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 article ‘Time 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.
Also published on Medium.