The autism chasm – medicalised words versus neurodiversity concepts; and dated paediatric processes. When will we reach a level of understanding?

by admin | Mar 9, 2020 | News & Views

It’s no surprise there’s some confusion and frustration between the neurodiversity proponents and the parents of autistic children going through assessment.

As an autistic adult who supports the neurodiversity concept, and a parent of a neurodivergent child, this author regularly witnesses a gaping chasm.

The neurodiversity supporters, who are often autistic adults, or parents whose kids ALREADY HAVE a diagnosis of autism, are sometimes further along their journey of education and awareness than many parents of children undergoing assessment. That’s because the language of the clinicians and ‘experts’ in the parents’ lives (e.g. school SENCOS, teachers, Local Authority spokespersons, paediatricians, etc) is DIFFERENT and DATED.

Monotropism and autistic inertia

Neurodiversity proponents use concepts and language like ‘monotropism’ (atypical patterns of attention that describe issues that doctors would call hyper-focused interests, or obsessions – source: www.tiny.cc/DMurray); ‘autistic inertia’ (to describe issues that doctors would state as including executive function); and words like ‘traits, aspects, facets’ etc, to describe common autistic features; meanwhile, Drs, use medicalised words like ‘symptoms’. Most famously, neurodiversity proponents describe a ‘neurology’, or at worst a condition, while Drs use the word ‘disorder’.

Autism pity memes or ‘warrior mom’ memes

Head on over to social media, and neurodiversity groups discuss issues like monotropism and autistic advocatism. Meanwhile, on the parents’ support groups, families and carers may post about how their son’s ‘strange noises’ are irritating; why their family dinner was a disaster because the child was ‘unbearable’ (read: overwhelmed); or a ‘pity meme’ or ‘warrior mom’ meme about bringing up an autistic child. (The two groups aren’t mutually exclusive – there are many, many parents learning about neurodiversity on these groups and pages, and many, many helpful individuals who support the neurdiversity paradigm helping out the parents on their support group pages, e.g. with info about supporting the kids in question.)

The thing is, we as parents can’t get away from the medicalised language. It’s how our kids (and ourselves) are diagnosed with autism. It is clear why parents at the start of their journey follow the terminology that their (often outdated) doctors use. It’s not only all around them, it is a REQUIREMENT to understand it, and use it when conversing with the so-called experts surrounding a child. No matter how many neurodiversity articles you read and absorb, the dated phrasing is around you at every turn, if you’re within the NHS assessment system, or British social and local authority pathway (UK-centric).

Autism asssessment

In the course of just two days, I recently had a couple of enlightening experiences (again, this is UK based). A paediatrician told me he could only recommend onward neurodevelopmental assessment for a child if indicative signs were pervasive across all periods, and were witnessed by him at the child’s FIRST paediatric meeting. Have these doctors not heard of autistic MASKING? Literally 10 minutes (which is the time the Dr spent with the child directly, as opposed to with the parents) in a room, and a Dr can decide ‘no signs of autism are apparent’ in a child, and discharge the child, when the parents have waited many, many months to be seen? It is non-sensical.

(Families, remember – these stickler NHS paediatricians usually need to see two examples of ‘autistic behaviours or traits’ to recommend onward neurodevelopmental assessment. If the school aren’t witnessing anything (which could mean the teachers in question aren’t experienced in the field, or don’t realise that what they’re seeing represents autistic processes and traits), and the paediatrician doesn’t see anything at the first meeting, you WILL likely need further evidence. This could include private diagnosis, or presumably could even include supportive letters and evidence from other adults that are responsible for the child, e.g. group leaders or tutors. It is NOT FAIR that a paediatrician can choose not to refer a child on for assessment just because insufficient signs of ‘pervasiveness’ were apparent in the tiny window you were granted on that day.)

(Read more about children’s autism diagnosis HERE).

Haven’t they heard of AUTISTIC MASKING?!

