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Towards a new understanding of autism

A deep dive into the progression of how we understand the intervention, diagnosis and treatment of autism spectrum disorder (ASD). Read now.

16 January, 2021

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The description, or rather the clinical denotation of autism, has come a long way. Originally labelled a form of childhood schizophrenia and referenced as a by-product of loveless parenting, autism was not measured as spectrum of conditions. Instead, autism was viewed as a singular condition that, in some cases, institutionalised people until the 1980s.

And since the ‘80s, we have come a long way in our comprehension of how autism manifests in humans, according to Dr Michelle Garnett, clinical psychologist and founder of Minds & Hearts. “We now understand that a child with autism does not always sit in a corner flapping with no language or social interest, which was the public view of autism from the 1940s until the late 1990s.”

We’ve made significant strides in understanding autism as a neurodevelopmental disorder that’s mostly likely caused by genetic and environmental factors, rather than a single disorder that’s pigeon-holed in diagnostic criteria. In addition, the landscape of research is showing signs of shifting from a solely causation (or biological focus), to being a more outcomes-based body of literature that’s embedded in understanding how individuals and their families can find autonomy to live independently, which helps people through the biology of autism.

We better understand autism presentation, but there’s room for improvement in diagnostics and assessment

Dr Garnett says that despite our understanding of autism presentation progressing, diagnostic and assessment processes are playing catch up. She adds that there’s more research required to understand how to detect autism in very young children who are camouflaging their autism, which can lead to prolonged diagnosis evasion and thus can be harmful at a macro level.

“Nevertheless, our diagnostic and assessment processes are still needing to catch up. The autism spectrum is exceedingly broad, and the group of people with diagnosed autism is hence extremely heterogeneous.

“Also, there is a lot of comorbidity, and there are many differential diagnoses to consider. We now know that many people on the autism spectrum use the coping mechanism of camouflaging, that is, they hide their social communication difficulties by observing others closely, and using imitation, masking and personas to be able to be what other people need them to be in their social interactions.”

According to Dr Garnett, autism brings a wealth of talent, character strengths, and abilities — but it also brings about several challenges. Dr Garnett notes that autism isn’t something that needs treatment but instead a deep understanding of one’s unique characteristics.

“As a clinical psychologist, I find that it is helpful to truly understand an individual's profile, in terms of their strengths and challenges, across their learning, language, social communication, personality, emotions, motor skills, sensory processing, and adaptive behaviour, across different settings and with different people. In very young children who have autism but no expressive language, the most important person for treatment becomes the speech and language pathologist to assist them to attain expressive language.”

There are many programs available for effective intervention that assist adults, children and teenagers with autism to enhance their social and emotional skills, says Dr Garnett, as well as to assist with the understanding and acceptance of one’s self, and to increase language skills and sensory processing (and coping).

“We find that the best approach is eclectic, and may include an early intervention program, such as the Early Start Denver Model (ESDM) or the DIRFloortime® model, for young children with more classic Autism. More verbally able autistic children benefit from the application of cognitive behaviour therapy to assist with their emotional and behavioural difficulties, and to learn social communication skills.”

Technology is gaining steam as a tool for autism education

The advancements in autism treatment go beyond the refined perception of autism itself — technology and digital platforms are being increasingly leveraged as educational tools to better understand autism. For Dr Garnett, there are applications available for teaching individuals with autism about emotions, language and the nuance of social communication.

“I think the use of a tablet or a computer is a terrific way to assist people on the autism spectrum to gain the theory behind navigating the social and emotional aspects of life. However, they also need to be able to apply this theoretical knowledge in real life with real people, so an on-site approach, as well as practise across different settings, remains integral to any intervention process.”

Autism education remains essential to positive outcomes, according to Dr Garnett. For parents of a child with autism, understanding the disorder helps with effective interaction and for conversations to be had on a level playing field. And for individuals with autism, education works to empower them.

Dr Garnett says that her primary intention now is to increase autism awareness among health professionals, educators, the broader community and autistic people. As Dr Garnett notes, a lot can be achieved with a positive attitude and greater education of autism.

“Over the 30 odd years that I have been in this field, I have found that the best two interventions for autism include knowledge and attitude. Knowledge about autism, and how autism affects the specific person, and an attitude that accepts and respects diversity, is hopeful and optimistic, that recognises strengths and abilities, as much as it acknowledges the challenges of having autism.

“I believe this so passionately that my own primary motivation and intention now is to increase awareness and understanding of autism amongst our health professional and educators, as well as the broader community and autistic people. With understanding and a positive attitude so much can be achieved, and we need people with autism. They have been at the forefront of every major advance of human endeavour. They take us forward.”

Collaboration between autism counsellors and clinical psychologists is key

Jo White, Melbourne-based autism therapist, special education teacher and director at Autism Counselling, has worked with autism for over 20 years. She says that a big part of her work is based around managing her client’s executive function and helping adults, children and their parents understand autism.

“If the client on the spectrum and if they have poor executive function, we will help express that to them to help them figure out what it is that’s going wrong. So, that’s things like organisational skills, planning, or even making phone calls —all the daily life stuff that are done as a neurotypical can be hard for someone on the spectrum.

“That kind of lack of executive function can often spill into things...so daily life skills are an important aspect to what we do as therapists. There are a lot of different challenges that go along with autism...they all fall into the executive function or emotional regulation areas where they're overloaded sensorily and don’t what to do with that, so they tend to shut down. So, that's where we come in to help make individuals aware of why this is happening and to give them strategies to help them cope and thrive.”

Ms White sees important synergies evolving between autism counsellors and psychologists to increasingly work closely to ensure that individuals (and their families) receive well-rounded, tailored autism support from the wider mental health community.

“I’ve seen a lot of change over the past few years — for example, I'm seeing more upskilling of mental professionals where they’re getting an understanding of how autism can present. There's not just this narrow view anymore to understand the broader ramifications of how autism can present, particularly with girls. The role I've taken now in supervising therapists who come to me for autism-specific supervision...it’s passing on that assistance, and teaching psychoeducation to other mental health professionals, too.”

Continue reading: 4 autism insights from a clinical psychologist