Autism Spectrum Trait Recognition

Autism spectrum traits or characteristics (AST)

are common in our population and may contribute to unique advantages or disadvantages. There now is better recognition and awareness of autistic traits. Current scientific evidence supports that there is a predominant genetic origin of AST.

Autism Spectrum refers to the varied presentation of individuals that may have unique strengths but also challenges with difficulties in social skills, communication, motor coordination, repetitious movements or behaviors, and early-life developmental issues.

Individuals with milder autistic spectrum characteristics that may have social difficulties and unique interests, but without language problems or intellectual disability, have been referred to in the past as Asperger Syndrome.  (Elizabeth Sinclair, ABA Programs Guide)

See the below story of Justin’s journey to discovery, and healing.

A discussion then follows about

• autism spectrum conditions
• Asperger traits
• early recognition and interventions
• assessment of adaptive functioning
• associated issues as anxiety and co-occurring problems

Justin was a 41 years old man who struggled to support himself. He couldn’t find a job that would allow for his odd or quirky behaviors, manner of speech, lack of social finesse, shyness, or inconsistent work performance. He had different jobs, here and there, as in restaurants or landscaping and earned a little money when work was available. Some support money was received from his mother, as well. His total income was enough to pay for his room and food. Jobs would only last for a few days at a time when he had them. He usually would leave because of being picked on or bullied by other workers or would get fired for not staying focused on his work, not working fast enough, or not following-instructions. 

Unemployment didn’t bother him too much. He could watch his favorite movies or TV show or pursue his special interests as playing video games. He became increasingly depressed, anxious with occasional panic attacks, poor sleep because of frightening dreams, and fearfulness about being homeless and destitute. Much more of his time was taken up with obsessive routines, leading him to become more homebound. Justin was becoming an increased loner, not going out much, and participating in minimal social activities.

His alarmed mother and aunt, followed a pattern they had done for years, rushing him to different health care providers, psychologists, or psychiatrists. Over the years, he had been given several different diagnoses and labels. He was treated with the respective medications felt to be best for the condition he was thought to have at the time. Earlier in his school years, he was tested and felt to be of average intelligence and verbal functioning, with Attention Deficit, Hyperactivity Disorder (ADHD), anxiety, depression, and obsessive-compulsive disorder (OCD). Treatment was with two different stimulant type medications, Ritalin and Adderall, and an antidepressant. It was not clear to him that the medicines were helping, and he finally refused to take them. 

Later he was diagnosed as having severe anxiety and was treated with sedatives and anxiety medication as Valium and Xanax. Medication treatment consisted of mood stabilizers and antipsychotic medication as Lamictal, Seroquel, and Risperdal. Two brief inpatients psychiatric hospitalizations were felt needed, as well. He went to several different types of therapies and therapists, but none seemed to help. Generally, he didn’t stay in treatment for more than a few months each time. He went to a holistic doctor, who did several expensive diagnostic tests and tried him on a few different diets and nutritional supplements. None of the medications, therapies, or more natural treatments seem to fix him or resolve his symptoms. He claimed though that the various treatments may have had some benefit. 

His mother and aunt asked for guidance from a friend who taught in one of the local colleges. The college professor told them that from her experience from years of teaching that their son was possibly on the Autism Spectrum. She expressed her opinion based on Justin’s difficulties with social skills, learning, processing information, and adjusting to the outside world. She recommended that he get tested by a psychologist specialized and experienced in Autism Spectrum Conditions and Asperger’s Syndrome. 

Justin was seen and diagnosed as being high functioning on the Autism Spectrum as he had average intelligence and verbal skills. Next was a referral to an autism specialist for help with information processing, learning, and social skills. The specialist hoped to improve his adaptations and coping with the demands placed on him by others. He was told of several support resources to consider and given instructions on the type of accommodations he would need for any future training or work situation. The autism spectrum specialist referred him to vocational rehabilitation services. The help fell short of helping him to find or keep a job. 

Justin was relieved to know about his autistic traits, his difficulties, and his needs. He applied for disability but was turned down. Social Security Disability Determination felt that he was “intelligent” enough to find a job and to adjust to it. Unfortunately, paralyzing fear and anxiety seemed to be also present and interfering with him getting or keeping a job. The psychologist that diagnosed the ASD recommended that he get a further evaluation for his level of adaptive functioning, as he still was not able to find suitable or accommodated work and not able to be self-sufficient, especially in terms of self-supporting himself. Justin completed additional testing of his adaptive functioning in the hope that it would help to qualify him in the future for government services, support, or disability (SSD). 

