Autism and the Shower: Tips

As a child and teenager, I was terrified of showers. I didn’t take my first full shower until the summer before I went away to college, because I knew the dorms didn’t have baths. Everything about the shower disturbed me: the water, the textures, being naked, etc. Especially bad was hair maintenance- washing, drying, brushing, all of it was unattractive.

It is, however, an unfortunate fact of life that everyone must clean their bodies and hair, to prevent illness, odor, and social avoidance. Here are some tips to make showering less aversive:

1) Timing: Most people have particular shower times: before bed, just post-waking, etc. But there is no set law that showers have to be taken at a given time each day. For individuals wary of showers, preparing oneself for the act of showering, and then calming down afterwards, can take time, with some needing more time than others. If they need prep time, consider an afternoon or evening shower. If they need calming time, be sure not to force showers right before bed as it may interfere with sleep. Experiment with offering showers at different times of day to see what works best for your child.

2. Getting into the shower. Showers can be a full-on sensory assault for autistic individuals. This may make them fearful of getting into or staying in the shower. If your child refuses to stay in the shower long enough to get clean, try building up to it. On day 1, let your child stay in the water as long as they can without getting upset. Even if the time is only ten seconds, reinforce your child for making it that long, with a token, a dessert, or whatever works as reinforcement for your child. The next night, require that they make it fifteen seconds before receiving the reinforcement, than twenty, thirty, a minute, etc. until they have reached a period of time long enough for a full shower to occur (maybe 8 minutes?). As your child becomes accustomed to the feeling of the water on their bodies and face, it will likely become less aversive and showering will become easier and easier until no reinforcement is needed.

3. Shower Products. Shampoos, soaps, and body washes can be a major issue of contention. They each have their own smells and textures that need to be dealt with, and they can leave your body or hair feeling different, even after they’ve been washed out. Offer as great a variety as you can and let your child choose what works for them. I used to hate the feeling of soap, and in college I found everyone had switched to body wash, which made for a much nicer experience. Travel-sized choices can helps save money while experimenting, as can stores such as big lots, which offer name-brand options at store-brand prices. When you find an item that works, stock up so that you don’t need to repeat this procedure again in a few months when the formulas change. I bought a 24-pack of the conditioner I use so that I won’t need to reassess conditioners for another 12 years or so.

4. Shower Tools: Once you have the item to be spread on the body, you need to find the perfect tool to spread it with. Washcloths, sponges, shower brushes, loofahs and even hands all make good options. Let your child try out each one and pick which is least aversive.

5. Shower Heads: Sometimes the biggest issue is water pressure. If you don’t already have one, consider picking up a multi-option shower head, the ones where you can choose how heavy or light and dispersed or concentrated the water is. When you find the setting that works best for your child, mark it on the head so that it can be set back to this level with ease.

6. Drying: Again, it’s all about options. My mom always used to towel-dry my hair and I hated that feeling. It would get caught up in the towel and the heaviness of a wet towel atop my head was awful. Switching to a hair-dryer helped eliminate that hassle, and I found the noise comforting. Towels can vary in texture and heaviness, so consider trying out a number of different ones before settling in on the one that works best.

7. Routines: Once you find the perfect time to have a shower, and have all your options in place, make it a part of the routine. Using a shampoo designed for daily use can eliminate the confusion between on and off days, and picking two particular days each week when conditioner will be used can assist in making it more routine. Hang a pocket-calendar in the bathroom if necessary to track which days are shampoo or conditioner days.

Showering can be a major battle, but it doesn’t have to be. Providing your child with options, respecting their sensory needs, and building the shower ritual into your daily routine can all help to make the procedure easier for everyone involved.

Simple Accommodations to Help Your Autistic Employee Excel

Focused. Meticulous. Dedicated. These adjectives could easily describe most autistic* employees. But Rigid, Neurotic, and Anti-social could potentially fit just as well. How do you accentuate the positive traits while minimizing the more negative ones? A little can go a long way, and these ten tips can get you started.

