1.2: What is autism?

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'Autism...offers a chance for us to glimpse an awe-filled vision of the world that might otherwise pass us by.' - Dr Colin Zimbleman

Autism, like most medical conditions, is usually studied from the point of view of differences. Just as we clinicians tend to spend our time talking about things going wrong, it is easy to reduce autism to a list of clinical features and 'problems' by which the majority of the population is unaffected.

Increasingly, however, the worldview of those with autism is being seen as a valuable point of reference for society as a whole: a way of examining and challenging our behaviours on both an individual and societal level. Over the course of this module, we will be examining the experience of people with autism through the lens of literature, and exploring the ways in which we as physicians play into this.

We would encourage you to bear in mind the words of Dr Zimbleman while working your way through the following clinical learning points: that as well as an illness, autism can be perceived as an axis for beauty in more ways than one.

Autism is defined in the ICD-10 as:

A type of pervasive developmental disorder that is defined by:

  • The presence of abnormal or impaired development that is manifest before the age of three years, and
  • The characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour.

In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.

The same resource defines Asperger Syndrome as:

  • ‘A disorder of uncertain nosological validity, characterized by the same type of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities.
  • It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness.
  • There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life.’

The reality, however is much more complex and nuanced. ASDs are among a small group of diagnoses which have implications not only for the health of the individual, but also for their identities as a whole. There is a good deal of heated debate about what it means to have an ASD outwith this clinical definition, some of which we will touch upon over the course of this module.

The following video, produced by the National Autistic Society, provides a further overview of the condition with particular empahasis on the challenges of living with autism.

People who have Autism Spectrum Disorders (ASD) may be referred to as ‘neuroatypical’ or ‘neurodivergent’, whereas those who are unaffected may be called ‘neurotypical’.

This distinction may seem arbitrary, but is one to which we will return repeatedly over the course of this module for a number of reasons.

It gives us a simple way in which to distinguish between the various viewpoints encountered in the literary works we will be studying and, more importantly, is a nomenclature widely embraced by those with Autism Spectrum conditions.

An excellent guide to how to talk about autism spectrum disorders can be found at the National Autistic Society - follow the link to read this useful information.

Please note that throughout this course, we will be using 'Autism Spectrum Disorder' or 'ASD' as this is the most widely-used term for the conditions in medical literature, and as it captures the wide range of abilities represented in the books we will study in this course.