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Is Autism’s Triad Of Impairments outdated? (ASC / ASD / Asperger’s)

Is Autism’s Triad Of Impairments outdated? (ASC / ASD / Asperger’s)

Autism is often defined by the famous ‘triad of impairments’, a concept introduced in the late 1970s. (Wing and Gould.) Undertake any course of further learning about autism or read a reference book, and you will come across it as the gold standard of diagnosis regarding autism spectrum conditions (ASCs).

Our question is – Is Autism’s Triad Of Impairments now dated?

The Triad of Impairments is a tool describing ASC limitations – it’s sometimes described as including the three elements of Communication, Social Interaction and Flexible Imaginative Functions (which can also mean repetitive or obsessive behaviours; sometimes, the third element of the triad simply refers to ‘flexibility’ and / or ‘imagination’.)

The triad has also been described as impairments in theory of mind and executive dysfunction, and a propensity to ‘detail-focused’ behaviour.

However, with the revisions to America’s DSM-IV, e.g. as the various sub-types of autism have been amalgamated into autism spectrum disorders (ASDs) / ASCs, the triad as a concept is more frequently being condensed further, as just two elements: (1) impaired social communication and social interaction (as one), and (2) restricted behaviour/flexibility.

Our question relates to whether (1) the triad is retained at all. And (2) whether ‘impairments’ is necessary as a term, being a description with such negative implications?

A 2009 Study states: “Exceptional pioneering work in the late 1970s gave rise to the concept of the triad of impairments: impaired communication, impaired social skills and a restricted and repetitive way of being-in-the-world. This allowed a new way for professionals and families to understand autism; this was a transitional idea.”

Some experts are moving away from the triad, which is seen as a single explanation for the symptoms of autism – as found in the articleTime to give up on a single explanation for autism’.

The authors state: “Despite half a century’s research into ASD, there is little evidence regarding the unity of the three core areas of impairment [as described in the triad]. The triad of impairments can be fractionated, and should be studied separately.”

 

RETAINING the triad (and considering it imperative for our learning) could do two NEGATIVE THINGS:

(1)Inhibit the development of research into strategies to help autists. The same article states: “If different features of autism are caused by different genes, associated with different brain regions and related to different core cognitive impairments, it seems likely they will respond to different types of treatment.” This is why the authors recommend studying the three ‘triad’ elements separately, rather than looking for SOMETHING that causes all the three ‘triad’ elements.

(2)Support the notion that autism requires a cure. Again the article, which supports the idea of focusing on each element of the triad, instead of clubbing together the three traits, states: “Abandoning the search for a single cause [for] autism may also mean abandoning the search for a single ‘cure’ or intervention.”

The link with genes

An interesting 2008 study asked whether GENES affect the triad – e.g. whether the triad of autistic-like traits is mirrored at the genetic level; with separate genes contributing to each so-called impairment? The authors found that: ‘Each aspect of the triad is highly heritable.’

The authors stated that the ASC triad could have multiple causes, at genetic, neurological and cognitive levels, meaning that autism can result when a number of independent ‘impairments’ co-occur. The authors suggested that: “Some avenues of (ASC) research may be best pursued WITHIN, rather than across triad domains,” e.g. focussing on each element of the triad, rather than looking at the triad itself, as a non-negotiable platform.

There are other issues with the triad too. Does it take into account age and gender? Not really. A 2014 study hinted at ambiguity, and stated: “Findings regarding gender differences in the core triad of impairments seen in ASD remain ambiguous.”

Also, should the triad somehow incorporate sensory issues in autists, e.g. their over-or under-sensitivity to sounds, touch, light, temperatures etc? As this is surely a major element or factor for people with autism.

Impairment or the autie advantage?

Let’s move onto the term impairment – an objective term. A ‘New Scientist’ article states: “Auties, as some people with autism call themselves, don’t merely think differently: in certain ways they think better. Call it the autie advantage.”

