The Spectrum (c) Colin Webber 2009
The most commonly used criteria for Asperger's Syndrome are the DSM-iv and Gillberg criteria that are reproduced on the related post "Criteria for Asperger's Disorder". While these criteria are almost ubiquitous, the methods of assessing whether an individual meets them for a diagnosis are varied. One of the first quantitative instruments developed was the Australian Scale for Asperger's Syndrome (Garnett & Attwood, 1995) designed by Michelle Garnett and Tony Attwood in Brisbane. This scale focused primarily on children, and other instruments including the Autism Quotient (AQ) (Baron-Cohen, Wheelright, Martin, Skinner & Clubley, 2001) and its variants, and the Autism Diagnostic Interview - revised (ADI-r) (Lord, Rutter & Couteur, 1994) are also now commonly used.
The table I have constructed below draws on a range of diagnostic criteria for Asperger's Syndrome (American Psychiatric Association, 1994; Garnett & Attwood, 1997; Gillberg & Gillberg, 1989) and is adapted and personalised to indicate some ways that the various traits can manifest, both positive and negative. It has been drawn up to direct focus on to my own traits and on music and collaborative situations. The descriptions borrow heavily from Gray and Attwood's "discovery" criteria (Gray & Attwood, 1999; Willey, 1999). The lay person, teacher or parent might find such a list helpful in spotting autistic traits and maximising their potential.
| Diagnostic Elements | Positive Manifestation | Negative Manifestation |
|---|---|---|
| Executive Function Deficits | Strong ability to take personal control of situations. | Strong need for personal control of situations. |
| Ability to concentrate deeply on tasks such as instrumental practice, composition or software use | Difficulty shifting between tasks or mental focus, obsessive behaviour | |
| Highly specialist and committed to field of endeavour. Music, maths, computers are common | Narrow, persistent interests to the exclusion of others | |
| Perseverance, loyalty, strong sense of justice and drive for task completion. Able to apply logical, systematic thinking to creative tasks. | Inflexible thinking, strict adherence to rules and routines | |
| Ability to make decisions based on fact and rational argument. Lack of emotional attachment to creative work. | Emotional disconnection from intellect | |
| Occasionally tangential or juxtaposing emotional response in creative work | Difficulty recognizing emotions in self and others. Lack of emotional response to music or arts | |
| Weak Central / strong local coherence | Focus on detail, patterns and minor inconsistencies. Strong perfectionist drive. Excellent analytical skills | Difficulty in generalisation and gestalt. Tends to focus on parts of objects rather than whole |
| Strong sense of verbal humour. Able to write clear, meaningful text | Literal interpretation of verbal and written language | |
| Often unique approach to problem solving | May tend to insist on "own way of doing things" | |
| Clarity of values unaffected by political factors | Rigid adherence to rules and laws | |
| Sensory Sensitivities | Highly accurate observation of visual, aural or tactile events. Often notices things that others do not. | Hypersensitive to visual, aural or tactile stimulus. May avoid certain sensory experiences. |
| Impairments in non-verbal communication | May not be easily offended, threatened or distracted by behaviour of others. | May not understand meaning in facial expressions, gesture or tone of voice |
| May not need eye contact for effective communication. May be suited to remote video or text based communication | May avoid eye contact or eye contact may be confusing or overwhelming. | |
| May be highly verbal and articulate, including analysis of subjective events | May rely on verbal communication for clarity. May miss verbal / non-verbal divergence, eg lying | |
| Tends to be honest and direct | May lack tact and appear arrogant, and tend to over-disclose personal detail | |
| Impairments in social awareness | Likely to be trustworthy and honest | May be over-trusting or gullible and expect complete honesty |
| Likely to be free of social or cultural biasand prejudice | May not recognise social or cultural customs | |
| May be highly self reliant | May not "know how" to make or keep friends | |
| Tends to treat everyone equally | May not understand social boundaries (friendships, colleagues etc) | |
| Impairments in empathy | May be strongly compassionate | May not spontaneously respond to emotions of others |
| May be clearly rational in emergency situations | May not spontaneously understand or adopt the emotions of others | |
| Impairments in Theory of Mind | Tends to assume others have the same knowledge or understanding as self |
It is interesting to note that the aspects of autism tabled above are defined largely by external parameters. These are things that are readily measured using controlled tests or observed by psychologists in diagnostic interviews. Research on autism in adults is lagging behind the understanding of children, in particular the compensatory mechanisms that adults develop, and which traits remain "in residue". The views of autistic persons, when they are available, point to some slightly different priorities in the symptomology. Brigitte Chamak recently led a team of sociologists and psychologists in examining the biographies of twenty-one authors with diagnoses of autistic spectrum disorders (Chamak, Bonniau, Jaunay & Cohen, 2008). These authors all point to sensory-perceptual idiosyncrasies and emotional regulation difficulties as being at the core of the autistic way of being (Chamak et al., 2008, p. 276) and many of the DSM-IV criteria as being symptomatic manifestations of these core differences. This is a clear indicator of the value of adult autobiographic and autoethnographic writing in this field. The insight that autistic writers can offer has the potential to help redefine the very core of understanding of the condition. As this document progresses, reference is made to these aspects of difference. The Insights section is laid out to indicate observations related to criteria and internal experience in these domains as they relate to my musical practice and interactions with others.
While diagnosis is currently done using external observation, self report and interview methods, there is much research ongoing investigating the differences in chemical and electrical brain functioning. On a neurological level, MRI and electrical function tests indicate that the Autistic brain does function differently to the "neurotypical" one (Baron-Cohen et al., 2006; Brieber et al., 2007; Deeley et al., 2007; Lotspeich et al., 2004; Murphy et al., 2002; Nieminen-von Wendt et al., 2002; Sokol & Edwards-Brown, 2004; Sugihara, Ouchi, Nakamura, Sekine & Mori, 2007), and there are differences in the average size and activity of various structures within it (Hallahan et al., 2008). The "intuitive" and "emotive" parts of the brain are significantly less active or exhibit delayed activity, and stimuli that normally generate activity in these areas, instead cause activity in the cognitive zones. These data support the concept of a "differently wired" brain, however the physical mechanisms of autistic thinking (indeed typical thinking) are still only partially understood.
It is possible that such observations or their implications will ultimately have significance to both diagnosis and management.
Related Posts
- Criteria for Diagnosis of Asperger's Syndrome: The American Psychological Association's Diagnostic and Statistical Manual - version IV and Gillberg criteria for Asperger's Syndrome.
- Jigsaw: Everyone has a bit of autism, a few of the pieces of the jigsaw. "Oh, yeah, I'm a bit like that too..."
- Speaking, Hearing, Seeing: People with Asperger's and HFA often have unusual ways of speaking, hearing and seeing interpersonal communication modes.
- Music as a Special Interest: Music is a useful special interest to have, but has a more sinister side.
- What is ASD?: A brief overview of the Autistic Spectrum and the traits associated with it.
- Surveys: The Cambridge Personality Index surveys - AQ and EQ
- ASD and Asperger's Literature: A brief overview of the major literature on Asperger's Syndrome