(Cross-posted at FacilitatedCommunication.org.)
As I noted in an earlier post, believing in FC means believing that autism is a sensory-motor/motor-planning/praxis disorder that cries out for facilitator support, as opposed to the socio-cognitive disorder that decades of clinical observation, research, and standardized diagnostic criteria have firmly established it to be. Also incompatible with our decades-old understanding of autism is the social content of many FC-generated messages, as seen in those I cited earlier:
“my desire for friends” (attributed to Jamie Burke)
“the social person that inside me I wanted to be” (attributed to Alberto Frugone)
“the truth” that “we'd love to be with other people” (attributed to Naoki Higashida)
“a big misconception” of liking objects more than people (attributed to Ido Kedar)
the appearance of lack of social interest as “only a self-preservation mask” (attributed to Amy Sequenzia)
In my earlier post, I pinned most of the blame for the notion that autism isn’t a social disorder on studies that rely on online surveys: surveys in which individuals provide subjective self-ratings on questions about social motivation and interests. Such self-reports are highly unreliable, are skewed towards the mildest end of the autism spectrum, and potentially include significant numbers of individuals who have diagnosed themselves as autistic but who don’t actually meet the diagnostic criteria.
But in the last few weeks I’ve heard several anecdotes suggesting that clinicians, as well, are starting to get in on the game.
Lilac Hadar via Wikimedia Commons
The first came from a friend of mine who was looking to qualify his adult son for SSI benefits. The young man was born at 30 weeks gestation and has a broad array of cognitive challenges, particularly in quantitative reasoning and executive functioning. After reading a two-page symptom synopsis written by his parents, and without having met, let alone observed, the young man, the clinician diagnosed him with high-functioning autism. This, despite all the examples of sociability, charm, and conversational skills that the synopsis included. Apparently certain of his difficulties—difficulties with judgment (excessive trust in strangers), with daily living skills (laundry, shopping, money management), and with fully communicating his needs to those who might help him—were sufficient for autism.
When the father re-iterated and re-emphasized the young man’s sociability, the clinician told him that the definition of autism has expanded beyond the formal criteria in the most recent Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) and that lack of sociability is no longer a necessary symptom. She then cited a non-academic article, possibly this one, in which Jaswal and Akhtar tell readers of the New York Times that autistic people are just as socially interested as the rest of us. (In that article, Jaswal and Akhtar reference a journal article of theirs that we’ve critiqued here.)
The second report of an “expansive” diagnosis of autism came to me just two weeks later. A cousin of mine told me that her sociable but chronically inattentive, impulsive, and distractible teenage daughter was just diagnosed with autism. When she expressed skepticism, the clinician told her that autism now includes ADHD and that her daughter, who has long met the criteria for ADHD, now qualifies as autistic. The origin of these claims, as far as I can make out, is a warped understanding of a keynote speech presented at last year’s INSAR conference by neurologist Evdokia Anagnostou. Anagnostou reported on neuroimaging studies that suggest more commonality between high-functioning autism (specifically, what was once called Asperger’s) and ADHD than between high-functioning autism and severe autism. If anything, these results should result in fewer people being diagnosed with autism and more being diagnosed with ADHD; not in those with ADHD being reclassified as autistic.
Two additional reports of questionable autism diagnoses by clinicians came to me just a couple of weeks ago on social media. Two young people recounted being diagnosed as teenagers via a 45-minute interview with a clinician (a different clinician in each case) plus the interpretation by the clinician of online self-survey results from the Autism Quotient Test. Both the interviews and the survey consisted mainly of questions about current interests and levels of social motivation. This, despite the unreliability of such subjective self-ratings and the fact that, according to the clinical definitions of autism, symptoms must be evident in early childhood. As one of the people pointed out, it’s quite obvious how to answer the questions if you want to come out autistic. That’s because most of the questions transparently tap into one or other of the two DSM subcategories for autism: either the social category (Category A), or the restrictive/repetitive behavior category (Category B). Here are the first two questions:
1. I prefer to do things with others rather than on my own.
o Definitely Agree
o Slightly Agree
o Slightly Disagree
o Definitely Disagree
2. I prefer to do things the same way over and over again.
o Definitely Agree
o Slightly Agree
o Slightly Disagree
o Definitely Disagree
Of course, this diagnostic route does involve acknowledging deficits in the social sphere. But once you’ve gone through the motions and gotten your diagnosis, you can return to your default levels of sociability—and, assuming those levels are higher than the ceiling for autism, contribute to the growing impression that autism isn’t a social disorder.
Three current trends—FC promotion, FC-friendly research, and the urge by some non-autistic people in today’s identity-obsessed culture to identify as autistic—depend on willing away the social deficits in autism. So successfully has each trend fed off the others that collectively they’ve launched a broader trend that, apparently, even includes some of the professionals whom society has entrusted to diagnose autism. And those professionals are happily doing so, even in light of recent findings that should motivate a shift from autism diagnoses to ADHD, and even in individuals who have no apparent social deficits.
It’s probably too early to say how far this will go, but the effects, like those of so many other of today’s trends, will almost certainly be favorable to FC.
REFERENCES:
Autism Quotient Test. https://embrace-autism.com/autism-spectrum-quotient/#test
Jaswal, V & Akhtar, Nameera. (2018, July 13). How to Meet Autistic People Halfway By Vikram K. Jaswal and Nameera Akhtar. New York Times. https://www.nytimes.com/2018/07/13/opinion/autism-social-life-new-research.html
Jaswal, V. K., & Akhtar, N. (2018). Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism. The Behavioral and brain sciences, 42, e82. https://doi.org/10.1017/S0140525X18001826
Lutz, A. (2022, May 22). New Research May Change How We Think About the Autism Spectrum INSAR keynote suggests brain differences correlate with cognition—not diagnosis. Psychology Today. https://www.psychologytoday.com/us/blog/inspectrum/202205/new-research-may-change-how-we-think-about-the-autism-spectrum
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