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ASPartOfMe
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26 Feb 2024, 12:27 pm

Amanda Moses, B S.Sc, PG.Dip, G.Dip, is dually registered as a clinical and counseling psychologist in the UK and a psychologist and board-approved supervisor in Australia. After 11 years of clinical practice, she now focuses on providing high-quality training and supervision to early-career psychologists. Amanda's experience has predominantly been working with adults in a clinical setting, providing therapy for a range of presentations such as mood disorders, anxiety disorders, suicidality and self-harm, stress, and burnout. She also conducts complex psychological assessments for medico-legal purposes.

Autism's Hidden Mental Health Epidemic: A Call for Awareness

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There is a mental health crisis among autistic people. A meta-analysis reviewing close to 100 studies revealed that most psychiatric conditions are significantly more prevalent in autistic individuals (Lai et al., 2019). Traditionally, the medical model has pathologised autism as a disorder needing a cure. In contrast, the neurodiversity-affirming movement, underpinned by the social model of disability, challenges this viewpoint by viewing autism as a natural variation of the human brain. This post aims to demonstrate why shifting our approach to autism toward a neurodiversity-affirming perspective is vital in addressing the mental health crisis autistic people face.

The mental health crisis among autistic individuals is marked by significantly higher rates of psychiatric conditions compared to the general population. Research indicates a stark prevalence of anxiety, depression, and suicidal ideation among autistic people. Autistic individuals are nine times more likely to experience suicidal ideation (Cassidy et al., 2014), and the mortality rate is 2.56 times higher across all causes of death for autistic individuals (Hirvikoski et al., 2016). Contributing to this crisis are systemic barriers to health care access, including diagnosis challenges and a lack of inclusive, adaptable services that meet the unique needs of autistic individuals, particularly for those with co-morbid diagnoses or from culturally diverse backgrounds (Malik-Soni et al., 2022). These barriers exacerbate the risk of psychiatric illnesses and compound the mental health crisis for autistic people.

Medical Model Versus Neurodiversity-Affirming Practice
Within the medical model framework, the approach to treatment for autistic individuals has focused on reducing symptom severity. However, research has highlighted that depression symptom severity, not the severity of autistic traits, was the most reliable predictor of quality of life for autistic people (Oakley et al., 2021).

We must move away from focusing on reducing "symptoms" of autism to understanding what it means to live meaningfully for autistic people.

Neurodiversity-affirming practice, at its essence, is about person-centred and strengths-based care.

It is crucial to acknowledge that the neurodiversity-affirming movement does not intend to diminish the challenges faced by autistic people or their necessity for services and support. It does not seek to negate the reality that autism is a disability, which is in itself a neutral term. The label "disorder" insinuates an inherent flaw or pathology, potentially leading to stigma and an emphasis on interventions that seek to "cure" or "treat" autism. Considering autism is a difference in neurological makeup and cannot be cured, one may argue what the value is in pathologising this form of diversity.

Autism, like other neurological differences, is still considered a disability because autistic people experience challenges in social communication and sensory processing (amongst other things) that make it difficult to navigate the world. However, by embracing a neurodiversity-affirming perspective, we can appreciate that the difficulties autistic people face are further compounded by the person/environment mismatch.

The ethical principle of "do no harm" is foundational in psychology, and, therefore, providing neurodiversity-affirming care is arguably an ethical imperative. Given what the research has indicated about the mental health crisis faced by autistic people, it demands a shift in approach. The approach to care for autistic people has not been working in a way that contributes meaningfully to the quality of life of autistic people. It has failed them, and the evidence is in the statistics. To address this crisis, we must strive to understand the autistic experience and how we can reduce the barriers they face to accessing care.

Overall the author is correct the but her argument is diminished by word salad.

While the vast majority of ND advocates are anti cure I do not recall objections to the term “treatment” . Most want better treatments. “Treatments” are designed to mitigate or cure something considered bad. This author does consider the autistic mental health crises bad. It is a crises which is really bad. So what is the issue with treating it exactly? Nothing, because that is exactly what she is advocating even if she objects to calling it that.

Acknowledging autistic differences from the NT world as a cause of mental health issues and mitigating/treating these by showing that being Autistic is not a curse that is going ruin the rest of your life is a good thing.

Disability neutral, Disorder negative might be linguistically correct but anything with a “dis” in front of it implies something wrong. A decade ago ND advocates said we are not disabled, the problem is society, now “disability” is largely accepted.


