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Author: Dr Dina GazizovaConsultant Adult Psychiatrist

People with Autism see, hear and feel the world differently to those around them and whilst there are common areas of difficulty, the challenges are different for every individual.


triad of impairment

Triad of impairment

There are 'core features' (also known as the ‘triad of impairment’) that are present in most patients with Autism to varying degrees. These include:

  • Persistent difficulties with social communication
  • Persistent difficulties with social interaction
  • Rigid and repetitive behaviours, resistance to change or narrowed interests1

1Nice

These core Autism symptoms are persistent throughout an individual’s life but will differ in severity according to various factors, including age, the presence of a learning disability or other comorbid conditions, and any therapy or treatment.


Triad of impairment – Social interaction

One of the signs of Autism and Asperger’s is social interaction - finding it difficult to build and maintain friendships, work in teams and know how to manage social situations.

Social interaction difficulties may include:

  1. Social awkwardness – not knowing what to say
  2. Limited ways of responding socially
  3. Finding it hard to hold two-way conversations
  4. Making social blunders or ‘faux pas’
  5. Coming across an unconcerned for others
  6. Finding it hard to make or maintain friendships

Difficulties with social interaction tend to continue into adulthood, whereas many people with Autism learn compensatory coping strategies for dealing with problems with social communication and social imagination.

Social interaction is perhaps the most important of the triad. Difficulties can have a heavy impact on day-to-day life for everyone involved and can result in other conditions such as depression or anxiety.

30-80% - the diagnosis rates of ASD and ADHD combined


Triad of impairment - Social Communication

Difficulty understanding and translating body language, metaphors, and sarcasm are can all be signs of Autism and Asperger syndrome.

Common difficulties include:

  1. It can be very hard for adults with Autism to engage in the ‘natural flow’ of social conversation and many may choose to stay away from social situations to avoid having to engage with others, which can leave the individual feeling lonely, anxious or depressed.
  2. Problems with social communication can manifest in an unusual use of gaze, facial expression and gesture. This differs from the persistent avoidance of gaze that is seen in shyness or depression.
  3. Difficulties with the non-verbal aspects of speech not only leaves the person with Autism struggling to understand what is being said, but may lead to serious misunderstanding of the conversation – which may results in problems in relationships or work.
  4. Thinking from another’s point of view or social imagination is another area people with ASD can struggle with.

Many people with Autism and Asperger’s find these things incredibly difficult and can lead to social isolation, anxiety and depression. Therapeutic support in the form of coaching, psychology or psychotherapy can help someone with autism develop skill sets that enable them to work more confidently in teams or build relationships.

Everyone was really helpful and answered my questions. I felt comfortable with the doctor and knew what the process was going to be. The report I have received is very thorough and the triage team have been there to help me along the way.

Daniel, Kent


Triad of impairments – rigid or repetitive behaviours

Repetitive Behaviour

A characteristic that is common across the Autism spectrum is something known as ‘restricted, repetitive’ behaviour. This can show in several ways:

  • An almost obsessive interest in a topic (many people with Autism have huge knowledge about certain areas)
  • Repetitive body movements, such as rocking or hand flapping, particularly when stressed
  • A strong preference for a set routine or way of doing things and huge discomfort if this does not happen

Restricted interests or activities are interests or hobbies that are unusual in their intensity, content or the amount of time they absorb, particularly when they lack a social aspect.

At their most extreme, the world of a person with Autism might narrow down to something (for instance railway timetables or a TV programme) to the exclusion of all other interests.

People with Autism can develop huge expertise in a specific, narrow, specialist field, mastering a wide range of content and information related only to that field, and are able to channel a great deal of attention to a specific area. These interests, whilst sometimes seeming a little eccentric to others around them are key to the autistic person’s wellbeing and happiness.

Routines and Change

As the world can seem like a very unpredictable (even scary), place to someone with Autism, a common characteristic of someone with Autism is a resistance to change. This inflexibility can present as a person who becomes very set in their ways, with fixed routines and an aversion to anything new and changes to the ‘rules’ can result in angry outbursts or emotional distress.


Sensory sensitisation

Another interesting aspect of Autism is an altered motor and sensory sensitivity to touch, light, sound and other external stimuli. Having over or under active senses is common to the Autism Spectrum.

Sensory sensitisations can include:

  • Certain sounds
  • Flickering lights
  • Loud noises
  • Clothing textures or labels
  • Texture of food
  • Placement of food on a plate
  • Colours of foods or clothes
  • ‘Anomalies’ like cracks in walls
  • Changes to people’s appearance like hair cuts or wearing fancy dress

The result is that the person with Autism can seem to be very distracted and may seem to be day-dreaming as they are preoccupied with experiences that others cannot appreciate. These sensitivities may also lead to various coping behaviours including avoidance of certain places or people, rocking or even self-injury as a way of calming the overload of sensations experienced.

People with Autism will often present with other disorders such as attention deficit hyperactivity disorder, anxiety, general learning disabilities or specific learning difficulties such as dyslexia or dyspraxia.
MBBS, MRCPsych

Consultant Adult Psychiatrist
London

Dr Dina Gazizova is a specialist in the Psychiatry of Learning Disability; she currently works as a consultant psychiatrist for Central North West London NHS Foundation Trust in a specialist Learning Disability Service.

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