Society becomes too sensitive and overreactive
published on 08/18/2020
Autism is a neurological peculiarity of being human. Characteristic are perceptual peculiarities such as sensory hypersensitivity or under-sensitivity, atypical learning behavior, special interests, a need for routine and order, motor, linguistic, emotional and social peculiarities, for example by withdrawing to oneself. Specific strengths can be seen in the perception of details, in concrete and logical thinking, in the awareness of rules and in properties such as reliability, punctuality or accuracy. All of these features need to be developed individually.
- 1. Summary
- 2 Concepts
- 3 prevalence
- 4 causes
- 5 Autism from a clinical perspective
- 5.1 Three key characteristics
- 5.2 Highly Functional and Low Functional Autism
- 5.3 DSM-5
- 6 discussion
- 6.1 Autistic Self-Advocacy Network
- 6.2 Neurodiversity
- 6.3 Against the pathologization of autism
- 7 The Autism Spectrum View
- 8 Critical Appreciation
- 9 Support instead of treatment
- 10 References
- 11 Bibliography
- 12 Information on the Internet
The understanding of autism has changed significantly over the past 10 years. While different types of autism have previously been differentiated from a clinical point of view (e.g. early childhood autism, Asperger's syndrome), these images have been grouped under the term "autism spectrum disorder" since the introduction of the globally recognized classification system DSM-5. Behind this is the realization that the types of autism described so far cannot be clearly distinguished from one another and have more similarities than differences. The world's largest self-advocacy movement for autistic people, the Autistic Self-Advocacy Network, welcomes this decision in the DSM-5, but nevertheless opposes tendencies to continue to pathologize autism and to only view it one-sidedly in the light of deficits. Instead of the term “autism spectrum disorder”, the term “autism spectrum” is preferred, and those affected also refer to themselves as autistic people in order to express their “autistic being”. Furthermore, in their own concept they highlighted characteristics about autism that are highly empirical and pave the way for an understanding of autistic behavior. Reflections on a support perspective for a “life with autism” round off the explanations.
The term autism, derived from the Greek word “autos” (self), originally refers to a person's withdrawal and self-centeredness. In this regard, the Swiss psychiatrist Eugen Bleuler (1857–1939) regarded autism as a symptom of schizophrenia at the beginning of the 20th century.
Observations and clinical examinations of children and adolescents with "strange" behaviors then led in the following decades - represented by the Russian child and youth psychiatrist Grunja E. Ssucharewa (1891–1981), the children who came from Austria and later worked in the USA. and youth psychiatrist Leo Kanner (1896–1981) as well as the Viennese child and youth psychiatrist Hans Asperger (1906–1980) - to the conviction that beyond the schizophrenia described by Bleuler there is an independent psychiatric-clinical picture in which the withdrawal to the own person, being in-yourself in connection with other abnormalities in the motor, linguistic, cognitive and emotional areas is of central importance (in detail Theunissen 2019a, p. 15 ff.). Ssucharewa chose the term “schizoid psychopathy in childhood” to differentiate it from Bleuler, Kanner spoke of “autistic disorders” and “early childhood autism” and Asperger preferred the expression “autistic psychopathy”, which is what the so-called Asperger's syndrome is now taken by. According to current knowledge, the writings of Ssucharewa, Kanner and Asperger are three scientific “first descriptions” of autism, which can be regarded as timeless and up-to-date with a view to the gain in knowledge (Theunissen and Sagrauske 2019, p. 13 ff.).
For decades it was widely believed that autism was a rare phenomenon. However, more recent statistics from leading industrial nations show that there has been a significant increase in the number of autism diagnoses in recent years (Beyer 2015; CDC 2014). A few years ago, for example, figures were published in the USA according to which it can be assumed that 68 newborns will have an autistic child. According to surveys from Europe, the estimated prevalence of autism is currently over one percent. Although there are no reliable data for Germany, the number of children, adolescents and adults with a diagnosis of autism seems to be increasing significantly in this country too. Experts also apply a value of one percent for Germany. That affects approximately 800,000 people on the autism spectrum.
As far as the background to this increase in autism diagnoses, which can be observed worldwide, is concerned, in addition to a growing social awareness and greater sensitivity with regard to autism, reference is made to refined, more precise instruments for diagnosing autistic characteristics. This benefits girls and women, among others, who are presumably too rarely diagnosed with autism. In addition, people with the so-called Asperger's syndrome were not adequately recorded.
In addition to this “catch-up effect”, in the last 15 years, especially in the USA, interests and the hopes of parents to get better support services for their disabled child through an autism diagnosis have played a role. This particularly affected children who were originally assessed as having intellectual disabilities. In this respect, the artificial character of the increase in autism diagnoses cannot be completely dismissed. Nonetheless, in the past there were not infrequently misdiagnoses in that affected persons were attested in childhood as having a “mental handicap” or severe disorder in social behavior and only in adulthood as a so-called autism spectrum disorder.
Whereas in the 1950s and 1960s it was assumed that autism was psychogenic (Theunissen and Sagrauske 2019, p. 16 f.), Today it is assumed that it is “genetic vulnerability” (Grabrucker and Schmeißer 2015, p. 384) . The interaction of biological factors (gene mutations, risk genes) with environmental components (e.g. advanced age of both parents, diseases of the mother and infections during pregnancy, pre- and perinatal stress, exposure to toxins, premature birth) play a central role. However, the exact relationships and effects of epigenetic processes are still unclear. So we mostly have one ideopathic autism to do.
