Category Archives: Classic Autism

Is an “autism community” a dangerous mirage, or a valid social construct?

LEGO puzzle piece (3)

I have recently been asked on Twitter the following:

“I’m going to ask a question but you don’t have to answer. So, I just started wanting to understand autism better since my son was dx, and I know the best knowledge comes from those actually in the community. Anyway, I imagine as you get (o)lder* it’s important to have an understanding community you can relate with; so why is this community so divided? I’ve seen many very respectful, but I also saw some downright cruel to one another. And guess my question is what happened, why [Are]* there some people in this community that [are]* so viscous and vile? I just can’t understand why a few are determined to tear others down?”

The question which I read at 06:26 this morning, grabbed both my mind and heart with its absolute, wise candour, prompting my following answer thread:

“A real “autism community” is a mirage, generated from noble intentions, an illusion however, because Autism is the epitome of individualism, defying any true group cohesion. 1->”

“Further, since Autism is characterised by polarised thinking patterns, it inevitably generates extremes, which will inevitably clash. This unfortunately, will tear down any attempts to create a monolithic unity, leading to “factionism”, dominated by belligerence and loudness. 2->”

“The ONLY way of mending this self-generated gap, is rationally accepting the legitimacy of situational truths, where valid, evidence-based fragments of an endless reality, are allowed to be mutually/reciprocally used as building bricks of a developing understanding of Autism. 3->”

“The Puzzle Piece was a valid beginning. However, the time of the LEGO brick has come. LEGO bricks are the best descriptors for infinity, better than the closed-circuit Mobius symbol, because they can’t be practically “complete”. Anything meaningful in LEGO must be agreed. 4->”

“And real-life agreements are reached only through the mutual acceptance of any remaining disagreements. Autistic nirvana is real. It is the simple acceptance of a perfectly autistic dichotomy of open ends, where for every aspect there will be an anti-aspect. 5->”

“Once un understanding has been reached about the fact that the very existence of “disagreement” as a concept, is guaranteed by the pre-existence of a concept called “agreement”, mutual acceptance becomes possible*. Life itself is built upon acceptance-rejection, yes-no. 6->”

“What makes us human nevertheless, is an understanding of this dichotomy, a rational acceptance of the axiomatic right of every disagreement to live in the protective shadow of an* agreement. The only other alternative is war, ultimately mutual annihilation. I’ve chosen therefore, the * LEGO way*.”

As you may see, I have intentionally left everything twitter-formatted; because it best covers the core essentialism of my thought, summarised in the last tweet:

“The only other alternative is war, ultimately mutual annihilation.”

I’ve seen and experienced cruelty and meaningless trolling on twitter, which has left me scarred for a lifetime. Lives on the brink of emotional ruin, behaviours which in a real-life scenario could seriously extend someone’s psychiatric hospitalisation, all for the almighty sake of winning oftentimes questionable arguments.

Much of the time I have spent on this platform hijacked by extremism and abuse, it was time robbed away from the duty I have due the talents I’ve been bestowed upon, a waste of energy and resources, with one apparent reason, an unwarranted albeit necessary dive in the rabbit hole of my own darkness and fears.

I’ve seen and experienced enough, time has come to move on.

I will start by unblocking all those (quite few unfortunately), of whom I believe to have seen a side different than the one I may have encountered while incidentally intersecting with their own, rabbit hole dives.

I will carry on building my side of what I believe to be valuable in a dialogue, at the moment between the moderate pro-ND and ND-critical sides, awaiting any reasonable proposals to interconnect with similarly minded individuals from the “other” side. The fact that individuals find themselves on either side of Neurodiversity, may show an interest, an eagerness to maybe find valuable aspects and details for a much necessary common ground. Exception from this willingness concern those determined at this time to trivialise the Medical/Clinical Model of Disability, together with those seeking to do the same about the Social Model of Disability in regard of their relation to neurodivergent conditions.

I am to this end, openly and respectfully calling Judy Singer @singer_judy to a constructive dialogue, away as much as possible from twitter, of reconsidering Neuro-Diversity from the perspective of nearly three decades since the concept saw the “light of day”.

It is a rather desperate call, rooted in my unwillingness to passively witness the annihilation of a genuine possibility for progress and development, long due in the lives of autistics, individuals with autism, their dedicated families and carers. We are already witnessing the disastrous results of a derailed neurodiversity militantism, in the lives of families having had drastic, valuable government funding reductions, following biased and unwarranted lobbying by groups unwilling to see beyond subjectivism in regard of effective behavioural interventions.

This is also an invitation to all those who are willing and capable for as much as possible to lay down or bury the hatchet of past grievances and participate in such a dialogue. I am aware that many such grievances have gone too far into the realm of personal offensiveness, having maybe left irreversible emotional trauma and scars. And while forgiveness is always on option, it doesn’t come for granted. It is up to every one of us, to seek, give or receive it as individually considered, because I do not see the Stockholm Syndrome an option for cooperation.

In my title, I ask, “Is an ‘autism community’ a dangerous mirage, or a valid social construct?”

I believe that if it becomes bound to a hive-mind, with enforced, rigid language policing and taboo subjects, it is no better than an aggressively militant mob, a mockery and indeed a dangerous mirage of a dystopian “community”.

