ARCHIVED The ‘Creatively Impaired’ Autism Fallacy – How a picture can paint a thousand words for us too!


ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology. 

My childhood artwork was never displayed proudly around the house (queue my mum feeling guilty when she reads this). I never thought anything of it until I started visiting friend’s houses, which seemed to be littered with clashing coloured finger paint drawings and wobbly pieces of pottery. I trotted home and asked my mum why mine just got hidden in unlabelled boxes in the attic, which my Dad would sporadically throw away declaring “don’t worry, none of the stuff in here is yours, that’s still safe in the attic”. My mother’s blunt reply was simply that it was crap. She had a point, but out of principle I rebelled and insisted she put my half finished phallic shaped totem pole on the windowsill of our lounge for all to see, and there it stood for almost a whole year until it met its unfortunate ‘accidental’ end. The problem I often had with art was not that I wasn’t creative or didn’t possess any artistic ability, it was that I could never get things looking exactly how I saw them in my head, and no slight alteration to my initial design could be tolerated. So my totem pole was the result of weeks worth of effort trying to create a sharp pointed top, which I couldn’t get exactly right so had chipped away at it until it resembled a phallic object. I then had no time left to paint it so only the top was coloured in, the rest left plaster white. I found this to be a recurrent theme with all my art and design work at school, woodwork sanded within an inch of its life brought home unfinished, pottery which had been so smoothed out it was caving in on itself, and paintings half painted and holey from excessive erasing. The point was it was not that I wasn’t creative, it was just that I needed the time and to find the right medium to express that creativity exactly how I saw it. I think this is why those with autism are often labelled as having no creativity. In fact, when someone with Autism turns to creative pursuits that creativity can be even more intense than a ‘neurotypical’ of the same disposition. So where has this myth come from?

I think the difficulty that may be faced by autistic people, who find it hard to express their creativity, is that it is not their ‘specialist’ subject, and they therefore have to think outside of the box and apply a different sort of abstract thinking to process those creative thoughts. As I grew older and more academic pursuits became my central interest, being creative seemed pointless, why did I need to waste time drawing the image in my head just so others could see it also? I applied my creativity instead to research projects, essay writing, and reading. I am passionate about music so I turned this into a psychology project on music and emotions. I love photography and computer art so I became a freelance designer, earning money to supplement my student lifestyle. However, in my last year of university I was thrown into art therapy and expected to draw and visualise my emotions on a weekly basis, nightmare! I started off just drawing things I’d seen and planned the night before and making up some elaborate emotional link; the planets and space after watching a documentary, which somehow mirrored my sense of loneliness , the anatomy of the brain during my dissertation finals, which somehow reflected my rigid thoughts. You would have been forgiven for thinking that my creativity was somewhat lacking, I just couldn’t connect the two, and until I could the therapy would have no benefit to me whatsoever. Eventually I managed to just let it all go and let that creativity flow. It was the most useful experience of my life thus far, it made me realise that not everything has to have a point to it, that just in the act of creating something disorganised and irrelevant it would untie a lot of the knots in my head, and that in itself gave it a purpose.

Impairments with creativity, however, are still being recognised as a tell tale symptom of autism, which no one seems to be questioning. When I often tell people I have Asperger’s they are surprised by my job as a designer; the myth has become an ingrained stereotype of the condition. It isn’t a stereotype without evidence though. In 1999 Craig and Baron-Cohen tested impoverished creativity in Autism and Asperger Syndrome and found that the ASD children did show impairments on creativity tests. Furthermore, although such children could create possible novel changes in an object, which required creativity, they made far fewer than the control children, and these tended to be reality based. For example the novel changes were all situations they had previously experienced or knew about, not elaborate imaginative fantasy situations. Finally they found that children with ASD did not seem to have imaginative fluency, in that they generated fewer suggestions involving attribution of animacy to foam shapes. They suggested that this was due to poor executive dysfunction, which refers to a set of mental processes that help us connect past experience with present action, thus aiding the production of creative novel experiences. This evidence added further to a debate started a decade before in 1988 when Shallice found that patients with damaged frontal lobes had a deficit in executive dysfunction, creativity, and were poor at generating novel responses; the three seemed to go together. This all sounds like a disaster for our future prospects as artists, and I’ve not even had time to mention all that Theory of Mind (ToM) we are lacking!