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“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman


carlos55
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26 Feb 2024, 3:31 pm

For a start the author incorrectly treats autism as an incurable single condition rather than multiple conditions that all have autism symptoms in common on a multiple circle venn diagram.

This means some autisms are likely to be curable in the future, but being a psychologist the area of genetics and neuroscience is not her area of expertise.

Quote:
The label "disorder" insinuates an inherent flaw or pathology, potentially leading to stigma and an emphasis on interventions that seek to "cure" or "treat" autism. Considering autism is a difference in neurological makeup and cannot be cured, one may argue what the value is in pathologising this form of diversity.


She makes the well meaning but flawed argument that somehow pretending something doesn’t exist makes it all go away and the world will be also be convinced that somehow these difficulties are not a disorder. The person that cannot exist independently without day to day help from others whether family members or carers from gov, that officially has a disability doesn’t have a disorder.

Maybe they could try the same approach on multiple things like world hunger, child abuse & poverty, it all goes away if you pretend it’s something else or re-label.

Even those with normal intelligence but suffering from mental health conditions related to having autism will have their depression lifted everything will be ok, but of course in reality it wont, everything will be the same caused by the same autism symptoms

You can’t be labelled disabled without a disorder, a disability is a human who is just as human as everyone else with the same rights as everyone else but has a disability like lots of others with different disabilities & medical conditions.

But what are you left with when you change that?

When you suddenly want to class something that is thought of as a negative or lesser human to 99% of the human population when you class it as a natural difference?

It’s called dehumanization of course, not quite the same as anyone else, a new form of neanderthal human species, somehow separate from other humans because of reduced functionality, looked at as lesser by the 99% because of reduced functioning, rather than someone the same as other humans but with a medical condition explaining their symptoms.

And of course this wont come with any discrimination? and pigs also fly of course :lol:

It’s a slippery slope to 1930`s nazi Germany and how the jews were looked at at the time.

Somehow inadvertently being naturally dehumanization will cure depression, will make us more employable, its so absurd it would be funny if not so sad

As they say the road to hell is pathed with good intentions.


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carlos55
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27 Feb 2024, 11:43 am

I forgot to add the nearest we have to the “natural difference” state where nobody bothers with cure talk is Down Syndrome.

Ask yourself are they any better off do they not get discriminated against.

Are they not looked down upon as lesser humans by others I think the huge abortion figures for Down Syndrome is the answer to that.


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ASPartOfMe
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04 Mar 2024, 7:57 am

Jessica Penot, LPC, is a licensed professional counselor in Madison, Alabama, who specializes in treating trauma and autism spectrum disorder. She has over 20 years clinical experience in a variety of settings. She is the founder and director of Tree of Life Behavioral Health and has spoken and written about autism on platforms including The Art of Autism. Penot was diagnosed with autism in her 40s and has spent a significant amount of time working to understand the specific challenges and traumas women with autism face. Her research and work focuses primarily on issues involving the underdiagnosis and misdiagnosis of women with autism and the impact it has on their lives and mental health. She is an advocate for neuroaffirmative approaches to treatment and works to help facilitate women with autism in moving from being self-critical to self-compassionate. Her perspective on autism comes not only from her clinical experience, research, and study, but also from her experiences living as a woman with autism spectrum disorder. Penot is also the author of 10 novels and books about exceptional women and girls who are born different and need to find magic in their “otherness.

Why Suicide Is All Too Common Among Autistic Adults

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One of the most impacting research studies I have read about autism is called Death by Suicide Among People With Autism: Beyond Zebrafish by South et al. In this study, researchers found that adults with ASD have three times the suicide rate of the neurotypical population. For women with autism, the suicide rate is four times that of the neurotypical population. Those with other co-occurring mental health issues have a 92% higher suicide rate than those without autism—and over 50% of autistic adults have co-occurring conditions. What all this means is that surviving as an autistic adult in a neurotypical society is a Herculean task.

Many neurotypical researchers have hypothesized as to why so many of us die by suicide. In South et. Al’s study, the team found that masking and camouflaging behaviors are a major contributor.

High rates of trauma associated with social naivete and increased victimization have also been linked to an increased likelihood of death by suicide. However, as an autistic adult who spends most of their life working with other autistic adults as a therapist, I feel this doesn’t really touch the depth of the problem.

