. What sets Autistic people apart is their intensity and sensitivity of experience of the world. To be Autistic is not to feel some Autistic traits, but it is in meeting the criteria for Autism.

 

DSM V Pros and Cons

The Autistic community has been let down by the language and rigidity of the DSM. Their medical, and psychiatric model of Autism has precluded many from receiving their diagnosis. There are many other reasons including harmful, historical criteria that have caused the Autistic community to reject the DSM. There is a movement in the Autistic community toward a neuro-affirming, autistic-informed and autistic-led understanding of Autism. For who better to describe and detail what it means to be Autistic than the Autist themselves?

 

The main problem that I, as an Autistic person and a therapist working with Autistic adults, have with the DSM V model of Autism is that it uses:

• Deficit language – The DSM V uses words such as insistence, restricted, and fixated.
• Confusing language – I find the language to be overly medicalised, vague, and non-user-friendly.
• Ableist language – Autism is seen as a disorder, and non-Autistic people are given the privilege and authority to interpret what Autism is.

 

However, the DSM-5 criteria for Autism are not bad—it is the wording that can be problematic.

 

So let’s look at this from a neuro-affirming, Autistic-led perspective.

 

DSM V – from a neuro-affirming approach

The DSM V criteria for Autism is broken down into five sections; two main categorise A and B along with three criteria C, D and E.

To meet the criteria for Autism, you must meet all three conditions of A, you must meet two conditions of B, and you must meet the conditions of C, D and E (there is only one listed in each of these sections).

A straightforward way to remember this is 3A, 2B, C, D & E

 

A     Social Communication and Social Interaction

Note: *to meet the criteria is to meet all three of the A criteria although how you meet these is different for everyone

 

A1 – Social-emotional interaction and reciprocity 

Autistic people:

• love talking about what they are interested in and are often described as enthusiastic people for this reason.
• Prefer small bouts of social groups (note that relying on alcohol can mask this)
• converse differently and often do not initiate conversation unless there is something they really want to say or know; as a result do not follow the neurotypical norms of chit-chat and back-and-forth chat.
• can have a flat, monotone voice (this can be more present in classic Autism).
• Value honesty and clarity and are known to be blunt, literal, and honest.
• do not need much social interaction, enjoy time alone and rarely feel lonely.

 

A2 – Eye contact, voice, body language

Autistic people:

• are drained by eye contact and often look away to draw on a thought.
• can tend to stare and laugh at inappropriate times.
• can also talk quite loudly – especially if we are passionate about something.
• can have difficulties in communication and find it hard to decipher how we feel emotionally (alexithymia) and/or pick up on body cues (interoception)
• can use gestures a lot, often pointing to things that are not there to illustrate a point and/or we use our hands to help us get a word out.

 

A3 – Differences in relationships

Autistic people:

• can find it hard to know a true friend from a friend which can lead to vulnerability.
• can find it difficult to build or maintain friendships with non-autistic people.
• Due to our different communication styles, we often do not notice hints, sarcasm, or jokes of non-autistic people – linked to point A1 above.
• due to our difficulty with executive functioning, we can often forget important dates such as birthdays and anniversaries which can be seen as hurtful for the non-autistic friend.
• as deeply authentic people we can find it difficult to shift how we are based on where we are – such as behaving differently at work as opposed to at home.

 

B          Repeated behaviour, interests, and activities, currently or historically

            Helpful to think of the 4s here

Note: *to meet the criteria is to meet at least two of the B criteria although how you meet these is different for everyone

 

B1 – Stimming

This is a short word for self-stimulatory or self-soothing behaviour. This can range from twirling to organising drawers, sniffing a sleeve to doodling, twirling jewellery to using a fidget toy, repeating phrases to listening to the same song on repeat.

These behaviours are used to soothe and calm and/or stimulate and help us to focus.

 

B2 – (A love of) Sameness

Living in a neurotypical world is not ideal for a neurodivergent and can lead to a lot of confusion and a feeling of not knowing the ‘unwritten rules’ everyone else seems to know intuitively. As a result, we love where we know what is going on and this is seen in our preference for order, structure, routine, planning, reason, and logic. We can ask a lot of questions which can be misinterpreted as rude – but is simply our desire to know and understand what does not make sense. We often like to have the same foods, dress, route, seat etc as this level of continuity in an otherwise chaotic world provides stabilization and disruption to this can cause stress.