1. Don’t make assumptions. Ask. Although all autistics have some basic traits in common, there is enormous variation within the autistic spectrum. An intervention which might be a tremendous assistance to one employee could be a burden to others. Provided your language is respectful, most autistics will be very willing to answer any questions you might have about their diagnosis and what they find helpful.

2. During Orientation, or when introducing a new policy, be as thorough as possible.For many autistics, if something is introduced to them once, they will understand it. For others, it will take multiple repetitions. In either case, it is extremely helpful to be very thorough when explaining new procedures or policies. Many autistics have difficulty with troubleshooting or adapting when things aren’t proceeding as expecting. If you review possible contingencies and their outcomes ahead of time, you will save everyone confusion and difficulty.

3. Use lists and schedules whenever multiple steps are involved. Autistics can have difficulty with planning or organization, as well as taking verbal directions. As a result, a printed list of steps or schedule can save both of you time and hassle.

4.  Ask your employee about sensory issues and attempt to accommodate their needs. Sensory issues are very common in autistics, particularly relating to sound, light, and smell. Switching from flourescent to incandescent light bulbs, encouraging other employees to use moderation when applying perfume, and allowing, when reasonable, an employee to wear head-phones or other noise-blocking devices can go a long way. When uniforms are required, be as flexible as possible about the materials and cut of the attire. Some autistics cannot wear clothing with seams, or that fits too tightly or too loosely.

5.  Use exact language wherever possible. Many autistics are very literally minded. Phrases like “be with you in a minute”, “I’ll call you in a little while,” etc. can be difficult for autistic employees to understand and may lead to confusion.

6.Communicate via email or memo, rather than over the phone. Many autistics have difficulty with phone conversations. Auditory processing issues can make messages sound garbled or cause misunderstandings. Social cues which indicate when to speak, or when sarcasm or metaphoric language are being used can be misinterpreted or missed entirely. Also, many autistics are much better communicators in writing, when there is less time-based pressure, than speaking. As a result, you’ll have an easier time communicating, and receive higher-quality responses when using email.

7. If the employee is doing something annoying, tell them explicitly. Autistics have difficulty interpreting social cues, and will require more than a frown or a raised eyebrow to communicate disapproval. It is likely that the employee will not be aware that what they are doing is irritating to others, and a quick, blunt conversation will ensure the situation is rectified quickly and easily.

8. Maintain confidentiality. Although you might think it would be helpful to others to know of the employee’s diagnosis, you should not take it upon yourself to reveal this information to others. Allow the employee to inform his co-workers at his own pace and on his own terms.

9. Understand that social situations can be very difficult. Office parties, gathering at the bar after work, and even group lunch breaks, which are enjoyable and re-energizing for most employees can be draining, if not impossible for some autistic employees. Attributing avoidance of such functions to unfriendliness or lack of team-spirit is a mistake. Many autistics find it much easier to socialize in one-to-one situations than with a large group.

10. Be respectful of routines and rituals. A defining characteristic of autism is a desire for routine and order. You may notice that an employee always performs the exact same activities in the same order every day before setting down to work. Whenever possible, wait until that ritual is completed before beginning a conversation or providing instructions. This will ensure that your employee is able to fully attend to what you are saying rather than focusing on the disruption of their routine.

Autistic employees can be a major asset to your company, and taking the time to find ways to help them perform at their maximum potential can reap incredible benefits for your company.

*The word autistic in this article is used to describe individuals with both Autism and Asperger’s Syndrome, which is a form of autism.

Physical Aspects of Autism

One of the most fascinating effects of autism is its multivariate effects on individuals. Characteristics of autism can fall into three broad categories: behavioral, cognitive, and physical. Behavioral attributes like stimming, eye-contact avoidance, etc. tend to attract the most attention, and may thus be seen as the most salient features. Cognitive aspects, such as altered language, difficulties with perspective-taking, and adherence to routines, also gain a fair share of attention. The physical attributes, however, tend to get far less attention, but seem the most important to address at this point in my life as an individual with Asperger’s.

