Autism

Aspergers, Autism Spectrum Disorder (ASD) and Empathy

My thoughts here are about the fundamental nature of autism, not its causes, which seem to be substantially genetic, but with symptoms also affected by the environment (e.g. the gut microbiome).

The term Aspergers has recently been officially dropped by the Americans, so people previously diagnosed as such are now considered to be on the high-functioning end of the autism "spectrum".  However, I think the "Aspie" label usefully distinguishes from those who suffer severe autism, and also I, along with many others, prefer it to "high-functioning ASD", because although I do have some deficiencies (disorders), I also have different abilities to "neuro-typical" (NT) people, which I consider a gift.  (I could equally, for example, label much of the NT population as having a 'disorder' for behaving illogically, being guilty of groupthink & tribal prejudice, communicating dishonestly and not having the same "special powers" in pattern-recognition & problem-solving skills as me!)

Here are two relevant online tests — notice that the first one is to estimate your Autism Quotient (i.e. to see where you might be "on the spectrum"), whilst the other measures empathy, which is not the same thing:

• Autism: https://aqtest.net/  (or same here)

• http://psychology-tools.com/empathy-quotient/

It is a common misconception to believe that people with autism lack empathy; on the contrary, in many ways we feel too much.  The reality is more complex and requires an understanding of the different types of empathy.

This link provides a good explanation of the different types of empathy and how it relates to Aspies.  This is my modified version of it:

There are 3 main types of empathy:

• 1. Empathic Concern (sympathy, or caring about others)

  2. Affective Empathy (feeling the pain, sorrow, love etc. of others)

  3. Cognitive Empathy (being aware of the thoughts, perspectives and motivations of others)

Aspies only have problems with cognitive empathy, which is the ability to perceive what another person is thinking (especially not intuitively & quickly like neuro-typical people can, although we can work it out logically with a bit more time).

In fact, Aspies can be overly good at affective empathy, which is the ability to sense what another person is emotionally experiencing (through the activation of "mirror neurons", which are not broken, they're too sensitive).  They may quickly pick up on the "emotional vibes" in a room, and sometimes they may even be able to tell others how they are feeling before the other person even knows themself (but not why, because of their deficiency in cognitive empathy).  This high sensitivity to other's emotions (or the plight of others in the community/world) makes Aspies very caring people, but if it is too intense it can also lead to anxiety, confusion and, potentially – if the reverberating emotions between people escalate out of control – conflict.

The reason an Aspie may sometimes seem to show less empathy and sympathy is because their intense emotions may become jumbled, which, along with poor cognitive empathy, makes it hard to demonstrate empathy through communication (which is not the same as not sensing or caring about other people's emotions).  When an Aspie can sense that their partner is upset, but not understand what they're thinking, they may assume their partner is upset with them and then try to "pick their brains" by badgering & pestering them with questions to try to understand (which may just annoy them).

Aspies tend to be very logical/analytical (& good at problem-solving by identifying inconsistencies & patterns by "joining up dots"), which, along with their poor cognitive empathy, makes them more direct & bluntly honest in their communication than neuro-typical people (not realising quickly enough what others are thinking and how they may interpret & react to what they say), and this gets misinterpreted as not caring or a general lack of "empathy".

Aspies are very capable of love, sympathy, compassion etc. (traits psycho/sociopaths are incapable of feeling), and because of their poor cognitive empathy, most Aspies have great difficulty lying (or detecting lies) and are completely incapable of manipulating people.  But Aspies assume others will behave the same, and sadly this trusting naivety means "they are far more likely to be victims than offenders" in abusive relationships.

That said, if an autistic child is subjected to abuse such as constant parental criticism (which may be quite common given autism's genetic link making it more likely that they have an autistic parent who is unintentionally critical due to a lack of cognitive empathy), then the combination of this critical environment with the child's "biological vulnerability" of high sensitivity (arising from autism), provide the two conditions that make the development of Borderline Personality Disorder (BPD) more likely.  Then, BPD – rather than autism itself – may cause the child to be abusive to others later in life.  Evidence of a link between these disorders has been found in research showing significant overlap in the traits of people with autism and/or BPD.  Some professionals characterise BPD as an excessive degree of typical female traits, including sensitivity, making it the opposite extreme to the concept of autism being an "extreme male brain" with a lack of emotional sensitivity.

