What I, an autistic adult, would like to tell my friends

Hypotheses and theories of autism

Today, the theory, used until the 1960s of the last century, according to which autism occurs due to the emotional coldness of the mother and lack of love for the child, is considered untenable. At the moment, among the possible causes of autism, other theories are taken into account:

1. Genetic implications . This theory suggests possible dysfunction of several different genes involved in brain development. It is also believed that autism spectrum disorders (ASD), which includes autism, can cause disturbances in the intestinal microflora that are passed on to offspring.
2. Brain damage . Most autistic adults have damage to brain tissue, mainly functional defects of the left hemisphere, abnormal changes in the brain stem. But the research results are ambiguous; it is impossible to accurately name these disorders as the cause of autism, its consequences, or a concomitant phenomenon.
3. Insufficient interconnection of think tanks . MRI shows that autistic people lack neural connections between brain centers. Therefore, it is believed that the disorder is associated with a violation of their coordination.
4. Male brain type . British expert Simon Baron-Cohen believes that autism in adulthood is exclusively characteristic of male brain types, which is caused by high levels of testosterone in the mother's body during pregnancy. The male brain type is characterized by insufficient interconnection between the hemispheres, leading to less emotional sensitivity.
5. Monotropic hypothesis . According to this hypothesis, autism in adults occurs due to increased concentration on a single stimulus. There is typically a much smaller focus on more things, which is necessary to understand rapidly changing social situations. This theory was first published in the British journal Autism in May 2005.

None of the theories have been scientifically proven. They all remain hypotheses.

Classifications of atypical autism

When a child is diagnosed with atypical autism, he is classified into a specific category of pathology. In total, there are two main types (according to ICD-10):

• the first is AA, which is combined with mental retardation. This type includes all possible types of mental retardation. They have autistic traits. The nature of the course of the disease is poorly progressive. This form of AA is most often indicated for Martin-Bell syndrome;
• the second type is characterized by manifestations of symptoms of atypical autism without intellectual disability. This type has other names - atypical childhood psychosis and atypical psychotic disorder. It is usually detected in childhood malignant schizophrenia, as well as when the child is diagnosed with Down or Rett syndrome.

The last type of AA (namely atypical childhood psychosis) is divided into three stages:

• autistic It can last from one month to six months. A characteristic manifestation of the disease is detachment, increasing passivity and fading of emotional reactions. These are the first symptoms of atypical autism in children of this form. The gradual natural development of the child stops and AA deepens. The next stage in the development of the disease begins;
• regressive. It actively develops from six months to a year. Has increased symptoms of atypical autism, characterized by a reduction in speech and hygiene skills. The patient's motor activity mainly consists of stereotypy. The patient may begin to eat inedible foods;
• catatonic. This stage is longer in time. It can unfold from one and a half to two years. The child develops catatonic disorders; they consist of motor agitation combined with stereotypies. Patients can endlessly run in circles, spin, swing their bodies, jump and do other similar things.

When the catatonic stage ends, a period of rest and gradual recovery from psychosis begins. But if remission occurs, then neurosis-like symptoms are observed, which manifest themselves in the form of primitive obsessive actions. All manifestations of AA are reduced, and gradual weak cognitive activity appears. The reaction to surrounding people begins to be restored, and the addressed speech is understood. The child's neatness skills return. But he remains emotionally cold. Fencing off from the real world also remains a stable manifestation.

How does autism manifest in adults?

Autism and ASD are manifested by disruption of a number of functions typical of a healthy adult: social, cognitive, executive, etc.

Social picture

How do autistic adults behave and manifest themselves in the social sphere:

• lack of long-term, confidential relationships;
• difficulties in understanding, observing social rules, inappropriate behavior;
• problematic perception of another person's perspective, excessive rigidity, formality;
• obsessive exhaustive exploration of social relationships, stalking;
• difficulties in accepting criticism, a strong bias towards the opinions of other people, bordering on paranoia;
• social immaturity;
• naive trust;
• inability to adapt behavior to changing social situations, lack of social intuition;
• difficulties in assessing the impact of one's own actions on other people;
• limited, rigid, mechanical ability to empathize, despite the presence of feelings of compassion.

Cognitive and communication sphere

Cognitive manifestations of autism in adults:

• uneven development of skills, low productivity;
• concentration on details, limited ability to judge the importance of a thing or event;
• specific thinking, difficulties with abstract thinking, need to visualize information;
• understanding partial steps but not goals.

Communication disorders:

• complete absence or dysfunction of speech;
• the possibility of impairment of all speech areas; in a high-functioning disorder, semantic-pragmatic deficits are most obvious;
• weakness of speech skills compared to other abilities;
• vocabulary, expressions – above average, too formal;
• special, harsh, sometimes strange expressions, neologisms;
• difficulties with metacommunication;
• problems in understanding the rules of mutual communication.