 

B3 – Special Interests* / Passions

*On a personal note, I do not like the use of the phrase special when linked to Autistic people. Therefore, I use the word passions, as opposed to Special Interests

We are passionate about our areas of interest. These passions can change over our lifetime or sometimes stay the same. Whatever it is we are deeply interested in it and gain a lot of joy from engaging in our passion, talking about it, and it soothes us and is a huge part of our identity. We are deeply curious and love time to hyperfocus on our passions. Our passions are often depicted in an image of a young boy lining up cars. Taking a broader look, they can range from trains to gardening, animals to spirituality, social justice to books, Lego to politics, sports to science. Often it can be an interest in a sub-topic of a particular area such as Jane Austen’s books or artillery used in World War II. We love to know a lot about our passions and this brings us great joy.

 

B4 – Sensory Sensitivity

Autistic people can be hypo (not at all) or hyper (very) sensitive to sensory input and these are felt extremely in either direction. Sensory input relates to sound, smell, touch, taste, and sight. It is also in reference to our emotions and how deeply we feel.

Examples of this can be:

• startling easily or finding noises very interfering and on the other end a love of loud music (sound)
• A love of deep pressure hugs and feeling intensely uncomfortable with certain food or clothing textures/tags on clothes, a desire to touch objects we like/see, a love for being in the water and not feeling pain as much as non-autistic people (touch)
• wearing sunglasses to shield our eyes, a dislike for strong lighting and loving the beauty of LED lighting (sight)
• getting comfort from smelling objects we love and a heightened sense of smell especially for unpleasant smells (smell)
• a heightened or lowered sense of taste
• feeling our emotions very deeply or on the other hand not connecting with feelings. There is a high prevalence of RSD (rejection Sensitivity Dysphoria) among Autistic people and along with emotional sensitivity, the trauma of a lifetime of being misunderstood is a contributory factor to this (emotion)
• Note: there is a great deal of research recently on the Double Empathy Problem – a breakdown in mutual understanding between autistic and non-autistic people – we feel misunderstood by them, and we find their behaviour hard to make sense of, and the same is often felt and communicated towards us.

 

C – Traits are present from early childhood

There are whispers there from youth, but they may not manifest as problematic to the individual until external demands exceed internal capacity. This can often happen for women as parenting or hormonal changes occur over their lifespan and for men as societal expectations to conform increase with age.

 

D – Traits cause significant difficulty in social, occupational, or other important areas of functioning

Autistic people tend to prefer calm spaces, often have a ‘safe space,’ require a lot of downtime, tend to have a small inner circle of family/friends, are often self-employed, work part-time or are unemployed, experience school refusal, find the demands of society too much and often withdraw.

 

E – These findings are not explained by an intellectual disability

Although intellectual difficulty can co-occur with Autism, it is not part of the diagnostic criteria.

 

 

Please note you do not need a formal diagnosis to be accepted as Autistic by the Autistic community but it is helpful and sometimes necessary to get access to appropriate services and benefits, reasonable adjustments in education and the workplace.

 

 

 

Personally, I have not benefitted from any adjustments and so I am an advocate for the self-identification of Autism. Recognising your neuro divergence (whether formally or self-identified) has many benefits including:

• It may help you (and your family, partner, employer, colleagues and friends) to understand why you may experience certain difficulties and what you can do about them.
• It may correct a previous misdiagnosis (this is common for late-diagnosed autistics and includes BPD, Schizophrenia as well as psychosis and mood disorders) and mean that any mental health problems can be better addressed.
• Self-belief; some autistic people welcome the diagnosis as a way of making sense of their life experiences and being able to identify with other autistic people.

 

Many Autistic people are self-identified. This is for many reasons:

• The gateway of long waiting lists and costs to a professional diagnosis
• Autonomy – when you know, you know – and who better to know (with the right information) than the Autist themselves?
• The Autistic community has a complicated history and has been severely let down by the medical model which has pathologized Autism.

 

If you are still curious about exploring more about Autism, please contact me at christine@christinedoyle.ie where I will be more than happy to support you on your self-identification discovery.