In this article, I would like to talk about Autism Spectrum Disorders, which are frequent but little research has been completed about the subject. I have always wondered about the different types of this disorder. ASD always challenged me as I myself have accompanied an autistic student during my university years.
There are two stereotypes of autism circulating in our society:
- Autism is “mental retardation”;
- The autistic individual is a “superhuman genius”.
These two stereotypes refer to the two forms of autism, which are now outdated.
- Typical autism with “mental retardation”
- And the Asperger syndrome (AS) called “high-functioning autism” (HFA), without intellectual deficiency.
Since the last update of the classifications (2013), it is believed that the autistic-like profile is a continuum. Indeed, one can have autistic-like traits without necessarily being diagnosed with autism.
We ask ourselves what Autism Spectrum Disorder is
Autism Spectrum Disorder is a neurodevelopmental syndrome affecting the development and functioning of “social communication” associated with the existence of restricted and stereotyped behavior.
The diagnosis of autism must follow a precise procedure, very well-documented by HAS (High Authority of Health)
The diagnosis is clinical but must be multidisciplinary.
There are different assessments in Autism Spectrum Disorder.
In fact, the assessment of social interaction is the first assessment to be done. Social skills are not the same according to age.
For example, in the very young child, the disorder may manifest as a lack of eye contact, difficulties in answering his first name, isolation; and this can go on until adolescence to difficulties in understanding social conventions or lack of empathy, i.e. being insensitive with other people’s feelings.
In addition, alterations in communication, mainly affecting language, are another manifestation of the disorder. These particularities can be repetitive speech – “I’m fine, I’m fine” -, an overly individualized use of language or a language resembling an echo with repetitions of words or whole previously heard sentences.
There are also alterations in non-verbal communication, i.e. the communication of the body. Autistic patients have difficulty in expressing facial emotions but also in understanding other people’s emotions.
The third domain is the behavioral and sensory domain. Patients with autism have motor stereotypies. These are stereotyped body movements that have no particular evocation. Beyond that, autistic people show repetitive actions and tend to use objects in the same way and repeatedly. They may have very specific and repetitive interests. For example, they may play with the “on/off” switch.
Sensory difficulties include hypersensitivity to noise which is not necessarily aggressive for us other people. They also have difficulties with physical contact as well as with the perception of cold and hot.
Management of autistic patients
When we speak of Autism Spectrum Disorder, we immediately think of children, but children grow up and become adults.
Studies show that 70% of patients with ASD do not have an intellectual disability. These patients will develop compensatory strategies to mask their communication and interaction difficulties.
Often, patients come to the clinic not to state an autism spectrum disorder but rather due to comorbidities, i.e., associated disorders. Indeed, they come to consult for a depressive episode, or for an anxiety disorder, which is very frequently associated with ASD.
The challenge of diagnosis is to adapt the management of these patients. It is particularly important to adapt to the patient’s difficulties but also to their strengths.
The first part of the treatment is the psychological care. This will be dedicated to social skills training. We help autistic patients to better interact with others, to improve their communication skills. This involves cognitive remediation, which is widely used with these patients. For example, group games with other autistic patients, playful games.
Another important aspect is the management of co-morbidities, i.e., associated disorders. They can be psychological (depression, anxiety) or physical (sleep disorders, digestive disorders etc.).
Finally, the last component is the medico-social care in order to integrate the patient in the socio-professional environment and improve his activities in his daily life.
The diagnosis of Autism Spectrum Disorder is complex in adulthood, so it is important to continue the research in order to better define the symptoms of this pathology in this adult population and to develop new strategies of care.
This is a disorder that interests me a lot and for which I have much invested during my university years. As I said in the introduction, I accompanied an autistic student without intellectual disability. An adult student, who as I mentioned, was masking his difficulties. Moreover, I decided to do my end of studies internship in a Foyer d’Accueil Médicalisé with an autistic patient in order to have more knowledge about this population and be able to observe the different ways in which these patients are cared for.
Afterwards, I would like to practice with this same type of patients and complete a university diploma in Autism Spectrum Disorders in order to improve my skills in this specialty.
I hope that this short article would have clarified for you the ideas about patients with Autism Spectrum Disorder. I also recommend the “Good Doctor” series, a different way to learn more about the symptoms of this disorder, while enjoying the plot