Diagnosing Adults with Autism | Free Essay Example

Diagnosing Adults with Autism

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Prevailing Theories on the Origin of Autism

First and foremost, it must be stated that at the present there is no single theory which any researcher or expert in the study of autism has found to be 100% convincing in that it thoroughly and accurately explains the origin and behavioral attributes of autism (Hebert & Koulouglioti, 2010). This is due to the fact that there may not be a single particular cause and it may in fact be due to multiple causes that result in the development of autism in young infants (Hebert & Koulouglioti, 2010). Most researchers though are in agreement that the primary cause of autism is biological rather it being psychological however different researchers have varying views as to the biological origins of autism itself (New Genetic Causes of Autism, 2011).

There are theories which advocate genetic causes behind autism since apparently some studies reveal that the prevalence of autism in specific familial lines is indicative of a genetic cause yet other researchers are also quick to point out that not all cases involving genetic predispositions actually result in autism. For example a couple may have a normal first child while their second child is autistic.

Other causes have been linked to specific forms of ingested medications such as opiates, stimulants, depressants or a variety of other drugs that cause changes to the mental development of the fetus. While it may be true that various studies do in deed show that the ingestion of particular substances does affect fetal development the fact remains that autism is just one of the possible adverse reactions that could occur and as such ingestion of particular substances cannot be ruled as a primary cause (Hebert & Koulouglioti, 2010).

Researchers have even gone so far as to link the use of vaccines and viral infections as the cause behind autism. It is based on this that it can be seen that there is no singular substantive theory which can sufficiently prove a biological reaction which is the definitive cause of autism. On the other hand new theories on autism published in 2009 do shed some light on very likely avenues of proper biological identification as to the causes behind this disorder. As explained by Dr. Mark F. Mehler, chairman of neurology and director of the Institute for Brain Disorders and Neural Regeneration at Einstein, the brains of people with autism can actually be considered structurally normal however suffer from a form of dysregulation that can actually be treatable (Mehler & Purpura, 2009).

As Mehler explains autism may in fact be a developmental disorder which came about as a result of the impaired regulation of a particular bundle of neurons located in the brain stem which normally processes sensory signals from all locations on the body. It was explained that people on average normally have a surge of the hormone cortisol when they wake up which slowly decreases in level throughout the day (Mehler & Purpura, 2009). As this new theory on the origin of autism states, this particular surge of cortisol actually makes the brain alert, enables the body to be prepared for the upcoming day and actually enables a person to be aware of the various changes around them (Mehler & Purpura, 2009).

In the case of several individuals suffering from Asperger syndrome who were examined for that particular study it was noted that they did not experience this apparent surge in cortisol when they wake up and as such is indicative of a genetic flaw in hormone release which could actually be “cured” so to speak with artificial cortisol ingestion when an individual wakes up (Mehler & Purpura, 2009). This particular study sheds new light on the potential origins of autism and as such could be used as a basis for future cures for this particular type of disorder.

Theory of the Mind – Explaining Why People with Autism Behave the Way they Do

While there are numerous theories based on biological factors which attempt to explain how autism occurs there are few which explore the cognitive processes behind why people suffering from autism behave the way they do. For the purpose of this study what will be examined in this particular case is the “theory of the mind” and how this particular concept impacts the way in which researchers view the thought processes of people with autism.

As stated by Williams (2010) the theory of the mind can be described as “the art of putting yourself in someone else’s shoes”. In other words it is a way in which an individual sees things from the perspective of other people and can infer that person’s emotional state (happy, angry, sad, scared, lonely, confident etc.) based on this particular perspective (Williams, 2010).

Ever since the mid 1980s various autism researchers have speculated that autistic individuals actually are unable to exert the so called theory of the mind and as such is the main reason behind their abnormal psychological process (Williams, 2010). Liane Young, a postdoctoral associate from MIT attempted to explore this particular aspect of autism by creating a study that tests the judgment of intentions in a moral situation of an autistic individual in order to explore the application of the theory of the mind in that particular case (Moran, Young, Saxe, Su Mei, O’Young, Mavros & Gabrieli, 2011).

The results of her study showed that adults with autism were actually unable to make moral judgments utilizing the theory of the mind based on particular situations involving unintentional harm (Moran et al., 2011). What Young and her team did was to place adult autistics in a situation wherein they were to judge intentional or unintentional harm on a particular situation given the circumstances involved (Moran et al., 2011).

