Autism – beyond the myths

I found it refreshing to read Christian Jarrett dispelling popular myths surrounding autism spectrum disorder in his article 'Autism – myth and reality' (October 2014). I have worked for several years with students who have autism and have found they face a constant struggle battling myths. In particular, the belief that people with autism are asocial and selfish has caused challenges for the young people with autism that I have worked with. They are often left out of normal social practices because people believe they are not interested in joining in; however, frequently they are interested in participating but just struggle to communicate this.

It is important to emphasise that in my years or working I have never encountered an individual with autism who I would deem to be asocial or selfish. I believe the distinction Jarrett makes between an autistic individual's struggle to complete theory of mind (ToM) tasks and their personality traits is fundamental to helping give people with autism support.

Autism causes difficulties in communication and understanding ToM; however, this does not halt an individual's desire to form emotional bonds. Expressing affection can be challenging for individuals with autism, and this can be an even greater challenge when the public believes myths about autism causing asocial and selfish behaviours. Psychology has greatly improved our understanding of autism in recent years, and therefore it is now important to dispel myths such as this.

Increasing the levels of accurate knowledge surrounding the disorder can lead to the correct support being provided for people with autism. With the numerous challenges these individuals face, it is important to dispel myths that can hinder the progress people with autism make in overcoming their difficulties. I was pleased to read an article in The Psychologist clarifying the reality of the disorder, making the steps to eliminate myths and making life easier for people who have autism spectrum disorder.
Dulcie Gray
Lincoln

I was interested to read the special edition of The Psychologist 'Autism: Myth and reality'. Having worked as a clinical psychologist with people with intellectual disability for over 30 years, I have been interested and concerned about the growth of the use of the autism label and its impact on services for people with intellectual disabilities in particular.

The collection of articles all attempted to explain the key concepts of autism, whether it is a continuum or a category, whether there is a way of explaining cognitive differences between people with the label and those without, etc. I was surprised that no author seemed to address a key issue. Surely an important reason to identify and categorise a subgroup of people is the hope that there may be key treatment implications for the members of that group? Yet no articles talked in depth about treatments or management for people with autism.

Yet in a way I am not surprised, because, when you look closely, there are no autism-specific treatment approaches. For example, the NICE Guideline 142 on recognition, referral, diagnosis and management of adults on the autism spectrum used 25 research papers that reached its criteria for acceptable evidence about treatment. Of these 25 papers, 15 were on people with intellectual disability, three were on people with intellectual disability and autistic spectrum disorder, while only seven were with people with autistic spectrum disorder alone. The approaches recommended do not differ from approaches that would be used for anyone with an intellectual disability. Many of the commonly used approaches in autism services such as TEACCH and PECS consist of sound behavioural, cognitive and communication principles that would apply to anyone with an intellectual disability.

Emerson and Baines (2010) estimated that between 20 and 33 per cent of adults known to local councils with social services responsibilities as people with learning disabilities also have autism. There is now a large autism specialist service sector of schools, residential services, day centres, peripatetic supports, etc., which is open to that significant minority of people with intellectual disabilities. If these services really offer nothing substantially different to a good intellectual disability service, we should be questioning whether it is fair that extra help is available to those people with intellectual disabilities who have the autism diagnosis, when those without the diagnosis share similar needs.

The UK autism strategy for England asserts: 'Diagnosis alone is not enough: the fundamental change we want to see is that diagnosis leads to a person-centred assessment of need, in line with the NHS and Community Care Act 1990' Department of Health (2010, p.36).  

A final thought: Why do we need the diagnosis in the first place for the person-centred response the guidance seeks?
Graham Collins
Alfreton, Derbyshire

References
Department of Health (2010). Fulfilling and rewarding lives: The strategy for adults with autism in England. London: Author.
Emerson, E. & Baines, S. (2010). The estimated prevalence of autism among adults with learning disabilities in England. Improving Health and Lives Learning Disabilities Observatory, Public Health England.
National Collaborating Centre for Mental Health (2012). Autism: The NICE guideline on recognition, referral, diagnosis and management of adults on the autism spectrum. National Clinical Guideline Number 142. British Psychological Society and Royal College of Psychiatrists.