Autism: Difference, Deficit - or Something Else?

I must start this article with something of a ‘TRIGGER WARNING’, as I realise this topic – its focus: if autism is a ‘difference’ or a ‘deficit’ –might resonate with some and rile others.  

It’s a complex issue and I don’t believe there is a clear cut answer.  Read on… 

Medical Vs Social Models of Disability 

The Medical and Social Models of Disability are both extreme models and neither work well for autism.

The Medical Model of Disability, when applied to autism, has connotations of deficit, treatment, and cure - to make people ‘not autistic’. This is often interpreted as ‘normalisation of behaviour’, or wanting to eradicate autism.

The ‘neurodiversity’ movement completely rejects the medical model and applies the Social Model of Disability. This model claims autism is a ‘difference’, or part of human variation, and that autistic people are ‘disabled by society’, rather than by their autism. It argues that disability is born from societal barriers and a lack of accommodation.

This movement hates diagnoses because a diagnosis classes autism as a ‘disorder’ with ‘deficits’. This creates contradictions because the movement needs diagnoses, allows self-diagnoses and celebrates ‘neuro-affirmative’ clinicians.

However, a key problem with saying autism is a ‘difference’ is that the powers that be then say that if autism is, in fact, a difference (that is part of normal human variation), then it doesn’t require funding for support. Of course, this upsets parents who are keen to get support for their autistic children. It also distresses autistic adults who need support to navigate everyday life and/or work.

The Problem with Both Models

Both models are problematic, especially when it comes to autism. The medical model, with its focus on deficits, rarely captures the whole of an autistic individual. Many, for instance, have strengths that are not even mentioned in the diagnosis.

Indeed, a common objection to the diagnostic process is that it is about what an individual cannot do (or struggles with), rather than what they can do. Many autistic individuals are very able in some areas, while having difficulty with other areas such as social communication. Therefore, the deficit model is inappropriate for autism.

The social model is unrealistic when it comes to autism, as it is not feasible for society to accommodate often contradictory aspects of autism. How can you accommodate hypo- and hyper- sensitivities at the same time, for example? Plus, most autistic people struggle with everyday tasks, irrespective of what society might or might not do.

It has always been the case that parents of profoundly autistic children strongly object to the narrative that their child is just ‘different’. How can someone who is not able to live independently just be ‘different’? That is ridiculous.

Essentially, the key problem is that both models focus on autism from the point of view of symptoms. But looking at autism through a lens of symptoms gets very confusing given the incredibly wide range of ways in which autism presents itself.

Would a cognitive approach be more fruitful?

Communication

The key diagnostic ‘deficit’ for autism is deficits in social interaction and communication. The social model would argue that it is simply because autistic people communicate differently, and point to the fact that, in general, autistic people communicate better with other autistic people than they do with non autistic people.

But this is not the whole story. Just like everyone else, autistic people tend to gravitate towards other people who think in a similar way. They have just as much difficulty communicating with autistic people with very different autisms as non autistic people.

In addition, groups of autistic people running groups and businesses have been tried. They tend to not last long without support from someone skilled in communication, who can smooth over disagreements and keep the group together. Non-autistic communication skills can be extremely useful, even when dealing with autistic people!

Those who think that autism comes with a communication deficit will point to what autistic communication is lacking compared to the general population. This includes things like not understanding hidden meanings, as well as social emotional reciprocity and not picking up on hints, sarcasm, and irony. They will point to the literal understanding that is common in autism. Some will refer to their children, who cannot communicate orally, or even at all.

On the flip side, those who work with autistic people often learn to appreciate their honesty, integrity, and authenticity. This is a side effect of literal communication.

So, is autistic communication a difference or a deficit? It depends on your point of view and the severity of the autism you are observing.

We could look at communication in autism completely differently and ask ‘WHY?’ or ‘What are the barriers?’ I have studied this in depth and there are many potential barriers that explain why autistic people do not develop their communication skills to the non-autistic level. For example:

• Lack of conscious control over your body, which performs different movements to what the individual intended

• A ‘gestalt’ way of processing language, which works from phrases and scripts rather than individual words

• Lack of ability when it comes to social emotional reciprocity. This causes social chit chat to be uninteresting and boring.

• Processing issues of varying kinds.

• How someone thinks. So, autistic author Temple Grandin’s way of thinking in pictures makes social chit chat pretty much unintelligible. That said, the way Temple Grandin thinks has enabled her to have a successful academic career.

This enables a more nuanced look at the issues of social communication in autism, and an understanding of WHY autistic people’s social skills have not developed as they have for ‘everyone else’. It also aids communication with an autistic individual without resorting to stereotypes. Best of all, it explains what can be a confusing mix of inability and ability, as in the case where someone can partake in emotional reciprocity but not be able to engage in conversation.

Empathy

There is a myth that autistic people lack empathy. This idea was widespread until parents of autistic children started talking about how empathetic their children are. They would talk about how they cannot hide their feelings from their children, even though those children are unable to read body language and facial expression.

What is going on?

This boils down to a communication issue. It is not that autistic people lack empathy: they generally have ‘affective empathy’ (emotional empathy) in abundance. Again, there are several potential issues that explain WHY:

They have not managed to learn how to express that empathy in ways that those who don’t know them understand. In other works, their lack of knowledge and understanding of social interaction has prevented them from learning ‘cognitive empathy’, or who to express empathy in accordance with social norms.

They are not able to process for empathy in real time. So they might realise someone was upset several days later, by which time it is generally too late to show empathy.

Most autistic people pick up on emotion directly, even if they can’t process it in real time. This is why autistic people can have a strong affinity with animals, who communicate largely via emotion. Babies and small children do this too. Is it the case that socialisation and learning social skills partly supresses this early skill?

Again, calling the apparent lack of empathy a deficit, or a different way of experiencing empathy does not get to the core of the matter. Neither demonstrate a true understanding of what is going on in autism.

Change

Change, especially unexpected change or a new situation, is known to be difficult, even impossible, for autistic individuals to handle.

A deficit? Or perhaps, as most people struggle with change, just a difference. After all, even some non-autistic people struggle when they approach a junction from an unfamiliar direction, for example. I’m not sure you could say they are therefore ‘disabled by society’, though.

But again, let’s look at some causes of difficulty with change:

• Processing issues

• Gestalt vision, where scenes are a whole and any tiny difference makes a different scene because the two are not identical.

• Tunnel focus, where changing from what you expected is challenging

• Inability to rotate objects in your head (the roundabout example). This could be a sign that visual perception is fragmented or has not created a whole from the parts.

Again, we see that thinking about this in terms of difference or deficit is not helpful. It’s far better to work out what is actually going on with each autistic individual (and non-autistic individuals who are struggling with a similar issue).

Conclusion

Neither describing autism via deficits nor differences captures autism. In fact, both approaches risk demonstrating a lack of understanding of what autism really is. Neither can work out how to help a specific autistic individual because of the variety of different causes of any particular symptom.

Instead, a cognitive approach is much better at capturing the person as an individual. Once you know how the individual ‘ticks’, you can work out how to help them.

What do you think? Let me know by commenting below.