This is the internet weblog of Bix Frankonis.

The Actual, Underlying Autistic Disorder

I’m becoming increasingly interested in this idea to which I keep returning that what usually are considered the pathologies of autism in fact might be adaptations to mitigate the actual pathologies of the actual, underlying autistic disorder.

Fundamentally the idea is this: that the true autistic disorder, per se, is one in which the nervous system and primarily the brain is atypically sensitive to and susceptible to becoming overloaded or overwhelmed by stimuli at levels lower than is the case for what are considered normative brains.

(This still, to be sure, gives us a situation where we can argue over whether or not this is disorder or difference, but for my purposes right now this is neither here nor there.)

If looked at this way, the allegedly defining pathological features of autism spectrum disorder as presented by manuals such as the DSM-V potentially take on an altogether different character.

Diagnostic Criteria

  • Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

    • Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

    • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

    • Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or making friends; to absence of interest in peers.

Severity is based on social communication impairments and restricted, repetitive patterns of behavior

  • Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

    • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

    • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

    • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

    • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

The purported “deficits in social communication and social interaction” as well as “restricted, repetitive patterns of behavior, interests, or activities”, then, begin to seem instead like adaptive strategies for managing and mitigating the autistic brain’s atypical tendency toward overload/whelm, rather than as symptoms or problems in need of cure or correction.

(This doesn’t even reach the important recontextualization known as “the double empathy problem”, wherein any communication deficits at least in part are the result of the mismatch between typical and atypical brains, not merely the fault of the pathologized brain.)

Like any management or mitigation strategies, some or all of these autistic strategies (née pathologies) of course can be taken to extremes which themselves begin to cause additional impairments, but they are not impairments inherently or in and of themselves.

It’s also true that the degree of the sensitivity and susceptibility to a large degree is what generates the wide range in the support needs of autistic people, and that’s why there’s a push for an administrative label of “profound autism” (and I part with most of the neurodiversity movement which opposes such a label). One wonders if in some autistic populations there’s a weaker set of adaptive mitigation strategies when compared to the degree of sensitivity and susceptibility to stimuli?

Sometimes people raise the question of why autism continues to exist given the selection pressures of evolution. In my view of “strategies-née-pathologies”, maybe what we’re seeing is that evolution has selected for autistic brains that have found ways to manage and mitigate the underlying disorder, precluding any evolutionary pressures to get rid of that disorder.

Arguably, in earlier aeons and eras, the levels of simultaneous stimuli from different channels would have been significantly less intense than they are today. It’s unclear to me whether or not early hominids even would have noticed this or that person’s nervous system being easier to overload or overwhelm. There might not have been any particular evolutionary “need” to pressure that trait out of existence.

I’d tend to think, though, that autistic brains with mitigating strategies built into them would have been evolutionarily “helpful” whether the stimuli pressure was high or low. Over time, then, what gets noticed and then inevitably pathologized are those adaptive strategies.

This view of the underlying autistic disorder helps better define, at least for me—although hopefully by extension people with whom I need to communicate about my autism—, from where the actual impairments come.

As an actually-autistic person, I am atypically overloaded and overwhelmed by stimuli, especially when present in multiple, simultaneous channels. That is an impairment, to be sure. Denying the use of the adaptive strategies evolved by autistic brains to manage and mitigate this impairment—especially by pathologizing them into the source of the problem—is for autistics a mass disabling event.

This post originally was published 1 month ago by Bix Frankonis on Posts older than a decade might not reflect my current views.