Internal manifestations include a feeling of insufficient understanding of a particular communication superstructure. They "don't read between the lines" despite understanding the words.

Sensitive Sphere

Sensitive signs in an autistic adult:

• hypersensitivity to sensory stimuli;
• hyperacusis in 18% of autistic people versus 8% in the general population;
• misophonia – aversion to certain types of sounds;
• phonophobia – increased sensitivity to sounds;
• difficulties in separating significant perception from minor, mild distractions from surrounding stimuli, “oversaturation” of stimuli with subsequent panic;
• fascination with certain sensory sensations, self-stimulation of sensory activity;
• Prosopagnosia – problems recognizing faces.

Emotionality:

• hypersensitivity or, conversely, undifferentiated smoothed emotionality; a sign of autism in adult women is tearfulness;
• low tolerance to frustration, emotional lability, moodiness, strong affective negative states, tendency to depression, a common sign of autism in adult men is impulsivity;
• limited ability for self-analysis;
• anxiety, nervousness.

Function and imagination disorder

Impairment of executive functions, imagination:

• preference for routine: difficulties when traveling, changing routes, daily schedules, making new plans;
• rigid behavior when sudden changes occur;
• difficulty interrupting activities, excessive concentration on a specific stimulus (hyperfocus);
• dysfunctions of attention: monotropic attention, rapid changes from one stimulus to another;
• time and planning: anxiety during waiting, schedule changes, activity transitions;
• need for predictability (visualized instructions);
• problems using unstructured time;
• reducing anxiety, confusion through rituals, compulsions;
• movement stereotypes: help cope with oversaturation of sensory stimuli, hypersensitivity, improve thinking.

Motor skills:

• difficulties in activities requiring fine motor skills, incoordination during complex movements;
• Difficulties in planning movements, their sequence, accuracy.

Symptoms of atypical autism

When talking about the symptoms of atypical autism, the first thing to mention is the unnatural ability to connect with other people. Moreover, this can be either weakly or strongly expressed. It is this sign of atypical autism that is key.

During the stable period, patients do not refuse to communicate, but at the same time it is difficult for them to start or maintain any conversation. If a severe form of AA is detected, then the child clearly expresses his desire to isolate himself from everyone and be left alone.

When trying to force a patient to communicate, he may begin to cry, scream, and show aggression. This will cause impulsive motor and emotional reactions.

Also a symptom of atypical autism is:

• coldness, which manifests itself in difficulties in expressing emotions, experiences and feelings;
• specific speech disorder. Characterized by the inability to express one’s own thoughts or formulate what the child himself wants to say. This also makes it difficult to understand common words and phrases;
• psychomotor rigidity.

These are the main symptoms of atypical autism in children.

Autistic adults – what are they like?

People with ASD have a number of characteristics; autistic adults have a number of characteristic characteristics:

• echolalia – repetition of what was heard;
• the use of whimsical monologues;
• creating imaginary friends;
• self-harm;
• fits of rage;
• self-pity;
• stereotyping, etc.

Inability to use a smile is typical; Often people attract attention by shouting and affect.

How autistic adults live, what’s inside them:

Causes

Possible factors influencing the development of autism include:

• pathological abnormalities during childbearing;
• injuries during childbirth;
• fetal asphyxia;
• environmental exposure;
• heredity. The disease has a predisposition at the level of gene abnormalities. As for inheritance, scientists are confident that it is not the pathology itself that is reproduced in descendants, but that there are prerequisites that influence its development.

Autism Spectrum – Signs and Differences Between Symptoms

According to the 10th revision of the International Statistical Classification of Diseases (1993), ASD (ICD-10 – F84) includes:

1. Atypical autism (F1). Heterogeneous diagnostic unit. Patients have some areas less affected (better social skills, communication abilities).
2. Asperger's syndrome (F5) - “social dyslexia”. A heterogeneous syndrome that has features and problems that are qualitatively different from other ASDs. Intelligence in Asperger's syndrome is in the standard range. IQ influences the level of education and self-care skills, but is not a guaranteed predictor of independent adult life.
3. Disintegrative disorder (F3). Regression of acquired skills after a period of normal development (for unknown reason).
4. Pervasive developmental disorders (F8). The quality of communication, social interaction, and play deteriorates. But the deterioration does not correspond to the severity of the autism diagnosis. Sometimes the area of ​​imagination is disrupted.
5. Rett syndrome (F2). A genetically determined syndrome accompanied by a severe neurological disorder affecting somatic, motor, and psychological functions. The main symptoms are loss of cognitive abilities, ataxia (loss of coordination of movements), impairment of the target abilities of the hands. The incidence occurs only in women.

