Understanding Neurodiversity
About Autism
What is autism?
Autism is a neurodevelopmental condition, the features of which can include atypical social development, difficulties with mental flexibility and aspects of processing, and also may include atypical sensory development. The developmental idea is key and distinguishes autism from other pathways that might also lead to these outcomes for people, such as trauma or anxiety.
What are the signs of autism?
There are no signs or symptoms of autism as such, as this views autism from a medical perspective. Autism is not a disease or a condition; it is a difference. There are however some features that many autistic people share. Many of these features include difficulties in social communication, a rigidity of thinking style, and, for some individuals, understanding the perspective of others (theory of mind). It is not uncommon for people to have unusual sensory experiences, struggle with learning in different contexts, and have co-existing conditions such as ARFID. Perhaps one of the most important signs of whether a person may be on the autism spectrum is their own sense of feeling different from other people.
Do I have autism?
If you are asking this question and you are an adolescent or adult, it is important to first reflect on what has suggested the idea of having autism to you. Many people that we diagnose, especially in adulthood, have often said to us that they had a 'feeling' that they were different in some way to their friends or even family members. This alone does not necessarily mean that you have autism, but there are a number of reflective questions that can help you to think about this further. 1) Do I know of or have I met somebody with a diagnosis of autism? 2) Has my awareness of autism been developed through the internet and social media? 3) Have friends, colleagues or family members discussed with me and suggested that I may misread or misunderstand certain social situations more than other people they know? 4) Have I always had a sense of feeling different from other people? 5) Do I like things to be predictable? 6) Is it really important for me to resolve this question? For adults in particular, there are simple screening tools such as the AQ50 which are not diagnostic tools in their own right, but can help people to think about whether it is worth pursuing a discussion with a professional or expert about a diagnosis. Ultimately, it is your decision whether you feel that pursuing a diagnosis would be worthwhile for you or not.
Is autism genetic?
Scientists have always struggled to say how much of our behaviour is environmental and how much is genetic. The simple answer is that autism is a very broad subject matter, and there is some evidence that autism recurs across generations in families, indicating some kind of genetic marker. There has been much speculation about autism and genetics which has been fuelled by research over the years, which suggests that many more males are diagnosed with autism than females. We now know that these gender differences are simply not as large as we first thought. So, we need to exercise some caution when people promote the idea of finding genetic causes of autism, as it raises questions of can autism genes be modified or changed in some way? So, to be clear, there is a complex number of genes that may be related to what we call 'autism,' but to date it is difficult to say conclusively what these links are.
Is there a test for autism?
Autism is a developmental condition, and so assessment for autism diagnosis requires a review of early developmental history alongside current information from the person and perhaps family, friends, or colleagues. This is a fairly comprehensive process. Whilst this might include the use of autism screening questionnaires, bear in mind that these questionnaires on their own can easily give false positives or negatives, and a proper diagnostic assessment for autism takes into account a much broader scope of information and context. It is very important to note too that features of autism can mirror those of other conditions, as is particularly so with early life adverse experiences (ACEs) or trauma. So, there is no simple “test” for autism, nor any kind of biological kind of test.
What causes autism?
Autism is not one condition. There is not one single form of autism, which means it is highly likely that there will be many genetic and environmental factors that are complex to understand. We do know that there are some genetic factors where autism may appear to run in families, but this does not account for what we experience in what would best be described as the ‘world of autism.’ Unfortunately, the autism field contains practitioners and individuals with very strong opinions about the causes of autism, which has led to a lot of myths. Over the years, suggested causes of autism have ranged from refrigerator mothers to suggestions about dietary factors. There are also groups and individuals who view autism almost like a medical disease that can be cured. The general consensus at present is that autism reflects neurological differences, and it is inappropriate to think about ‘curing’ it like it is a medical condition. Often, individuals can be overwhelmed by trying to understand autism. It is caused by multiple factors, many of which we have little knowledge or experience of. At present, the scientific understanding of the causes of autism is still poorly understood.
Can girls be autistic?
Absolutely yes. It is a myth that autism is predominantly a difference found mostly in males. Studies have shown that women who meet the criteria for being on the autism spectrum often present with different conditions. A common example is eating disorders. Professionals often use the term 'masking' when discussing why so many women on the spectrum are missed by the system. For us, masking is too strong a word, because sometimes it implies that a person is deliberately concealing their differences. Since autism was labelled by Professor Leo Kanner in 1943, autism has been thought of as predominantly occurring in males, even though 3 of Kanner's 11 case studies were women. We have evolved in our knowledge about the complexity of autism, and there is little doubt that there is a significant 'silent' minority of autistic women.
