ITMHD - autism

what is autism + the spectrum model

Concept	Details
Autism Spectrum definition	Not a “mild → severe” line. Instead: spiky profile showing uneven strengths/challenges across domains.
Purpose of the spectrum wheel	Helps identify individual support needs; communicates variability; used in assessment, therapy, and education.
Why autism matters in counselling	Higher co-occurring mental health conditions (Lai et al., 2019); more negative life experiences (Griffiths et al., 2019); harms of late identification (French & Cassidy, 2024).

DSM-5 criteria overview.

DSM-IV (Old)	DSM-5 (Current)
Autistic Disorder, Asperger’s Disorder, PDD-NOS	Merged into Autism Spectrum Disorder (ASD)

• core domains (must have difficulties in BOTH):

  • social communication & interaction.

  • restricted/repetitive behaviours (RRBs).

• extra requirements:

  • present early in development.

  • clinically significant impairment.

  • not explained by other conditions.

• severity levels:

  • level 1: requires support.

  • level 2: substantial support.

  • level 3: very substantial support.

DSM social communication & interaction criteria.

• 3 of 3 required

Area	What It Includes
1. Social-emotional reciprocity	Unusual back-and-forth conversation, reduced sharing of interest/emotion.
2. Nonverbal communication	Differences in eye contact, gestures, facial expression.
3. Relationships	Difficulty making/maintaining friendships; less interest in peers; difficulty adapting behaviour to context.

DSM restricted & repetitive behaviours (RRBs).

• 2 of 4 required

RRB Type	Examples
1. Stereotyped movements, speech, or object use	Hand-flapping, echolalia, lining up toys.
2. Insistence on sameness	Distress at changes, strict routines.
3. Fixated interests	Highly specific, intense interests.
4. Sensory differences	Hyper/hypo-reactivity (e.g., sensitivity to sound, seeking pressure/stimulation).

prevalence, gender & identification

Topic	Key Points
Prevalence trend	787% increase in UK diagnoses (1998–2018; Russell et al., 2021).
Gender ratio	3:1 Male:Female (Loomes et al., 2017).
Female underdiagnosis	More camouflaging/masking; stereotypes bias clinicians (Parsole, 2015).
Diagnostic barriers	Chronic underassessment, long waitlists, gender bias, self-identification common (Halsall et al., 2021).

biological explanations of autism

Biological Factor	Evidence
Genetic	High sibling recurrence (Hansen et al., 2019); strong twin concordance (Tick et al., 2016); gene variants (Thapar & Rutter, 2020).
Neurochemical	Dopamine & serotonin differences (Marrota et al., 2020).
Brain structure/function	Limbic system differences; atypical connectivity.
Comorbidity genetics	Shared genetic vulnerability with ADHD/ADD (Khachadourian et al., 2023).

cognitive explanations.

Model	Key Idea	Limitations
Executive Functioning	Planning, inhibition, flexibility differences (Demetriou et al., 2019).	Performance strongly influenced by response time (St. John et al., 2022).
Theory of Mind (ToM)	Difficulty inferring others’ mental states.	ToM performance does not predict autistic traits (Gernsbacher et al., 2019).
Empathising–Systemising (E-S)	Lower empathising; high systemising drives ASD.	Over-simplifies; risks dehumanising people.
Double Empathy Problem	Miscommunication is mutual between autistic & nonautistic people (Milton, 2012).	More accurate but less known in clinical settings.

interventions: medications & behavioural approaches

Intervention	Description	Notes
Medications	No drug treats autism itself; meds treat co-occurring conditions (anxiety, ADHD).	SSRIs, stimulants; mixed evidence; side effects common (Lim et al., 2021; Turner, 2020).
Applied Behaviour Analysis (ABA)	Behaviourist training to shape “desirable” behaviour.	Controversial due to ethics and negative outcomes (McGill & Robinson, 2021); Lovaas origins problematic.
Parent-implemented interventions	Daily-living and communication training at home.	Some benefits; concerns about parent guilt/blame.

inclusion & support strategies

Context	Effective Support	Issues
Education	Social modelling programs; tailored support.	Often not personalised enough (Olsson & Nilholm, 2023).
Employment	Supported employment models.	Support varies by employer.
Healthcare	Autism passports; reasonable adjustments.	Patients often forced to “educate” staff (Radev et al., 2024).

stigma, camouflaging & mental health

Topic	Key Points
Stigma (Goffman, 1963)	Autistic traits perceived negatively → worse mental health.
Camouflaging/Masking	Conscious or unconscious hiding of traits (Hull et al., 2020).
Negative outcomes	Burnout, delayed diagnosis, poor wellbeing, identity confusion.

diagnosis: formal vs self-diagnosis

Type	Benefits	Issues
Formal diagnosis	Self-understanding, access to adjustments, identity clarity (Ardeleanu et al., 2024).	Services overstretched; long waits (esp. Scotland).
Self-diagnosis	Improved wellbeing (Cooper et al., 2017); accessible; positive identity (Parsole, 2015).	Not always accepted; varies across services (Sarrett, 2016).

autism & chronic illness / pain

Area	Key Findings
Central Sensitivity Syndromes	ME/CFS, fibromyalgia, IBS; 21% diagnosed, 60% meet cut-off (Grant et al., 2022).
Pain	Autistic people report higher pain experience despite similar ratings (Zhang et al., 2021).
Alexithymia	Common in autism (Kinnaird et al., 2019) and chronic pain → affects pain communication.
Gender issues	Women’s pain dismissed (Lloyd et al., 2020); adds barriers in gynaecology, sexual health.