Do ALL people with Aspergers have the triad of impairment?

You are right, as I said, the test only gives a small part of what the reality would be.  And of course, they are average scores, so with the two averages being so close you would expect some nts to score less than some aspies and vice versa.

I think it does ilustrate that there isn't some massive gap in ability between nts and aspies in terms of basic ability.  It's as you say, it's more a case of not being able to do everything, when we have so much else going on in our heads.

Even with the eyes I think I probably see more than an nt: in a lot of them I see different emotions in each of the eyes, or a mix of emotions, and that makes it difficult to decide on an overall one choice.  I have a suspicion that I am not wrong in seeing it like that!

Atypical said:

I recently did a test that involves trying to work out emotions just from people's eyes (https://www.questionwritertracker.com/quiz/61/Z4MK3TKB.html).

I got a neurotypical score, despite having a diagnosis of ASD (Asperger's).  But this test was only looking at eyes and choosing an answer from a multiple choice list.  I wasn't having to do anything else at the time.  I wasn't having to listen to what they were saying, I wasn't having to speak while deciding what to say, I wasn't having to interpret what was being said, I wasn't having to think about the implications and consequences of what they or I were saying, I wasn't having to try to take any context into account, or anything like that.  It's when I have to do those other things, as part of a social interaction, that I can find it difficult.

When I was assessed, the consultant clinical psychologist asked me to interpret various gestures and expressions.  They were simple, clear and obvious, and I wasn't having to try to interpret them in some sort of social context, or anything like that.  It was just a simple matter of interpreting the strongly expressed gestures and expressions.  It was easy that way!  That doesn't mean it wasn't a useful part of the assessment, since it indicated that if I had an impairment in that regard, it wasn't so severe that I couldn't manage that particular task.

But as I say, it's when it's part of a real life social interaction, where non-verbal stuff isn't strongly expressed, where there's context that I might have difficulty understanding, where I'm actively involved in the interaction, etc, that I can have difficulty.  If I passively observe, I'm pretty much fine.  If I'm actively involved, or potentially actively involved, it can be a very different matter.

By the way, DSM-5 does include sensory sensitivity as a diagnostic criteria (as a 2 out of 4 option, not a requirement), so things are getting better I think.

Re the triad: I'm currently undiagnosed (though just referred, yay!) I've had a health proffesional in the past tell me I can't be asd as I'm too good at conversation.  Yet to find out if that's actually true for me, but what I'm learning is that impairment of social skills doesn't mean no social skills.  Of course there is the thing about women being able to mask symptoms: so in a way its not that asd women can't do social things, it's that they don't come naturally, have to be thought about, are more difficult and tiring and might include conscious role playing.

I recently did a test that involves trying to work out emotions just from people's eyes (https://www.questionwritertracker.com/quiz/61/Z4MK3TKB.html). As I went through it I thought I was doing quite well, and it would be more evidence for me not being 'bad enough' to be asd.  To my surprise my final score was dead on what was expected for a 'high functioning autistic' (sorry for those that hate the term, it's what the test says...).  But I'd still done quite well: I won't give away the figures, but the difference in scores between me and an average neurotypical is actually only about 11%.  So that's not far off saying if you asked me and a neurotypical 10 questions the difference in scores would be about 1 question. Not that much!  Of course this is only one tiny piece of reality: still pictures of eyes instead of moving whole faces that are perhaps overwhelming to look at, but it's still interesting that it shows so little difference (if still significant difference...) on a task that you'd expect to be hard for autistics.

So overall I wouldn't rule out your daughter being diagnosable on the triad!

