Autism Spectrum Disorder: Perspectives From A Neurodiversity-Affirming SLP Part 1
Author: Kendra Wormald, Reg. CASLPO Speech Language Pathologist
Date: Wednesday, November 06, 2024
Table of Contents
Diagnostic Criteria
Autism is typically diagnosed in childhood, but many individuals may go undiagnosed until adulthood.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) outlines the diagnostic criteria for ASD as including five main components:
Persistent deficits in social communication and social interaction;
Restricted, repetitive patterns of behavior, interests, or activities;
Symptoms must be present in the early developmental period;
Symptoms must cause clinically significant impairment in social, occupational, or other important areas of functioning; and
These disturbances are not better explained by intellectual disability or global developmental delay.
If you find that the above criteria reflects your lived experience, it is important to seek support and more information from a medical professional. If you are seeking a diagnosis, speak with your doctor. There are limited professionals who can provide an ASD diagnosis. A Speech-Language Pathologist cannot diagnose but can support you in the unique ways autism spectrum disorder impacts you.
What ASD Is and Is Not
ASD Is
A disability
Autism spectrum disorder (ASD or Autism) is a complex neurological and developmental disorder. This means there are challenges and differences with the functioning of the nervous system.
It is vital to acknowledge the term “spectrum” in the name, as challenges and abilities may vary depending on person or environment.
ASD is not dependant on age, racial, ethnic, and socioeconomic group
ASD in the DSM-5 version includes terms, “Autistic Disorder, Asperger Syndrome and Pervasive Development Disorder Not otherwise Specified (PDD-NOS)
It is important to consider how a person would like to be identified. Some people prefer “People with autism' which is person-first language, vs. ‘'Autistic people' is an example of identity-first language.
ASD Is Not
Contagious
Less intelligence
An illness or a disease
Temporary
Caused by vaccination
Caused by parenting style
Levels of ASD
It is important to remember, different levels can exist within one person. Support needs may be low in one area and high in another. The level a person is ‘assigned’ at time of diagnosis may change throughout the lifespan.
Although these level categorization can be useful in determining what a person’s support needs are, the levels do not give a full picture of the person themselves, their strengths, capabilities and needs
Level 1, “Requiring Support” : Autistic person who requires support but have low support needs. People experiencing this level are often labeled as “high-functioning” which can often lead to having significant needs that are overlooked.
“It's not uncommon for autistic people with Level 1 support needs to mask their autism fairly well, and this can lead to challenges accessing the care they do need” (verywell health, 2024)Level 2 – Moderate (Requiring substantial support): Autistic person who
The DSM's Level 2 expression of autism includes … “ people who have very specific interests and who engage in repetitive behaviours that veer far from accepted, neurotypical behaviors. Or, the behavior may appear in spaces that neurotypical people view as a mismatch with time and place” (verywell health, 2024).Level 3 – Severe (Requiring very substantial support): Autistic person who is likely unable to mask and has very high burdens of self-regulation.