Classification of severity

The disorder is classified into several degrees of severity:

1. Easy . Communication ability. Confusion in an unusual environment. A mild form of autism in adults is characterized by slow movements and speech.
2. Average . The impression of a person “switching off”. In contrast to mild forms of autism, moderate signs include the ability to talk a lot (especially about a well-studied area) but respond poorly.
3. Heavy. Panic attacks (even suicidal thoughts) when visiting new places. Substitution of pronouns is typical.

Definition of the concept and classification

Autism is a disease caused by genetic defects in the central nervous system. As a rule, this condition is diagnosed in the first years of life.

There are a number of forms of autism in adults.

1. Kanner's syndrome. There are deviations in speech, aggressiveness, and a low level of intelligence. It is almost impossible to find an approach to such a patient.
2. Asperger's syndrome. It has similar manifestations to the previous form of the disease. In this case, it can have both a mild and complex form, but often proceeds mildly. Mild autism does not interfere with a full life in society if a person is able to overcome his timidity and fear. However, the patient may become fixated on a particular activity and spend most of his time in isolation.
3. Rett syndrome. Inherited through the female line. It is one of the most dangerous forms of this disease. Behavioral symptoms can be controlled with medications, while external and speech abnormalities cannot be eliminated with medications. Characteristic manifestations include: lack of communication, tendency to symbolize, unsociability. There are very few patients with this form. As a rule, such women do not live longer than thirty years.
4. Atypical form. There are no characteristic manifestations, which complicates the diagnostic process. Motor and speech abnormalities may be observed.
5. High functioning autism. This form is diagnosed in patients with an intelligence level above 70. Characterized by the presence of a certain or acute sensory perception, weakened immunity. The disease may be accompanied by periodic attacks of muscle cramps, intestinal irritation, and problems with the pancreas. Also characteristic is the presence of behavioral activity accompanied by sudden outbursts of aggression, a narrow range of interests, and difficulty in the socialization process.

Diagnostics

To make a diagnosis, 2 diagnostic systems are used:

1. First system . Diagnostic and statistical manual presented by the American Psychiatric Association. Version 4 of DSM-I is available today. Detailed recommendations contain the ICD-10 criteria, especially in the research version, which is used by most European doctors.
2. Second system . Today, the relatively simple CARS observation scale is most often used. (CARS) Autism is assessed with 15 items. The actual examination lasts about 20-30 minutes, the total time (including assessment) is 30-60 minutes. Primary attention is paid to major and minor clinical manifestations.

Problems in society, life, socialization, education

When looking at photos of autistic adults, they appear aloof. It is so indeed. People suffering from the disorder sometimes appear deaf. They have problems communicating, create an impression of indifference to the environment, avoid eye contact, react passively to hugs and affection, and rarely seek comfort from others. Most autistic people cannot regulate their behavior. This can take the form of verbal outbursts or uncontrollable rages. Autistic people do not respond well to change.

Autistic people are unhappy in groups. They are loners living in their own world. Creating imaginary friends is a common trait.

Social indecisiveness determines the way autistic adults live, complicates relationships in employment, marriage, and affects family relationships.

People with autism receive basic education in special or practical schools, while others are integrated into mainstream institutions. After completing their primary education, they can attend various types of educational institutions. Some people with ASD attend universities, but due to problems with social behavior do not complete their studies.

The transition from school to work is a significant burden. Without sufficient family support or institutions that employ people with disabilities, autistic people often remain unemployed, have no money, and in some cases end up on the street. Sometimes it is possible to find a job through social rehabilitation programs.

Pathogenesis

The pathophysiological basis of the disease is damage to the children's brain. The provoking mechanism may be one or another factor that affects the child’s body at a certain age. This age coincides with the most critical period of development of the central nervous system and other body systems.

Ontogenesis of the central nervous system represents a certain sequence of these crises, which influence changes in physiological and mental processes in the child’s body. A characteristic feature of these periods is a special sensitivity to the effects of all unwanted and unfavorable factors.

Severe forms of AA usually occur between 16 and 18 months of age. It is at this time that important structural changes and ontogenetic processes occur in the child’s brain. This time also coincides with the peak of natural neuronal death in the visual cortex.

How to help?

Structured learning is the basis for effective treatment of autism in adults.

The environment and daily program should provide a person with confidence and predictability due to the weak ability to plan and foresee.

A structured learning program, North Carolina's TEACCH program, is also widely used in Europe. Basic principles – individual approach, structuring, visualization.

When to see a doctor

In adults, autism is treated by a psychotherapist. If necessary, the specialist can refer you to a psychiatrist or other specialist. You should seek medical help if you have the following symptoms:

• lack of desire to communicate with others, including loved ones;
• lack of desire to participate in group activities or general conversations;
• passivity or irritability appeared;
• complete ignorance of events in your life and in the lives of loved ones;
• stereotypical movements appeared, a tendency to repeat phrases;
• the sense of real time is lost.