(I am aware that Asperger’s Syndrome is leaving the diagnostic vernacular, and will soon be a passe phrase. You can see my thoughts on this change here. However, there are times when it is significant to discriminate between the forms of Autism Spectrum Disorder, because significant differences exist. In the case of physical difficulties, this distinction can be important. A recent study showed one of the only key differences in individuals with AS and those with HFA was the amount of motor and coordination difficulties.)

Two key areas within the physical subfield are particularly troublesome for me:

• Clumsiness: A quick survey of my lower left leg revealed six bruises, two of which house dried blood. My right leg looks relatively similar. Of course, we’re in a time of year when everybody has bruised legs; there is snow and ice all over the ground, and people are naturally having difficulty staying upright. But none of these marks are the result of a fall in the ice. In fact, I think I might have an easier time walking on snow than on land because of the greater prorpioceptive input from my foot passing through the ice. All of the marks I have were acquired walking indoors or on grass, and either bumping into something or falling down. Least year I made the mistake of going to my doctor with shorts on. When I explained that I had gotten so marked up walking into things, she called in for a child-abuse evaluation, telling me that “No body is that clumsy”. In the end my mom was cleared and the doctor was forced to simply caution to “Watch where I was going.” Because I hadn’t thought of that one before.
• Mirroring: I wrote awhile back about my previous history and success in karate, and my surprise that it did not translate into success in Tai Kwan Doe. I then came to the realization that the one significant difference in the way the two were taught was that in karate the students all faced the same direction as each other and the instructor, while in Tai Kwan Doe, we stood in a circle, all at different angles and facing the instructor. The impetus for this post, however, came far more recently. Earlier in the week, I was asked on two different occasions by different people if I was left-handed, which I’m not: In lab when I set up the hemostat in the wrong direction, at the triplet’s house when Aaron was teaching me how to hold a hockey stick and his dad noticed I had my hands inverted. In both cases I had been facing the demonstrator, rather than along-side them. When I corrected this, I immediately noticed my error and was able to adjust accordingly. The conclusion was simple: while I can imitate others, I cannot mirror them. Or rather, I mirror them incorrectly, winding up inverting all the actions.

I find it interesting that this aspect of autism is, for the most part, ignored in the DSM, versions past, present, and future (aka the proposed DSM-5 described here). Perhaps because these difficulties would be difficult to quantify (how does one measure excessive clumsiness?), or perhaps they are only present in a certain percentage of autism cases, or because they are considered a co-morbid deficit rather than a central one (this explanation makes the most sense to me at least).

Further thoughts, comments, or anecdotes?

My childhood food issues

Food has always been an issue of contention for me. I wrote in a recent post about the difficulties I’ve been having in politely declining food, and in another previous post about forgetting to eat for extended periods of time, and using Ovaltine as a nutritional boost. But my issues with food extend back into childhood.

My grandfather used to take my mom, Carl, and I out to Friendly’s once a week when my dad worked late. During the seven years we did these weekly visits, I never once changed what I ordered: Root beer, chicken fingers (no sauce), Fries, and  two scoops of cookie dough ice cream (no whipped cream, no cherry). Knowing how much I enjoyed that meal, I did not want to take a chance on another meal which I might enjoy less, and thus I avoided getting any other food there. The rest of the menu at Friendly’s may have been quite enjoyable, but I did not want to miss the chance of having the best possible meal, which was the chicken finger meal I was so familiar with.

Another area of difficulty was that the way I ate was generally not proper or common. For example, when we went for fast food, I would get a burger (no sauce, no cheese), and fries. But since I didn’t eat the bun on burgers (I went through a two-year no-bread period), I would tear the burger up with my fingers and then dip it into the ketchup designed for the fries. (This was in the age before salads became dishes at fast food venues, so forks and knives were not available). Although my mom viewed it as “just Cale’s way”, it was deemed impolite/offensive by other adults who accompanied us out such as parents of friends or more distant relatives.

