Today more and more people are thought to be autistic. Are they really autistic in the clinical sense? Are their symptoms being confused with ‘virtual autism’ or ‘electronic screen syndrome’ which arise over time as a result of internet addiction and mimic the characteristics of real autism? Here are some tips on recognising autism. This guidance builds on the work of Gill Merrill, a Consultant Forensic Psychologist specialising in identifying autism and learning disabilities. She is a practitioner whose goal is to assist and educate those on the autistic spectrum and help others who may come into contact with them recognise and understand autism.
“Autism is something which can be difficult to spot and is often referred to as the ‘hidden disability.’ Autism traits can be confused with other difficulties or disorders. Therefore, if you have no awareness of autism traits how can you be expected to identify it as a possible explanation for behaviours and make a referral for an assessment? At the same time, every autistic person is different, but there are common elements worth looking out for.
It is not always possible to recognise from an individual’s physical presentation or their initial verbal communication that they are on the autistic spectrum. However, after speaking or observing for a while you may notice that there is something different and interesting about them.
After one of my presentations at a Medium Secure Hospital, the Principal Psychologist asked, ‘Gill why don’t we recognise autism in our patients?’ I replied, ‘It is because you are not looking for it’.
Gill Merrill has met many individuals who have spent years in hospitals, prisons and the community undiagnosed. The individuals she meets generally have found themselves in the criminal justice system having been arrested for various offences, for example – murder, assault, sexual, arson and stalking. She has often thought, “If only they had received a correct diagnosis earlier, perhaps I would not have met them and be preparing a Forensic Psychological Report for them!”
Below are some of the behaviours/traits she has observed during the past 25 years. As such they are tips for others in potentially recognising individuals that may have an autistic spectrum condition.
“However, as the famous quote by Stephen Shore reference says, ‘If you’ve met one person with autism…. you’ve met one person with autism.’ Everyone is different and therefore this list is not exhaustive just some of my experiences in order to assist others.
When meeting an individual, you may have an instinctual feel that they appear eccentric, naive, odd, just something different that you cannot quite put your finger on. Although they are able to engage in conversation (usually a question-and-answer type), it may be stilted; there is lack of reciprocal interaction, eye contact, body language or appropriate facial expressions. They struggle with social chitchat or to initiate a conversation. They also may become focused on one area of conversation, not appearing to want, or able to move on, and rigid in their thinking, as taking another’s perspective or approaching things differently is difficult.
Very often adults who have not received a diagnosis of autism have learned skills by observation or being directly taught. They may have learnt social scripts for situations and imitate others’ behaviours to fit in, for example, smiles, nods, laughing. However, when observing them it will feel different and noticeable, as once described to me, similar to an individual who is speaking English but they have an accent that indicates they may be from a different country.
On occasions you may think that an individual’s behaviour is somewhat unusual or inappropriate for the situation. One man I met during a prison interview picked up my pen took it to pieces and put it back together. I was so surprised that I did not say anything, just watched him – he wanted to know how it worked. I think it was this man that started my fascination with autism. I remembered his focus of conversation was not that he had spent 20 years in prison for an offence he said he did not commit, but how he was able to get various news radio channels by using coat hangers and was interested in what my local news channel was. For those with autism their focus on a special interest can be all encompassing at the expense of issues we would deem as much more important.
Individuals on the spectrum may talk relentlessly about their special interest and provide lists of events or information relating to it, for example, bus routes, DVD’s, football scores, dates, Dr Who, archaeology, Lego, washing machines, dinosaurs, yet show no curiosity in what you have to say about your interest. If you can show an interest in their special interest your interaction is more likely to be easier. They may enjoy collecting items, bottle tops, articles made of wood/tin, hearing aids, cups of drink and even have bought them to your meeting. I recall asking an adult male if he collected items, he told me that he had collections of hearing aids and had in fact brought them in his bag to our meeting. This fact helped me identify that he may be on the autistic spectrum, something that had been missed for 45 years but was an explanation for his other difficulties and his offending.
During your conversation with an individual, you may make a joke or use an idiom, and they may not respond as they find such conversation difficult. They may take a sentence literally. One of my clients told me that once he was told, ‘Next time the police are called you will be charged’. My client thought he would have to pay. Another client told me that when he asked the police officer how long he was going to be kept in the cell the officer replied, ‘How long is a piece of string?’ He told me that he had no idea what he meant but thought it was related to his trainer laces so started to do his trainers up expecting to be released. He was being interviewed for a serious offence.
Individuals on the spectrum may not be able to make inferences so need direct questions or instructions. For example, ‘Your tee shirt is dirty’. They may not see that as a hint in that they need to change their tee shirt but rather a statement of fact. Also bringing a conclusion to an event can be difficult. A young man told me that he found it difficult to pick up on social cues from others. He told me that he never knew when to leave a person’s house and as such probably overstayed his welcome. He said that he now no longer visits others and prefers them to come to him.
When in conversation individuals may not display the social niceties one would expect and appear abrupt, direct or even rude in what they say. They may not demonstrate the correct emotion for the situation and be seen as lacking in empathy. Their voice may be void of intonation; speak in a monotone or high-pitched voice or be too loud. They may display tics, which could be obvious such as flapping of hands or less obvious – stretching of fingers or movement of shoulders.
Anxiety is a huge difficulty for individuals with autism; they may become anxious and stressed over small issues. Recognising and expressing emotions is one of their major difficulties. They either do not express their feelings at all or they react with intensity far beyond what the actual situation would indicate. From my experience this has led them to become involved with the criminal justice system.
Individuals may have a comfort item with them that assists with their anxiety. Comfort items could be fiddling with a shoelace, sweets, clothes label. The comfort item may not be age appropriate. I attended a conference where Jamie Knight (aged 27 and a developer for the BBC) stood on stage lecturing and with him he had a 4-foot toy lion. He says, carrying an object brings structure and predictability and particularly helps when he feels overloaded.
To assist in their anxiety, individuals need to know what is going to happen next. So predictability, structure and routine all helps them to cope in a world, which for them is chaotic. Sometimes I am asked 20 times a day the same question because my client needs to be reassured of an event or the time I will meet with him. If I am not on time this will lead to disproportionate stress and anxiety.
Sensory issues (for example, touch, taste, hearing, sight) may be observed when meeting individuals on the spectrum. They may be light sensitive, wear sunglasses or become anxious with strobe lighting. Cover their ears with their hands or wear earplugs due to being noise sensitive. I have met a number of individuals who have reacted extremely violently to touch, leading to family members, teachers, care workers and police being injured. In particular their violent tendency could be triggered if restraint is used.
Social situations can be very difficult for autistic individuals, and they may try to avoid them, thus appearing to be difficult or not complying. I recall a client refusing to meet me in the reception area of a building although they agreed to meet me outside and walk into the building with me.
Making choices or decisions can be very difficult for an individual on the spectrum. I recall asking a client which cake he would like, believing that was polite, however he just stood in the shop for five minutes looking at the cakes and becoming extremely anxious. When I said do you want an egg custard or a doughnut, he was quick to respond. He told me making a decision/choice was too difficult.
These are just a few examples of behaviours that you may observe during interaction with your clients. If you have some awareness of autistic traits, it may help improve your understanding and possibly identify an individual on the Autistic Spectrum.”
This guidance may identify autistic traits in either a child or adult. Recognition of autism helps the individual and their family receive the correct support and to follow the autism pathway. The guidance is reproduced with her permission.
See our other blogs about autism: Porn and Autism, and Real autism or Fake?