Autism = brain sensitivity

Besides sensitivity to feelings, people "on the spectrum" often also have extreme neuro-sensitivity to other stimuli, including light, sound, physical/touch, spatial/balance, taste/smell (depending on the person), which, as with emotional sensitivity, can cause them to feel totally overwhelmed & stressed (and in severe cases, have a "meltdown").  However, the sensitivity of autistic people to stimuli was barely recognised by professionals for many years, and is still not a core requirement of current autism diagnostic guidelines (although it is now part of the many traits included in a full assessment), which are based on someone showing qualitative impairments in all three areas of:

1. Social interaction — such as lack of eye contact, relationships, sharing or emotional reciprocity

2. Communication — delayed (not Aspies), impaired or idiosyncratic language

3. Rigid thinking — preoccupation with a restricted range of (often unusual) interests, inflexible adherence to routines, repetitive physical mannerisms.

There's no medical "test" to determine whether someone is autistic, so diagnosis of being "on the spectrum" is basically determined by how many boxes you tick out of a wide range of characteristics/behaviours ("traits") that are commonly observed in autistic people.  But there is no underlying explanation for impaired social communication & rigid thinking, nor do the above "triad of impairments" explain or include sensitivity to stimuli (possibly because they were developed by NT people).

A variety of theories to explain autism (sourced from this free online course) have been proposed (& it's not caused by vaccines!), many of which relate to a strongly systematic/logical, or "extreme male brain" (which has many benefits, besides the problems of rigid thinking), along with an empathic deficiency related to a delayed & not fully developed "Theory of Mind" (ToM — the ability of humans to recognise that other people may have different thoughts & feelings to themselves, which most children rapidly develop as a highly intuitive skill between the ages of 3 & 4).  However, a deficient ToM does not obviously explain the systematic features, or vice versa (unless one considers these to be somewhat opposing characteristics at either end of a continuum).  Moreover, the proponent of the concept that autism's "core deficit" is an impaired ToM (Baron-Cohen, 1985) still found that 20% of autistic children between the ages of 6-16 passed "false belief" ToM tests, indicating that it is a typical but not universally defining condition of autism.  

Also, whilst the “extreme male brain” characterisation seems to fit with the apparently greater prevalence of autism in males, there is increasing evidence that this is at least partly due to greater masking of traits by girls & women — either intentionally with behaviours to fit in, or perhaps because being highly sensitive is simply seen as "typically female".

One proposed autism theory that seems closest to the mark is that of "monotropism" (Murray et al., 2005), which is the tendency to focus on narrow interests to the exclusion of broader ones.  However, this theory still doesn't really explain why that tendency exists in autistic people.  

Not surprisingly, there is still much debate about the "defining features" and root cause of autism, but I think it's brain sensitivity that is at the core of the condition and is responsible for all the other commonly recognised autism traits, as proposed in the "Intense World Theory" (see also this article, discussion and academic paper). 

However, complicating the matter is the apparent paradox of autistic people also displaying hypo-sensitivity (low sensitivity), even for the same type of stimuli for which they are hyper-sensitive.  For example, like many others with autism, I am very sensitive to certain kinds of sudden sounds or loud voices (making me twitch!) and struggle to filter a conversation from background noise in a crowded room, or lyrics from an accompanying tune, yet I can detect a lot of detail out of instruments playing together, and when I am concentrating on a task, people may have to say my name many times before I notice (to which one person remarked, "It's as if you've got headphones on!").  

This paradox of hypo-sensitivity may be explained as a response to hyper-sensitivity, due to the brain shutting down neural pathways to muffle the impact of otherwise overwhelming senses (when the brain isn't able to do this, an autistic person will try to physically avoid the excessive stimulation, e.g. by covering their ears).  Essentially, the brain turns inwards to protect itself from excessive external stimulation, thus reinforcing the typically introverted characteristic (self-firing brain activity) that may be caused by an  underlying condition of fast-growing, hyperconnected, highly sensitive and highly active neurons (presumably due to impaired, myelin insulating sheaths around brain nerve fibres).  Based on my personal history, I suspect this muffling commences soon after birth, in reaction to the overwhelming sensory experience of a new, "noisy" world (which is why autistic babies are often extremely difficult ones, especially at night, when their brain may still be hyper-active and every little sound or other sensation is a scary unknown in the dark!).

I also exhibit a lot (but not all) of these traits (& these) for "highly sensitive people", who make up 15-20% of the population — which suggests people with autism could simply be those with an extreme level of “sensory-processing sensitivity”.

So starting from this basic proposition and applying some speculative imagination, the following table is my explanation for how brain sensitivity produces a wide range of other common autistic "traits":