What they found out was that adults with autism actually had the predilection to blame someone for causing unintentional harm to the same degree as they would blame someone for causing intentional harm (Moran et al., 2011). What must be understood is that most normal individuals create judgments based on intentions and the factual elements of the given situation whereas based on the findings of Young it can be seen that autistics base their judgment on final outcome. It seems as if they do not take into consideration whether the person intended to do it or not and as such reveals how they cannot seem to place themselves in the other person’s shoes and judge actual intent versus the created result.

Other cases where this can be seen was noted by the research of Young and Saxe (2009) which showed that people with autism actually have a certain degree of difficulty in trying to comprehend when other people don’t know what they know (Young & Saxe, 2009). This creates a certain degree of agitation which Young and Saxe (2009) describes as being a direct result of people with autism being unable to understand that other people think differently than they do or have had different experiences (Young & Saxe, 2009).

It is further suggested by Lerner,Hutchins, & Prelock (2011) that this may actually be the reason behind difficulties in socialization and communication that people with autism suffer from since they become unable to properly comprehend or predict what others will say or do due to the different opinions, expressions and ideas which are being relayed which is outside of what they know (Lerner,Hutchins, & Prelock, 2011).

Based on this it can be assumed that people with autism are more insular individuals basing their interaction with the world around them on already learned experience. It is when new external stimuli is presented that is outside their insular world that problems occur in data interpretation due to the overall unfamiliarity and the predilection of autistics to base their thought processes on what they currently know and understand instead of interpreting new outside data and incorporating it effortlessly into what they know and understand (Shaked & Yirmiya, 2004). It is this lack of subsequent immediate incorporation of new external data and stimuli as well as the inability to take into account the perspectives of other people that various researchers state is the main causes of the abnormal behaviors and thought processes of people with autism (Shaked & Yirmiya, 2004).

Diagnosing Adults with Autism in Today’s Modern Society

It is rather interesting to note that there are cases where an individual can go for years with an undiagnosed case of autism (Thousands may have undiagnosed autism, 2011). This is not to say that the symptoms don’t manifest themselves later on in life (as it has been pointed out in this paper autism starts early on in an individual’s life and manifests itself in gradual stages) rather what apparently occurs is that the symptoms associated with the disorder are at times mistaken for shyness, slowness or peculiar traits inherent to individual children (PR, 2011).

In fact it was mentioned by Dr. Shana Nichols who belongs to the Fay J. Lindner Center for Autism on Long Island, New York that while she utilizes numerous diagnostic tools in identifying specific symptoms related to autism it is often the case that the relevant literature (manuals), processes of evaluation and tools used to measure autism are often outdated and in need of significant improvement and updating considering the sheer amount of accumulated knowledge on diagnosing the disorder within the past 20 years (Nichols & Waschbusch, 2004).

Another interesting aspect to take note of is the study of Keenan, Dillenburger, Doherty, Byrne & Gallagher (2010) which showed that while some parents do note of certain peculiar behaviors that manifest in their children at an early age such as during infancy or their third birthday it was seen that they often did not take their children to be diagnosed for any inherent mental disorders due to the apparent social stigma attached to it (Keenan, Dillenburger, Doherty, Byrne & Gallagher, 2010). Furthermore due to the variable nature of autism wherein it can affect individuals to either to a lesser or greater degree this results in kindergartens, pre-schools and even grade schools being ill-equipped to recognize the more subtle aspects of abnormal developmental characteristics that manifest themselves at an early age (Koenig, 2010).

Based on the study of Robinson, Munir, Munafò, Hughes, McCormick, & Koenen (2011) which examined population estimates and the prevalence of autism within particular populations it was shown that nearly two out of every 10,000 children had autism with males often having a greater predilection of having autism as compared to females (Robinson, Munir, Munafò, Hughes, McCormick, & Koenen, 2011).

While there have been no definitive studies explaining this prevalent genetic manifestation of autism in males the fact remains that based on the study of Robinson et al. (2011) it can be seen that the potential for numerous cases of autism to manifest itself within several communities and populations sets is a very real fact and lends credence to the potential for undiagnosed cases to continue well into adulthood (Robinson et al., 2011). One way of seeing how this may occur is when a particular individual has PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) or Asperger’s wherein abnormal learning or slow developmental behavior is not as immediately apparent as compared to individuals that have Autistic Disorder, Childhood Disintegrative Disorder or Rett Syndrome wherein significant abnormal regression in physical, social and mental development is noted.

Lopez-Wagner (2008) also explains that in certain cases it is often assumed that if no problems in early development occur parents and school personnel often think there is no problem whatsoever with certain behavioral characteristics related to social challenges, clumsiness or certain degrees of uncoordinated movement which are often attributed to normal childhood behaviors (Lopez-Wagner, 2008).