Finally, I had issues with family dinners. During the period when I wasn’t eating bread (in addition to my other never-foods including cheese and sauce,) and Carl wasn’t eating meat, my mom might  have to prepare three different meals to cover everyone’s specific food needs.

Today I have fewer issues with food then I did in the past. After several years of refusal I finally tried shrimp and realized I really enjoyed it. Sweet potatoes and rice pilaf were also recently added to my diet. Now that Carl and I can both prepare our own meals, the pressure on my mom has been reduced, as well as the pressure on us to adhere to the dietary standards she was setting.

I think that expanding and conventionalizing my diet will be a lifelong goal/challenge. But seeing the progress I’ve made in that area over the past decade, I have high hopes for the strides I can make in the future.

Dish Declining Dillema

I will admit that I am a very picky eater. Having no sense of smell, taste is irrelevant to me, but consistency is of the essence. So when the meals are up to me, I tend to choose from a limited menu of items, mainly ramen, burgers, fries, pizza,and tuna fish. I won’t eat anything creamed, whipped, gravied, or buttered. Actually, as many parents of kids with sensory issues know, “won’t” isn’t exactly the right word there. I can’t eat anything creamed, whipped, gravied, or buttered. The mere sight of lemon meringue pie has me running for cover.(Actually, when it’s served at the dining hall, all of my friends know to put up folders, napkin holders, or some other opaque item to keep it entirely out of my sight). When my thumb runs along the rest of my fingers in three sets in quick succession, it’s a signature move that a consistency is bothering me, and something needs shielding.

But this poses a problem when I’m not at a cafeteria or among close friends, for example when I am invited to stay for dinner at a friend’s house. In many of these cases, the parents serve a food that I will not (cannot) eat, particularly macaroni and cheese or creamed corn. If I ask that it not be put on my plate, this can be (I’ve learned), taken offensively by the hostess who takes it as an insult to their cooking. If I allow it to be put on my plate and don’t touch it, this can be taken offensively, and is a waste of food (unless of course, a tween/teen sibling is present and the controversial food is not a vegetable). Not wanting to offend the host(ess), particularly if it is a first time at the house, I’m usually left in an awkward state.

 I know the proper etiquette is to take a few bites of the less than ideal food, say something complimentary about the cooking, and then claim satiation, but with most problem foods, the issue is non-negotiable. Even one bite would be one bite too many.

 I’ve tried claiming allergy, but that complicates matters further, because parents tend to remember allergies, so declining Mac n Cheese, for example, will exclude any future chances of an offer of pizza, a coveted dish. Then I have to admit to lying about the allergy, and that is a terrible start to a relationship.

 Any suggestions on how to handle this delicate issue without offending a host or lying? It’s an issue I’ve been struggling with for over a decade and still haven’t worked out a useful solution to.

Weight: Carl’s Biggest Battle

Two and a half years ago, when I left for college, Carl and I were the same height and weight, down to a quarter of an inch and half a pound.  We were both moderately overweight, in the 70th percentile. Now, there would be no chance of confusing us. While I’ve dropped 25 pounds,  Carl’s weight has grown by 45 pounds, moving him into the 96th percentile for height and age. His waist has grown four inches, and he’s moved from finding a Medium roomy to finding a Large snug. I wrote a post on this last year, but despite my family’s efforts, he has only continued to grow.

There are two main obstacles to his losing weight and reentering a healthy state.

First, he is (or seems to be at least) willfully ignorant. He has no interest in counting calories or learning about the consequences of being obese. He knows his food groups, but insists, “they are guidelines, not rules. Guidelines means I can ignore them if I want to.” His doctor has attempted to give him the “get healthy” lecture, but he’s seen both my parents ignore their doctor’s suggestions for years, so he assumes he can do the same. It’s impossible to teach someone who refuses to learn.