Twin studies in particular show that genes cannot be viewed in isolation from environmental factors and associated individual experiences (ibid., P. 392). Despite the high autism concordance rate of 77% in male and 50% in female identical twins, not every second identical twin develops autistic behavior. Furthermore, the degree of disability among identical siblings from the autism spectrum seems to vary considerably.
Besides ideopathic autism, for which the cause is unclear, there are few clinical pictures that characterize syndromic autism. The syndromic autism is mostly associated with complex (cognitive) impairments and indicates certain (mono-) genetic causes, in particular metabolic disorders caused by gene mutations (e.g. Rett syndrome; tuberous sclerosis), chromosomal abnormalities (e.g. fragile X syndrome) or a Deletion (loss) or alteration of chromosomal material (e.g. Angelman syndrome). Syndromic autism affects 10% to 25% of all people diagnosed as autistic (Moss and Howlin 2009; Rosti et al. 2014; Richards et al. 2016).
With regard to the clinical pictures, the concept of Behavioral phenotypes referenced. Sarimski understands this to mean “a combination of certain developmental and behavioral characteristics that are more likely to occur in children and adults with a defined genetic syndrome than in children and adults with a disability of another cause” (1997, p. 15). However, individual differences must be taken into account here. For example, not all children with Angelman syndrome or Fragilem X syndrome develop autistic behavior to the same extent. Therefore, Sarimski rightly warns of “one impermissible generalizationthat all children with a certain syndrome develop the respective forms of behavior in the same way ”(2013, p. 404). In addition, the concept of behavioral phenotypes leads to a deficit or disorder-oriented view of behavior. In contrast, we should take into account that there are not only behavioral problems with regard to the various clinical pictures, but also behavioral phenotypic strengths or abilities (see Theunissen and Drescher 2021). In addition, caution should be exercised when interpreting the similarities between autism or autistic behavior and the behavioral phenotypes of certain genetically determined syndromes (e.g. Fragile X syndrome; Sanfilippi syndrome) (Moss and Howlin 2009).
More recent findings allow the conclusion that, on the background of genetic vulnerability in autistic children, there is mostly global neuronal hyperconnectivity (networking, connection), which is associated with unusual brain growth in the earliest age. These examination results are primarily associated with the perceptual peculiarities and abnormalities in social behavior. Nevertheless, changes and often a reduction in neural connectivity and activity occur from school age at the latest. However, there is no uniform picture of this, so there is currently “atypical connectivity” (Maximo et al. 2014) on the basis of an abundance of “competing neurobiological hypotheses” (Lai, Lombardo and Baron-Cohen 2014, p. 901) in autistic people is assumed. An overview of important neuroscientific theories and assumptions about autism can be found in the publication “Understanding Autism” (Theunissen 2020) and the “Hand Lexicon Autism Spectrum” (Theunissen et al. 2015).
5 Autism from a clinical perspective
According to the still valid classification system of mental disorders ICD-10 of the World Health Organization, autism is considered to be "Profound developmental disorder". In this regard, a distinction is made under the key F84 in F84.0: early childhood autism, F84.5: Asperger's syndrome, F84.1 atypical autism and F84.2 Rett syndrome (Dilling, Mombour and Schmidt 2015).
We encounter a similar classification in the classification system DSM-IV published by the American Psychiatry Society (Saß, Wittchen and Zaudig 1998).
The differentiation between “early childhood autism” (often referred to as “classic autism”) and “Asperger's Syndrome” goes back to the “first descriptions” by Leo Kanner and Hans Asperger. However, insufficient account was taken of both authors; for example, Kanner had attached importance to the distinction between early childhood autism and intellectual disability and attested the strengths of the children he examined (Theunissen 2019a, p. 33 ff.); and Asperger not only observed atypical learning behavior and forms of over- and under-sensitivity, but also viewed autism as a weakness and strength at the same time (ibid., p. 23 ff.).
5.1 Three key characteristics
Nevertheless, in the period that followed, autism was only seen in the light of negative symptoms and 'signs of illness', which can be found in the two “initial descriptions”. From this consideration, three core characteristics (triad of impairments) for the diagnosis of autism emerged:
- Impairments of social interaction and interpersonal relationships
Numerous deficits are mentioned, for example the inability of many autistic people to develop age-appropriate relationships, a lack of friendships with their peers, the lack of desire to share interests with others, the reduced ability to intuitively recognize social or non-verbal signals from other people and to interpret socially and emotionally inappropriate behavior or lack of social and emotional reciprocity.
- Impairments of (verbal) communication
While people who are said to have (severe) classic autism are often barely able to communicate verbally (e.g. only with sounds, in one- or two-word sentences or echolalia), people with the so-called Asperger's Syndrome often fall through a monotonous speech melody , an eccentric or pedantic style of speech.