There are also problems with present day diagnosis as emphasized by Jeong & Kim (2011) in their examination of the current prevalence of social isolation among many of today’s youth (Jeong & Kim, 2011). As Jeong & Kim (2011) explains the creation of many of today’s modern conveniences such as mobile phones and the internet has actually created problems in properly differentiating autism with regular social isolationist behavior brought about by a greater predilection towards interaction through a technological medium (Jeong & Kim, 2011).

In other words gaming consoles, computers and the internet have created a trend in social isolationist behavior resulting in many individuals going undiagnosed due to the assumption that it is merely the manifestation of their predilection towards gaming and internet use. It was also revealed by studies that adults suffering from autism often interacted better on a social level when utilizing online social media such as Facebook and online chatting. It is believed that the controlled nature of such activities actually facilitates a greater degree of communication due to the impersonal nature of the activity.

It was also noted that children suffering from autism actually performed remarkably well when introduced to various games on certain gaming consoles often developing better hand eye coordination over a period of time as a direct result of constant gaming (Blum-Dimaya, 2010). What all of this means is that the current prevalence of online social media and gaming among many children has made it that much harder to diagnose cases of autism in the present day and as such contributes to the higher prevalence of undiagnosed cases in adults.

Identifying Autism in Adults

Based on the study of Hess, Matson & Dixon (2010) which examined the main areas of difficulty that people with autism suffer, the following is an extended method of examination detailing what signs and symptoms to look for in adults afflicted by autism.

Communication

As seen in the case examples provided by Hess, Matson & Dixon (2010) as well as general examinations of adult suffers of autism it can be seen that people with autism possess the distinct problem of finding it difficult to express themselves both emotionally and socially (Hess, Matson & Dixon, 2010). One of the reasons why this particular symptom is often misdiagnosed in the case of adults is that it is sometimes thought of as the person merely being shy.

Various popular culture shows depicting shyness ranging from Gossip Girl, Twilight, One Tree Hill as well as a plethora of other forms of popular culture programming seemingly give out the message that shy people have difficulty communicating and socializing. As such these particular traits are accorded to most adults who possess the distinct disability of being unable to communicate socially and emotionally and not of thought of as originating from autism. What must be understood is that an autistic person isn’t necessarily shy rather they interpret social conversations and interactions in a different manner.

One clear example of this can be seen in the case of a person being a beginner in learning Japanese and not knowing anything about the cultural nuances and predilections of the Japanese culture and expecting them to converse fluently with a person from Japan. What results is a distinct inability for that individual to understand the rapid fire phrases and conversations being utilized by the Japanese speaker, being unable to understand particular facial expressions and gestures and overall having the inability to know where to start or end a conversation due to that individual never having been truly able to properly contribute to the conversation at all. Further more the use of words is taken quite literally since they don’t understand the finer points of the Japanese language and complex words and phrases utilized by that particular individual are sometimes utilized but they don’t fully understand them nor do they sometimes know what they mean.

All of these given examples are exactly what a person with autism experiences when they try to hold a social conversation and as such are clear indicators of what to look for in an individual suffering from autism. Furthermore it must also be noted that based on the studies of Kunda & Goel (2011) which examine how adults with autism think it was discovered that adults with autism don’t necessarily think with words rather they are more image based and as such interpret external information into a form of imagery before they translate it into language (Kunda & Goel, 2011).

It is actually similar to the process that a person learning a second language utilizes wherein they pause and compare what was said to what they know and try to come up with some near approximation. Based on this it can be said that one of the best ways to personally experience autism is to attempt to learn a second language and try to carry on a conversation with a set of native speakers. The overall experience is the same as well as the delays in interpreting the overall flow and emotions utilized throughout the entire conversation itself.

Social Interaction

Another indicator of an adult having autism is when they have distinct problems in relation to social interaction wherein they have difficulty either initiating or sustaining relationships. As Causton-Theoharis (2009) states this is not due to distinct anti-social tendencies in people with autism, far from it some adults with autism display great initiative in wanting to form relationships, the problem actually lies in their inability to pick up on certain “unwritten social rules” that most individuals learn without really thinking about it (Causton-Theoharis, 2009). This can come in the form of bringing up inappropriate topics, displaying abnormal behaviors in public (picking one’s nose while talking to another person, standing too close etc.)or even seeming to appear aloof and uninterested in the conversations when in reality they are actually disconnected from the normal flow of conversation that occurs in normal social settings.