However, going back to the question of can you be autistic without the triad, I think in a way it depends on what autism 'is'.  At the moment we don't really know what autism is.  We know that if you have it you are also more likely to have some other conditions (dyspraxia, dyslexia, adhd, tourettes...).  We know that there are a great many genes that seem to be linked to asd, which means it's probably not a single syndrome, but a mix of many genetic and enviromental factors. We also know there tend to be some differences in the structure of the brain.  For instance neurons in asd brains tend to each have more connections to other neurons.  The normal pattern of development of brains is that they initially grow more connections (and neurons I think) than are actually needed. Then the uneeded/unused ones die away (this process is happening after birth). So possibly what autism 'is' is that this 'pruning' hasn't happened to the 'usual' extent.  Another way of looking at this is that the nt brain throws away what probably won't be needed, and is therefore more efficient. The autistic brain retains the ability to 'see' all sorts of stuff, which personally I think is nice, but is less efficient.

But... if autism is defined as 'more complex brain wiring' then what about the other linked conditions?  If you look just at the movement co-ordination aspects of dyspraxia (I think there is a condition name for people who just have these aspects, can't remember what), then I have heard this explained as being also due to excess connections not having passed out of use, just this time in the part of the brain that controls movement.  So basically the same thing, just in a different part of the brain?

So basically I think that the difference between those different conditions listed may simply be borders decided by humans, just in the same way as we decided to put a border between France and Germany.  Sure they are different countries, and that's important in many ways, but do you see that much difference if you are standing on the border?  You may find the same type of rock underneath the surface both sides of the border.

Currently we don't really have much idea of what underlies autism.  So it may be that there's dyspraxics with the same underlying syndrome/cause as some autistics, while other autistics actually have something totally different.  So yes, I sort of do believe it's possible that your daughter could be 'autistic' without the triad (dyspraxic might be the current label!)

But what you probably want right now is to get her assessed and find the current label that is best for you to use....

It bears repeating, Longman, and you put it so well.

I'm always going on about this so please excuse any repetitions in recent posts.

The triad is a diagnostic tool that excludes things that can be confused with other conditions. Hence sensory issues such as sensitivity to sounds or sensations is excluded.

But it also concerns me that the triad is designed primarily to diagnose more marked autism where it is likely that people being assessed will show up on enough points in each section. I think it lets people down badly who are nearer the threshold and may have difficulty ticking off enough characteristics in each of the three areas.

It is really down to this notion that there is "mild" autism, not helped by the theory that the spectrum is a steady curve towards normal.

The key difficulties that people seem to have are difficulties with social engagement and difficulties with sensory overload and other environmental factors. The way the triad addresses social engagement issues is rather specific and even quite peripheral.

Where I've sounded off about this before is what triad questions really mean. I'm looking at one version of DSM-IV in a book, for want of something in front of me, excuse if unfamiliar wording...

"Marked impairment in the use of mutiple non-verbal behaviours such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction". 

How do you tell if someone has poor eye contact? It is easy if someone has conspicuous gaze aversion (looks down all the time etc), but many people get conditioned into trying to look at a face, even if looking at the mouth. It is still poor eye contact but how do you spot it? On facial expression and body posture, it is about both reading this information from others (how do you measure that?) and making the right expression/gesture for others to read in a given context, which is also hard to measure.

"Lack of social or emotional reciprocity" - well if your social engagement is hampered by poor eye contact or difficulty reading facial expressions, that is going to impact on reciprocity - so how do you distinguish an actual lack from one that would be better if the social inputs improved?

"persistent pre-occupation with parts of objects" OK how do you establish that in an interview context, as distinct from long term observation of behaviour?

I've analysed other criteria on other posts. The one that amuses me is literal understanding - the examples given are too obvious, and is it always not being able to understand metaphors, or just sometimes having trouble with them? Or just having to think about them longer?

A lot of the triad has been around for several decades. Knowledge doesn't seem to have advanced much.

Some people call me Asperger's since my diagnosis, but my actual diagnosis does away with this out of date label.

I am type 1 ASD.

As Coogy says, there is no known substitute for a proper assessment by a qualified professional. Anything less is tinkering and best avoided.

If you feel concerned and her behaviour is becoming extreme, I'd ask for an assessment for her from your GP.

Reading about the condition is a guide, but no substitute for professional assessment.

What you feel may be social behaviour may be masking, which is common in girls.

Perhaps have a read of some of the literature on girls presentation.

Regards

C