Second,Carl prefers fast food, candy, and snacks to real food.  He doesn’t want to spend money any more than the next person, and the cheapest food is decidedly fast food. Most nights my mom cooks dinner, but he claims “I’m too full” to eat it, but then an hour or two later he is downstairs putting pretzels in the microwave or grabbing a handful of chocolate. My mom tried throwing out the junk food, so he began purchasing it behind her back and hiding it in his room. We’d only know how much he ate based on the wrappers that fell out of his garbage can at the end of the week. Any talk about portion control goes totally ignored; today he ate an entire box (12 pieces) of 200-calorie a piece nutty bars. And then proceeded to go out for lunch at McDonalds!

We seem to be running out of options in tackling this problem. If he is going to lose weight, the impetus has to come from within himself. Any obstacles we might put in the way he can find a way around, and any advice, no matter how strongly worded, goes ignored. I’m afraid for his health and his future, but it seems there is little I can do at this point to help him.

Missing the Obvious

We’ve been having a noise issue in our house for the past two years. Like everyone else in the family, my brother has a deaf ear. Unlike everyone else, he compensates by playing everything exceptionally loud. This would be fine except for the fact that he goes to bed three to four hours later than my parents. So every night, my mom goes up to his room and tells him to turn down the noise. They argue, he eventually concedes, and the problem is resolved, at least until the next night when the exact thing happens.

I developed a number of ideas. I put an arrow post-it note on his television showing him which volume point was too high. I left a sticky on his lamp which read “remember to turn the noise down at 11.” I left a different pair of headphones in his doorway every day for a week. Nothing changed. He continued to play the noise too loud, and continued to argue with my mom each and every night.

Tonight, after getting sick of the same routine every single day, I walked into his room with five pairs of earphones in my hand. I had him try each one on to check the fit. When he finally picked one out, I asked why he couldn’t have just grabbed a pair like these eighteen months ago and solved the issue.  He does, after all, work at Wal-mart which has an extensive collection.

He gave me the “I can’t believe you don’t collapse each night under the burden of your own stupidity” look that we inexplicaby both share without either parent being able to even approximate it properly. When I failed to respond, he clarified, “Headphones are used for CD and MP3 players. I don’t want to listen to my CD player at night; I want to use my tv.” At this point, I was able to show him, to his amazement, that both his television and computer had a headphone jack identical to the one on his CD player. “Hey, listen, I can hear this better now,” he responded.

I think our noise problem is solved.

Tourette’s: An anniversary commemoration

Tourette’s Syndrome is a fascinating disorder. I realized my first anniversary of having the full-blown disorder was this month, and it is worth commemorating in some way. So I thought I’d try (again, and likely fail, again) to explain what my experience with TS is like (fortunately, I’ve taken as motto, “Try again. Fail again. Fail better.”). People seem endlessly curious about it, and this seems natural because it just looks and is so odd. So here’s another shot:

At any given point I will have a particular repertoire of tics. These are the ones that will show up the most often during that particular period, though there are occasions where you’ll see the entire history of my TS in one five-minute interlude. These are relatively rare, and are usually followed by one of the old tics entering the newer repertoire.

My current collection includes five base tics, two “vocal” and three “motor”. The two vocal are clearing my throat and sharply intaking breath such that the tongue to roof of mouth suction creates the “Hut” sound. (The “hutting” is a crowd-favorite, as it supplied endless fodder for lame one-liners like, “What’d you see in the forest?” and “What dwelling is larger than a tent but smaller than a cabin?”). The current motor tics are touching my shoulders, tapping a surface in patterns of three, and snapping or stretching my fingers in patterns of three. Old tics which pop up again for a brief visit on occasion are sniffing, adjusting my jaw, blinking patterns, and tapping other people’s knees/notebooks/shoulders in patterns of three.

I go through frequency/intensity periods with my tics, and the patterns do seem to be weather-connected, with colder days seeing a higher frequency. On an average day I’ll experience roughly 100 tics an hour, with fewer during the mid-morning to mid-evening and up to ten a minute within the first few hours after waking and before sleeping. I also go through periods where I’ll tic twenty times a minute and periods where I might not tic twenty times all day. I’m still attempting to trace back and determine what factors impact the frequency.