This actually creates a certain degree of anxiety resulting in people suffering from autism to be discourages in continued social interaction which creates the social isolation noted by various psychological researchers such as Reynolds (2006) who examined differing degrees of social isolation among people suffering from autism. As

Reynolds (2006) indicates “communication is the basis for all social interaction since it is the primary method of sharing ideas and emotions”, due to the fact that adults suffering from autism have problems communicating ideas properly due to certain differences in perception (imagery vs. words) this would of course result in them having problems expressing themselves and communicating in a social setting.

On the other hand based on the studies of Davis (2011) which examined the use of online social media by people suffering from autism it was noted that they were actually able to communicate and socialize almost normally utilizing tools such as online social media and online messengers (Davis, 2011). It is thought of that the distinctly impersonal and direct method of communication utilized by such forms of online socialization are actually more suited for autistics since it enables them to communicate in a manner of their choosing and not the rapid fire method usually seen in a normal social setting. It is actually based on this that the assumption of autistics being unable to maintain social relationships comes into question since based on the study of Xin & Sutman (2011) it was actually seen that they were quite able to maintain several personal online friendships (Xin & Sutman, 2011).

Taking this into consideration it can be assumed that the difficulty of autistics in maintaining social relationships isn’t that they are unable to but rather the problem may in fact lie in the setting in which average social interactions occur. By utilizing a different medium for communication autistics were shown just as capable of maintaining friendships as any other person utilizing the internet for social interaction.

It was also noted by another unique study by Longman, O’Connor & Obst (2009) involving Massively Multiplayer Online Role-playing Games (MMORPG) such as World of Warcraft (WoW) that people with autism were actually able to engage in the social elements of online gaming with little difficulty whatsoever (Longman, O’Connor & Obst, 2009). In fact it was seen that autistic children and adults that played WoW were able to interact with other players, conduct missions, and establish friendships as well as all sorts of other social aspects of online gaming with the same competency as an ordinary player (Longman, O’Connor & Obst, 2009). This lends a greater credence to the argument that it is the setting that people with autism find themselves in and not an inability to do so that prevents them from being able to interact socially and develop friendships.

Social Imagination

A rather interesting aspect of autism explored by Geddes (2008) details how people with autism can actually be quite imaginative when it comes to the use of certain words and actually leads to many individuals with this particular type disorder to seek careers as writers (Geddes, 2008). On the other hand McCorkindale (2011) also explains that people with autism often find it difficult to imagine alternative outcomes to a particular social situation or even to predict what may happen after a particular situation (McCorkindale, 2011).

Furthermore, as explained by Krebs, Biswas, Pascalis, Kamp-Becker, Remschmidt, & Schwarzer (2011) who examined the correlation between facial expression, body language and adapted communication, people suffering from autism are often unable to unable to interpret facial expressions or body language resulting in awkward social interactions where anger, happiness, sadness or joy are often unable to be sufficiently understood (Krebs, Biswas, Pascalis, Kamp-Becker, Remschmidt, & Schwarzer, 2011).

Krebs et al. (2011) explains this by indicating that people with autism are more “inward thinkers” rather than input interpreters (Krebs et al., 2011). This means that the imaginative and at times almost brilliant and striking artistic works they are able to create are a direct result of inward thinking wherein a particular aspect, object or topic is looked at from every angle in a rigid and almost repetitive manner. This is one of the main differences between people with autism and normal people since in most situations individuals take into account various forms of external stimuli in order to interpret the world around them. In the case of people with autism, expression and interpretation is done through internal processes which concentrate on a particular subject of interest and only concentrate on that particular subject.

Ordinary individuals cannot delve into such deep personal introspection into a particular object, topic or interest since such levels of analysis excludes oneself from the outside world which for most people cannot be done due to the need for constant interaction with the external environment. As such when diagnosing adults with autism seeing a singular overriding, rigid and repetitive obsession with a particular subject, skill or object is often one of the indicators of autism.

On the other hand it was mentioned earlier that this form of inward thinking has resulted in brilliant and often imaginative forms of artistic achievement both in the literary and abstract arts. It was often thought that some of the greatest abstract artists of the past century such as Picasso suffered from some form of autism and that some of the greatest artistic works of mankind developed by the likes of Van Gogh, Da Vinci and Neruda were attributed to some form of autism each artist had due to their rather peculiar forms of behavior.

Present Day Problems and Coping Mechanisms

When examining the current coping practices of adults with autism it is necessary to first categorize the two types of adult autistics:

Low Functioning Autistic Adults

Adults classified as being low functioning autistics are individuals who need constant care and attention with even nearly every single aspect of their daily life. These particular individuals can actually be classified as “adult children” in that while they may have the bodies of adults their mental acuity and aptitude can actually be compared to the average five year old. Such individuals not only have a problems socializing and communicating particular ideas but they even have problems associated with toilet training, basic social skills as well as have outbursts of aggression born out of agitation. In fact it is the aggressive outbursts born out of agitation that presents the biggest issue for dealing with low functioning autistic adults due to the fact that the person in charge has to in fact prevent a large adult from not only harming themselves but other people around them.