What is high-functioning autism?
There are a confusing number of labels that are used. High-functioning autism is a way to describe an individual who has no associated learning difficulty. We believe this accounts for about ⅓ of people with a diagnosis. Whilst it is not appropriate to talk about IQ levels, it is appropriate to think about people with average and above average intelligence. Before the change in diagnostic criteria, the term used for high-functioning autism was Asperger’s Syndrome. It was thought to simplify the diagnostic process that Asperger’s Syndrome should be removed. Today we speak of individuals as being ‘on the spectrum’ somewhere. Unfortunately, terms like high-functioning autism can have very negative connotations. Presumably, if there is high-functioning autism, there is something called low-functioning autism. Increasingly, practitioners are trying to avoid using these terms as they often focus too much on individuals’ deficits rather than their strengths.
Are there other conditions associated with autism?
Because diagnostic classification is not an exact science, there are many overlapping and associated conditions with autism. It is impossible to fully understand the complex inter-relationship between conditions, or in some cases whether these conditions ever existed at all. It is perfectly possible to have overlapping conditions such as autism and ADHD. It is also true that there are conditions that are strongly associated with autism, such as eating related conditions like ARFID. It is not uncommon for individuals to develop restrictive diets almost as a ‘special interest.’
Individuals with intellectual disabilities and autism also have a range of overlapping genetic conditions (Smith-McGennis, Corneilia DeLange etc). Pathological Demand Avoidance (PDA) where an individual is sensitive to demands and requests of others is increasingly being associated with children on the autism spectrum. There is considerable debate about whether PDA is a separate condition or not. Interestingly, terms such as ‘obsessive compulsive disorder (OCD)’ are used quite frequently when referring to people on the autism spectrum. It is highly debatable whether individuals with a primary diagnosis of autism should also be labelled with OCD. This is because routines and rituals are strongly associated with autism. At present, we do not have adequate explanatory frameworks to distinguish between this range of conditions and autism. Autism as a neurological difference does logically mean that autism will have other associated risk markers such as depression. Finally, the complex understanding of trauma and in particular Adverse Childhood Experiences (ACEs) and how this impacts on individuals on the autism spectrum is still relatively poorly understood.
Is autism a disability?
Autism is technically considered to be a disability as it can make aspects of day-to-day life more challenging for many autistic people. At Studio III, we understand that autism is a developmental difference and that most of the systems and norms within society were not built with autistic presentations and needs in mind, and this can be very disabling for many autistic individuals. That’s to say, being autistic in itself is not a “problem”, but trying to navigate a world that wasn’t built with you in mind as an autistic person can be extremely challenging and often causes its own problems.
A lot of the language used around autism can feel very outdated and somewhat medical which can feel very stigmatising for some people (e.g. “disorder”). The campaigner Jim Sinclair championed the idea in the 1990s that people on the autism spectrum were “not broken or damaged versions” of neurotypical people, where they needed to be fixed or repaired. The term ‘neurodiversity’ was first coined by Singer (1998) and this reflects the natural variation and range of differences in brain functioning and behavioural presentations amongst human beings - no two people are the same. ‘Neurodivergence’ is a term often used when speaking about autism and this indicates variation and difference from the average or ‘neurotypical’ brain.
It is important to note that many autistic people do require additional help and adjustments - the level of need and the type of support needed varies from person to person. It is unhelpful to generalise too much when it comes to autism and at Studio III we take a person-centred approach to getting the right support for the individual.
What support is there for autistic people?
For many people, autism is a life-long condition where individuals may need additional supports such as specialist advice, therapy, support staff. Increasingly, there has been an awareness that the supports that people need need to focus on equipping individuals with ‘tools’ to help them become valued members of their communities. There are also a huge range of therapies and interventions that are advocated in the autism field, many of which have limited or rudimentary scientific basis. Some individuals require autism-informed therapeutic engagement,’ and there is some evidence that for some individuals on the autism spectrum, specific therapies such as CBT, DBT and mindfulness may be of some help. Increasingly, recognising the supports that family members and supporters require has received more focus. There are many training programmes which have evolved in the field that equip supporters to communicate more effectively with the individuals they support. These range from behaviourally-based interventions (although it is debatable whether these are interventions per se), to support systems such as TEACCH, PECS, SPARKS, Low Arousal Approaches. Many individuals and their families on the autism spectrum do experience behavioural crises where they may require specialist advice or input.