- A restricted repertoire of interests and activities associated with repetitive or stereotypical behaviors
This involves, for example, a fixation on special things that are usually not sold as toys, the unusual and often long-lasting use of objects, a rigid adherence to routines, an insistence on routine and striving to preserve the environment, compulsive behavior or motor mannerisms or abnormalities (flapping hands, bizarre finger movements, twisting movements, walking toes, hyperactivity, awkwardness in gross or fine motor skills, awkward body language, restricted gestures and facial expressions).
5.2 Highly Functional and Low Functional Autism
However, there were always difficulties in differentiating precisely between the autism images shown in the classification systems. As a result, some people received different diagnoses of autism throughout their lives. For example, there were young people with “early childhood autism” who were not, as originally assumed, more of a reduced intelligence, but were of average intelligence.
Other adolescents with classic autism were even found to be highly intelligent, which sometimes led to a diagnosis of Asperger's. In view of such diagnostic uncertainties, two subforms derived from “early childhood autism” were introduced, on the one hand "Low-function autism", which is characterized by severe features and cognitive impairments; to the other one "Highly functional autism", which should be differentiated from the Asperger's diagnosis due to the lack of motor abnormalities, but which is still often associated with this syndrome as a mild form. In this respect, irritations and ultimately inadequacies persisted, among other things, where non-speaking autistic people were labeled as "low-function", but were actually in no way intellectually impaired.
As a result, increased efforts were made to differentiate more precisely between “early childhood autism” and cognitive impairments. While around 75% of all people diagnosed with “early childhood autism” were considered to be “mentally disabled”, today, at most, half of all autistic children and adolescents are assessed as having a below-average level of intelligence. As we now know, many of those affected have not been tested with suitable (speech-free) methods (e.g. Raven's progressive matrices) in the past few decades. Nevertheless, this group of people still underestimates specific interests, memory and intelligence skills (e.g. strengths in the mosaic test, figure laying, hyperlexy-like skills, detailed perception, visual thinking) and given too little attention for a later professional activity (Courchesne et al. 2015; Mottron 2011; 2017; Theunissen 2020).
In addition, experts gradually had to admit that, with a view to the descriptions by Kanner and Asperger, there are more similarities than differences between “early childhood autism” and “Asperger's syndrome” (Theunissen 2019a). This finding is largely supported by the "actual first description" by Ssucharewa from the 1920s (on this, ibid., P. 15 ff.).
Against the background of all these objections and findings, the previous classifications and differentiations were completely questioned about 10 years ago. From here, the step was not far to dispense with the classification analogous to the ICD-10 or DSM IV classification systems in the future. With the DSM-5, a corresponding system has been available since spring 2013, which is now known as "Autism Spectrum Disorder" (Autism Spectrum Disorder) has leveled and incorporated the previous characteristics and symptom descriptions of various autism images (according to APA 2013; translated into German by the author):
A. Persistent deficits in social communication and interaction
B. Restricted, repetitive behavior, interests, or activities
- Deficits in social-emotional reciprocity
(e.g. in the context of a "normal" conversation; reduced exchange of interests or emotions; reduced initiative or avoidance of social interactions)
- Deficits in non-verbal communication in the context of social interactions
(e.g. poor integrated verbal and non-verbal communication; lack of eye contact, weak body language, facial expressions or gestures; deficits in understanding and using non-verbal communication)
- Deficits in developing, maintaining and understanding relationships
(e.g. difficulties in maintaining interactions in different social contexts; difficulties in joint fantasy play and in making friends; disinterest in other people)
- Stereotypical or repetitive language, motor movements, or use of objects
(e.g. simple, motor stereotypes; echolalia, repetitive handling of objects; idiosyncratic [stubborn] sentences; stringing toys)
- Excessive adherence to routine, ritualized verbal or non-verbal language behavior, pronounced resistance to change
(e.g. insistence on routine, e.g. on the same route or on uniform food; motor or linguistic greeting rituals; fear of change; inflexible, rigid thought patterns; extreme stress reactions with even minor situational changes)
- severely restricted, fixed interests associated with “abnormal” intensity or focus
(e.g. strong attachment to unusual objects; narrowly circumscribed, excessive, sustained preoccupation with unusual things or interests)
- Hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in environmental sensory stimuli
(e.g. apparent indifference to sensory stimuli such as pain, heat, cold; negative reaction to certain noises or tissue; excessive sniffing or touching objects; fascination with luminous or rotating objects)
C. Symptoms must show up in early childhood (However, they can only become fully visible when social requirements exceed limited performance capabilities or can be masked by learned strategies in later life)
D. The entirety of the symptoms lead to a clinically significant impairment of everyday behavior (in social, professional, practical terms)
E. Symptoms cannot be explained by intellectual retardation or general developmental delay.
For the diagnosis of Autism Spectrum Disorder (ASD), the criteria for areas A (in all three sub-categories), B (in at least two sub-categories), C, D and E must be met.
In addition, there are additional codes for "comorbidities" (such as intellectual impairments [so-called "intellectual disabilities"], language or communication disorders, epilepsy, ADHD).
In contrast to the DSM IV and the previous agreement to differentiate between three core characteristics (triad of impairments) of autism, with the summary of the first two areas only two main categories are distinguished. This step is justified primarily with the close interweaving of deficits in communication with social behavior. Furthermore, the selection of the symptoms mentioned, which has been carefully researched empirically, should contribute to an improved, specified assessment of autism in terms of an autism spectrum disorder. For this purpose, an assessment of the two core categories in three different degrees of severity is provided to determine the need for support.