People with autism may not be aware of the problem. In such cases, it is recommended that relatives consult a doctor.

JSC "Medicine" (academician Roitberg's clinic) in Moscow offers the services of qualified psychotherapists in the field of autism treatment. The clinic is located at 2nd Tverskoy-Yamskaya Lane, building 10, a 5-minute walk from the Mayakovskaya metro station. Highly qualified psychotherapists and the use of modern treatment methods allow patients to be confident in the success of therapy.

First-hand life stories

The stories of autistic people serve as a kind of “manual” for healthy people, helping them understand the life of a person with ASD.

My family accepted me for who I was. All 3 sisters (including me) were neurotic in their own way, so our parents did not compare us to anyone. As children we read, drew...

No one thought it strange that we spent our days in our rooms, in the forest, on the river, with horses, and other animals.

I sometimes ignored my surroundings, focusing on one thing. But we laughed about it. No one ever punished me or told me about the need for changes.

Everything changed at school. “You have to try harder... You have to do it better...” Mom was on my side. When there was an oversaturation of stimuli (this was often), she left me to read at home and did not demand communication. Now, looking through old diaries, I see that the gaps were up to 45 days.

Emma, ​​27 years old

Boundaries have always been a problem for me, mainly because I can't figure out where they are. This leads to misunderstandings and social breakdowns. Either I don't talk at all or I talk too much.

Alisa, 35 years old

How does a person with ASD feel? A healthy person will not feel this, but can understand from the following stories.

My problems didn't come to the surface until I started school. The classroom was a crazy place: fluorescent lights, noise, work that was either too hard or ridiculously easy. School was sort of a combination of anxiety and boredom. I was a polyglot, I read in 2 languages. But mathematics was a dark forest for me. The teachers didn't understand this. I gave up and my behavior worsened. After leaving school at 15, I joined a cult and was interested in witchcraft...

Inga, 30 years old

I often realize that I am behaving inappropriately, but I cannot discern the reactions of others. I take jokes literally, seriously, and engage in a defensive reaction, often disproportionate... I feel insecure in social situations. Meeting a man in the cafeteria whom I once greeted at a kiosk, I don't know whether I should greet him going to lunch with female colleagues. I'm afraid to seem provocative. That's why I prefer not to look at them.

Alexander, 40 years old

Punitive medicine

We had a rather unpleasant experience in dealing with the healthcare sector. Old school is punitive medicine. We visited some kind of pedagogical center, where a commission consisting of young women locked themselves in a room with a boy and began to closely watch him. Ignat is not aggressive, but he senses the atmosphere very well. In the end, he ran away and hit one of them in the face. This has never happened before.

Some doctors said that Ignat would never speak to us. Someone said that I was worrying in vain, that he would definitely talk. We came across a rather tough defectologist, of Soviet training. Nevertheless, she forced Ignat to listen to the speech and instilled in him the understanding that every object has a name. This was a breakthrough. Before this, Ignat existed in an abstract world, did not respond to his name, did not know what it was. He could use the chair for its intended purpose, he sat on it, but he did not know what it was called. And through simple words and concepts - bunny, bear, carrot - our defectologist explained to him that every object has a name. This was a serious breakthrough, otherwise Ignat would still be living in the dark, blind and deaf.

At the same time, Ignat knew how to read. He knew that there were letters and could put them into sounds. As in Marquez's novel, we put notes with names on all the objects in the house, and he had to read them and relate them to the objects. I just trained him: “What’s your name?” - “Ganya.” And so dozens of times. And gradually the understanding of what he was saying began to dawn on him, and he spoke meaningfully.

Myths and facts

Myths are prejudices associated not only with the concept of autism, but also with the acceptance of autism by society.

Myth: There is an “epidemic” of autism

No. The increase in the number of people diagnosed with ASD is due to the expansion of the diagnostic category and public awareness.

Myth: The disorder is caused by food, heavy metals, vaccinations, bad parents, etc.

There is no scientific evidence to suggest that there is a “trigger” for ASD. The disorder has a strong genetic basis; it is not caused by food, heavy metals, vaccinations, or bad parents.

Myth: All autistic people are the same

No. Every person with the disorder is different. The differences lie in communication, movement, processing of sensory, social and other information, and interaction with the environment.

Complications of atypical autism

Almost all children suffering from this disease find themselves outside of public relations. Their quality of life remains unsatisfactory. They do not have any social support to create their future. Moreover, they themselves do not want to receive it, hiding from the outside world.

They have significant limitations in their capabilities. This most often concerns self-determination. It is difficult for the patient to get an education and find a job. Social deficit is the main cause of complications. Children diagnosed with AA experience certain learning difficulties. They need intensive and constant individualized psychological and pedagogical support.

In adult life, such people usually do not realize themselves in a profession and do not create families.