There’s clearly a massive skills gap with some paediatricians who are generalists (e.g. don’t specialise in neurodevelopmental conditions), or have more experience of individuals that ARE autistic, but also have support needs, e.g. who present differently, with less masking. They NEED to know about autistic masking, and that not all autists display all their traits at once – and they need to stop relying on questions like ‘Does he/she hold eye contact?’ and ‘Does he/she line toys up?’, as if these are the key factors that would allow forward assessment for an autistic child.

The second experience I had in the space of those two days was that a local authority representative mentioned the ‘levels’ of autism, e.g. 1, 2 and 3. (This describes, at level 1, someone with so-called mild symptoms, who doesn’t need much support. Those with level 2 or 3 autism are said to have so-called moderate to severe symptoms, and require more substantial support.)

Autistic functioning labels

Using these descriptions (and the word ‘symptom’) is fine medically/diagnostically, as it relates to the (American) DSM-5’s description, which advises diagnosing clinicians to use the broad term Autism Spectrum Disorder (ASD), for diagnosis, with numbered sub-categories as described. BUT, no autistic adult uses these sub-categories. Neurodiversity advocates campaign for ALL such functioning labels (e.g. also including ‘mild autism’ and ‘severe autism’) to be disbanded.

Read more here – https://spectra.blog/news-views/autism-labels-and-language/

So, the parent trying to find their way along a journey where (they hope) that an autism diagnosis will allow their child support, are barraged with medicalised jargon and dated views on autism. Yet, as they try to self-educate about modern concepts of neurodiversity and neurodivergence, they are faced with yet more language that is confusing, and is the opposite of what their so-called experts use. (Remember, the experts are bound by law and the jurisdictions of their diagnostic manuals.)

The neurodiversity proponents have it right

What’s the answer? In this author’s opinion, the neurodiversity proponents have it right. Their concepts about supporting difference (not disorder), and of celebrating the benefits of neurodivergence along with recognising the challenges it may bring, are no-brainers. Of course it makes sense. But the educators and ‘experts’ are still on their own journey. They’re surrounded by medicalised textbooks and training courses. Some had next to no training on autism in the first place, and may not have had much exposure to autistic individuals who have little in the way of support needs. So education is KEY. But alongside this, it’s important to educate ourselves about the WHOLE PICTURE – the diagnostic guidelines, the medicalised jargon we can’t bear, the dated paediatricians who have no obvious understanding of what it’s like to experience the world as an autistic person.

I wrote the book ‘Autism from A to Z’ to address some of the issues touched on here. I wanted a tome that helped experts and professionals (as well as families and carers, and autists themselves) to understand some of the finer points of modern-autism thinking, from an #actuallyautistic perspective. But equally, I needed to outline the diagnostic facts, for individuals at the start of their journey. It launched at a UK-based SEN event (The Autism Apprentice’s Special Educational Needs (SEN) Information Day at The Appleyard, Sittingbourne, Kent on 20th March 2020). #autism #autismawareness #SEN #Kent

BUY AUTISM FROM A TO Z HERE.

Here are a few reviews:

‘Autism from A to Z is full of information that people new to the autistic world would find extremely helpful when either discovering themselves, or supporting a loved one or client.”

EM, Kent Autistic Trust

“Autism A-Z is easy to digest – I love how its compartmentalised in alphabetical order to find areas easily. The content is the most up to date inclusive of diagnostic changes. Autists are amazing and unique and this book consolidates information and experience supporting this view point. Autists, Parents and Professionals will benefit from having a copy.”

TH, Independent Cornwall Autism Network

‘I recommend this book for anyone new to autism. Autism from A to Z  is refreshingly free of ‘politics’; it simply states the facts and points the way towards further study. It is a very positive book, which promotes self-care and mutual respect for differing views. It’s a very good starting point for further study, and is written by someone with personal experience; I found myself hooked.’

LA, autistic adult

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