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What is autism, how to treat it?

What is autism?

History

The history of autism begins in the 1940s.
Leo Kanner identified a subgroup of children with mental retardation, also presenting with social interaction disorders and rather homogeneous behaviors, which would later be termed Kanner Autists.
At the same time, Hans Asperger identified a subgroup of children without mental retardation, but also presenting with serious social interaction disorders, which would later be termed Asperger Autists.

Some key milestones

1. Autism is a continuum.
Autistics with the mildest forms are often not identified as such by the general population, who simply find them 'a little strange.' In contrast, they experience immense fatigue characteristic of neurotypical (non-autistic) social interactions.
Autistics with the most severe forms present rudimentary or non-existent language, and/or mental retardation.

2. Autism is not a disease in itself, just a different way of being in the world.
Think about thinness. It is not a disease, except in extreme cases such as anorexia nervosa. It is the same for autism.
More specifically, a small dose of autism favors constructive social behavior, via a better mastery of one's ego, but limits the capacity to acquire power. In the same vein, I conjecture that most great Indian sages were slightly autistic.

3. The social problems of mild autistics do not stem from their nature, but from the particular functioning of society, imposed by neurotypicals.
There is autism-phobia, just as there is racism against black people. For example, the restricted interests of autistics are often mentioned, but the superficial interests of neurotypicals are forgotten.

Consequences

1. When talking about autism, it is important to specify whether one is talking about the mild form (elaborate language and normal intellectual level), the severe form, or both together.

2. Mild autistics should not be treated. There is a political struggle to be waged, just as people of color and women had to do.

Definition

It is only now that we can propose a definition of autism. However, it is only comprehensible after integrating what a human being is based on scientific empirical data rather than introspection and mere plausibility.
Autism is characterized by a lesser interest in social interactions, and even more by a lesser importance accorded to social status. It is often accompanied by sensory peculiarities.

Note that this definition of autism is quite far from the usual definition, which would rather be: « Autism manifests itself through communication disorders, obsessive interests or activities, repetitive behaviors, and a strong resistance to change. »
The usual definition is stigmatizing, biased by the confusion between the majority individual and the optimal individual. This is dangerous because it fosters a second confusion between curing and normalizing through conditioning. Furthermore, it tends to confuse personality structure with habitual reactions to stress.

Diagnosis

History

In the late 1980s, the two main standardized tests for autism diagnosis were established: ADI-R and ADOS.

Significant efforts and progress have been made since then to allow for earlier diagnosis, from 12 months of age.

However, diagnosis in adolescents and adults for mild forms of autism remains unreliable, as it is based on the out-of-specification use of ADI-R and ADOS. Indeed, these two tests, too focused on identifying disabilities, are defeated by any significant compensatory capacity. This compensation takes mainly two forms: on one hand, at the individual level, masking, meaning trying to appear like everyone else. On the other hand, at the family level, the influence of a parent who is also autistic, who helps find practical solutions.

Diagnosis of mild forms of autism

The question 'Tell me how you make decisions, and I will tell you who you are' proposes a diagnosis based on observing specificities in the way of conducting problem-solving.

Treatment

History

The treatment of autism has been influenced, for the worse, by the conflict between psychoanalysis and cognitive behavioral techniques (CBT).

Originally, autism was interpreted using pre-existing psychoanalytic concepts. This led to it being presented as a consequence of a so-called 'refrigerator mother,' meaning one offering her child an unsatisfying affective relationship. This led to several decades of guilt-inducing treatment for the mother, and ineffective treatment for the child, until the rebellion of parent associations against the medical establishment, which finally put a stop to it.

The next step was the ABA method, the product of Skinner's radical behaviorism(a form of CBT). It involves conditioning aimed at teaching new behaviors to the child. I have reservations, but no experience regarding its application to severe autism (language disorder or mental retardation). However, for mild forms, it is clearly inappropriate because it tends to produce a child who meets adult social expectations, rather than a child who learns to cope with their specificities.

With the Teacch Schopler method, the emphasis is on optimizing the environment and structuring time to limit sensory disturbances and help the child access learning. Again, for severe autism, I lack the necessary experience to formulate a definitive opinion; I can only express a priori a more favorable view compared to the ABA method. However, for mild forms, it seems to me that 1. emphasizing the learning of techniques applicable in open environments (directing the exchange, withdrawal, relaxation) is more productive than trying to avoid stress in an ideal environment, even if one does not exclude the other. 2. emphasizing the importance of the problem-solving analysis phase is more productive (helps development more) than trying to implement an optimum organization. Ultimately, the question raised by Teacch is: Is it more relevant to direct most of the effort towards creating an ideal environment for the child, or to give them tools to cope in an open environment?

Finally, regional Autism Resource Centers (CRA) offer social skills training to mild autistics. This is also counterproductive as it relies on a idealized vision of the human. Mild autistics are not in difficulty because they do not correctly decode facial expressions in win-win relationships; they are in difficulty when the other seeks to manipulate (Eric Berne's psychological games), and it is not by decoding non-verbal language that they will get out of it, but by mastering the advancement of reasoning.

Optimal treatment of mild autism

Let us understand clearly: the mild autistic is simply less tolerant to certain oppressive aspects of our social organization. Consequently, optimal education, which does not rely on denying the negative aspects of so-called normal individuals, works better for normal children and also works for slightly autistic children.
In other words, the best mode of care for mild autistics is the same as for normal children: it is to provide what I calltranscended education as opposed to conventional education.

This educational method consists of 4 points, exposed here.
The main obstacle comes from educators who are unable or unwilling to move out of their mental representation where social status is at the center, substituting it with a relationship based on problem-solving.
A similar problem arises at the level of parents. They tend to exhaust themselves by persisting, with doubled efforts, in applying the solution that works particularly badly with autistic children, namelyconventional education, based on the application of social rules. The fear of change will be the strongest: « if we stop applying arbitrary social rules, it will be chaos ». Eventually, the parent will adopt an opaque vocabulary based on non-discrimination, HPI, and other 'superpowers of autistics,' but in practice, they will continue to try to make their child accept an inadequate system. Consequently, the parent will experience exhaustion, complaints, and poor results.
Faced with such inadequate parental efforts, the autistic child will feel guilty, redouble their largely useless efforts, and eventually isolate themselves even more, or try to become their own parent's savior.
This is a lose-lose system from which one can only exit by applying the problem-solving of transcended education. To overcome any apprehensions related to this paradigm shift, one must work on what the ACT psychotherapy calls mental flexibility.

Deepening

↣ Excerpt from the film 'The Taste of Wonders' by Eric Besnard
     Striking illustration of the alternative perception of autism.