Fortunately the debate hasn’t been completely one sided. Professor Michael Fitzgerald of Dublin Trinity College believes that some of the most brilliant minds have been autistic. He compared the behaviour of his patients with that described in the biographies of the famous. Both Lewis Carroll and Yeats showed signs of Autism Disorder, two of the most creative minds in literary history. Professor Fitzgerald suggest that Asperger’s syndrome actually provides a benefit and makes people more creative, they are typically hyper focused and their attention to detail lends itself well to creative pursuits. Could it simply be the case that autistic people are very tricky to test in a laboratory setting as it isn’t realistic to real life? Or just that like the ‘neurotypical’ population some of us are incredibly talented with our creativity, some of us absolutely useless, and the rest lying somewhere in the middle?

What I think is important is that autistic people are helped to express the innate creativity they have. What can be better for the jumbled disconnected autistic brain than organising disorganised elements? Clashing colours turned into beautiful drawings, random noise turned into soothing music, muddled ideas turned into comprehensive plans. Being creative involves expressing emotions, so therefore those with emotional problems and/or communication problems can benefit from creative recreational pursuits and therapy, we just need a bit of patience and some help sometimes to make the link!

ARCHIVED Plug in Baby – Early vs Late Autism Diagnosis


ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology. 

Yesterday I was drawn to an article in the paper entitled “Plug in Baby”, mainly because of the cute baby wearing a peculiar hat sprawled across the page. The article was referring to a study conducted at Durham University which hoped to reveal how babies learn from others, and in particular how autism develops. Using a sensor filled cap the babies were shown images of people walking, then placed in a small bath to ‘walk’ using their ‘walk reflex’. The results will be compared to babies who have no experience of ‘walking’ in order to enlighten us on how exactly babies learn. If all goes accordingly then psychologist Dr Vincent Reid hopes the test may help to spot the signs of autism in infants at an early age. Currently diagnosis cannot be reliably made until the infant is around three years of age.

This got me thinking, what exactly are the advantages to an early diagnosis and are there any drawbacks to being diagnosed so early in life? For myself, having had a much later diagnosis, it depends on whether or not the autism is in my good books. When I’m feeling particularly inept at life I often curse the teachers and doctors who didn’t pick up on my strange and anxious ways when I was a child; I think life would have been much easier for me had people known about it from the word go. However, when I am sat around with a group of friends having a laugh and feeling totally at ease, I am thankful I didn’t know because it forced me out of my shell, I strived to appear ‘normal’ and would not allow myself to become the recluse I so desperately wanted to be. But the grass is not always greener on the other side, and if researchers could come up with a reliable way to test infants early in life then I would be the first to celebrate, right after I’d criticised their methods and the implications of it of course!

Advantages to Early Diagnosis:

  • Special developmental tools can be put in place, e.g. education and therapy, to ensure the child reaches their full potential, which may also in turn lessen the impact of mental health problems and improve general well being.
  • Ease the child’s anxiety as they will not be expected to do things they find difficult.
  • Increase the understanding of the condition and how it develops.
  • Increase the speed other members of the family also with the condition may be detected.

Disadvantages

  • Misdiagnosis may occur as many will be too young to fully observe behavioural patterns. No test is 100% exact.
  • Labelling from an early age may lead to negative stereotypes being placed on the child, which they in turn will conform too.
  • Doesn’t tell you how  functioning the child is/will be.

The article can be read here: http://www.dailymail.co.uk/sciencetech/article-2181542/Extraordinary-images-shows-baby-wired-autism-research-university.html

ARCHIVED The Spectrum: A little high, a little low


ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology. 

As a psychology student studying Autism, the idea of an Autism Spectrum appealed to me. I liked how it could reduce a plethora of ‘impaired’ individuals onto one simple scale with one umbrella condition that grouped them all together, whether they liked it or not. If only more mental disorders and mental illnesses could also be reduced to such a scale, revision would have been much easier, and more time could have been devoted to playing Guitar Hero and sitting in the pub garden. After my diagnosis, however, I despised this idea of a spectrum, which so easily allows professionals to ignore the individual behind the impairments. When I went to see my GP after my diagnosis, she merely reassured me that it was only ‘mild autism’ I had, and that I seemed to be making good eye contact, and then promptly touched my knee in an anything-but-reassuring manner, which made me recoil off my chair and mentally repeat the scarring event days after the appointment. Had I not been seconds away from an unexpected touch related meltdown, I would have explained to her that the term ‘high-functioning’ autism does not equate to ‘mild autism’, it simply means that I am able to function to a higher level than those diagnosed with ‘low-functioning’ autism, which is not indicative of the severity of traits I may or may not have. High-functioning means I am able to hide it better than others who are ‘lower-functioning’, not that it makes me any less anxious or any more skilled in those areas. Take for example eye contact; one of the first things people often say to me when I tell them about my diagnosis is that my eye contact seems too good for an autistic person. Little do they know how anxious face-to-face meetings are for me, and how I am constantly counting the amount of time I look them in the eye before looking away.

