Part 5 – B1: Repetitive Behaviors

The Autism Spectrum in the DSM-V

#neurodiversity #autism #dsmasd

What the DSM says

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaus­ tive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

What it can mean

Communication

• My way of speaking is often very “formal”
• I communicate by repeating words and phrases I have heard before, like on TV or in person
• I communicate by repeating what the other person said just before me
• Because it's difficult for me to come up with new ways of saying things, I often have “scripts” for everyday interactions (like what to say to the employee at the grocery store worker, or how to greet my neighbor)
• The language I use is so different from other people, that a lot of it can only be understood by those who know me well. I sometimes need people to “translate”
• when i'm tired/overwhelmed and withdrawing, i speak as if i were a child (”[my name] tired!“)
• I use nonsense/made-up words to communicate certain concepts that only people I know well can interpret
• I repeat the same inside jokes so frequently that they stop being funny (to everyone else in the group)

Stimming: How I stim

• I enjoy repeating the same word, phrase, or sound over and over again
• I stim by making sounds with my mouth, like tongue-clicking or humming
• Hand-flapping, rocking, jumping, clapping, hand-twisting, finger-flicking
• Spinning in circles
• tensing my body, then releasing the tension
• Moving my face a certain way, which can look like grimacing
• grinding my teeth
• Tapping against my ears really quickly. I like the sound.
• I always pick my skin. I've tried to stop, but I even do it when I'm half asleep
• I enjoy looking at things move quickly, for example waving a pen in front of my eyes
• When I was little, I never pretend-played with my toy cars. But I did enjoy spinning the wheels *Turning lights on and off
• this overlaps with my eczema, but i'm constantly scratching!
• dancing, pacing, swaying/rocking back and forth between feet while standing, playing with my hair, letting other people play with my hair

Stimming: Why I stim

• To express my emotions
• I stim when I'm anxious or angry because it calms me down. I stim when I'm happy because it makes me even happier
• It's fun
• I'm so full of energy sometimes, I need to move
• It's like I'm “releasing happy-energy”. It just... boosts my happiness in a way?
• It helps me concentrate
• it's grounding when i'm anxious or overwhelmed, not specifically calming me down but sometimes like, brings me back into myself and my body — the opposite of disorienting
• I just do it, automatically

Other

• Some of my co-workers have nicknamed me “ballerina” because I always walk on my toes
• I like to sit in positions that others consider uncomfortable or painful (this can also be a stim). “Normal” positions, on the other hand, are uncomfortable or painful to me
• “T-Rex arms” or “raptor hands” (like this)

Continue to Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors

Part 4 – A3: Relationships

The Autism Spectrum in the DSM-V

#neurodiversity #autism #dsmasd

What the DSM says

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history 3. Deficits in developing, maintaining, and understanding relationships, ranging, for ex­ample, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

What it can mean

• I can't “adapt” my social interactions to the circumstances. I talk to all people the same way, whether it's bosses, co-workers, friends, teachers, family, or casual acquaintances. To me, that means I am equally casually-friendly to everyone. But I know people for whom it means being equally distanced and polite to everyone.
• Even when I understand the “clues” people give me (e.g. that they're uninterested in the conversation), I don't respond to . I don't know how to “control” the course of a conversation in that way
• When I don't know how to react to a situation, I laugh. I know it's an inappropriate reaction, but it's automatic. It has resulted in things like me laughing after someone told me about the death of an acquaintance
• I don't know what kinds of things are “appropriate” to say in a given context. I might make jokes or ask questions that aren't considered okay in that situation
• I don't notice when someone else is uninterested in our current conversatiom
• I have always enjoyed solitary daydreaming more than imaginative play involving other children. I am very imaginative; it felt like involving other children forced me to compromise on my own imagination
• I stopped actively building on friendships in elementary school. For example, I stopped inviting other children to play, but still played with them when invited myself. To the adults around me, this only became apparent years later, when I started going to a new school with no old friends to initiate contact with me. This didn't purely happen out of shyness, but because I had found my first special interest – and that was simply more interesting to me than other children. I filled my time thinking about my SI, so I didn't feel a need to ask others to play or talk
• When I was younger, everyone seemed to have strong preferences about who they liked. I didn't have a “favorite teacher” or even a “best” friend
• Sometimes I don't know if people are having fun with me or about me
• As a teen, I get along well with children and adults, but not with my peers. Children are less complicated, and easier to understand. And adults are more patient with me than my peers, probably because they don't expect me to be “on their level”
• I want to make friends, but I don't know how
• I am not interested in making friends. Sure, it sounds good in theory, but not great enough to put that much time and energy in it
• I'm mostly too caught up in my own mind to pay much attention to the people around me
• I have a “fantasy world” I am continuously working on. It's much more engaging than the “real world”, and I trust the people in it more than my RL friends
• Sometimes I am so focused on my own thoughts, that I don't even notice the people around me
• Socialising is tiring. I prefer being alone, or at least with only one other person
• i struggle to form relationships and make connections with people who aren't on the spectrum or otherwise neurodivergent
• when i was younger, even when there were people i hung out/around with, i felt constantly ostracized and rejected by them, because i was never saying or doing the right thing
• feeling like you have a friend group where no one is really your friend
• I don't like being around strangers, but there's one thing that makes new groups easier than old ones. Once you have a certain image of me, that's set in stone. I adapt to what people seem to expect of me. I can't change in front of people. The only way I can embrace new aspects of me is by meeting new people. Because I don't know how to change the way I act in a group I already know. I just... adapt. I adapt to the roles people give me, the assumptions they make about me.
• I have never had more than one friend at a time. Friendships are work.

