Saturday, 9 July 2016

The Birth and Death of the Triad of Impairment





So your child has just received a diagnosis of either autism or Asperger syndrome, so what does this mean? For your child to receive this diagnosis it means that they will have difficulty in three/four areas which are as follows. Communication, Social Interaction, Rigidity of Thought and Sensory Issues. Originally this was called the Triad of Impairment (A lot of individuals on the spectrum hate this because they say that all we neurotypicals do is focus on what someone with autism can't do and not what they can't, which is fair comment) Now imagine that these are interlocking circles, I use this to show how we as neuro-typicals (that’s our label) change all the time. One way of looking at ourselves is to say that we are many different people to many different people. Take communication as an example, how many of us have a telephone voice? One minute we are talking to the family in our regional dialect then as soon as the phone goes we suddenly turn into someone who is quite posh then no sooner have we done this and we realises it is someone that we know then we suddenly change back to our regional dialect. We also talk to different people differently, for instance you talk to young babies in a way that’s described as motherese, such as using over the top facial expressions and dramatically changing your voice. Now imagine if we used the same way of communicating with our manager at work, that interaction probably wouldn’t end well. The same can be said for the way we interact socially. In the press recently people have been getting into trouble at work because of what they have written on the social media website ‘Facebook’. The problem is that they have forgotten that they have befriended their friends down the pub and also their colleagues at work. The floor in doing this is that we present as different people to each social group and when we make a comment that our friends down the pub find funny we get into trouble. This is because if you had acted or spoke the way you do down the pub at work then you would not have got the job. For me what helps us adjust the way we are is our ability to have flexible thinking. We magically seem to just shape shift from different personality to different personality dependent on the social situation. When someone has autism you tend to get one version of themselves and regardless of the situation they can only be their one true self. During the course of this book you will come to realise just how complicated we neuro-typicals truly are.




Dan who has asperger syndrome and my-self were giving a series of lectures on autism in Gibraltar. The night we arrived we made our way to a local pub and began to chat over a glass of beer. As the night wore on we began to broach subjects that only friends should discuss i.e. politics. The next day whilst we were having breakfast Dan looked really worried so I asked him what was wrong. Dan told me that he was worried that I was going to get us deported, when I quizzed him further to find out why he told me it was because of what we were talking about the night before. He was convinced I would talk about our discussion with the group we were about to meet. I had to explain to Dan that Grant in the pub is in fact a different person than Grant the trainer and in no way would I jeopardise our trip or in fact my career and there was no chance of me saying anything that would upset or be deemed insulting to any group that I would work with. It took until the end of the day to convince Dan that I would stay true to my word.
Now inflexibility of thought helps you to do amazing things like see into the future such as predict the consequences of your actions. It also helps you to problem solve if things don’t go according to plan and helps you plan things such as your day or breaking down a task. Without this skill you would become quite anxious, which is a very common trait of individuals on the spectrum.





 The two manuals used for diagnosis are the DSM 5 http://www.dsm5.org/Pages/Default.aspx which is the American model or the ICD 10 https://en.wikipedia.org/wiki/ICD-10 which is the World Health Organisations diagnostic manual. The DSM 5 no longer uses the term Asperger Syndrome and has replaced it with ASD which is Autistic Spectrum Disorder. The DSM 11 which is due in 2017 will also follow suit and already in the UK some clinicians have stopped using the term Asperger Syndrome. The term the triad of impairment is also being phased out as it didn't sit quite right with the diagnosis of Asperger Syndrome. It is now referred to  as the diad of impairment which is Social Communication and Rigidity of thought or inflexible thinking and sensory issues. I will try to break down each category in the up and coming weeks.

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