A genuine community allows for growth, change and constructive debate, where all members have equitable rights and responsibilities, aware that behind all objectivity, hide real lives of individuals with subjective ideas, behaviours and needs.

[Rev.] Romulus Campan LTh (Hons), FDScMH (Forensic), CertEd, QTS,
PgCert Religion, Spirituality & Mental Health,
PgCert Special Psychopedagogy,
PgCert Autism & Asperger’s
Chair, Disability & Neurodivergence Staff Network – BSMHFT

*later addition

-original image: https://www.pinterest.es/pin/403635185323282537/

Advertisements

A critical introduction to “The nine degrees of autism, a developmental model” (editors Wylie, Lawson & Beardon, 2015) -1-

dsm-bibleFew may remember, even from amongst the book’s actual readers, that its complete title is “The Nine Degrees of Autism, a Developmental Model for the Alignment and Reconciliation of Hidden Neurological Conditions” (editors Wylie, Lawson & Beardon, 2015)
The necessity of mentioning the book’s complete title is justified by a title’s further reaching implications. With scarce (mediocrity justified) exceptions, the title of a written work carries deeper summarising intentions, oftentimes a book’s legacy, if any.
Since its 2015 publication, the Nine Degrees has become for some autistics -according to some of their Social Media accounts- their “Bible”, however, the book has remained lesser known than some might have hoped considering its authorship of fairly well-known autism and Asperger’s specialists. The reason in my opinion, could be exactly the clear structurally different autism narratives embraced by its many authors through their scientific and academic backgrounds.
Because co-authorship of scientific works carries with itself the ever-present danger of maybe losing its “essence”, often divergent amongst authors; because while “essence” has a grammatical plural, in a scientific endeavour a plurality of essences could be detrimental, even confusing.
Being nearly impossible to comprehensively review a book by so many different authors, this short introduction has been written with an openly acknowledged intent of revealing a conflictual situation caused by the influence on the book, of an extremely poorly considered (un) categorisation of the autism spectrum, by authors of the DSM 5 followed by the WHO’s ICD 10/11. And since from amongst authors Tony Attwood took upon himself the indeed difficult task of writing a pertinent “introduction” to a complex, co-authored book knocking on misty doors still hiding the autism’s complicated secrets, it will be exactly his introduction, the subject of this introductory critique.
My task is greatly facilitated by Prof Attwood’s compact, nevertheless conceptually rich academic style, however, beyond this rather personal style matter, my choice was motivated by indeed the representative content of his summative introduction, reiterated degree by degree, by the book’s many authors.
As most may remember, Attwood has gained a well-earned international reputation as a clinical specialist and academic in the developing field of autism spectrum disorders, especially it’s Asperger’s syndrome subcategory. For many, many years, discussions around autism rarely missed Prof Attwood’s valuable insight in the -mainly- behavioural aspects of autism, emphatically Asperger’s syndrome.
Generations of seekers found answers in the clinically documented accounts of individuals diagnosed with Asperger’s syndrome often aligned side-by-side with aspects of individuals from the general category of “neurotypicals”. However, and rather unfortunately, my notes will not dwell on Prof Attwood’s unquestionable contributions to the field of autism research, but on what I identify as a caveat to the chaos caused by the unwarranted -with devastating consequences- interference in the autism narrative of Judy Singer’s new-age infused “neurodiversity” derailment, followed by Silberman’s brilliantly written gay-rights movement influenced book, which continues nevertheless to undermine not only the desperately needed Autism research, but also the desperate efforts of individuals and families affected in life altering ways by not only autism, but also by disastrous, government dependent social support reduction consequences, for people with very little or no capacity of understanding the world around them, incapable therefor of autonomous/independent living. And instead of having the social support sphere’s efforts channeled towards finding and defining the best ways of supporting in an individually established way all individuals affected by autism, opportunistic sociology and fame seeking journalism are leaving literally millions in the shadows of a limelight hijacked by a militant, identity confused minority. Because until autism and its multi-faceted Dependency Model will be understood, the only “beneficiaries” of this -short lived- “fame” will be those profiting from “teaching” individuals and organisations about how to expect from all these “cool” “neurodiverse” autistics to happily look forward to the golden age when with a few, low-cost “social adjustments” they will be fully accepted as simply another “tribe”, the “neuro-tribe”, by the “happy” community of this newfound tribalism.
It is not however, the short study’s purpose to expose the sad, irresponsible attitude exhibited by individuals having virtually weaponised Singer’s -in her own words- “sacrosanct” neurodiversity concept, against any opposing views and “opponent”, many of whom are hard-tried parents of ASD children. These “neurodiversity vigilantes” have made and are actively making their way as far as government advising bodies, “coincidentally” governments responsible for sadistic reductions of funding for proven, successful therapies such as ABA, simply because the #NDcult decided to demonise something they have no understanding about. And governments have never been shy of loving anything cost-cutting…
Returning to the title, the reader has to remember the rather silent mention of what the authors agree to be referred on the cover as a “developmental model”.
When I first saw the book’s title, I was hopefully intrigued, expecting maybe some viable alternative in the unwarranted war between proponents of the medical and the social models. Instead, upon opening at the under-cover page, I was surprisingly informed that this -according to the editors- “ground-breaking” model is a “positive tool” for understanding autism’s “developmental process”, meant to “facilitate the improved mental health and well-being of individuals on the spectrum”, which should “encourage people on the spectrum” to positively “accept themselves by focusing on their gifts”… (emphasis mine)
Unfortunately, my hopes of having maybe found a reconciliatory model, fell sadly apart upon reading the -hidden in plain sight- bias of the editorial team, against what’s mentioned as “negative medical classifications”.
I am not entirely sure that the de facto authors of the book, especially the internationally respected academics of complex -much more than behavioural- medical sciences, were aware that their contributions will have as foreword a clearly subjective bias, basically setting their “negative medical classifications”, and therefore much of their scientific, medical associations with these “classifications”, against the editorial team’s self-proclaimed “positive” approach.
Few are probably aware of what theologians acknowledge as the “principle of the first mention”, which asserts that the conceptual and contextual first mention of a thought/principle within an autonomous writing, letter, scriptural book, et cetera, will set the thought/principle’s definitory influence throughout the writing.
I am therefore obliged by virtue of my interpretative training, to observe that mentioning this bias on the book’s very first page is in fact a declaration of the editorial team’s assumption, about their own model’s “superiority” against other “negative medical” models.
Returning once again to the title, might leave one wondering about its meaning; meaning which stubbornly eludes me to this day, failing at each reading to understand the meaning of a developmental model, “for the alignment and reconciliation of hidden neurological conditions”. My bewilderment isn’t at all helped by the book’s aforementioned trend setting first page, which as previously mentioned, attempts to apply da capo the proposed model, to other “hidden” neurological conditions such as dyslexia, dyspraxia, apraxia, and ADHD, because as the unfortunate recipient of most mentioned disorders, I fail to grasp how am I supposed to see anything positive in often antagonising conditions constantly competing for the last patches of my shrunken sanity, leaving me daydreaming day after day of past “positive experiences” of which I’ve never been part.
If anyone reading my thoughts and deciding to read the book will have arrived at a conclusive understanding of the meaning behind “a developmental model for the alignment and reconciliation of hidden neurological conditions”, let them kindly approach me for a much sought-after enlightenment. Because as much as I am trying to grasp even the syntactic coherence of it, I am constantly thrown back to square one reading that the book’s title and therefore presumed subject, were conceived by one of the editors, “during his identity alignment process while writing a book about very late diagnosis of Asperger’s syndrome”.
Now again, my theological training of connecting metaphysical dots, became useful at proving right a feeling about this “identity alignment” concept, which could be related to the presence amongst co-authors of a “shamanic healer”, whom seems to have transformed the very complex “identity crisis” concept, into an even more unfathomable “identity alignment” concept. As a fairly well read theologian, I am no foreigner in the ever fluid lands of spirituality -shamanism included-, being left baffled nevertheless by the “necessity” of introducing metaphysical concepts into an already abused, autism narrative, where confused and burnt-out autistics and/or parents of severely handicapped autistic children, are forced to battle governments and powers to be, callously insensitive to their plight.
But that again, isn’t at the purpose of my thoughts…
The overall, conclusive purpose of this first part, of a “to be continued” introduction, is my utter failure to understand how authors with a valid, evidence based understanding of both autism and Asperger’s, have engaged in writing -some of them- absolutely valid perspectives of their own scientific fields, “forgetting” to clarify that actually MOST of the book is written about and for the subcategory of autism known as Asperger’s syndrome, and no one, not even the DSM 5 or the ICD 10/11 with their arbitrary removal and attempt to annihilate Asperger’s as a subcategory of autism, can change the fact that basically nothing written in this book could be applied to any other category of autism besides -mostly- Asperger’s syndrome and high functioning autism.
Writing a book about “autism”, when most of it doesn’t apply -as implied by its title- to the entire Autism Spectrum, but only to a segment which far from neutral medical authorities, want for undisclosed reasons to obliviate, is unfair, unscientific and ethically questionable; raising false hopes followed by depths of despair, for many parents of children with severe, High Dependency Kanner’s or Asperger’s autism.

