Published on 12, July, 2020
This might be one for the Moderators to look into, but I wonder if others have insight on this.
I've had several conversations recently with professionals dealing with adults on the spectrum who've just spouted the triad of impairments, or who've said its all in the triad of impairments.
With all the literature on theories about autism and various interpretations, and approaches to treatment, I could quite understand professionals looking for the easiest synthesis to hand. But what is to hand? Is it just too easy to read up on the triad and related summaries? Or is there nothing else to hand for professionals to use.
The Triad of Impairments, as far as I can see, is of no more value than for diagnosing children. It has little relevance to the everyday lives and experiences of adults, and is hardly appropriate to helping professionals understand adult needs.
It doesn't explain a lot of issues facing adults.
But just what are the main texts used by professionals? And how useful are these texts for supporting adults?
I have also looked at a background document to the NICE Guidelines for adults on the spectrum. This is about the work of the Guidelines Development Group from the National Collaboration Centre for Mental Health, which is chaired by Simon Baron Cohen. It is titled Recognition, Referral, Diagnosis and Management of Adults on the autistic spectrum.
This proposed modifying the Triad of Impairments by merging the Social and Communication Elements and replacing the rigidity part with something about repetitive behaviours. While these may be diagnostic, what it seems to me to lack is any comprehension of the sensory sensitivity and overload problems that probably explain many of the parameters they use.
As I've mentioned earlier the first parameter under Socoal-Communication Difficulties is "atypical eyecontact" whether staring too long or not making eye contact. They don't explain how they detect this or seem to comprehend that by adulthood many people on the spectrum hide or compensate this because they get told to look at me when I'm speaking, pay attention, don't stare etc so much that it is one thing resolved. Are these clever psychiatrisyts really asking people on the spectrum?
Likewise all the parameters listed seem to be similar tgo what might be expected of children without the impact of life experience up to and beyond 18, from which they define adult. Its a long list including social anxiety and loneliness. It includes difficulties keeping track of what a person needs to know - which to some extent is affected by background noise. I don't see any grasp of adult needs here.
But it is the reptitive behaviour and narrow interests section that is more worrying: "avoiding crowded places" is the first. Surely that's environmental (sensory overload) rather than repetitive behaviour or narrow interests?
Another is "preference for predictability and predictable events (watching washing machines spinning or trains going down tracks)" - is that an adult or child characteristic?
The subsequent discussion keeps talking about teenagers. While over 18 includes some teenagers I thought these were guidelines for adults! This mentions sensory and gastro-intestinal issues being very common, in the former 90% of those with a learning disability, but that seems to be all they know about sensory overload.
Is this really the peak of scientific understanding of adults on the autistic spectrum. It is a dismal outcome of the Act.
Surely NAS has better insight on what is going on?