Adult ASD
Below are examples of how ASD may show up in an adult’s life. Keeping in mind, every autistic person’s experience may be vastly different from others and may change based on environmental factors. Some of the factors listen in one area may also present in others:
Professional Life:
When talking with your boss, you have difficulty telling if they are happy or mad with your performance
You have received feedback that you seem uninterested, speak like a robot, or are monotone
You’re unsure about which behaviors are considered appropriate
Connecting with co-workers socially is a challenge
Moving, vocalizing spontaneously or are suppressing these
You struggle when given nonspecific or ambiguous instruction or information
You feel overwhelmed by the sensory input in your environment which may get in the way of your productivity
Unexpected occurrences or changes may derail your focus, productivity and emotions
Increased emotions when others don’t follow rules or guidelines
Responding in a way that does not fit the context, such as in an accent during a meeting with the CEO
Challenges speaking when under high stress
Difficulty understanding verbal instructions
Time management and planning may be difficult
Noticing small details and patterns, smells and sounds
You repeat specific behaviors
You have a narrowed interest on a specific topic, project or responsibility
You feel you must finish one task before being able to move on to something else
Social Life:
Challenges understanding sarcasm or jokes
Challenges making and maintaining friendships; connecting with others
Challenges expressing your emotions
May avoid eye contact in conversation because it us uncomfortable
Challenges starting and maintaining conversation
Challenges engaging in social niceties such as discussing the weather or asking someone how they are at the start of a conversation
Feeling anxious around social situations
Repeat words or phrases
Finding it hard to understand your friend’s or partner’s thoughts or emotions
Difficulty expressing and understanding tone in communication
Taking things very literally
Difficulty following social ‘rules’ such as not speaking over someone, getting too physically close
Speaking very bluntly
Not responding in emotionally sensitive or appropriate ways
Want to speak about the same topic frequently
You follow the same schedule every day and strongly dislike change
In leisure time, you may prefer to do things alone
Difficulty responding to or using gestures such as pointing, facial expression and body posture. These may provide contradictory information to verbal communication
May more easily speak with older adults compared to peers
Challenges regulating your emotions
Impairment of the ability to change communication to match context or the needs of the listener, such as talking differently to a child than to an adult
Difficulties understanding what is not explicitly stated (e.g., making inferences)
Difficulty waiting for others to stop talking or take their turn before taking yours
Difficulty bonding with a child, partner or friends
Masking
Masking may also be referred to as: ‘camouflaging’, ‘social camouflaging’, ‘compensatory strategies’ and ‘passing’.
Masking is a strategy used by some autistic people whether intentionally or not, in order to appear non-autistic. This may be seen as tightly controlling and adjusting how you express yourself in order to ‘fit in’ with society. Although part of the human experience is to unconsciously disguise ourselves in order to connect with others, it is much more ingrained and harmful to the wellbeing and health of those who are autistic.
Bradley et al. (2021), concluded that masking can lead to
… “exhaustion, isolation, poor mental and physical health, loss of identity and acceptance of self, others' unreal perceptions and expectations, and delayed diagnosis. Second, “positive aspects of camouflaging” included greater access to social spaces, and protection from harm. Camouflaging was, therefore, seen as necessary to survive in a world designed for the neurotypical majority.”
Masking may look like:
Forcing yourself to sit still, suppressing stimming
Forcing yourself to make eye contact during conversation
Imitating expressions and gestures
Preparing jokes and phrases
Changing your speech speed or tone
Asking more questions than you care about
Speaking less directly
Women and ASD
According to the Centers for Disease Control and Prevention (2024), Men are four times more likely to receive an ASD diagnosis compared to women.
Researchers suggest this may be due to women being better at imitating behaviour that is “socially acceptable”.Males may experience symptoms that are more visible whereas females may internalize their symptoms more.
Others suggest women may have more repetitive behaviours that aren’t seen as ‘socially unacceptable’ such as needing a very clean and organized house.
These assumptions can be harmful and may lead to reduced diagnosis and therefore support, as well as feelings of invalidation and isolating.
It has been repeatedly suggested that more longitudinal studies are needed to draw more clear conclusions about the diagnoses between autistic males and females.
Conclusion
Autism Spectrum disorder can be significantly challenging and even debilitating in engaging successfully in everyday life. Recognizing the impact of ASD across different areas of your life is an important step in learning about and supporting your unique needs.
Resources
Autism diagnostic criteria: DSM-5 (2024). autism speaks. https://www.autismspeaks.org/autism-diagnostic-criteria-dsm-5
Bradley, L., Shaw, R., Baron-Cohen, S., Cassidy, S. (2021). Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood, 3(4), 320-329
Mayo Clinic Staff (2024). Autism spectrum disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928
Rodden, J. (2024) What are the signs of autism in adults? ADDitude. https://www.additudemag.com/autism-spectrum-disorder-in-adults/
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