I am always overwhelmed by the neurotypical world and its pressures and expectations. When I go to the grocery store, the volume of people, the lights, the music, the vastness of the choices, and the constant rearranging of the shelves all contribute to a cyclone of unpredictable overwhelm that drives me away very quickly. I can work for 60 hours a week if it is a task I am hyper-fixated on and good at, but if you throw in some extra variables that aren’t rational or are chaotic, I am quickly overwhelmed. I forget things, I drop balls, I make mistakes, and people are always mad at me when I am overwhelmed. All of this remains true even though I have the most ideal work environment and most supportive home life imaginable for an autistic adult.

A study by Schwartzmann and Corbett (2021), discussed the well-documented fact that autistic adults struggle with obtaining and maintaining employment. Many autistic adults struggle to keep jobs beyond two years even when they are qualified. Meaningful employment is important to the mental health of autistic adults, and so is a stable income, but it is elusive for most of us. If I didn’t run my own practice, I believe I would be unemployable. I am not good at networking with neurotypical coworkers. I am not good at communication and I loathe teamwork in all its forms. At the last job I worked at before opening my own practice, the clinic doctor wrote “ding dong the witch is dead” on my door the day before I left. I never fully understood why he hated me so much, but I know enough to understand that I am often hated by neurotypical colleagues.

In a world in which autistic adults are constantly overwhelmed, rejected, and victimized, it isn’t surprising that we dance with daydreams of suicide regularly. Yet, I think it goes even deeper than that. The more I talk in support groups and therapy with other autistic adults, the more I realize that if our support needs were met, autistic adults might find lives that didn’t make them daydream about dying. They could find lives of meaning that they enjoy.

For many of my autistic peers and clients and me, I have found that much of the suicidality is linked to being overwhelmed. I spent many of my early years daydreaming of death and it wasn’t until the last several years that I realized it wasn’t really death I craved; what I craved were quiet and understanding. When I am overwhelmed and close to meltdown, I will reach for anything that will make the loudness and brightness of the neurotypical world quiet. Ideally, I would like time off and a quiet place, but neurotypical work environments, peers, and family members are almost never willing to offer these supports.

I find that this is a hard concept for most neurotypicals to understand. It is hard to explain to neurotypicals how overwhelming the world is for autistic people. Neurological studies of autistic people show that we have something called hyperconnectivity: atypically high whole-brain activity and connectivity between neurons. For us, this feels like we always have every window in the browser open, each with music playing, and we can never shut it off.

How can we use this information to reduce suicidality in autistic adults? We need to create workplaces with fewer social demands that allow autistic adults to have flex time and quiet spaces. Allow autistic people to work and live in their own ways even if it is weird or different. Currently, I am a happy, thriving autistic adult and I find that what most autistic adults who are thriving have in common is environments that support neurodiversity. I can work for 80 hours a week for 2 weeks and then take one week off. I can find quiet space in my home and work environment when I am overwhelmed. I am comfortable bringing my service dog to the places where I need him. The others in our autistic adult group who are also thriving have similar work environments. Many are engineers who have jobs that allow them to work at their own pace if their work is done. They aren’t expected to be master communicators or to master neurotypical social skills. No one at work complains if they are “socially awkward” as long as they get their job done.

On the flip side, those in the group who are struggling are in work environments and home environments that expect them to network, go to meetings, and conform to unnecessary neurotypical social norms even if it isn’t part of their job requirements. They must go to places on the regular with no supports in place. This is where the work needs to begin for the mental health of autistic adults. Not with teaching them to change, but by creating a world that supports their needs so they can flourish.


The shame of it is informally we had elements of what she is talking about but ditched it about 30 or 40 years ago. If you were a salesperson you needed to be able to socialize. If you were an accountant or computer programmer not so much. Reasons this changed is fear that non team players will sue you or shoot up the workplace. The hypersocial expectations are more comfortable for bosses who tend to be extroverts.

The emergence of remote work mitigated that to a degree. Unlike 50 years ago remote work means you do not have to be tied down to certain hours. Unfortunately now that the pandemic is “over” there is a backlash against remote work but in my opinion there is no going back to 1980.


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Professionally Identified and joined WP August 26, 2013
DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity

“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman


carlos55
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04 Mar 2024, 10:43 am

I work remotely and it certainly helps. It’s great that the range of good jobs open to autistic people has exploded inadvertently due to COVID homeworking initiatives.

I once remember Mona saying she wanted the end of the open office, that would be good for the small no of days when people are expected to office work, but unlikely but at the same time I don’t think we need to worry so much about that anymore to the same degree.

Of course sadly many autistic people will be unable to work and with remote office and the removing old barriers will come the realisation that it’s their neurological condition that prevents this rather than society.


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"The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends upon the unreasonable man."

- George Bernie Shaw