The American Psychiatric Association (APA) are proposing to remove the term ‘Aspergers’ and high- and low-functioning altogether, and group it under the umbrella term ‘Autism Spectrum Disorder’.  This will mean that the Diagnostic and Statistical Manual of Mental Disorders (DSM), which provides one of the main set of criteria used in the UK for Autism diagnosis, will also be changed. Aspergers was first introduced into the DSM as a separate disorder to Autism in 1994, 14 years after Infantile Autism was first recognised in the manual. These two conditions were grouped with several others under the term ‘Pervasive Developmental Disorders’. This seemed like a massive step forward for the Autistic community, many now fear we are taking several steps backwards. Francesca Happe from the Institute of Psychiatry, however, believes that the changes will not have negative consequences. She emphasises that there is no basis to distinguish Aspergers from ‘high-functioning’ autism, and the disorders have been known as a ‘spectrum’ for years. The National Autistic Society’s (NAS) experts Lorna Wing and Judith Gould on the other hand, are recommending that the Asperger subgroup remain. In a paper they have submitted to the APA they instead call for stronger focus on social imagination, diagnosis in infancy and adulthood, and on the possible under-diagnosis of girls and women with autism. The verdict seems split amongst the professionals, always a reassuring sign!

The change in diagnosis terms will mean the triad of impairments previously relied upon by professionals will be reduced to two main areas: social communication and interaction, and restricted, repetitive patterns of behaviour, interests or activities (FYI I don’t think it takes a genius to work out the fundamental point of calling it a triad of impairments seems to have been missed…). Sensory behaviours will be included for the first time, and an emphasis during diagnosis will change from giving a label to identifying the needs of a person. On paper this sounds like a great leap forward, however, when the fact that there are no services available, this change of emphasis seems a bit redundant.  The NAS also points out that the minimum criteria for level 1 severity ‘needs support’ are considerably higher than the minimum criteria for a diagnosis. Will this mean people deemed to be below these criteria will not even receive a diagnosis in the first place? If so, we might as well scrap the last twenty years of autism research. Bizarrely, they are planning on introducing another disorder to the group, which will be known as ‘Social Communication Disorder’ and does not include restricted or repetitive behaviour in its criteria. They have also assured that the changes will not affect those already diagnosed with Asperger’s, however, realistically how can it not? Many will be bumped down to ‘mild autism’, and the individual and specific needs associated with the condition will gradually fade away as new generations of doctors take over our current professionals. Ironically, if these professionals knew anything about Asperger’s and autism, they would know how much most of us hate change, which makes me doubt their expertise at all!

Overly opinionated and biased rant over, how do you feel about the proposed changes?

These changes will be included in the 2013 revised DSM manual. More information and contact details can be found at: www.dsm5.org/pages/default.aspx

 

ARCHIVED Autism Diagnosis II – The Psychology of it all


ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology. 

I had been looking forward to my Autism Assessment. Mainly because I was being offered three hours to fill in questionnaires, one of my favourite activities; ticking boxes which then creates some sort of output result – if only real life was like this! Upon leaving the assessment however, I felt completely inept at life, and like I’d just discovered I was an alien who had merely learnt to pretend to communicate with ‘neuro-typicals’; a word that incidentally makes me feel even more like an alien who has been brought up in a defunct test tube. The psychiatrists congratulatory “well done on getting this far”, did not help matters. On the other hand had I really considered what a diagnosis would mean? In order to be diagnosed you’re sort of admitting there is a problem, something which sets you apart from the ‘typicals’ of this world; people don’t get diagnosed as being very sociable or having a good sense of humour. There are many valuable and positive traits to Aspergers, but the assessment will only ever look at the impairments it creates, and for many reasons I am glad I went through it.
Despite Hans Asperger recognising autistic behaviours in children over 76 years ago, adult testing for Autism Spectrum Conditions (ASC) has only really become available in the last decade, thanks to research centres such as Simon Baron-Cohen’s Autism Research Centre in Cambridge. The Adult Autism Assessment (AAA) questionnaire was devised by his team in 2006, and revealed a whole generation of missed autism diagnoses. The condition is clearly life long,  so why did it take so long so get diagnosed? The typical method for testing children revolves around the observation of their behaviour and play; in particular the ‘Sally-Ann’ test became a popular method. This tests the child’s ‘Theory of Mind’ (ToM), or in laymen’s terms their ability to understand that someone else may have different beliefs to their own. However, even adults with autism will have developed a better ToM and learnt to cover up their ‘autistic behaviours’ by the time they are in their 20s or 30s compared to when they were 5. A more objective assessment was needed. The AAA teamed with the Empathy Quotient for Adults (EQ), the Adult Systemising Quotient (SQ) and a highly detailed history regarding the childhood from both the patient and a Next of Kin who has been with them since birth, creates both a reliable and valid assessment for adults seeking an autism diagnosis.
I was fortunate enough to be assessed by CLASS (Cambridge Lifespan Asperger Syndrome Service) led by Baron-Cohen. I was also fortunate enough to be tested during a period where much has come to light about autistic females. When the tests were first devised it was thought that females with autism were very rare; with a ratio of 4 boys to 1 girl with the condition. This stemmed from the idea that those with autism seemed to show an extreme form of the male brain, loving systems and showing a lack of empathy. I recently sat in a room with 12 others discussing autism, none of the males had an autism diagnosis, but at least two of us females had, go figure. Recent research suggests that instead women are much better at covering their symptoms due to their expected role in society. If I had had the assessment five years ago my autism would probably have been missed, as I have become highly skilled in covering my traits. This is a very exciting time in the history of Autism Diagnosis, one that I am proud to have taken part in both personally and, hopefully in the near future, professionally also, even if I have spent every day since wondering if I should employ a full-time carer to help me negotiate the foreign land of social beings in order to ensure my survival.