(to be continued…)

*Image credits: https://psmag.com/social-justice/dsm-psychiatry-diagnostic-bible-mental-disorders-58075 

Proposing the “Medi-Social© Model of Disability and Neurodivergence” II -The Unwarranted Bias of the Social Model of Disability and Neurodivergence-

Medi-Soc Mod Neurodivergence Title Pic 1

The late Prof Mark Oliver, presented on 23rd July 1990, at the Joint Workshop of the Living Options Group and the Research Unit of the Royal College of Physicians, a paper titled “THE INDIVIDUAL AND SOCIAL MODELS OF DISABILITY”, where he wrote:

“The genesis, development and articulation of the social model of disability by disabled people themselves […] does not deny the problem of disability but locates it squarely within society. It is not individual limitations, of whatever kind, which are the cause of the problem but society’s failure to provide appropriate services and adequately ensure the needs of disabled people are fully taken into account in its social organisation. […] Why then is the medicalisation of disability inappropriate? The simple answer to this is that disability is a social state and not a medical condition. Hence medical intervention in, and more importantly, control over disability is inappropriate. Doctors are trained to diagnose, treat and cure illnesses, not to alleviate social conditions or circumstances. […] Disability as a long-term social state is not treatable and is certainly not curable. Hence many disabled people experience much medical intervention as, at best, inappropriate, and, at worst, oppression.” [emphasis mine]

I have deliberately chosen to ignore for the moment, the infuriating, existential, onto- and deontological ineptitude of the “disability is a social state and not a medical condition. Hence medical intervention in, and more importantly, control over disability is inappropriate” statements, unwilling to divert from the purpose of this study.