About ADHD
What is ADHD?
Attention-Deficit/ Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterised by persistent inattentiveness, impulsivity, and hyperactivity that pervasively interferes with functioning and/or development. While these core symptoms indicate key areas of difficulty for individuals with ADHD, a sole focus on these components does not appropriately capture the scope of the challenges associated with this condition such as executive dysfunction, emotional dysregulation, and impaired psychosocial functioning. The ‘developmental’ part of ADHD is key and distinguishes it from other pathways that might also lead to these outcomes for people, such as trauma or anxiety.
ADHD was historically believed to be a childhood disorder but it is now supported in the available research that ADHD can often persist into adulthood. A common stereotype associated with ADHD is that it is just for “hyperactive young boys” but this is not the case as ADHD is diagnosed in both males and females of all ages (though there is a trend of missed and late diagnosis amongst girls and women with ADHD).
Is there an ADHD test online?
While there are plenty of questionnaires and ‘screening tools’ for ADHD online, these would not be considered enough to support a diagnosis. ADHD is a developmental condition and so assessment requires a thorough review of developmental history as well as clinical assessment (by a qualified professional) to rule out any other causes of the symptoms. The assessment process is further supported by discussion about behaviour and symptoms in the different domains and settings of the individual’s life. Information from other people such as family, friends, and colleagues are also helpful parts of the diagnostic assessment process. It is very important to note that features of ADHD can mirror those of other conditions and so a comprehensive assessment process is necessary. In conclusion, there is no simple “test” for ADHD, particularly not one found online!
What are the signs/symptoms of ADHD?
ADHD can present in a very individual way and so there is no exhaustive list of specific symptoms. Inattentiveness, impulsivity, and hyperactivity are the main areas of difficulty found in ADHD but what this looks like can vary from person to person. Inattentive symptoms might manifest in presentations such as forgetfulness, distractibility, inability to concentrate, and disorganisation. Impulsivity can look like rash decision making, disruptive behaviours, and risk-taking with little thought of the consequences. Hyperactivity might present in extreme restlessness, talking too much, and excessive fidgeting. An important aspect of this is that the symptoms are pervasive and have resulted in psychological, social, and/or educational or occupational impairment. A lot of people with ADHD report long-term feelings of being different to others and feeling unable to function in the same ways as other people.
What support is there for ADHD?
There are various support options for ADHD and what this looks like will often vary depending on the individual. There are different medications that are supported to be effective in the management of ADHD and this is something that should be explored with a specialist prescriber. At Studio III, we don’'t provide or prescribe medication for ADHD, but we do take a more psychology-informed approach to support. People with ADHD can benefit from learning about how ADHD impacts them as an individual and this can help them to increase their awareness, develop useful compensatory strategies, and implement reasonable adjustments at home/school/work. There are also useful environmental and lifestyle changes that can be made to help with managing ADHD. Relationships are an important source of support for everyone and so information-sharing, learning, and collaborative support planning with important people in the life of the person with ADHD can be helpful for some people. Due to the long-term challenges associated with ADHD, some people can struggle with associated difficulties such as low self-esteem, burnout, depression, and anxiety, and they may benefit from working with a therapist.
Can girls have ADHD?
Girls and women are somewhat under-represented in ADHD research and there are lower rates of referral and childhood diagnosis. While ADHD can present in quite an individual way, the available research supports that women are more likely to present with inattentive symptomology. This can be less disruptive than other ADHD presentations such as hyperactivity/impulsivity and is potentially linked to the lower rates of referral as it does not attract as much notice. The research supports that inattentive symptoms are more likely to persist into adulthood which suggests that women may be prone to a more persistent form of ADHD. Women may therefore be more likely to struggle with ADHD across their lifespan and are less likely to receive timely diagnosis and support which can negatively impact long-term outcomes around relationships, academic achievement, employment, mental and physical health, and more.
Many women with ADHD report lifelong feelings of being “different” to others and describe having to mask their difficulties in order to fit in and get by. Some describe that their mind is never quiet and that day-to-day activities that seem easy to most are extremely challenging or near impossible. Without the right understanding and support, ADHD can impact all areas of life and many women with ADHD can also struggle with their mental health as a result. Despite the challenges associated with ADHD, many people with this condition lead full and gratifying lives which can be supported through diagnosis and tailored treatment intervention.