A blog on SEN Assist sums our question of ‘impairment’ up well, with author Adele Divine stating – “The ‘triad’ is a helpful tool in that it highlights difficulties, which are common to those with a diagnosis of autism, but I have an issue with the word ‘impairment’. The dictionary definition of impairment is: ‘The result of being impaired; a deterioration or weakening; a disability… ‘The Triad of Differences’ would be less harsh. Differences may lead to difficulties, but with the right structures and supports differences can also lead to great discoveries. Many of the difficulties represented in the triad can also be positive character traits. The word ‘impairment’ does not suggest this.”

Focussing on autism’s positives

The existing triad does focus on impairments where an autistic person is concerned, but as we touched upon in our blog: ‘Tony Atwood’s theory of ‘discovering’ the strengths of Asperger’s instead of diagnosing traits and disorders’, perhaps we (as a group of interested parties) should focus more on positive autism traits, described by Professor Atwood as including aspects like consideration of details, a determination to seek the truth, and an original, often unique perspective in problem solving? (For interest, see Professor Atwood’s books HERE.)

As described on a blog for workshop provider, Autism Awareness Centre, autist John Simpson has created his own, more positive triad for the autism spectrum, which is:

*The need for predictability

*The need for motivation

*An uneven cognitive profile (splinter skills)

To conclude this rather lengthy musing, we’d love our followers’ feedback on the triad of impairments within autism – how valuable is it in today’s more enlightened culture and #actuallyautistic mindset, whereby autists promote acceptance?

A little disclaimer – here at Spectra.blog we don’t claim to be experts about Autism Spectrum Conditions / Disorders; the information we post here is based purely on our own exposure and experiences.

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Tuesday, 15th May: Judy Eaton of Help 4 Psychology tells BBC Radio 5 Live why awareness of PDA (pathological demand avoidance, an autism profile) must increase

Tuesday, 15th May: Judy Eaton of Help 4 Psychology tells BBC Radio 5 Live why awareness of PDA (pathological demand avoidance, an autism profile) must increase

NEWS FLASH!

This Tuesday, 15th May, at 6.30am, Judy Eaton of Help 4 Psychology has been invited to the studio of BBC Radio 5 Live (UK) to discuss PDA (pathological demand avoidance), and help raise awareness of this autistic profile.

According to the PDA Society, an organisation that provides information and support for parents, families and teachers, PDA is currently recognised as an autistic profile. Key areas of concern for the individual are: ‘An anxiety driven need to be in control and avoid other people’s demands’, and ‘An Intolerance of Uncertainty.’

Read our blog ‘A short introduction to PDA /pathological demand avoidance’ HERE.

(The interview should be available on the BBC i-player afterwards as part of 5 Live’s programming.)

 

Steve O’Connor’s song: “Just Me (Sam’s Song)” – a beautiful song helping autists find their voice (ASD/ASC)

Steve O’Connor’s song: “Just Me (Sam’s Song)” – a beautiful song helping autists find their voice (ASD/ASC)

Steve O’Connor, a talented singer, songwriter, recording artist and poet from Liverpool in the UK (pictured above), has recorded a beautiful song he wrote about a very inspirational young lady by the name of Sam, who has Autism.

“The song is called ‘Just Me (Sam’s Song)’ and by its nature is designed to raise awareness on such an enigmatic subject – I hope this song may help in this way, for those who sometimes cannot speak for them selves, this is their song, their voice,” Steve tells us.

Click HERE to listen to the song!
Tony Atwood’s theory of ‘discovering’ the strengths of Asperger’s (High Functioning Autism Condition, or ASC) instead of diagnosing traits and disorders

Tony Atwood’s theory of ‘discovering’ the strengths of Asperger’s (High Functioning Autism Condition, or ASC) instead of diagnosing traits and disorders

We recently came across a beautiful article by Tony Atwood, a psychologist well known for sharing his knowledge of Asperger’s Syndrome. (He has an Honours degree in Psychology from the University of Hull, a Masters degree in Clinical Psychology from the University of Surrey, and a PhD from the University of London. He is currently adjunct Associate Professor at Griffith University in Queensland. Professor Atwood’s son has Asperger’s, and Professor Atwwood now speaks very honestly about the family’s issues – we recently showcased two excellent videos on autism / Asperger’s from Professor Atwood, which you can see by clicking HERE.)