I have nevertheless, emphasised the “Why then is the medicalisation of disability inappropriate?”, in order to point the reader to a major source of what the proponents of the Social Model of Disability (SMD) are increasingly advocating as the ‘de-medicalisation’ of disability, and more precisely in the context of my study, of Autism, through what has become an increasingly militant -and in my opinion increasingly divisive- movement called Neurodiversity (NDv).

Why do I perceive this, as an unwarranted derailment from the principles of the Autism Act 2009? Because the Act’s “1 Autism strategy” states “(1) The Secretary of State must prepare and publish a document setting out a strategy for meeting the needs of adults in England with autistic spectrum conditions by improving the provision of relevant services to such adults by local authorities, NHS bodies and NHS foundation trusts”, therefore in my educated opinion, any Autism strategies antagonistic of the medical/clinical aspects of Autism, contravene to both the spirit and the letter of a legal framework mandating such strategic responsibilities also to the UK’s NHS.

Far from being of an isolated incidence, according to the “DEMAND FOR AIMS AND SCOPE” of a renewed effort in 2018 to restart the “Autism Policy & Practice Journal”, “Recent years has seen the growth of autistic activist academics aligned to the neurodiversity movement”.

The Neurodiversity Movement (NDvM) is home to an Autism Rights Movement (ARM), introduced to the larger public by Andrew Solomon in 25th May 2008 as:

“The Autism Rights Movement – A new wave of activists wants to celebrate atypical brain function as a positive identity, not a disability. Opponents call them dangerously deluded.”

Unfortunately from the perspective of the past nearly three decades, Judy Singer’s “sacrosanct, universal truth” legacy, which I have discussed in one of my previous articles, seems to have completely missed Prof Oliver’s paper’s core target, clearly stated as having been written “on PEOPLE WITH ESTABLISHED LOCOMOTOR DISABILITIES IN HOSPITALS”!

In all honesty, I have always had a sense of derailment when confronted with the ridiculous claims by NDvM’s proponents, of the Social Model’s applicability in Autism, which turned out to be somehow subconsciously linked to Prof Oliver’s exact goal with his paper, i.e. the inpatient needs of individuals with locomotor disabilities! And to ensure fair justification for my judgement, it was Prof Oliver himself, in an interview with the National Union of Students UK posted on 22nd Nov 2018, who said the following:

“The two main criticisms are one, that the social model doesn’t take account of the experiences of impairment, in other words you know, as disabled people we have, we do have medical consequences and so on we do have, sometimes we feel pretty shitty about ourselves in our lives, sometimes we’re real just like non-disabled people […] but the social model was never designed to do that…” [emphasis mine]

In other words, it becomes obvious that despite the clear and harsh anti-medical attitude of the 1990 paper, Prof Oliver seems to dissociate himself of the snowball effect on his 1990 stand, claiming that the Social Model was never designed to consider individual experiences of impairment and their medical consequences, which in my opinion and context, include the severe, debilitating physical, psychological and emotional consequences of living with any and all forms of Autism and other Neurodivergent (NDg) conditions, but especially severe, Higher Dependency Autism!

It doesn’t take much investigative research for one to understand that this nearly three decades-long “misunderstanding” of the SM’s intended goals resulted in a many-headed hijacking of disability rights from generations of individuals living with Autism Spectrum conditions by an elitist, Lower Dependency, Intellectually Proficient wave of diagnosed autistics and their “self-identified” club. All this with detrimental consequences for especially those having to rely due to the severity of their disorder(s)/condition(s) on their oftentimes exhausted and desperate families, left year after year without vital assistance and help by their local governments, at the dire mercies of social services without much competence in Autism and Intellectual Disabilities.

And if most would expect that self-proclaimed “national” spearheads of autism expertise are working hard to give all individuals with Autism Spectrum Disorders and/or their dedicated families a stronger, more meaningful voice at the dialogue tables where more favourable decisions are made, they’re heading for disappointment.

Reading through the National Autistic Taskforce’s (NAT) “An independent guide to quality care for autistic people”, encouraged by being informed from the start that “This guide is authored entirely by autistic people” (pg 3) also that “We seek to ensure autistic voices are included alongside those of families, policy makers and professionals” and knowing from a lifelong personal, pastoral, educational and clinical expertise, the unquestionable importance of family infrastructures for the support of Autistic individuals, I applied to the 54 pages-long document, a search for the word ‘family’. To my surprise -and dismay-, the result showed a meagre 13 (thirteen) words, which as much as I would hope to be wrong, reveals a narrative in which family doesn’t seem to be considered the supportive and protective structure around the centrality rightfully assigned to the autistic individual. At a closer look, my fears don’t seem entirely unjustified:

“A particular challenge is that “the rights of autistic adults to autonomy … includes the right to make decisions that others may consider unwise.” (P.20 National Autism Project, The Autism Dividend (2017) citing Mental Capacity Act principles) […] Staff, service users, family, friends and other interested people must feel confident and comfortable in recognising and challenging policies, practices and assumptions which are risk averse or undermine autonomy.” (pg 10) “Have a designated member of staff (preferably a Communication Support Worker (CSW) responsible for exploration based on observations and trials to find the most appropriate communication systems for individuals […] responsible for helping each person initiate and maintain contacts with family and friends, and people in positions of authority (such as professionals).” (pg 13)

The reason why my fears don’t seem at all unjustified is the fact that besides noticing that it took 13 pages for the document to mention the third occurrence of the word ‘family’, it does it in a context where the family’s supportive and protective rights (with a partially justified caveat in cases of prolongued institutionalisation) are undermined by the intercalation of a CSW, whom seems to be expected to act as a ‘guardian of autonomy’ including situations when this could mean “unwise” decisions and actions, apparently also “responsible […] to find the most appropriate communication systems for individuals” and for “helping each person initiate and maintain contacts with family and friends, and people in positions of authority (such as professionals)” which I would presume imply medical/clinical professionals. I shouldn’t probably wonder why a similar search using the word “medical” returned “No results”…

However, it beggars belief as to why would a “staff member” other than e.g. a family member or a highly competent clinician, intercalate to help “initiate and maintain contacts”?

The answer to my question is to be found on pg. 3:

“The more autonomy a person has, the less support services need to rely on external authorities such as good practice guides, instead looking to the person themselves as the primary source of information, instruction and guidance. The intention is to move beyond co-production towards autistic leadership. This guide sets out some of the practical details involved in achieving self-determination for autistic people.”

The major problem with this maybe otherwise laudable effort, (which echoes nevertheless Prof Oliver’s idea of “oppressive medicalisation”), quite obvious from introductory statements according to which “This guide is authored entirely by autistic people with extensive collective knowledge and experience of social care provision to autistic people” (pg 3) and “Critical to the success of the National Autism Project has been an advisory panel of autistic people who provided expert input and critique throughout” (pg 7), is an apparent exclusion from authorship, of family members providing the care for Higher Dependency autistic individuals, and equally important their clinical teams.

It is also clear from all these statements that as mentioned on pg 3, this guide has been authored by “autistic people with extensive collective knowledge and experience” of absolutely nothing else but “social care provision to autistic people”, and therefore severely lacking the prerogatives to indeed become a nationally relevant guide for the overall health and wellbeing of not only autistic individuals themselves, but also their 24/7 care and dedication providing families.

Regardless of how benevolent one reads these pages, it would seem that neither the “oppressive” medical system (Oliver, 1990) nor the autistic individual’s family are being trusted anymore to promote, achieve and maintain their autonomy, this role being apparently assumed by the Social Model biased ideology outlined in the NAT’s guide, facilitated by a CSW “staff member”.

Interesting times are these for a theoretical philosopher; times when suspicions of bias need not to be justified by a thesis’ opponent, being readily provided by the proponents themselves.

Such could be the case, reading through the “Focus and Scope” of the “Autism Policy & Practice Journal” where the very first of the journal’s focus and scope is:

“To be an autistic-led (emancipative) good practice journal with a bias towards social model based adjustments and good practice.” [emphasis mine]

Now, I am aware that paraphrasing one’s indulgence towards themselves,  “The finger of each saint points towards themselves” (Hungarian proverb). However, no Journal of Autism & Policy Practice, which hasn’t included in their title “A Social Model based Journal of …” should allow itself to have even a shadow of bias, not to speak about a declared, biased focus and scope. Please do not imply maliciousness when I wonder if this may have been the reason why one could read in its Archive, that “Unfortunately, due to lack of support this journal has been discontinued”; “Open Access Autism” should exist unbiased…

As I mentioned in my previous article, the “Medi-Social Model of Disability and Neurodivergence would holistically and intersectionally consider Neurodivergent conditions in their Medical and Social complexity, with a realistic emphasis on understanding these conditions through also considering the invaluable lived-experience of individuals living with these conditions, and/or the accumulated co-participative experience of their families, caregivers.

I can boldly assert that the structural elements of a Medi-Social Model of Disability and Neurodivergence have always been present in what has been known as the Medical Model, which could have never existed without its Social aspects, proven by the well-known existence of Multidisciplinary Teams, mandated by legislation to safeguard each step of an individual’s journey through their Recovery.

A Medi-Social Model of Disability and Neurodivergence would open the possibility of exploring new and necessary horizons of how all participants in these multidisciplinary teams, such as the individuals themselves, their caregivers, their clinical team, their social worker team etc, could change the Recovery Pathway Dynamic from a Clinical-Team-dependant hierarchical, to a Multidisciplinary Co-participative/Intersectional.”

 

(to be continued…)

Proposing the “Medi-Social© Model of Disability and Neurodivergence” I

[Rev.] Romulus Campan FDScMH (Forensic), LTh (Hons), CertEd-QTS,
PgCert Religion, Spirituality & Mental Health,
PgCert Special Psychopedagogy,
PgCert Autism & Asperger’s

Medi-Soc Mod Neurodivergence Title Pic 1The Medi-Social© Model of Neurodivergence Logo-Created by Romulus C.