This actually presents itself as a challenge for most families since as the parents of autistic children grow older their ability to reign in the behavior of their children lessens as a direct result of their continually diminishing physical capabilities. Overall for low functioning autistic adults their overall quality of life is drastically affected by autism resulting in them never being able to gain work, establish close friendships with multiple individuals or even fall in love and have families of their own. Basically what is in store for such individuals is a life where they will either be under the care of their family until their death or be placed in some form of facility that specializes in the care of autistic adults.

What must be under stood is that in this particular case the learning of adaptive skills is impossible and there is little if no hope for any normalcy in this particular individuals future life. It must also be noted that such individuals may at times suffer from varying degrees of OCD (Obsessive Compulsive Disorder) or ADHD (Attention Deficit Hyperactivity Disorder) resulting in manic behaviors resulting in an inability to sit still, displaying strange motor habits, or a certain degree of impatience resulting in agitation leading up to physical aggression.

When going back to examining their mental acuity it can be seen that while they are able to accomplish some levels of basic communication the fact remains that when it comes to extended conversation on topics they are not familiar with especially in a social setting they withdraw even more and sometimes show signs of agitation over not being able to follow the flow of the conversation. While they do show the ability to remember certain facts, faces and procedures this is actually plausible when such aspects are committed to long term memory.

As examined by the study of Dawson, Soulières, Gernsbacher & Mottron (2007) which examined autism and mental capability it was noted that in some cases of low functioning autistic adults there was a certain degree of deterioration in short term memory but they did possess the capacity for rather remarkable long term memory (Dawson, Soulières, Gernsbacher & Mottron, 2007). It must also be noted that in the case of such individuals the lack of an overall outlet to express themselves was seen as another possible reason behind episodes of agitation and aggression. Studies such as those by Roger (2009) showed that when given an outlet in the form of art or some form of expression such individuals were actually able to lessen their degree of agitation and aggression and were actually able to create rather incredible pieces of art (Roger, 2009).

High Functioning Autistics

High functioning autistics are far different from low functioning autistics in the sense that they can become highly successfully and actually have the ability to live relatively normal lives despite having autism. Such individuals are capable of working at highly intellectual careers, possess the ability to support and care for themselves and even have the capacity to live on their own. What must be understood is that based on studies such as those by Ryan, Hughes, Katsiyannis, McDaniel & Sprinkle (2011) which examined the development of autistic children into autistic adults it was seen that the ability of individuals with autism to take care of themselves is directly proportional to the amount and type of need-based education that they had received when they were young (Ryan, Hughes, Katsiyannis, McDaniel & Sprinkle, 2011).

It was stated by (Odom, Collet-Klingenberg, Rogers & Hatton (2010) that in such cases where proper need based education was provided capacities related to social responses and acceptable behaviors can actually be expressed by adults with autism resulting in them becoming functional members of society Odom, Collet-Klingenberg, Rogers & Hatton, 2010).

Furthermore it was also noted by Odom, Collet-Klingenberg, Rogers & Hatton (2010) that such individuals were actually capable of having families, careers and social lives and as such emphasizes the importance of proper early childhood education in creating the proper cognitive mechanisms for an autistic child with the capacity to become a high functioning autistic to express themselves properly when they become adults (Odom, Collet-Klingenberg, Rogers & Hatton, 2010).

Another way of looking at high functioning autistics is that through constant training as a young child they were able to internalize particular social and behavioral lessons into their long term memory and as such utilize those as the basis for their future interactions with other individuals. It was actually seen in the study of Toichi & Kamio (2003) that examined the connection between autism and memory that autistics that were able to internalize certain social behaviors and norms of conduct early on in their life were actually able to perform almost normally in social situations when they matured as compared to other autistics that did not receive the same type of need-based education (Toichi & Kamio, 2003).

Another factor to take into consideration is the fact that the overall ability of a person with autism to actually maintain a job, take care of financial obligations as well as have a family is actually dependent on the severity of their disorder in the first place. Mild cases of Aspergers or PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) actually enable a person with such disorders to live a relatively normal life so long as they are provided with sufficient need based education early on in their life. It is actually based on this that it can be stated that adaptive skills training for autistics to life relatively normal lives should be done as early as possible so as to ensure that proper internalization of learned behavior is created.

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