Further help and treatment were also recommended for his severe anxiety, felt to be indistinguishable at this point from Post-Traumatic Stress Disorder (PTSD). He also considered the referrals to community support programs and support groups for adults on the autism spectrum. Justin now seemed to have a more purposeful, hopeful, and positive attitude about himself. (The above narrative is a composite of stories from my clinical experience and is not a representation of an actual person.)

There are advantages and disadvantages of AST as the frequent difficulties with adaptive skills and anxiety.

In the review that follows any reference to “AST” can also be understood to describe possible issues or characteristics of individuals considered to have Autism Spectrum Conditions (ASD) or Asperger’s. (Tony Attwood 2008, comprehensive book on Asperger’s)

 When an individual with significant AST is average or above average in verbal, intellectual skills, and academic performance (either with or without accommodations), he or she would be considered as being high functioning on the Autism Spectrum. In the past high functioning autism was referred to as Asperger’s Syndrome and now is classified by the current American Psychiatric Association, “Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” as Autism Spectrum Disorder (ASD). (American Psychiatric Association 2013)

Use of term high functioning has led to misunderstanding

and denial for many individuals needing community or government support or services – especially when there was significant impairment in social and adaptive behaviors that interfered with them being self-sufficient or successful in non-accommodated training or work settings. (Katherine K.M. 2019), (Dalmeet Singh Chawla 2019)

Adaptive functioning or skills are the age-appropriate behaviors that individuals, with and without intellectual or learning disabilities, need to live independently and to function in everyday society. Difficulties identified early, with training and practice, can lead to future gains in social competence, life skills, and independence.  (Julian Tillmann 2019)

Adaptive behaviors and skills difficulties

can interfere with typical day to day functioning and the ability to be successful in school, training programs, or work when provisions and accommodations or support services are not available or adequate. Careful assessment of adaptive behavior will better delineate the actual experiences, needs, strengths, or weaknesses of the AST individual. Help then can be more successfully sought for support, services, and accommodations that are needed to succeed and flourish.

Adaptive functioning and skills assessment would be a priority in individuals with AST, that have average to above-average intellectual and verbal functioning, who need services, or social security disability support. Common problems or impairments in adaptive functioning may be related to AST traits, that contribute to

• challenges with executive functioning, planning, and priority setting
• obsessive preoccupations over individual interests and topics, or with activities that are more immediately gratifying
• social behavior difficulties related to issues with understanding/interpreting social context or cues
• the tendency to hold one-sided conversations
• awkward mannerisms
• processing, deciphering, learning, and the remembering of new information
• slower processing speed – taking longer to accomplish the same task that is easier for others without AST
• impairments in working memory
• high distractibility that can be amplified by anxiety, mood, or PTSD like symptoms 

Individual differences in learning, processing, and retention of information, can be a significant advantage to people that can ultimately become specialists, scientists, teachers, professors, or analysts – as in the tech fields, mathematics, computer sciences, or the arts. Anybody that has a unique fund of information and knowledge can not only succeed, but be an essential component or contributor in businesses, industries, the military, or in any endeavors requiring innovation for new products or approaches. 

Individuals that have a distinctive manner of accessing, capturing, retaining, and processing of information, can take much longer than people with more typical learning styles. More usual or common learning styles may allow for the more rapid and superficial gathering of information but may lack the depth and breadth of details absorbed by those with AST. The person with these unique talents will need to take more time, focus, and concentration to access, decipher, put into a rememberable context – the linking and consolidation with other information into memory for recall and retrieval. Therefore, a person with such a learning style can accumulate and remember much more information or data relevant to a specific area of knowledge. 

Being able to successfully store, recall and utilize a mass of specific information and knowledge is an excellent advantage to a specialist – a help to others – organizations and businesses – that are dependent on access to a specialized fund of knowledge. People that can assist with their information talents also can bring their creative abilities to apply their expertise in innovative ways, which can be difficult for people with more typical (neurotypical) learning styles. Anxiety, noisy, distracting, pressured, or stressful environments can interfere with a person with AST, who has a potential advantageous learning style. Adverse or a non-advantageous, non-accommodated, or unconducive environment can place a talented individual with AST at a marked disadvantage. 