Tics are divided into three parts: the urge, the action, and the repercussion. Sometimes the urge and action are entirely intertwined, so that I won’t know I needed to tic until the tic is already in progress. Most of the time, however, there is the knowledge that I have to perform a particular tic, with a conscious pause between when the signal to tic arrives and the tic is physically carried out. If the interchange is not instantaneous, there is the repercussion. This is a feeling of tension/pressure that builds and builds until it is the only thing I can think about. Sometimes the latency period between the signal and full pressure is a matter of seconds, and sometimes it can be as long as seventy minutes (which all of my professors of 75 minute classes are quite familiar with at this point). If I let the need build to maximum pressure, the release is tremendous with an incredible slew of tics occuring one after another for what feels like an eternity but is typically no longer than thirty seconds.

Tics can be aggravating, to both the performer and the observer. They can be frustrating, annoying, and limiting. But they can also be amusing and are an excellent diversion technique. Having Tourette’s, I get to see the worst in people- their impatience, their tempers, their ignorance, and their fear. But I also get to witness some of the best, when people laugh with instead of at, when I get shown compassion that isn’t tinged with pity, and when others take the opportunity to educate rather than join in taunting an easy target. Having Tourette’s isn’t all sunshine and rainbows, but it certainly isn’t a thunderstorm either. If I learn as much from year two of living with the disorder as I have from year one, I should be a sage by thirty.

The Problematic Term ASD: Part 3

Now that I’ve given the reasons why the current, “we can’t distinguish Autistic Disorder and Asperger’s Syndrome empirically, so instead we’ll just lump all autistics together into one diagnosis called Autism Spectrum Disorder” is faulty, from both a personal and research perspective, I thought I would offer my take on a possible solution. Instead of lumping even more, we should instead swing the opposite way and split further.

I don’t think the current AS/AD split is working. The two categories manage to be simulatenously far too similar, leading to struggles over who to put into which, and yet also so different, such that the terms “Asperger’s” and “Autistic” connote two very different presentations. But I don’t think the solution is to give up on trying to categorize the types of autism. Instead, common sense needs to be utilized to determine a practical way to distinguish different forms of autism from each other.

Here are some ways we can split:

• Family History: it seems pretty clear to me, at least, that some families can trace spectrum traits up the family line. It is possible that in these cases, the individual who finally fits enough criteria to get an autism diagnosis, might not have any other root cause of disorder exhibition than inherited traits. For example, my grandmother has sensory issues, food issues, limited interests and poor social skills. My father has a “special interest”, food issues, impulse control and anger management issues. My brother and I have ASD diagnoses. I think in these cases, it might only be a matter of how extreme each “symptom” is. However, in other situations, an autistic child is born into a family with no history of spectrum traits. These are likely two different forms of autism.
• Age of symptom onset: Many individuals with autism were clearly autistic from birth. Seemingly from when they left the womb, they didn’t want to be touched, cried all the time, and didn’t seem interested in faces or people in general. Others seemed neurotypical until between fourteen and twenty-four months, when spectrum traits began to appear and then never left. These two different situations can even occur in the same family such as with the twins vs. the younger son at Everyday Adventures. Autistic from birth vs. later-onset are likely two different forms of autism.
• Presence or Absence of Food issues: I do not endorse the notion of “leaky-gut” which anti-vaccinists are quite fond of. But it seems clear to me that there are some autistic individuals who cannot tolerate gluten, casein, lactose, or food additives, or for whom the presence of these ingredients can cause erratic behavior. There are many autistic indivuals, however, that have no issues with food, who have regular bowel movements and whose behavior is totally unaffected by diet. These characteristics might be indicative of different forms of autism.
• Speech Capablities: Some autistics have no issue creating new, spontaneous phrasing, but cannot participate in a typical conversation. Some use scripting and echolalia to communicate but can stay fully on topic. And some produce no speech at all. Perhaps these differences are also indicative of different forms of autism.