Continue to Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors

Part 3 – A2: Nonverbal Communication

The Autism Spectrum in the DSM-V

#neurodiversity #dsmasd #autism

What the DSM says

A. Persistent deficits in social communication and social interaction across multiple con­texts, as manifested by the following, currently or by history 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnor­malities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication.

What it can mean

• Eye contact is painful to me, so I avoid it
• Looking at someone's eyes takes a lot of my attention. I'm not able to both look at someone's eyes and focus on what they're saying
• People always tell me that I make too much eye contact, or not enough. No matter what I try, I can't seem to get it to the “right” level
• When I talk, I focus on my words, so I can't focus on things like body posture or eye contact. Because of this, I might do things like facing away from my listener
• I don't understand how to use posture for communication. How is the way I sit or stand supposed to communicate anything?
• Speech is just words to me. I don't understand all the other “layers” like tone or volume
• People sometimes tell me I speak too loudly or too quietly, but I didn't notice.
• I don't use gestures like pointing or waving
• I use gestures a lot. My hands are more expressive than my words
• I don't express my feelings through facial expressions, at least not the way others do
• I try to copy other people's facial expressions, but people tell me it looks “weird”, “unnatural”, or “exaggerated”
• I have had to practice to understand the body language and facial expressions of other people. There are some I still don't understand
• I know an autistic child, and understanding how he feels comes very naturally to me. I can understand how neurotypical people feel, but it's a skill I've had to work on. However, understanding the body language of this autistic child is something I can do very intuitively. I think this might be how neurotypicals recognize each other's feelings all the time.
• I don't express my own emotions the same way other people do. For example, others smile or laugh when they're happy. I jump up and down or flap my hands instead.
• I don't understand the way people communicate. I understand the words they're saying, but all the other things that are supposedly included in communication – like body language, tone of voice, or facial expressions – seem like a riddle I can't solve
• I constantly feel like I am performing and micromanaging my facial expressions, body language, etc., which is extremely tiring because I am constantly having to think about them
• Sometimes people tell me my tone was dismissive/annoyed, even though I was imitating my tone from a time people told me I sounded friendly/supportive. It's confusing
• my tone of voice doesn't change in conversations depending on the subject/emotions/my level of interest. I pretty much always sound disinterested even if I'm very excited by a topic
• I respond to stimuli differently to most people – for example, I make singing noises rather than crying when I'm in pain or distressed

Continue to Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors

The Autism Spectrum in the DSM-V

#neurodiversity #autism #dsmasd

What The DSM says

A. Persistent deficits in social communication and social interaction across multiple con­texts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.”

What it can mean

• I have trouble processing social cues or hints, like understanding when somebody is flirting with me or doesn't want to talk to me
• I can't spontaneously react to what people say; I have to “script” interactions before they happen. Because of this, I might be better at interactions that don't require me to respond immediately, like e-mailing.
• I often do not know how to start a conversation, especially when I don't have a “script” for the specific situation
• I usually only interact with people when I need them for something. For example, I wouldn't play a card game with a person because I want to play a game with that person, but because I want to play the game and I need a second person for it.
• It's difficult for me to let people know when I haven't understood them. It disrupts the “flow” of the conversation, making it more difficult
• I don't know how to rephrase things when others don't understand me
• I don't know how to phrase things on my own, so I usually communicate through things I have heard before. This might be quotes from movies, or things I have heard other people say
• To communicate, I sometimes repeat what the other person just said
• In a conversation, it's often just the other person talking. I might respond, but not “add new things”. For example, when other people ask me how I'm doing, they expect me to ask the same question back, or otherwise keep the conversation going. I don't do that, or I have had to practise it
• In a conversation, it's often only me talking. I don't instinctively do things like taking breaks to let the other person respond.
• I might not notice, or pay attention to, whether the other person is uninterested in what I am talking about.
• In a conversation, I usually feel like I am the “object”, like the conversation is something done to me, rather than with me
• If people don't notice my difficulties in conversations, it's because I've spend my whole life practicing how they work
• I have a strong need for privacy. It often feels invasive when people ask me about my thoughts, feelings, or interests, as those things feel very private to me
• I don't feel a need to share my interests with others; when someone else is interested in the same things as me, it might even feel like they're invading a personal space
• Or: I am only interested in a conversation when it's about a topic that interests me
• When I see something interesting, I don't instinctively point it out to others. That might only come to my mind much later
• When I succeed at something, I prefer enjoying it on my own rather than by telling others about it. “Sharing” joy about something doesn't make me feel happier than enjoying it alone
• I don't know how to react to other people's feelings, like how to comfort them when they're sad
• I am uncomfortable with or indifferent to displays of affection (like hugs, or saying “I love you”)
• There are some feelings I can't show in a way others notice. For example, people sometimes tell me to “be more enthusiastic” but I don't know how to express that
• Sometimes my mouth is better at wording things than my brain is. It's like my brain mixes things I have heard before, to create a response that fit the context. It's usually unrelated to what I actually believe, but my actual thoughts take a much longer time to express. So I often rely on this “automatic” process. (To me, this often feels like my mouth “generates” appropriate responses)
• “Simple” questions like “what do you mean?” or “how do you feel?” sometimes catch me off-guard. I don't know how to answer them
• I don't know how to signal things like when I'm uncomfortable with or disinterested in a conversation
• Other people often tell me that I was rude, when I thought I was being friendly
• To cope with or hide my social difficulties, I might use multiple techniques mentioned here, like: scripting, delayed echolalia, or automatic speech
• Even when I understand that something is meant to be humorous or sarcastic, I don't know how to respond to it. So I just reply as if the person had been serious
• sometimes in conversations, i don't know what people expect from me / don't understand the rules or expectations of our conversation, and that tends to make me feel very anxious and confused and disoriented
• one of the primary reasons i struggle with conversation is because it feels like there's an unwritten set of rules/expectations that i'm unfamiliar with and so i get anxious and freeze up
• if I want to initiate conversation with someone, I jump right in with my question or comment, rather than doing small talk first. Sometimes this means people don't realise I'm talking to them specifically
• I am often surprised when people tell me I have been rude, which happens quite often
• Sometimes I offend others by saying what I am thinking, even if I don't mean to.