Further Reading
More on the Sally-Ann Test
More on CLASS and the tests used

ARCHIVED An Autism Diagnosis – The bigger picture I’d been searching for


ARCHIVED: Please note, whilst every effort has been made to update blog posts, this blog post has been archived and may present outdated and incorrect information and terminology. 

“She seemed fine as a baby; in fact she was really good. She rarely cried, rarely needed me, and would just sit for hours happily playing by herself”, my mum proudly boasted to the young female Doctor during my three-hour autism assessment. My mum had clearly come ready for attack, from either her own emotionally stunted daughter, or the vicious doctors who would try to blame her bad parenting. Considering she went in expecting not to be able to recollect anything from my childhood, she managed to remember an exceptional amount; five A4 pages worth.
“Did you have any friends when you started school?” the mild-mannered doctor asked me from her page of interview questions.
“Yea, I always seemed to have friends, I just didn’t like playing games with them.” Was my vague and to the point reply. To which my mum piped up “You didn’t really. Most of them were the children of my friends and you sort of just followed them around.”
Thanks mum, the illusion of my semi-normal childhood was being shattered. There then ensued a never-ending list of all my weird quirks and behaviours, from selective-mutism, obsessive hand washing, limited diets, a fear of all things moist, hatred for the colour red, gagging at certain textures, toileting issues, severe anxiety, to all my obsessional interests with music, books and people, remembering conversations word for word and not always understanding people’s emotions.  Meanwhile I sat flicking my thumbs as I always do, drawing a mental map of the outline of the room. I counted the plugs as I went along, they didn’t look like normal plugs so I drew them extra carefully so I could recall them later if I needed to.
After three hours the assessment came to its end. My mum and I got up ready to leave, fully prepared for a break or even to go home whilst the doctor looked through the evidence on what we thought would be a tough borderline case.
“Usually I need some time to go through the evidence or talk it through with my supervisor, but I think the evidence is pretty conclusive. I am pretty certain you have Aspergers”. The Doctor then went on to congratulate me for making it in life this far, which rather ashamedly I took as a compliment and secretly hoped she’d provide me with my own special medal, or at least some sort of bravery award.

I was 23 when I received my diagnosis. I wasn’t even aware I could have Aspergers until a year previous, when it came to the attention of my exceptionally observant Art Therapist that I didn’t seem to process my emotions how other people do, they seemed somewhat stunted. Rather embarrassingly I had just completed a three-year Psychology Degree, and had even studied autism in my finals, yet never had it occurred to me that all the issues I had had in my life could be down to that. I assumed I was too social and functional to have autism, but in fact I had just learnt to imitate and hide my impairments really well. I asked my mum how she had never noticed given the list of weird behaviours I had presented since childhood. She said she had never placed them altogether, that they had always thought it was ‘just me’, they hadn’t seen anything wrong with it. Aspergers was the bigger picture I had been searching for.

I chose to write this blog as a way to collect all my thoughts, both from personal experience and from current research and theories. My dream is to go on and study autism, particularly females with autism, so maybe in the future people with Aspergers won’t have to wait so long to find answers.

%d bloggers like this: