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Autism in children / autism in adults

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Sanctuary

Autism can manifest itself quite differently in adults compared to children. I've been thinking about this topic recently and a particular prompt came when watching a video in which someone talked about the common characteristics of autism. She referred to issues such as lack of contact and made the very good point that this characteristic may be much less evident in autistic adults. This is because adults have learned (or been told) that eye contact is important and so most of them do try to make it. The same is probably true for other indications such as engaging in monologues, e.g. about a personal interest, rather than engaging in conventional interaction. Adults have learned that this is frowned-upon so most try to avoid it. Other indications may become less prominent not because of fears of disapproval but simply through social learning. For example literal-mindedness or lack of ability to detect irony can reduce as an autistic person develops and becomes more attuned to the nuances of language and communication - they may take longer to learn them but the abilities do develop. The picture then is often one of autistic characteristics becoming more subtle and less obvious with the movement from childhood to adulthood. However those characteristics are usually still present beneath surface appearances. For example eye contact and efforts at conventional conversation are likely to be present but occur in unusual and perhaps less convincing ways, lacking the fluency and apparent ease of neurotypical individuals. Eye contact may even be too prolonged as an autistic person feels he or she must sustain it. Conversation may falter as he or she recognises the need to avoid monologues but struggles to find things to discuss and maybe even "shuts down", just not knowing what to say.

A drama analogy may be helpful. Life is like a play in which we all play a part. The autistic youngster and some autistic adults with lower-functioning autism may seem to act as if they don't have a script at all, or aren't even aware they are in a play. Although this often disconcerts others it can lead to a very "naturalistic", uninhibited performance, relatively free of social anxiety. Many autistic adults are though well aware of the script, what they are supposed to say, how they should move, etc - indeed they may be much more aware and try to be more observant than the neurotypical "actors". However their performance is often judged by others as "wooden" or "unconvincing". The right words may come out but in a hesitant way, not unlike an actor who seems to be trying to remember the script and the stage instructions. Social anxiety - the social equivalent of "stage fright" - becomes common and makes playing social roles more difficult and may even lead to social withdrawal.

Clearly these are all generalisations and to some degree speculations. There are definitely cases where autistic children and adults deliberately challenge social norms or observe them very reluctantly. Some become very skilled in certain social activities although rarely as clearly or consistently as the neurotypical norm. Others may seem to become "more autistic", perhaps as they tire of trying to "fit in" or become socially isolated and lose touch or confidence in social settings. Overall most autistic people do reduce to some degree some of the areas of weakness or lack of awareness (real or supposed) which were prominent in childhood. This can present some challenges to diagnosis or recognition and is why attention to autism in adults needs to go beyond surface appearances.  

 

 

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Dr-David-Banner

It's a good post you made although I may be able to respond to some of the points to give some feedback. The big point I would make is personally I am convinced my own developmental process took a third way. It was a coping method to aquire knowledge and thought processing, through by-passing reliance on social interaction. This was along the lines of books and meditation (alone). To simply it if you imagine an individual has very poor childhood interaction skills and becomes isolated, the isolation will either lead to deeper depression or withdrawel into special interests, books, fantasy and lots of time to think. In my case this has led to a serious problem. Symptoms like one-sided conversation to this day applies. I can make eye contact but I tend to look beyond people into space. I hardly smile but can break barriers a little by telling funny stories or acting childish. In fact I interact at a kind of childish level and mostly with women (changing the subject rapidly). It took me years to actually discover how specifically I differed from "normal" which meant I had to observe normal people. The bottom line is I made huge progress overcoming all the learning delays, missed school, poor self expression (up to about 22). However, I remain unable to form stable relationships of any kind and that even created family issues. I may easily cause offence by simply not understanding emotions so thereby sounding insensitive. I may be so inwardly engrossed in my projects I forget birthdays or fail to thank someone. I am sadly totally unemployable - seemingly incapable of just interacting with others. It may be my self-educating blitz made me even more remote. However, there is hope yet. At least now I can pinpoint and outline where the problem lies and that there definitely is a problem. My condition likewise should have been addressed years ago at school but sadly many of us were left to struggle. So now here is where I'm at: People with autism have a lot of problems but they have rights. They are not stupid. They don't deserve to be penalised or discriminated against in cases where school or employment is problematic. They need inclusion, support, therapy and extra help so as not to be shut off from society. Ultimately my hope is to "manage" my autistic traits and try and not be so cut off as in the past. Collectively we need to push the message that autism is very real and needs to be diagnosed early where possible. 

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Dr-David-Banner

With regard to points about "acting" I made this simple discovery. Try and picture yourself in a movie scene. I had been watching re-runs of Dallas so I tried imagining myself in one of the dinner scenes, where the family chat. I studied the smiles, eye expression and use of language. Wow, it made me feel very uncomfortable to feel myself in the scene. Even worse was a school scene. Daniel Larusso going into this school packed with conceited footballers and groupy cheerleaders. Of course we know he had to learn Karate and he was a normal NT kid from New Jersey. To be honest with you, studying NTs in films is hugely educational if you view it through psychology. How often do they smile? How do they fit in? What about tone of voice and facial expression? Finally I had to specifically do this when I sing. To sing and sound for real I learned I had to force expression and intonation into my voice. I had to play it back repeatedly and make pitch go higher on end notes and project feeling. Sure you can learn to do it mechanically.

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Sanctuary

You're right that it's possible to learn social skills just as it is possible to learn any skill. Everyone can make progress. In your example with singing (and it could no doubt be widened to a singer or musician's "stage presence") there are expectations about how words should be delivered, use of emotions, gestures and so on. Someone could choose to sing very differently, maybe in an "emotionless" way, but that is unlikely to resonate with a wider audience although it might be appreciated by some for its distinctive character. 

While social skills can be learned, sometimes very well, there are often small signs that they are having to be consciously performed - a self-consciousness that may seem "unnatural" or "odd". Often these signs are so subtle that the person making them and the "audience" can't specifically identify them but all the same they are aware of something that doesn't quite fit. Scientific study of video and audio evidence may be better at picking up on micro-signals in a person's movement, tone of voice, rate of speech, etc, that are unusual. I've given a foreign language analogy before. Foreign languages can be learned with varying degrees of success. Some learners are remarkably successful and may speak flawlessly - indeed to a higher standard than most native speakers. However their accent - even a slight one - can mark them out as an "outsider" - not necessarily someone who is to be disliked but someone who is different. Sometimes ironically it is the accuracy and "correctness" of the speech which seems odd - the speaker perhaps not having the confidence of a native speaker to relax and "break the rules". I feel the same can apply with ASD. Autistic individuals can have a remarkable grasp of social rules and expectations and can do their best to follow them rigorously to "fit in". However even when they do this they may still come across as not truly convincing. By contrast many neurotypicals have the confidence to break the rules at times and do so without seeming socially incompetent or anti-social.

A final point is that while skills can be learned it can be a strain to "put on a performance". Some on the spectrum may just prefer to "be themselves" and just act in ways they feel comfortable. I'm sure everyone with ASD has experienced this tension between wanting to fit in and be accepted and wanting to follow their own path. It can certainly be a relief to take the "authentic" path and it can lead to success and respect of a different kind but is certainly not a path without consequences.  

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Dr-David-Banner

I agree a certain level of success may be obtained by analytically re-creating a level of social interaction. I was forced to do this with my singing because it involves emotional expression and "feeling". I experimented by raising my voice at the end of a line and so on. For example, I recall a humorous story when The Beatles first wrote She Loves You and a relative commented, "Shouldn't it be 'she loves you, yes,yes,yes?'" (as opposed to yeah, yeah, yeah). Lennon just laughed in amusement. Phrases such as "some day eeyay" as sung by sixties bands are going to sound more communicative than "some day". Given I have no vocal coach or sadly even feedback from others who might do music where I live, I am forced to just analyse how the experts did it. Then record myself over and over. As you stated, were I to apply this to spoken communication, yes, it would work to some extent. However I feel a significant level of human interaction also takes place at the subconscious level. Stuff you can't define. Interesting too to consider Michael Jackson. This guy could sing and dance to perfection yet he was clueless over social interaction. He probably never understood that wearing a surgical mask in public created an awful impression. Neither did he understand how street-wise people can use or hang on those who are unaware or exploit weaknesses. Clearly there was a huge gap between Michael's routine performance skills and his actual connection with the real word. 

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Dr-David-Banner

To add one more point: It now seems to me factors surrounding childhood are crucial to help diagnosis. Any initial symptoms are going to arise during school years especially. One big point to understand is "all" Asperger's patients had been removed from mainstream school. Some autistic kids managed to pass through mainstream school but none of Asperger's children did. So, in a sense, the actual studies of Asperger are narrowed down only to include German speaking children whose autistic symptoms were associated with dyscalculia, motor issues, difficulties with group based schooling. So, Asperger's scope was a little narrow although personally I consider his understanding of the subject better than any other neurologist to date. There has been a problem, however. All the child research on autism has been through observation and interpretation of what "doesn't fit normality". The children were not articulate enough to add any analytical feedback. Asperger, though, deserves huge credit for one observation that sets him apart from other psychiatrists. He definitely recognised his children under study were often more intelligent than "normal" children. He observed a lot of unique characteristics and experimented with a different educational approach. All other psychiatrists tended to be misled by the assumption that clever children always come top in the class. Not true. John Lennon was a terrible student at school but in fact musically gifted. Final point: I often read that autism abnormalities get worse as you age. Personally I am not so sure. Being an adult I am now able to research aspects of psychology or simply make observations. I no longer have to beat myself up over not being able to meet standards of normality. I can recognise areas where autism is going in a negative direction and acknowledge the problem. Children however have to rely on adults so may be dosed up with medications as an easy fix. 

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Sanctuary

Characteristics of autism can ease or intensify as a person develops through childhood into adulthood. My broad hypothesis is that awareness of social rules and conventions in particular should increase from early childhood and lead to behaviour that is more in line with these rules and conventions, e.g. an autistic person tries more to make eye contact. With increased awareness though often comes increased anxiety and this may stall or even reverse this process. The case of special education (or any kind of special support) raises interesting issues. While it is intended to help those with autism make better progress there is always the possibility that being educated around others with autism can intensify autistic characteristics. This can also happen with forms of support which may reinforce differences or lead to lower expectations. Being educated in a mixed environment does offer more opportunities to become more familiar with the neurotypical world and this lead to more "conventional" behaviour; however it can also lead as we know to feelings of stress, isolation and even victimisation. Much can depend on the individual and the type of environment they experience but they are issues we all need to be aware of. 

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Dr-David-Banner

I never paid attention in the past to how emotionally normal people interact but films helped me analyse it. The most obvious thing to notice is movie stars really know how to smile. Then I realise I rarely smile at all. If asked to smile for a photo I will flee. How on earth do these people manage to do those huge, happy smiles? My point is I know there are times when I'm supposed to smile yet it doesn't happen. I'm also supposed to show interest in group or community efforts but I tend to be too inward or goal orientated to show interest. That stretches back all the way to school and team games. I can say over the last couple of years I've made the greatest improvements mainly in recognizing in what ways I differ from normalised behaviour. So far only recognition. That is I know my friends smile naturally, say or do things that neatly fit into "normality". They are far more at ease being with other people and nobody will react negatively to them. In my case I guess I tend to control the flow of conversation, look or turn away from those I talk to, act kind of silly and, of course, I almost always chat with groups of women. At the moment I find just watching actors or people I know talking makes me more aware of eye expressions, voice tone, boundaries and so on. 

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Sanctuary

In a sense we are all acting in social situations and have the job of conveying the "appropriate" emotion or response. In some cases this means simulating feelings we do not have. I must stress this is not the same as lying or hypocrisy although those are also examples of simulation. Often we simulate an emotion or response in order to help or support others, or to fit in with a required mood. For example a person may have all sorts of personal problems on their mind but at work he or she is expected to put them aside and be positive with customers, other staff, etc. The same applies if an unhappy person goes to a party or some other kind of upbeat event. Sometimes it's a case of fitting-in with a more downbeat mood even when the person feels indifferent or even happy. Social "acting" though is also involved in convincing others of our true feelings and intentions, e.g. a person who is telling the truth has to convince others of that fact and that is not always easy. One of the problems for those on the autistic spectrum can be that they can struggle to convey their true feelings and are therefore unfairly seen as "lacking interest", "being insincere", "being cold" and so on.

We can certainly study how these emotions and behaviours are successfully or unsuccessfully acted out. To some degree we can improve or "make more appropriate" how we project ourselves but it is not an easy task as our personae have developed over decades and are hard to modify. Another issue - and certainly a problem for those with ASD - is reputation. If a person develops a negative reputation often even when they do all the right things they are still viewed negatively while those with positive reputations often seem to be able to do what they like and still be well-regarded. 

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Dr-David-Banner

Just to divert a little (before I continue with fresh posts), I just add here my blog link. The blog will be based around autism research (higher-functioning), especially making available some material from the USSR. I am doing the blog sometimes in English and sometimes in Russian (as writing the odd blog in Russian is good practice). Last blog is simply about Asperger's.

https://www.teslapsychology.home.blog/

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