Rethinking Autism

Over the last 40 years, Autism has been viewed as a developmental “disorder”, currently categorised under the diagnostic term Autism Spectrum Disorder (ASD). However, there is growing recognition that this label can be problematic. Firstly, the term “disorder” carries negative connotations, implying that something is inherently wrong. Increasingly, many prefer the term Autism Spectrum Condition (ASC), which shifts the focus away from “disorder” and toward a more balanced understanding of autism as a different way of being. This article explores the idea of autism as a condition, emphasising its advantages, the role of therapy, and whether a diagnostic report is always necessary.

The History of Autism Diagnosis

The concept of autism has changed enormously over the years, since Bleuler originally coined it in 1911 to describe a form of psychosis. From the mid-60s, child psychologists used the word ‘autism’ to describe the exact opposite of what Bleuler had meant. In the 1980s, Lorna Wing, a psychiatrist, shaped a more modern understanding of autism, introducing the idea of a spectrum, highlighting that autism was not a singular condition but a range of traits that vary widely among individuals. Asperger’s syndrome, which had been included as a separate diagnostic term for individuals without diagnosis of learning disability, was then brought under the umbrella of ASD in 2013. This has contributed to the ever-expanding spectrum associated with the condition.

While this may have helped bring attention to the wide range of experiences within the spectrum, it also created challenges. Autism now includes a vast array of symptoms and behaviours, from non-verbal individuals with significant intellectual disabilities to highly functional people, with social or sensory difficulties. This wide scope has led to calls for a more nuanced approach, recognising that each person with autism has unique strengths and challenges that require individualised support, centred around a needs-based approach.

The Strengths of Seeing the World Differently

One of the most compelling reasons to shift from “disorder” to “condition” is that people with ASC can display remarkable abilities, arising from distinct ways of thinking. A well-known example is Allan Turing, the brilliant mathematician and logician, who is believed to have been on the autism spectrum. Turing’s unconventional thinking is widely credited with shortening World War II by two years through his work on cracking the Enigma code. His ability to think outside the box, a hallmark of people on the autism spectrum, allowed him to solve problems in ways that others could not.

This “different” way of thinking is not a deficit. People with ASC are often highly analytical, detail-oriented, have excellent pattern recognition, a strong sense of justice and are capable of intense focus on subjects of interest. These attributes can lead to groundbreaking innovations, as Turing showed. Whilst challenges such as difficulties with social interactions are often highlighted, it’s important to remember that there are clear advantages associated with ASC.

The Role of Therapy in Supporting People with ASC

Therapy can play an essential role in helping individuals with ASC navigate the world, especially when challenges arise, for instance, helping people develop strategies to manage anxiety, social difficulties and sensory issues.

However, it is crucial to recognise that therapy should not be about “correcting” autism, but rather about providing individuals with tools to help issues that distress them and cause difficulties functioning in life, such as anxiety, particularly in a world that is not always neuroinclusive. A person with ASC may struggle with sensory overload, for example, and therapy could offer coping mechanisms to manage this - without trying to fundamentally change who they are.

Is a Formal Diagnosis Necessary?

One of the most debated issues amongst individuals with ASC, family members, schools, workplaces and professionals, is whether a full diagnostic report is necessary for everyone. Unlike diagnosis of other mental health conditions, including depression, anxiety, OCD, eating disorders, amongst others, such diagnostic reports require lengthy assessments and questionnaires, to produce a comprehensive report. Given NHS wait times of 4 years in some areas, the costs of obtaining a report privately can be prohibitive. The more important question is whether a full report is always necessary.

Advocates argue that, instead of spending resources on producing a lengthy report, the focus should be on addressing individual difficulties. Of course, discussing the core symptoms indicative of ASC is helpful. It is a condition characterised by social communication and interaction difficulties, and by restricted, repetitive patterns of behaviour, interests and activities. Primarily, psychoeducation gives individuals a sense that they are not alone: that their experiences are not unique. For some individuals, particularly those who face significant challenges in daily life, such as being non-verbal or having learning difficulties, a full and detailed report is required to ensure that needs are fully documented. However, in many cases, a letter from a qualified mental health professional, noting the characteristics of ASD and difficulties faced by the individual, is frequently sufficient.

It is important to note that an individual does not necessarily need to have been diagnosed with autism to get extra support. Far more importantly, the individual, school or workplace environment may simply require advice on ways around specific issues faced by an individual, much as with any other condition.

Hence, instead of diagnosis of a “disorder”, individuals might benefit more from discussing what the issues they are having difficulties with and focusing on learning strategies to address the challenges they face, such as social skills training or anxiety management. Individual therapy and support should include a tailored approach, focusing on the specific symptoms under the umbrella that are problematic to an individual – social anxiety, noise tolerance, self-esteem, and self-harm to name a few.

Conclusion

It can be helpful, when thinking of what help individuals need, to move away from the idea of autism as a “disorder” and instead embrace it as a condition that varies hugely amongst different individuals. Therapy and support should focus on helping individuals with the issues that impact on their mental health and functioning, allowing them capitalise on their unique strengths. A letter from a qualified mental health professional, noting the characteristics of ASD and difficulties faced by the individual, is frequently sufficient for communicating any reasonable adjustments needed to employers and educational institutions. By shifting our perspective, we can foster an approach that is neuroinclusive and supports individuals to reach their full potential.