The new version of autism according to DSM-5 is not undisputed (Theunissen 2020, p. 23). For example, there is concern that the so-called Asperger's Syndrome and the unspecified (atypical) form of autism will be recorded less frequently by the DSM-5 in the future. Furthermore, some adults who call themselves Asperger's or Aspies would like to keep traditional differentiation for reasons of identity.
The innovation is widely welcomed by several parent organizations in English-speaking countries, because in many places the Asperger's diagnosis (especially in the case of higher intelligence) has not or hardly been considered for state-funded support services.
6.1 Autistic Self-Advocacy Network
The DSM-5 category Autism Spectrum Disorder is also popular in the US Autism Society (AS) and in the camp of the Autistic Self-Advocacy Network (ASAN), the globally networked and most influential self-advocacy organization of autistic people. The ASAN had worked in an advisory capacity on the revision of autism and had an influence on the change process (detailed on this Kapp and Ne’eman 2020).
From the point of view of those affected, the consideration of hyper- and hyposensitivities, for example, which have so far been largely ignored in diagnostics, is noted as positive. Research and explanatory approaches from the last 15 years suggest that particular perceptual features are a central feature of autism, which is why neglecting them can now be regarded as malpractice (Theunissen 2020; Theunissen and Sagrauske 2019, p. 31 f.). This does not mean that there can be people with sensory hypersensitivity or hypersensitivity regardless of autism. In addition, the development perspective recorded in DSM-5 that autistic characteristics can also manifest after early childhood is viewed as a way in the right direction (Theunissen and Sagrauske 2019, p. 177). This also applies to the renunciation of the healing aspect (recovery), since autism is a permanent characteristic of being. This view ultimately collides with the subsumption of autism among mental disorders. So not everything was achieved. Above all, this concerns insufficient consideration of one's own learning strategies, strengths or resources, linguistic and motoric abnormalities and peculiarities as well as the particularities with regard to autistic girls or women. In addition, the one-sided, negative view of repetitive, stereotypical behaviors is criticized, since such behavior patterns as so-called stimming (self-stimulating behavior) can very well be subjectively meaningful (e.g. serve to calm down and reduce stress). It is just as inadequate from the perspective of those affected if only autistic people are said to have “deficits in social-emotional reciprocity”. Because non-autistic people can also have empathy problems, namely difficulties in empathizing with the thoughts and actions of autistic people and understanding the meaning of their behavior (Milton 2012).
A fundamental criticism is directed against the deficit language and the practice, continued by the DSM-5, of pathologizing affected persons. Ultimately, the classification of autism as a mental disorder is only tolerated for external reasons (to receive support services). From the point of view of the autistic people Steven Kapp and Ari Ne’eman (2020, p. 188 f.), The diagnosis of autism should not be dispensed with, as suggested by the anti-psychiatric movement, because the phenomenon of Neurodiversity must be observed. Here is a "naturally" different functioning brain, which, compared to the brains of non-autistic (neurotypical) people, is characterized by atypical neuronal processes, activities and interconnections, so that an "autistic being" characterizes. With this position, the activists are not only concerned with the removal of medicine from autism, but also with the defense of eugenic tendencies through biomedical research. Furthermore, the neurodiversity approach is assigned an identity-creating function. However, the neurodiversity-oriented self-image of autistic people should be accompanied by a self-critical attitude and critical reception of neuroscientific findings (Russell 2020). On the one hand, this is intended to avoid excluding autistic people who have considerable difficulty speaking for themselves (e.g. people with additional severe cognitive impairments). On the other hand, the absolutization or heightening of the neurodiversity hypothesis harbors the danger of a reductionist biologism, which transitions the being involved in mutual relationships and lifeworlds as well as sociocultural influences and conditions. From here, the medical model of autism should be challenged and overcome by a "non-pathological system" (Kapp and Ne’eman 2020, p. 189).
6.3 Against the pathologization of autism
In everyday life and in the media (press), the term autism is often negatively connoted and associated with psychological suffering.
In the opinion of many self-advocacy organizations and a growing number of unorganized experts in their own affairs, autism is not a disease or mental disorder that per se includes a condition. Instead, autism is considered an expression of human existence, which is why those affected speak of autistic women, autistic people, autistic people or people on the autism spectrum. Formulations such as people with autism or autism spectrum disorders, however, are discarded. World-renowned autism researchers have joined this position by using the term "Autism spectrum condition" (ASC) (Lai, Lombardo and Baron-Cohen 2014, p. 897) in order to be able to cover both autism-typical problems and strengths.
7 The Autism Spectrum View
Against this background, ASAN represents an autism concept that distinguishes seven features that have been processed in detail in recent years and supplemented by an eighth aspect that is clearly evident in the "initial descriptions" of autism (see Theunissen and Sagrauske 2019, p. 39 ff.). Since it is not possible for reasons of space to go into the complexity of these characteristics (in detail in Theunissen 2020), only individual aspects are taken up in the following that are intended to enable an approach to an understanding perspective of autism.
