I have talked to many parents who highlight the ‘downside’ of Autism. They talk about their child’s challenges with seizures, ‘tummy troubles,’ sleep disturbances, dietary restrictions, anxiety, depression, and the list goes on. I acknowledge these challenges may exist for a child and I also wish they would just disappear. However, it is important to note that these things are not an innate part of Autism. Not everyone realizes that. Autism is advertised as the ‘Big Bad’ by even organizations supposedly hoping to help Autistic people and their families.
It is easy to want to blame any unfortunate thing on Autism. Seizures, anxiety, piranhas, the stagnation of minimum wage… But the reality is we don’t KNOW if these things are directly caused by Autism or if they would have presented even if the child was otherwise neurotypical.
Clinically speaking, this is how the APA defines Autism Spectrum Disorder (ASD):
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
1. Deficits in social-emotional reciprocity.
2. Deficits in nonverbal communicative behaviors used for social interaction.
3. Deficits in developing, maintaining, and understand relationships.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
1. Stereotyped or repetitive motor movements, use of objects, or speech.
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
3. Highly restricted, fixated interests that are abnormal in intensity or focus.
4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
(American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.)
Who knew diagnostic manuals were so dry, right? Long story short, Autism Spectrum Disorder describes challenges interacting in a way that the neurotypical majority finds appropriate and/or pleasing plus special interests, routines, stimming, and “sensory stuff” as an old supervisor used to say. That’s it. Now, what is listed here can certainly be challenging and stressful but – and here’s the moral of the story – We can’t blame Autism for every single thing that is not going the way we want. It is important to really explain to Autistic people and their families what is meant by the phrase ‘comorbid disorder.’ ‘Co-‘ from the Latin ‘cum’ which basically means ‘with.’ Not here is some ADHD to go with your Autism as though it were a side of fries, an irreplaceable part of the Happy Meal. With as in “I have a blue jellybean and I have an orange gummy candy, too.”
As I wrap this article up, I would be remiss not to give a nod to neurodiversity.
‘Comorbid disorder’ is about as pathologized as a term can get by implying multiple irregularities or faults. It is important to note that with multiple forms of neurodivergence also come multiple strengths.
For example:
“I have been diagnosed with both anxiety and depression. Both the anxious and depressive neurotypes impart deep thinking abilities but in slightly different ways. The anxious mind sees every possibility, both good and bad, while the depressive mind is acutely aware of human pain. Each skill is uniquely beneficial to me in my work as a clinical social worker. My depressive thinking allows me to genuinely empathize with my clients while my anxious thinking allows me to support families in avoiding difficulty and seeking out good fortune.”
So-called ‘comorbid diagnoses’ are just another opportunity to draw out and capitalize on client strengths.