Continue to: Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors

The Autism Spectrum In The DSM-V

#neurodiversity #autism #dsmasd

The series is a work-in-progress. Other sources might be added anytime.

So far, 3 autistic people have contributed to this list. Other sources include:

Books

• The Diagnostic and Statistics Manual, 5th Revision
• “Aspergirls” by Rudy Simone
• “Twirling Naked In The Streets And No One Noticed” by Jeannie Davide-Rivera

Papers and Screening Tools

• DSM-V Autism Spectrum Disorders, Laura Carpenter, 2013
• The Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R)

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Continue to Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors

#neurodiversity –> #autism —> #dsmasd (The Autism Spectrum In The DSM) Series (Work In Progress) -Part 0 – Sources -Part 1 – Introduction -Part 2 – Social-emotional reciprocity -Part 3 – Nonverbal communication -Part 4 – Relationships -Part 5 – Repetitive Behaviors -From Childhood Schizophrenia to ASD – The Classification of Autism Over Time -Ctioning – Functioning Labels aren't fun -Autistic Traits based on the ICD-11 -The Way We Play

#politics -Left and Right -Liberalism vs Left-Libertarianism

#typology -Cognitive Functions 101 -Loops and Grips

The Autism Spectrum in the DSM-V:

#neurodiversity #autism #dsmasd

The diagnostic criteria for Autism Spectrum Disorder often seems vague – Many autistic people, including myself, have had the experience of reading it for the first time and immediately going “no, that's not me”. The autism spectrum is so broad, that any list of criteria will either exclude some people or be so vague that at first glance, we don't really know what to do with it.

So I want to do my best at giving examples to explain what the different parts of the criteria actually mean. In a multiple-part series, I will take different quotes from the DSM and give you examples of the traits described in them. The examples are based partly on scientific papers about autism, but mainly on the experiences of autistic people who have contributed to the list

Issues:

1. The DSM-V criteria is written based on what autism looks like to an outside observer. That's probably one of the main reasons we don't relate to it. It also means that the categories don't always make sense from an autistic person's perspective. For example, category B1 mostly covers self-stimulating behavior (stimming), but also some forms of communication. This is because they can look similar to an outside observer
2. Also, the DSM-V is written for professionals who are qualified to diagnose the conditions classified in it. It is not directed at us, nor does it have an interest in us understanding it. However, I think that, as autistic people, we have a right to understand how our minds are described.

For reference, here is the full DSM-V diagnostic criteria for Autism Spectrum Disorder. Note that the chapter does not only include this criteria, but also other sections such as specifiers, prevalence, differential diagnosis, and others.

“A. Persistent deficits in social communication and social interaction across multiple con­texts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnor­malities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for ex­ample, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. [...] B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaus­tive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circum­ scribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse re­ sponse to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity: Severity is based on social communication impairments and restricted, re­ petitive patterns of behavior (see Table 2). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other im­ portant areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual devel­ opmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spec­trum disorder and intellectual disability, social communication should be below that ex­ pected for general developmental level.”

This is going to be a list of experiences by autistic people as they relate to the DSM-V diagnostic criteria. I have been working on the list for a few weeks now and will publish them over time.

Continue to: Part 0 – Sources Part 1 – Introduction Part 2 – Social-emotional reciprocity Part 3 – Nonverbal communication Part 4 – Relationships Part 5 – Repetitive Behaviors