(1) Different sensory experiences
This aspect draws attention to the broad field of perceptual peculiarities that can be observed in many autistics, for example an over-sensitivity to noises, lights, temperatures, pain, textiles or flavors. An under-sensitivity to sensory stimuli is also conceivable. For example, knocking on and sniffing objects can be used to create increased stimuli and to acquire the consistency or properties of things. Difficulties in discriminating sensory stimuli, processing and coping with them at the same time, as well as the phenomenon of synesthesia and considerable abilities such as grasping details of specific perceptual features, which are not infrequently observable in autistic people, also include difficulties.
(2) Unusual learning behavior and problem-solving behavior
According to reports and observations, it appears that many autistic people develop their own ways in learning and use self-developed strategies to solve tasks (Theunissen and Sagrauske 2019, p. 43 ff.). Quite a few autistics impress with special ways of thinking, for example by using visualization (e.g. thinking in pictures or patterns) and logic (through concrete, analytical thinking) (Drenkhahn and Heuer 2020).
In addition, it is also important to consider cognitive difficulties in the context of executive functions (e.g. planning ahead, calculating obstacles, setting priorities, action control, lack of cognitive flexibility) that can arise when dealing with tasks in everyday life.
(3) Focused thinking and special interests
Although Kanner and Asperger already knew how to appreciate strengths, special interests or so-called island talents in their “initial descriptions”, this topic has only gained the appreciation it has for in recent years all People on the autism spectrum should apply. Those affected repeatedly report that dealing with their own special topics not only serves to enrich knowledge and gain quality of life, but also to relax, calm down or compensate for stressful situations (Preißmann 2012, p. 67).
(4) Atypical, sometimes repetitive movement patterns
This includes all behaviors that are considered to be motorically conspicuous, such as rocking with the upper body, walking toe, bobbing on the feet, flapping with the hands, bizarre or cramped arm movements or stiff posture. It is not uncommon for this to be self-stimulating, stereotypical, repetitive behavior that is functionally significant for the person: “I myself react more sensitively to people's attitudes. When I know that someone is watching me with curiosity, I feel uncomfortable. My body reacts to it immediately. I become hyperactive and wave my hands to at least partially vent my stress ”(Mukhopadhyay 2005, p. 103).
Another motor characteristic relates to so-called "action disorders" (Zöller 2020). In this case a person knows what to do, but cannot do it because his motor is "frozen". This motor abnormality should not be viewed in isolation from perceptual peculiarities and executive functions.
In addition, motor strengths (e.g. high skill in fine motor skills) can also be recorded under this fourth characteristic.
(5) Need for consistency, routine and order
This is about a fundamental need that often plays a central role in the life of autistic people and points to potential fears that can arise when those affected have to find their way in changed or unfamiliar situations. Routine and a pre-determined schedule with built-in alternative solutions can provide a feeling of security, familiarity, and predictability. “If something wasn't exactly in place, I had to straighten it out; and this activity, restoring order, made me feel safe ”(Williams 1992, p. 121). Many autistic people attach importance to creating content and time schedules as well as rules or principles of order by which everyday actions are aligned. Otherwise, time, task or job-related structuring aids should be worked out jointly or for one person in order to be able to take account of the need for order and stability.
(6) Difficulty understanding language and expressing oneself verbally, as is usually expected in communication situations (conversations)
On the one hand, the lack of verbal communication, delays or peculiarities in language development (the swapping of personal pronouns), special linguistic phenomena (e.g. echolalia, conspicuous intonation) and comprehension difficulties (verbal understanding, misunderstanding of irony) can be recorded under this sixth characteristic.
On the other hand, exceptional linguistic achievements (word creation as a creative achievement, writing poems or autobiographical texts, encyclopedic vocabulary collections, communication in several foreign languages) should not be disregarded.
Autistics * who can communicate verbally report that it is often very exhausting to master the modulation of the voice adequately and to "speak at the same time in conversation situations and to pay attention to the looks, facial expressions and gestures of the people involved" ( Pinke quoted in Preißmann 2012, p. 100). In addition, words or numbers that are perceived in the context of communication can lead directly as (sensory) stimuli to associations, to the creation of structures, systems, rhymes or poems (Mukhopadhyay 2005, p. 37), so that the actual conversation is no longer followed and problems of understanding arise. Such situations create stress; and in order to avoid it, the situation is evaded or, if necessary, kept silent. If eye contact is avoided, this often serves to improve concentration or focus on what is being said. As for the echolalia that is said to be common to many autistic people, autistic Donna Williams (1992, p.292) a means of "getting closer to others and showing that they can establish a relationship, if only as a mirror."
(7) Difficulty understanding typical social interactions and interacting with other people
This characteristic applies in particular to interpersonal encounters and manners, social conventions such as greeting, small talk or other forms of contact with strangers as well as the maintenance of social relationships. Many autistic people find it difficult to turn to non-autistic people in the form of “divided attention”. Against this background, friendships are formed less often, especially in childhood and adolescence, and social situations are avoided through withdrawal, self-isolation and being withdrawn.
If teasing, bullying, social exclusion and discrimination by non-autistic peers occur, especially in adolescence, this leads to a high level of suffering and the development of accompanying psychological disorders (e.g. affective disorders, anxiety or eating disorders in not a few affected adolescents from the autism spectrum ). Some try to counteract the risk of psychological decompensation through a self-confident, non-conformist demeanor and appearance, or through special interests to initiate social contacts or friendships.
