Persistent deficits in social communication and social interaction

DSM-5 says that to meet the diagnostic criteria for ASD there must be persistent deficits in all three of the areas below.

  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.

So why is it some of us are completely alone and isolated while others seem to have friends, partners and active social lives?

How do people who meet the above criteria achieve this?

Parents
  • Some autistic people can see that if they wish to achieve their goals in life that they have to push themselves and do uncomfortable things, others either cannot see this, or have genuine limitations that make it impossible.

    For example, I make apparently 'normal' levels of eye contact, but I do so entirely consciously, I time when and for how long I make eye contact when talking to someone. I do not have a neurotypical unconscious ability to do this, but I compensate for this by using my conscious intellect. As a result the neurotypical majority find me comfortable to talk to, and that helps with making friendly connections. An autistic unwilling or unable to make such a concession to neurotypical norms, would find it much more difficult to make friendly connections. Therefore, you can have two people who are equally autistic, both with eye contact difficulties, producing two very different social outcomes.

Reply
  • Some autistic people can see that if they wish to achieve their goals in life that they have to push themselves and do uncomfortable things, others either cannot see this, or have genuine limitations that make it impossible.

    For example, I make apparently 'normal' levels of eye contact, but I do so entirely consciously, I time when and for how long I make eye contact when talking to someone. I do not have a neurotypical unconscious ability to do this, but I compensate for this by using my conscious intellect. As a result the neurotypical majority find me comfortable to talk to, and that helps with making friendly connections. An autistic unwilling or unable to make such a concession to neurotypical norms, would find it much more difficult to make friendly connections. Therefore, you can have two people who are equally autistic, both with eye contact difficulties, producing two very different social outcomes.

Children
  • I did push myself. As autistic people go I’d probably be regarded as unusually successful.


    I somehow made it through university then into a very successful career on a salary I still can’t believe sometimes. That wouldn’t be possible without me being an excellent masker. I had some friends from school who stayed part of my life into my 30s with whom I went to lots of social events and I made plenty of work friends (not the same as “real” friends, I realise).

    But friends always eventually drop me without falling out and I’ve gotten to the stage where I have no one.

    I must have had thousands of social events and opportunities and yet here I am, alone.

  • both with eye contact difficulties,

    Eye contact is just a non autistic cultural expectation though. This becomes even more obvious when you realise that some other cultures around the world find the social expectation of eye contact offensive or too intimate.