There are probably hundreds of other ways to divide individuals on the spectrum into different groups. These were just the first four which immediately sprang to mind. What makes these divisions better is that they can be practically utilized. Interventions which will help autistic individuals with no speech will likely be unhelpful for individuals with full speech capabilities but poor social skills, who will need interventions that won’t help those with scripted on-topic speech as much as another therapy geared specifically for them. So how nice would it be to find a center which is specifically geared to help with your (or your child’s) particular communication issues, rather than a particular nearly-arbitrary diagnostic category?

Maybe this is what the board of the DSM is thinking. They tend to go through cyclical periods of splitting and lumping. Perhaps this revision is re-lumping so that the next edition can re-split along practical lines. And perhaps once the re-split occurs, we will have the technology needed to begin to sort autism out a bit better- a way to examine brain physiology and say, for example, “Individuals with and without a family history of autistic traits have a similar presentation and therefore should not be categorized separately” (or the opposite might be found. We really have no possible way of knowing at the moment).

Once we know how many distinct forms of autism there are, and what the hallmark of each of the separate types are, we can begin to formulate specific interventions which are geared to helping the members of each particular group live up to their full potential.

The Problematic Term ASD: Part 2

Yesterday, I offered some thoughts on the planned use of “ASD” to replace the separate diagnoses of Autistic Disorder (AD), Asperger’s Syndrome (AS), and PDD-NOS from a personal perspective. Today, I’ll talk a bit about why, from a research perpective, this isn’t a very good idea either.

Autism has been, naturally, receiving a great deal of focus in various research communities. But it seems the more questions we tackle, the more crop up. One particularly sticky questions is, “Should Asperger’s and Autistic Disorder be considered: a)variations of the same underlying disorder, b) two disorders on an “autism spectrum” or c) two entirely different disorders?”  Each of those answers has its own supporters who have their own arguments as to why their answer makes the most sense. But, really, we don’t have much of an idea.

The first area of interest is cause. Obviously, no one knows what causes autism, and the answer is likely far more complex than we can even consider at the moment. However, there is a  known genetic component. Based on the fact that AD and AS often appear within the same family (mine and statmom‘s, for example), it seems possible that the two share a common gene. It may be then that environmental factors determine whether the eventual presentation is consistent with an AS or an AD diagnosis. But even this is still unknown.

Another area of interest is anatomy. Are AS brains different from AD ones? This would seem like it would have a quick, easy answer. Scan some brains, take some measurements, and presto, an answer is produced. But reality is more complex than that. The differences between NT brain and autistic ones are proposed to be differences in connections and in transmission of signals. With current technology, we can’t measure these sorts of characteristics in living humans. We can look at post-mortem brains and at animal models, but neither can supply exactly the kind of data needed to hash this question out. Seeing as the differences between AS brains and AD brains, if they exist, are likely far more subtle than those between autistic brains and NT brains, we’re likely looking at an additional two decades of research before we can really begin to answer this question.

And finally, there is the issue of intervention. Do those with an AS diagnosis respond differently to therapies like ABA or Floortime than those with AD? What about in the medication realm? Or diet? This is a question we have the technology to answer, but not the fore-knowledge. Before we can tackle this one we need to make sure we have the right individuals in the right groups, i.e. we need a way to exactly distinguish between AS and AD. And until we know which genes or physiological differences to look for, the best we can do is guess.

The solution to this, is not, however, to combine the two categories until we have a better understanding of the differences. If the two aren’t separated diagnostically, recruitment for research will be further complicated and finding answers will only take longer. The solution might be, instead, to find new ways to distinguish between the “autisms,” ways which the DSM is currently not using. We can separate individuals with an ASD by these criteria, do the reseearch into the differences and similarities between and across categories, and from there, rebuild more meaningful diagnostic categories.  In my next post, I will discuss what these potential distinguishing features could be.