Anyway, back to the recently-discovered article (for readers’ background / information, ‘Asperger’s Syndrome’ is no longer specified as a stand-alone condition within the DSM IV manual – Professor Atwood’s article was published before the change was made). You can read his article in full HERE.

Framing Asperger’s (High Functioning Autism) in a positive light

To summarise, Professor Atwood aims to frame Asperger’s (High Functioning Autism) in a positive light. “Making any diagnosis requires attention to weaknesses; the observation and interpretation of signs and symptoms that vary from typical development or health. The DSM IV (American Psychiatric Association diagnostic manual) assists in the identification of a variety of disorders. It is used by psychiatrists and other mental health professionals to match observed weaknesses, symptoms and behaviours to text. Asperger’s Syndrome is identified by specific diagnostic criteria, a constellation of observed social and communication delays and/or deviations,” Professor Atwood writes.

In the article, Professor Atwood ponders what would happen if we used, instead of the term diagnosis, the term DISCOVERY, in terms of autism spectrum diagnosis.

“Unlike diagnosis, the term discovery often refers to the identification of a person’s strengths or talents. Actors are discovered. Artists and musicians are discovered. A great friend is discovered. These people are identified by an informal combination of evaluation and awe that ultimately concludes that this person possesses admirable qualities, abilities, and/or talents,” Professor Atwwood continues.

If Asperger’s Syndrome was identified by observation of strengths and talents, it would not be referred to as a syndrome! After all, a reference to someone with special strengths or talents does not use terms with negative connotations. “It’s ‘artist’ and ‘poet’, not ‘Artistically Arrogant’ or ‘Poetically Preoccupied’,” Professor Atwood notes.

Aspies rule

Nor would the term ‘Discovery’ over diagnosis attach someone’s proper name to the word ‘syndrome’ (for example, it’s vocalist or soloist, not Sinatra’s Syndrome), Professor Atwood explains. Focusing on autistic strengths requires shedding the former diagnostic term, Asperger’s Syndrome, for a new term. Professor Atwwood feels that ‘Aspie’ (used by many autists in self-reference, including Liane Holliday Wiley in her book, Pretending to be Normal, 1999), is a term that seems right at home among it’s talent-based counterparts: soloist, genius, aspie, dancer.

Professor Atwood urges everyone to take advantage of the contribution of aspies to culture and knowledge. He suggests many criteria for the term ‘Discovery’ (instead of diagnosis), including the below – so, to clarify, these are POSITIVE ‘Aspie’ (high functioning autism) traits that we should celebrate, instead of considering their ‘flip-side’ negatives:

Positive Asperger’s / High Functioning Autism traits:

An advantage in social interactions, in terms of absolute loyalty and impeccable dependability where peer relationships are concerned; the ability to regard others at ‘face value’; speaking one’s mind irrespective of social context; the ability to pursue personal theory or perspective (despite conflicting evidence); consideration of details; listening without continual judgement or assumption; preferring to avoid ‘ritualistic small talk’ and superficial conversation; a determination to seek the truth; advanced vocabulary and interest in words; an original, often unique perspective in problem solving; exceptional memory and/or recall of details often forgotten or disregarded by others; persistence of thought; a focused desire to maintain order and accuracy; a ‘social unsung hero’, with trusting optimism; an increased probability over general population of attending university, after high school; and the propensity to often take care of others, outside the range of typical development.

What a magnificent list of autistic traits!

Here at Spectra.Blog we are thrilled to share with our readers and followers Professor Atwwood’s theories. (You can see a link to his many excellent books below – the link is titled ‘tony attwood.’

A little disclaimer – at Spectra.blog, we don’t claim to be experts about Autism Spectrum Disorders; the information we post here is based purely on our own exposure and experiences.

Visit our ‘Foundation Posts’ page for some of our favourite posts about autism spectrum conditions.

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