A fundamental problem, which often comes to light in the context of social situations and makes interactions more difficult, is that non-autistic people do not understand the behavior and experience of autistic people and that at the same time autistic people feel alien to the non-autistic reference world. Here we encounter the “double empathy problem” (Milton 2012). Nevertheless, it should be mentioned that despite the difficulties mentioned, autistic people can develop a fine feeling for social relationships through a high level of reflection (Seng 2019, p. 116). For this purpose, even momentary observations of social situations and other people through a sidelong glance are sufficient. In addition, autistic people are very well able to sense the inner states of another person (Vero 2020, p. 26). The autistic woman Gee Vero describes this phenomenon as "sensing" (ibid.).
(8) Emotional peculiarities
Emotional peculiarities that already come to light in the "first descriptions" of autism relate, for example, to a weak emotional attachment to people and a not infrequently strong emotional attachment to objects or animals, as well as "flattened" feelings towards non-autistic people or difficulties to recognize, assess and deal with one's own feelings.
Likewise, the eighth feature can be justified by neuroscientific theories that assume a neuronal “overexcitation”, an overreactive amygdala (“fear center” of the brain) and “increased emotionality” in autistic people (detailed in Theunissen 2020, p. 57 ff.). Indeed, those affected often report increased anxiety, increased emotional sensitivity and sometimes a slight emotional excitability, explosive expressions of emotions with a lack of impulse control or affect regulation (meltdown). However, this sub-feature of emotional peculiarity can also be a symptom of ADHD. In the case of autism, it is discussed in connection with increased sensitivity to stimuli, susceptibility to stress (vulnerability) and fear of failure (due to “overperfectionism”).
8 Critical Appreciation
As for the reading of these eight aspects, they can appear in a person in a weakened or more pronounced form. This means that the individual characteristics can only be developed individually. Their interaction and effects must not be lost sight of when an assessment is to be made with regard to autism. It would be discussed when, according to the concept outlined, a person can be described as autistic. If only a few distinct autistic features appear, we would certainly not be dealing with the “full picture” of autism. If several characteristics are only slightly expressed, the boundaries to “normal behavior” become blurred, which is why we should be aware of the attributional character, the dependence on norms and subjective assessments. If all characteristics appear to a greater or lesser extent, however, autism should be undisputed.
Since the concept of the autism spectrum, in contrast to DSM-5, was not operationalized, it is viewed critically from a scientific (clinical) point of view. In this respect, given the lack of an empirical basis, it has a heuristic function.
Its prominent importance lies undoubtedly in the fact that features are taken into account or emphasized that have so far been largely neglected diagnostically. Furthermore, language and description are omitted that emphasize deficits and directly associate the autism spectrum with disorders.
9 Support instead of treatment
This view, based on the autism spectrum concept, has practical implications. Since autism is not viewed as a disease, one cure or treatment approach should not dictate the practice. The criticism of those affected is unmistakably directed against aversive therapy methods that have not been banned to this day (Neumeier and Brown 2020; Theunissen 2019b). Furthermore, restrictive interventions under the label of "applied behavior analysis" (applied behavior analysis) rejected (Craine 2020, p. 273; Kapp 2013). It is about a so-called ABA practice, which on the basis of the medical model regards autism as a "profound developmental disorder" and tries to influence it with the aim of adapting to a "normal" (inconspicuous) development through targeted, strictly empirically calculated interventions . At this point, until recently, high expectations were placed on early interventions through the "discrete learning format" (discrete trial training) as a prominent method of intensive behavioral therapy. In the meantime, the scientific assessment towards the tightly knit (restrictive) ABA interventions has been cautious (Theunissen and Sagrauske 2019, p. 97 ff.). For example, no sustainable developmental progress was found in autistic children with severe cognitive impairments and no positive effects on challenging behaviors, accompanying psychological disorders or stress. There have also been reports of a lack of spontaneity and traumatic sequelae.
Therefore, broad-based prevention and intervention concepts, for example the Early Start Denver Model, are recommended today, in which ABA methods such as the discrete learning format are embedded but not prioritized (on this, ibid.).
However, these further developed approaches do not yet overcome the disorder of autism and pathological thinking. Rather, they are based on an outdated understanding of mental health.
Instead, ASAN and other activists from the rights movement of autistic people want an orientation towards the modern health concept of the World Health Organization. This suggests a health-promoting practice, which is about coping with problems, critical living conditions or life events that impair physical, mental or social well-being. This process is to be supported by “participatory health promotion”, which is not only about medical-curative measures, but also about the creation of health-promoting living environments (Kapp 2018). The focus is on a support perspective for a socially inclusive “life with autism” (in detail in Theunissen and Sagrauske 2019, pp. 82 ff., 102 ff.).
APA - American Psychiatric Association, ed., 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington, DC: American Psychiatric Association Publishing. ISBN 978-0-89042-555-8
Beyer, Johanna Mirjam, 2015. Epidemiology. In: Georg Theunissen, Wolfram Kulig, Vico lamp and Henriette Paetz, eds. Hand Lexicon Autism Spectrum. Stuttgart: Kohlhammer, pp. 123-125. ISBN 978-3-17-023431-4 [review at socialnet]
CDC - Centers for Disease Control and Prevention, 2014. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States [on-line]. Washington, D.C .: U.S. Department of Health and Human Services [accessed on: 09/08/2019]. Available at: https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm
Courchesne, Valerie, Andree-Anne Meilleur, Marie-Pier Poulin-Lord and Michelle Dawson, 2015. Autistic children at risk of being underestimated: school-based pilot study of a strength-informed assessment. In: Molecular Autism [on-line]. 6 (12) [accessed on: June 2nd, 2015]. Available from: https://doi.org/10.1186/s13229-015-0006-3
Craine, Monique, 2020. Changing Paradigms: The Emergence of the Autism / & ZeroWidthSpace; Neurodiversity Manifesto. In: Steven Kapp, ed. Autistic Community and the Neurodiversity Movement [on-line]. Stories from the frontline. Singapore: Springer Singapore, pp. 255–276 [accessed on: November 12, 2019]. PDF e-book. ISBN 978-981-13-8437-0. Available from: https://doi.org/10.1007/978-981-13-8437-0
Dilling, Horst, Werner Mombour and Martin H. Schmidt, 2015. Eds. International Classification of Mental Disorders: ICD-10 Chapter V (F) - Clinical Diagnostic Guidelines. 10th edition. Göttingen: Hogrefe. ISBN 978-3-456-85560-8
Drenkhahn, Ralf and Imke Heuer, 2020. Unusual learning behavior. In: Georg Theunissen, ed. Understand autism. 2nd, updated edition. Stuttgart: Kohlhammer, pp. 126-141. ISBN 978-3-17-037906-0
Grabrucker, Andreas and Michael Schmeißer, 2015. Causes. In: Georg Theunissen, Wolfram Kulig, Vico lamp and Henriette Paetz, eds. Hand Lexicon Autism Spectrum. Stuttgart: Kohlhammer, pp. 382-392. ISBN 978-3-17-023431-4 [review at socialnet]
Kapp, Steven, 2013. January 23. ASAN statement on fine study on autism and "recovery" [on-line]. Washington, DC: Autistic Self Advocacy Network, January 23, 2013 [accessed March 26, 2015]. Available from: https://autisticadvocacy.org/2013/01/asan-statement-on-fein-study-on-autism-and-recovery/
Kapp, Steven, 2018. Social Support, Well-being, and Quality of Life Among Individuals on the Autism Spectrum. In: Pediatrics [on-line]. 141 (4), pp. 362-368 [accessed on: December 17, 2018]. Available from: https://doi.org/10.1542/peds.2016-4300n
Kapp, Steven and Ari Ne’eman, 2020. Lobbying Autism’s Diagnostic Revision in the DSM-5. In: Steven Kapp, ed. Autistic Community and the Neurodiversity Movement [on-line]. Stories from the frontline. Singapore: Springer Singapore, pp. 167–194 [accessed on: November 12, 2019]. PDF e-book. ISBN 978-981-13-8437-0. Available from: https://doi.org/10.1007/978-981-13-8437-0
Lai, Meng-Chuan, Michael V. Lombardo, and Simon Baron-Cohen, 2014. Autism. In: The Lancet [on-line]. 383 (9920) [accessed on: March 26, 2015]. Available from: https://doi.org/10.1016/S0140-6736(13)61539-1
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Mukhopadhyay, Tito R., 2005. The day I found my voice: an autistic boy tells a story. Reinbek: Rowolt. ISBN 978-3-499-61933-5
Neumeier, Shain, M. and Lydia X. Z. Brown, 2020. Torture in the Name of Treatment: The Mission to Stop the Shocks in the Age of Deinstitutionalization. In: Steven Kapp, ed. Autistic Community and the Neurodiversity Movement [on-line]. Stories from the frontline. Singapore: Springer Singapore, pp. 195–210 [accessed on: November 12, 2019]. PDF e-book. ISBN 978-981-13-8437-0. Available from: https://doi.org/10.1007/978-981-13-8437-0
Preißmann, Christine, ed., 2012. Asperger's - Living in Two Worlds: Those affected report: That helps me in my job, partnership and everyday life. Stuttgart: Kohlhammer. ISBN 978-3-8304-3777-2 [review at socialnet]
Richards, Caroline, Christopher Jones, Laura Groves, Jo Moss and Chris Oliver, 2016. Prevalence of autism spectrum disorder phenomenology in genetic disorders: a systematic review and meta-analysis. In: The Lancet [on-line]. 2 (10), pp. 906-916 [accessed on: July 10, 2019]. Available from: https://doi.org/10.1016/S2215-0366(15)00376-4
Rosti, Ramsin O, Abdelrahin A. Sadek, Keith K. Vaux and Joseph G. Gleeson, 2014. The genetic landscape of autism spectrum disorders. In: Developmental Medicine & Child Neurology [on-line]. 56 (1), pp. 12-18 [accessed on: July 10, 2019]. Available from: https://doi.org/10.1111/dmcn.12278
