Understanding of autism has grown exponentially over the past few years thanks to advocates in the community who share their stories and promote awareness. Through that advocacy, the psychiatric and medical community has grown to understand autism in a revolutionary way. The term neurodivergence has become a term used to both affirm autistic people and to help step away from “disorder” terminology, which implies there is a deficit, rather than a difference. Through these fundamental lessons (and many more), we strive to give neurodivergent affirming care while helping with other issues that may come up. We say “strive”, because as non-autistic providers, we continually learn from our patients and will continue to evolve through their lessons.

What is Autism?

Great question. Autism encompass such a large, diverse group of people, with differing strengths and challenges, as such, generalities are difficult to make.

There are three major diagnostic criteria for autism: differences in reciprocity, non-verbal speech and relationships. These are incredibly complex topics with extensive overlap. Even experts disagree on how to classify some details, but all of that is beyond the scope of this blog. Here, I will give you a basic understanding of these areas. Try not to get bogged down in the details.

1) Reciprocity

To over-simplify things: “reciprocity” is the volley back-and-forth in a conversation. It’s the “bid” sent from one person to another and the other person’s response. For non-autistic people, there is an unspoken, assumed set of rules that most struggle to articulate, but somehow we know them. When someone asks me about my day, I respond with “Good. How is yours?”. Was my day really good? Possibly. Do I really care about the other person’s day? Will they really answer that question honestly? Who knows. But, I know that I am supposed to answer and respond. Autistic people may or may not follow the same rules. These rules may not come naturally to them, or may even seem odd or difficult to follow. “My day wasn’t good. Why would I say it was?” This is first defining difference in autism, a difference in reciprocity, or back-and-forth in conversation.

2) Non-verbal Speech

Non-verbal speech is everything we use to communicate other than the specific words. Imagine if you could only communicate with old-school text messaging (no emojis or hearts), that is speech with all non-verbal communications removed. This can be everything from facial expressions, to gestures, body positioning, speech patterns and eye contact. There too are unwritten rules and expectations to how people should or should not use non-verbal speech in conversation. I should look someone in the eye when talking to them because that lets them know I am listening to them. I should smile and lean in when someone says something I like or when I like them because, society says that’s how I show interest. There are infinite examples of this in our every day life. For autistic people, these rules may or may not come naturally. Some people have told me that looking in someone’s eyes is physically uncomfortable. Others have told me that smiling doesn’t come naturally to them, but they realize when they do it people are nicer to them (we'll get to masking soon). It is this difference in ways of using non-verbal speech that define the second diagnostic criteria.

3) Relationships

Our relationships are some of the most important and complicated things in our lives. During all of our interactions we change what we do based on the people we are with. Our behaviors are different when are with our family, compared to when we are with our close friends or people we just met. There are a cadre of unwritten rules that describe “how” people “should” interact in relationships to maintain them over time. For autistic people, these rules may or may not be automatic for them, or there could be other rules. It may help to break into some specific areas

• Social Energy, Motivation and Flexibility - Autistic people can have wide ranging levels of energy to be with other people (i.e. does it “take a lot out of me” to be with others). This is separate from the motivation to be with other people. Someone with high social motivation, but low social energy may find they want to be with their friends, but they have difficulty staying with the before needing a break. Someone with high social energy, but low social motivation may find it easy to be around other people, but may not care much to be around others. Then there is every combo in between.

• Interest in others, awareness of others, use of social conventions, adjusting behaviors in various social contexts, playing with other children and the type of responses.