There is also a disadvantage with having a manner of consolidating more specific data into memory stores, from a more focused, narrower range of attention – as occasional misinterpretations when recalling information may result. The information recall would be from less remembered points of reference. An example would be someone with AST, hearing something, and then sharing the same information without the common interpretations as others may have with more typical learning styles. Typical learners that take in the broader array of data and information at the time of learning may be more astute in grasping context or in relaying a more relevant or commonly interpretation or point of view – better grasping or putting something in a way that is more widely understood or accepted by others.

The level of anxiety in persons with AST can become so severe

that there may be significant impairment in doing or accomplishing important life tasks as forming social relationships, doing meaningful work to support one’s self, taking care of his or her health, and maintaining employment. The extreme of severe anxiety could lead to becoming homebound or isolative (a loner). At a point, there can be a close resemblance or overlap with Post Traumatic Stress Disorder (PTSD). 

An individual with AST may develop progressive severe fears and anxiety from their disadvantages and related adverse childhood or adult experience. Communication and information processing differences, when entering or engaging in social situations, can lead to significant anxiety and accumulative traumas as from bullying, discrimination, maltreatment, embarrassment, physical abuse, and rejection by significant others and peers. 

Other diagnosed conditions may be co-occurring conditions or be simply the result of the emotional, behavioral, or psychological impact of adverse experiences on AST individuals. Commonly seen diagnosises or labels given to AST individuals are

• depression
• anxiety
• PTSD
• Attention-Deficit Hyperactivity Disorder (ADHD)
• Obsessive-Compulsive Disorder (OCD)
• Tourette’s

Severe anxiety may occur in AST individuals and can lead to failures in adaptive functioning and interfere with self-sufficiency. The fear and stress can be associated with irritability, depression, anger, rages, and temper tantrums. When there is interference with inflexible routines and needs for sameness and predictability, emotional reactions can occur. Panic attacks can happen when an unexpected environmental cue or memory triggers a fight or flight response. Heightened anxiety is often accompanied by increased alertness, tension, and hypervigilance for the sudden return of prior traumatic experiences. 

Common associated complaints with anxiety in individuals with AST are

1. difficulty relaxing
2. lack of peacefulness
3. sleep disturbance
4. anxiety dreams or nightmares
5. avoidance, isolation, and lack of social participation
6. reduced interest in peers or peer activity

Other behaviors or characteristics are seen in AST may also be related to anxiety, mood disturbance, or past traumas as

• decrease or lack of emotional sharing or reciprocity
• narrowed range of interests and focus on specific activities
• increased vulnerability to dependence on things or activities that are safer and more immediately gratifying, like a computer, the internet, foods, drugs, or alcohol
• obsessive interests, repetitive habits, or routines
• intrusive memories, or obsessive recall of past negative experiences, trauma, or humiliations
• nightmares or flashbacks of prior remembered experiences 

 (K.M. Stavropoulos Ph.D. 2018), (Lauren Gravitz 2018) 

 As a result of these difficulties there may be significant problems with

• finding, getting or sustaining work
• not being accepted in various social settings or groups
• being up against considerable rejection, discrimination or bullying
• not being able to succeed as well in education, training, or work settings
• the lack of accommodations, understanding, or support 

Individuals with AST that have average or high intelligence (IQ), verbal and cognitive abilities, but who lack adequate adaptive functioning skills may still need significant accommodations, services, or disability support. A thorough assessment of adaptive functioning and skills is essential for a fair determination of needs for a person with AST. Such a person may appear more capable than they “actually” are, as compared to others without AST, in such areas as the ability to work, pursue careers, or to be self-supporting. Where there is co-occurrence of anxiety, depression, OCD, or ADHD like symptoms, there may exist even more profound impairment. 

Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders, by Celine A. Saulnier and Cheryl Klaiman, 2018, is a helpful guide for assessing adaptive behavior with useful information and advice on interpreting profiles of adaptive functioning. Chapter 7, pp. 112-115, focuses on “Adaptive Behavior Profiles in Adults with Autism Spectrum” (Celine A. Saulnier 2018c) 

Several helpful quotes in the Saulnier and Klaiman book that better clarify adaptive behavior are:

• “The construct of adaptive behavior is defined as the independent performance of daily activities that are required for personal and social sufficiency.” (Celine A. Saulnier 2018d)
• “Adaptive behavior is defined by the expectations of others within a social context. Adaptive behavior is modifiable. Adaptive behavior is defined by typical performance, not ability”. (Celine A. Saulnier 2018a) 
• “Adaptive skills are defined by what an individual does do with independence and not what an individual is capable of doing but doesn’t.” (Celine A. Saulnier 2018b)

Evaluations for adaptive functioning, anxiety, or other co-occurring conditions needs to be done by a healthcare specialist trained and knowledgeable in doing the testing for children or adults with AST, ASD, or Asperger’s.

Continued development of tools for doing a better assessment of underlying issues – that may benefit from early interventions – is needed and an essential task for specialists and researchers in the future.

by Ron Parks, MD, editor Shan Parks

(see Ron Parks, MD, prior article “Unique Talent Attributes vs. Autistic Traits”)

Bibliography:  

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm.

Celine A. Saulnier, Cheryl Klaiman. 2018a. “‘Adaptive Behavior Is Defined by the Expectations of Others within a Social Context. Adaptive Behavior Is Modifiable. Adaptive Behavior Is Defined by Typical Performance Not Ability.’” In Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders P12. 11 River Street, Hoboken, NJ 07030, USA, John Wiley & Sons, Inc., 1.

———. 2018b. “‘Adaptive Skills Are Defined by What an Individual Does Do with Independence and Not What an Individual Is Capable of Doing but Doesn’t.’” In Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders P13. 111 River Street, Hoboken, NJ 07030, USA: John Wiley & Sons, Inc.

———. 2018c. Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders Book. First Edition. 111 River Street, Hoboken, NJ 07030, USA: John Wiley & Sons, Inc.

———. 2018d. “‘The Construct of Adaptive Behavior Is Defined as the Independent Performance of Daily Activities That Are Required for Personal and Social Sufficiency.’” In Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders P1. 111 River Street, Hoboken, NJ 07030, USA, John Wiley & Sons, Inc.

DALMEET SINGH CHAWLA. 2019. “Large Study Supports Discarding the Term ‘High-Functioning Autism’ BY DALMEET SINGH CHAWLA / 3 JULY 2019.” Spectrum. July 3, 2019. https://www.spectrumnews.org/news/large-study-supports-discarding-term-high-functioning-autism/.

Julian Tillmann et al., 2019. “Investigating the Factors Underlying Adaptive Functioning in Autism in the EU‐AIMS Longitudinal European Autism Project.” Autism Research. April 2019. https://www.zotero.org/ronrparks/items/action/newItem/collectionKey/HDC8DF9E/itemType/webpage/mode/edit.

Katherine K.M., Stavropoulos Ph.D. 2019. “Should We Discard the Term ‘High Functioning’ in Autism?”, Psychology Today, July 6, 2019. https://www.psychologytoday.com/us/blog/neuroscience-in-translation/201907/should-we-discard-the-term-high-functioning-in-autism.

K.M. Stavropoulos Ph.D., 2018. “Autism and PTSD: Similarities and Differences.” Psychology Today. October 1, 2018. https://www.psychologytoday.com/us/blog/neuroscience-in-translation/201810/autism-and-ptsd-similarities-and-differences.

LAUREN GRAVITZ. 2018. “At the Intersection of Autism and Trauma.” Spectrum. September 26, 2018. https://www.spectrumnews.org/features/deep-dive/intersection-autism-trauma/.

Elizabeth Sinclair. ”History of Autism Treatment.” Applied Behavior Analysis Programs Guide. https://www.appliedbehavioranalysisprograms.com/history-autism-treatment/

Ron Parks, MD. 2019. “Unique Talent Attributes versus Autistic Traits.” Parksmd.Com. February 2019. https://parksmd.com/unique-talent-attributes-versus-autistic-traits/.

Tony Attwood. 2008. The Complete Guide to Asperger’s Syndrome 1st Edition. Jessica Kingsley Publishers; 1 edition. https://amzn.to/2LnGrk2.