The Medi-Social Model of Neurodivergence is an alternative to the prevalent Medical and Social models of Neurodivergence, applicable to the following, commonly accepted as, Neurodivergent conditions:

The Medi-Social Model of Neurodivergence could also provide a replacement to the imbalanced Psychiatric perspective of the Medical Model and the derailed Social Model Militantism, proposed by the “Neurodiversity Movement” and its ‘biodiversity’ dilettantism.

This Model would holistically and intersectionally consider Neurodivergent conditions in their Medical and Social complexity, with a realistic emphasis on understanding these conditions through also considering the invaluable lived-experience of individuals living with these conditions, and/or the accumulated co-participative experience of their families, caregivers.

I can boldly assert that the structural elements of a Medi-Social Model of Disability and Neurodivergence have always been present in what has been known as the Medical Model, which could have never existed without its Social aspects, proven by the well-known existence of Multidisciplinary Teams, mandated by legislation to safeguard each step of an individual’s journey through their Recovery.

A Medi-Social Model of Disability and Neurodivergence would open the possibility of exploring new and necessary horizons of how all participants in these multidisciplinary teams, such as the individuals themselves, their caregivers, their clinical team, their social worker team etc, could change the Recovery Pathway Dynamic from a Clinical-Team-dependant hierarchical, to a Multidisciplinary Co-participative/Intersectional.

Reflections on the Psychopathology of Demand Rejection and Avoidance

1200px-Mud_Volcano_in_Gobustan_01[1]Honouring a long-due promise to Demand Avoidance researcher Richard Woods @Richard_Autism I will attempt to summarise a personal perspective of the psychopathology of Demand Rejection and Avoidance, conscious of the topic’s vast scientific interdisciplinarity, muddled unfortunately by rather recent research derails, causing unnecessary confusion and delays in therapeutically addressing valid psychotherapeutic necessities.

In this short article I will deliberately avoid citing/quoting any post Newson “P/E/DA” researchers, because of what I perceive as bias in their motives to establish a stand-alone diagnostic of “P/E/DA”, separate from the already existent Kanner’s and Asperger’s Autism Spectrum subcategories.

I will use instead as a lose structural frame, citations and my own personal interpretation of these citations on the topic of PDA from the National Autistic Society’s (NAS) webpage which under the “What is pathological demand avoidance?” subtitle, lists the following:

-“(PDA) is increasingly, but not universally, accepted as a behaviour profile that is seen in some individuals on the autism spectrum. (emphasis mine)

 -“This demand avoidant behaviour is rooted in an anxiety-based need to be in control.(emphasis mine)

-“the demand avoidant profile has been found to be relatively uncommon“. (emphasis mine)

-“People with a demand avoidant profile can appear to have better social understanding and communication skills than others on the autism spectrum and are often able to use this to their advantage.(emphasis mine)

-“uses social strategies as part of avoidance, eg distracting, giving excuses” (emphasis mine)

-“appears comfortable in role play and pretence” (emphasis mine)

-“Parents very often use the term ‘manipulative’ to describe this aspect of their child’s behaviour and will comment on how it seems to be their greatest skill(emphasis mine)

It doesn’t require an exceedingly vast (necessary however) mental health experience to understand and notice that nearly everything mentioned in the citations above, and also much of the source material, seems to extrapolate into a rather clear anamnesis showing similarities with subcategories of Personality Disorders.

There is a generally recognised divide between the Neurodevelopmental Autistic Spectrum Conditions which have a Genetic background, and the Psychopathological Personality Disorders which seem to have a Traumatic background, each with very much different approaches to what’s best in providing support to individuals diagnosed with these conditions.

Further, the NAS material states under “Guidelines for parents” that “tried and tested strategies used with children who have other autism profiles are not effective for their child with a demand avoidant profile. This is because people with this profile need a less directive and more flexible approach than others on the autism spectrum” which seems to me fairly similar to the approach of the Dialectical Behaviour Therapy, designed to help individuals with Personality Disorders. This in my opinion seems to be also supported in the advice by the same source that the “use of structured teaching methods, which can be useful for people with other autistic profiles if individual needs have been considered, are often much less helpful for people with a demand avoidant profile and need considerable adaptation. People with this profile don’t usually respond to structure and routine. An indirect style of negotiation is more likely to lead to them feeling the control over their learning that they need.” (emphasis mine) Again, in my opinion this appears to be in direct contradiction with what the NAS seems to be emphasising that “a person with PDA does not make a deliberate choice to not comply and they can’t overcome their need to be in control”, because “feeling the control”, negotiating and responding in an expected manner to this, does to a significant extent imply the repeated use of “deliberate” choices, not to mention the sharp contrast of this behavioural profile with the clinically proven stability provided to autistic individuals by “structure and routine”.

In conclusion, I am very much concerned that exactly at a time when the future of both Kanner’s and Asperger’s Autism research have been jeopardised by historical blunders caused by arbitrary decisions made by the respective APA and the WHO to dismiss decades of research into the differences between the two major Autism subgroups in their DSM-5 and ICD-11, scientifically questionable research is being used to include -in my opinion- primarily mental health conditions into a neurodevelopmental category.