Russell, Ginny, 2020. Critiques of the Neurodiversity Movement. In: Steven Kapp, ed. Autistic Community and the Neurodiversity Movement [on-line]. Stories from the frontline. Singapore: Springer Singapore, pp. 287-304 [accessed on: November 12, 2019]. PDF e-book. ISBN 978-981-13-8437-0. Available from: https://doi.org/10.1007/978-981-13-8437-0
Saß, Henning, Hans Ulrich Wittchen and Michael Zaudig, 1998. Diagnostic and Statistical Manual of Mental Disorders DSM IV. Göttingen: Hogrefe, ISBN 978-3-8017-1166-5
Sarimski, Klaus, 1997. Developmental Psychology of Genetic Syndromes. Göttingen: Hogrefe. ISBN 978-3-8017-0970-9
Sarimski, Klaus, 2013. Behavioral Phenotypes. In: Georg Theunissen, Wolfram Kulig and Kerstin Schirbort, eds. Hand lexicon of intellectual disabilities. 2nd Edition. Stuttgart: Kohlhammer, pp. 403-405. ISBN 978-3-17-022531-2 [review at socialnet]
Seng, Hajo, 2019. An Approach to Autistic Experience: Attempting a Collage [Dissertation]. Halle-Wittenberg: Martin Luther University Halle-Wittenberg (publication in preparation)
Theunissen, Georg, 2019a. Autism and Challenging Behavior: A Guide to Positive Behavioral Support. 2nd Edition. Freiburg: Lambertus. ISBN 978-3-7841-3196-2
Theunissen, Georg, 2019b. Dealing with severe challenging behavior in adults with complex impairments - results from a research project in Baden-Württemberg. In: Participation. 58 (4), pp. 154-160. ISSN 1867-3031
Theunissen, Georg and Isabell Drescher, 2021. Autism for cognitive impairment (Working title), book in preparation, before. Freiburg: Lambertus
Theunissen, Georg and Mieke Sagrauske, 2019. Pedagogy in Autism: An Introduction. Stuttgart: Kohlhammer.ISBN 978-3-17-036318-2 [review at socialnet]
Theunissen, Georg, ed. 2020. Understanding Autism: Inside and Outside Views. 2nd, updated edition. Stuttgart: Kohlhammer. ISBN 978-3-17-037906-0
Theunissen, Georg, Wolfram Kulig, Vico lamp and Henriette Paetz, eds. 2015. Hand Lexicon Autism Spectrum. Stuttgart: Kohlhammer. ISBN 978-3-17-023431-4 [review at socialnet]
Vero, Gee, 2020. The other kid in school: Autism in the classroom. Stuttgart: Kohlhammer. ISBN 978-3-17-034701-4 [review at socialnet]
Williams, Donna, 1992. I could disappear if you touch me: memories of an autistic childhood. Munich: Goldmann. ISBN 978-3-426-75020-9
Zöller, Dietmar, 2020. Unusual, repetitive movement patterns and motor disabilities with effects on the ability to act. In: Georg Theunissen, ed. Understand autism. Stuttgart: Kohlhammer, pp. 153-162. 2nd, updated edition. ISBN 978-3-17-037906-0
Barnett, Kristine. 2014. The spark: the story of an autistic boy who showed it to everyone. Munich: Kailash. ISBN 978-3-424-63069-5
From the point of view of a mother, strength-oriented thinking and sensitive forms of support are impressively demonstrated, which are counterpoint to a deficit-oriented approach to autism.
Stupid, Ina. 2016. Highly functional autistic people at work: navigation aids through the world of work. Paderborn: Junfermann. ISBN 978-3-95571-460-4 [review at socialnet]
This book is highly recommended as a treasure trove for everyone who wants concrete help for autistic people entering the world of work and for successful inclusion in the first job market.
Schmidt, Peter. 2020. Out of the ordinary: Hands-on autism studies from someone who should know. Ostfildern: Patmos. ISBN 978-3-8436-1175-6
This book offers an entertaining introduction to the subject from the perspective of an autistic person.
Theunissen, Georg, ed. 2016. Understanding Autism: Inside and Outside Views. Stuttgart: Kohlhammer.ISBN 978-3-17-030786-5 [review at socialnet]
This edition introduces the topic of autism, offers an overview of current theories and allows parents and prominent personalities from the autism spectrum to have their own contributions on autistic characteristics and abilities.
Theunissen, Georg. 2014. Dealing with Autism in the US: School Practice, Empowerment, and Social Inclusion. Stuttgart: Kohlhammer.ISBN 978-3-17-023466-6 [review at socialnet]
This book is recommended for everyone who wants to find out about interesting developments in the field of autism and especially about innovative offers.
12 Information on the Internet
Prof. Dr. Georg Theunissen
Full professor of education for the mentally handicapped and pedagogy of autism
Martin Luther University Halle-Wittenberg (retired)
There are 2 lexicon articles by Georg Theunissen.
Theunissen, Georg, 2020. autism [on-line]. socialnet lexicon. Bonn: socialnet, August 18, 2020 [accessed on: May 19, 2021]. Available at: https://www.socialnet.de/lexikon/Autismus
This lexicon article is, like all other content on socialnet, protected by copyright. If you are interested in using it, please make an agreement with us beforehand. The editors of the lexicon will be happy to answer any further questions you may have.
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