Unmasking Autism: The Question You Need to Ask to Reveal Hidden Characteristics

Camouflage photo by Suzanne D. Williams on Unsplash

This post reveals the amazing truth that autism features can "hide in plain sight." Dr. Regan supplies the knowledge you need to unmask the characteristics of ASD in daily life.

Narrative: def

a spoken or written account of connected events; a story

We all have narratives about what makes us (and those around us) tick. For example, 

1. A father provided a summary of his daughter by saying, "She's very helpful and kind to others." 

2. The family members of one client described her as "controlling, manipulative, and dramatic." 

3. An adolescent described himself as "really social" and having many friends. 

The narratives are summaries about character, motivations, and behaviors. These descriptions can be helpful when trying to provide an "at a glance" summary to others. 

The problem is that autism often hides behind mistaken narratives. A clinician may not consider an autism diagnosis for the above individuals based on the descriptions provided.  

HOW TO PEEK BEHIND THE NARRATIVE TO UNMASK ASD

Whenever I hear a client present a narrative, I know I need to dig deeper.

This is my go-to question:

"What does social look like?"

"Tell me what helpful and kind looks like in her? What's an example." 

Let's go more in-depth with the original examples: 

1. "She's very helpful and kind to others." [Give me some examples of helpful and kind]

"Well, sometimes we go visit a neighbor or one of my work colleagues. If we get invited into the house, she likes to line up all their couch pillows so that they are even and arranged by color. One time, we found her organizing someone's refrigerator by lining up and grouping the food by categories."

2. She is "controlling, manipulative, and dramatic." [What does that look like in her. Give me some examples]

"For one, she spends two hours loading the dishwasher exactly the way she wants it. Everything has to be spaced out and even and in a certain order. Anyway, she had a complete meltdown yesterday when I loaded the dishwasher in my own way. She can't control me like that!" 

3. He is "really social" and has many friends. [What does social look like for you? How do you know when someone is your friend?]

"I love talking about trains. And I invite all my school friends to watch them with me down at the railroad tracks. They can't come, but I always include an invitation. That's a nice thing to do. I also make up games where they have to answer trivia questions about trains. Really everyone is my friend. I don't discriminate."

THE "AH-HAH MOMENT" WHEN ASD FEATURES ARE EXPOSED

"Oh!" You can picture me smiling and nodding my head, as I begin to understand the actual behavior patterns (as separate from the narrative). "This is starting to come together and make sense."

What I learned in speaking through the narratives above was:

1. Kind and helpful = a rigid concern for how objects are lined up and grouped in the environment.  

2. Controlling and dramatic = an inflexible adherence to routines or ritualized patterns of behavior with a resulting meltdown.

3. Social and connected with friends = the intense enjoyment of talking to others about a special interest and a lack of awareness of what friendship actually entails.

note: the above statements link the narrative with specific criteria in the DSM-5 about autistic characteristics.

Separating the narrative from the basic behaviors will often unmask the presence of any underlying developmental traits as described in the DSM-5 criteria. It is the unmasking that allows understanding, direction, and purposeful strategies for well-being.