Finally, I am genuinely surprised and deeply disappointed by the @Autism NAS’s indulgent participation in this far from clarified and at the moment highly controversial subject. Their carelessness in making unclear statements such as “PDA (pathological demand avoidance) is a behaviour profile within the autism spectrum” have already given grounds to some groups such as “The Jigsaw Tree” to claim that “Pathological Demand Avoidance (PDA) is now recognised as an Autism Spectrum Condition by the National Autistic Society.” I’m curious if the NAS @Autism would confirm this conclusion…

Maybe researchers should consider another path as suggested by Rebecca McElroy whom has noticed that “PDA describes a child who is primarily led by a need to avoid demands and control situations, struggles with social communication and relationships. However, these exact same characteristics could equally be used to describe a child with disordered attachment (NICE, 2015).”

Because in my opinion, the major difference between the Autism Spectrum and the Pathologic Demand Avoidance is that while the first is Neurodevelopmental the second is Pathological.

Ref: NICE (2015). Children’s attachment: Attachment in children and young people who are adopted from care, in care or at high risk of going into care. Clinical guideline, first draft.

Disclaimer: The interpretations and re-contextualised use of the citations from the indicated NAS website are entirely my own, and therefore do not represent in any form the official position of the NAS concerning PDA.

 

The Cognitive-Behavioural Interpretative Isolationism of Intellectually Proficient Kanner’s & Asperger’s Autism (IPKAA)© Part 3 – The Myth of “Weak Central Coherence”

012-salvador-dali-theredlist[1]

Part 3 – The Myth of “Weak Central Coherence”

(Rev.) Romulus Campan
FdScMH, LTh (Hons), CertEd, QTS,
PgCert Special Psychopedagogy, PgCert Autism & Asperger’s

‘Frith (1989) attempted to sketch out the preliminary theory that one deep underlying cognitive deficit in autism has to do with a lack of coherence. In other words, autistic people lack the drive to pull information together into overall meaning.’ Hill (2004)

Hill seems to continue Frith’s rather hidden mentioning of the fact that while she proposes her theory as a ‘deep underlying deficit’, a door has been left open to a ‘lack of drive’ which implies a selective-volitional aspect, with what she proposes as an ‘information processing style, rather than a deficit’.
The coherence theory postulates that incoming information is usually processed in its context. Now, while acknowledging that oftentimes communicated information is meant to be processed in some context, I don’t believe that noticing ‘needles in the haystack’ while paying no interest whatsoever to the haystack’s any aspect, should be considered a deficit, but rather a valuable control asset, through which the flow of information can be monitored for systemic accuracy. And the fact that autistics may decide to ignore the context in order to gain through focus, a deeper understanding of the detail which flagged their attention, does not substantiate that contextual coherence is the required norm, but as Hill suggests, a ‘cognitive style’, which no autistic should be expected to justify, an even less to change.
I am also a theologian. This means that I was trained, and apparently excelled in interpreting textual and contextual details way beyond the newspaper reading level. And since theology should be first of all philosophy, I was given the chance to observe and contemplate, also judge and analyse thoughts hidden away, sometimes even to their writers.
Now if I would take Hill’s above quoted text, and gaze upon it just superficially, but with a rather merciless analytical rigor, I should note the following about “autism”:
-Autistic people suffer from a deep underlying (basic/fundamental) cognitive deficiency, which is lack of coherence, leaving them without the “drive” (ability/willingness/capacity?) to see/understand meaning in scattered fragments of information.
Unfortunately, “thanks” to the unmandated vigilantism of a way too noisy herd of dilettantes, whom mostly out of genuine, however misplaced concern have come to oftentimes falsely represent the entire intellectually proficient Kanner’s and Asperger’s autism (IPKAA) community, autistics without cognitively impairing intellectual deficiencies/disabilities have been left stranded at the mercies of a mercilessly mercantile “healthcare industry”, for whom the daily torture of having ALL our senses tortured, our personal space assaulted, our meticulousness abused, our silence raped and our solitude violated, means nothing because we have degrees and jobs…
So, here we are, probably the most vulnerable and exposed of us, trying to convince an already biased world that there’s no such “thing” as “simply autism”, that the Autistic Spectrum has two, fundamental categories, the Intellectually Proficient and the Intellectually Deficient, fact which shouldn’t be tampered with by semantic militias resembling more and more to editors of 1984’s Newspeak. Proficiency and Deficiency are existential opposites present everywhere from our vitamin D synthesising capabilities to our intellectual capabilities and shouldn’t be subject to any thoughtless political correctness. As most of the well-meaning, dedicated and yes, oftentimes heroic carers of intellectually deficient autistic individuals expect that those they love and care for will be given assistance as required by their specific needs, we, intellectually proficient autistic individuals expect to be listened to and assisted as required by our specific needs.
I hope to be mistaken when I speculate that the reason why the profiteering “healthcare” industry has successfully manoeuvred the not so neutral DSM and ICD into practically grinding to a halt decades of extremely promising research into High-Functioning and Asperger’s Autism by obnoxiously dropping Asperger’s as a subcategory, is the fear of having to listen to the scientifically and experientially valid opinion of a new generation of extremely capable autistic academics, diametrically opposed to the reductionist and generalising, clinically flawed stereotypes by which it’s cheaper to provide helmets to intellectually deficient, self-harming autistics, than answers to intellectually proficient, self-harming autistics.

-Frith, U. (1989). Autism: explaining the enigma. Oxford: Blackwell
-Hill, E. L. (2004). Executive dysfunction in autism. TRENDS in Cognitive Sciences Vol.8 No.1, January 2004, 26 http://www.ucd.ie/artspgs/langimp/autismexecdysf.pdf

(to be continued…)

The Autistic Maelstrom …

The_Corryvreckan_Whirlpool_-_geograph-2404815-by-Walter-Baxter

In the new, updated edition of “The Autistic Spectrum” (2002), Lorna Wing offered on page 23 a brief history of the chaos which seems to continue to this day, surrounding risen and fallen efforts to decide the main, and sub-categories of what she identified as the Autistic Spectrum. In order to justify my statement, please allow me to quote:

“The changes in ideas about autistic disorders can be seen in the history of the two international systems of classification of psychiatric and behavioural disorders. These are the International Statistical Classification of Diseases and Related Health Problems (ICD) published by the World Health Organisation, and the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. The first edition of the ICD did not include autism at all. The eighth (1967) edition mentioned only infantile autism as a form of schizophrenia and the ninth (1977) edition included it under the heading of ‘childhood psychosis’.
The 10th edition of the ICD (1992) and the third (1980), third revised (1987) and fourth (1994) editions of the DSM take the modern view that there is a spectrum of autistic conditions and that they are disorders of development, not ‘psychoses’.”

On page 29 of the same book, Wing details the reasons for this nosologic maelstrom:

“When an autistic disorder is diagnosed, there is the further problem of deciding which sub-group in the spectrum the individual belongs to. Now that the term Asperger’s syndrome is being used more widely, parents and professional workers as well, want to know how it differs from other forms of autism. Since Asperger’s group, unlike Kanner’s, includes mostly those of average or high levels of ability, the main question is how to tell Asperger’s syndrome from high-functioning Kanner’s autism. There is no simple answer.” Because as she establishes further, while some individuals present all the features of either, other individuals fit neither of these symptoms precisely, having (as myself…) mixtures of features of both.

And we haven’t even touched the serious problem of symptomatic and existential gender differentials, which is becoming more and more obvious, at least for the individuals on the autistic spectrum, because for the diagnostic and assessment services (at least in the UK, in my understanding) the primary diagnostic differentials are only age related. However, the UK’s NAS (The National Autistic Society) proves a genuine awareness of the necessity for further research at http://www.autism.org.uk/about/what-is/gender.aspx

To make things even more confusing, the DSM-5 published in May 2013, factually canceled Asperger’s as a separate diagnosis and included it as an autism spectrum disorder, with adjacent severity stages. It mentions nevertheless, that “Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.”

But if one may think that the ICD-10 is of any better clarity, a quick look at its ‘F84.5 Asperger syndrome’ entry, reveals an opening statement which I would call at least seriously problematic: “A disorder of uncertain nosological validity“, as I’m not really sure that a standard international classification should be based on anything “uncertain”.

The reason for the rather thought-twisting title of this post, can be found in a well hidden -in plain sight- introductory statement, on an oddly placed (right after the front cover page, without obvious authorship or number) page of Uta Frith’s “Autism and Asperger syndrome” (2010) edited book, which opens its last phrase with the statement “Current opinion on Asperger syndrome and its relationship to autism is fraught with disagreement and hampered with ignorance”, followed nevertheless by the reassurance that the book “gives the first coherent account of Asperger syndrome as a distinct variant of autism …” I have insofar found the attempts to systematize Autism maelstrom-like, because as their aquatic correspondents, they absorb all concepts and definitions in their way, just to scatter them on devastated, more or less scientific ocean-floors, without seemingly ever considering that behind words and terminologies, are real-life human beings, suffering the oftentimes indifferent detachment of those we trust(ed) for a better life…

And this very statement would be exactly the conclusion-prelude to a series of open enquiries attempting to discover the adult, gender specific understanding of first of all, the most commonly and widely used autism screening tool, the Autism Quotient 50 (AQ-50). As an incentive for the reader’s personal consideration and most welcome comments, I am providing a link to a short scientific paper from the “Journal of Autism and Developmental Disorders, Vol. 31, No. 1, 2001” at http://docs.autismresearchcentre.com/papers/2001_BCetal_AQ.pdf

In my next post, I will attempt to offer for an even more personalized analysis and comments, the first ten (1 ÷ 10) questions of the AQ-50 autism screening questionnaire, in the hope of initiating a “real-life” and “Actually Autistic” blog-forum, where especially adults on the autistic spectrum can evaluate in a safe, anonymously confidential environment their gender specific, unique understanding of the relevance of these questions for their own screening and diagnostic assessments, in an atmosphere of non-belligerent acceptance, mutual respect, civilised ‘agreement to disagree’ attitude and constructive tolerance.

Most sincere apology to my readers and followers, and Word of Caution:

Having painfully learnt my lessons elsewhere, and in order to protect the emotional wellbeing and dignity of all well-meaning viewers and participants, all comments and replies henceforth, will be monitored and subject to approval. Therefore, if your comment and/or reply doesn’t show immediately, please be patient. But if your comment and/or reply doesn’t show at all, please rephrase!

Because no one shall be bullied or harassed in my own blogyard! 👾🤓

 

Photo credit: By Walter Baxter, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=33579199