Yesterday, I had a discussion with a nurse, who said that I am very mildly autistic, if I’m autistic at all (which she can’t comment on of course). This got me thinking, because I know that in some respects, I’m not stereotypically autistic, but then again, that’s not the same as not being significatly affected by autism, is it? I am for this reason posting an updated version of a post I wrote several years ago about what mild autism is. I wrote a list of common assumptions similar to the one on high-functioning vs. low-functioning autism, and am going to add some more.
- Mild autism means Asperger’s Syndrome. This is a common assumption among auitsm advocates trying to discredit people with an Asperger’s diagnosis. Indeed, it is true that people with Asperger’s diagnoses in DSM-IV-TR must not have significant impairments in cognitive or language abilities, but having an IQ above 70 and being able to speak, says little about real-life functioning.I know that adaptive functioning cannot have been impaired in early development either. In this case, I was misdiagnosed with Asperger’s, but then again maybe my adaptive functioning impairments were presumed to be due to blindness. The DSM-IV-TR expanded text uses other differentiation criteria, like “active but odd” vs. “passive” social behavior. Again, I am passive, as are most women on the autism spectrum.
- Mild autism means the person has an IQ above 70 (or 85, in some cases). This doesn’t say anything about one’s autism, but about the presence or absence of comorbid intellectual disability. Why would the severity of one disorder be defined solely by the existence of another disorder?
- Mild autism means the person meets fewer criteria. Relatively speaking, then, again, Asperger’s can be considered to be milder than autistic disorder, because for an Asperger’s diagnosis, you need to meet only three criteria (out of eight), whereas you need six (out of twelve) for an autism diagnosis. I could be considered to have moderate Asperger’s, because I meet five criteria (as I walk myself through the DSM-IV-TR right now, I forgot how many I met during my diagnostic interview). However, most people with an Asperger’s diagnosis will in fact meet some criteria from the “communication” set that isn’t included with their diagnosis, but less obviously than those with an autistic disorder label (I for one have periods when I use a lot of repetitive language, but am generally judged to have normal communication). Also, some people experience more trouble due to one area of impairment (eg. repetitive behaviors) than another, and may therefore meet fewer criteria but still be equally severely impaired. And, of course, I’m not even speaking about those autism symptoms that haven’t made it into the DSM-IV, like sensory processing differences, executive dysfunction, etc. I for one find these particularly impairing.
- Mild autism means few behavioral problems, like aggression or self-injury. Even though this is often assumed to be a logical determiner of severity, these problems aren’t anywhere in the DSM-IV-TR or DSM-5 as far as I know. I got this one thrown at my by my therapist and social worker. They don’t realize that I’m heavily medicated and that, besides, my aggression/self-injurious behavior is considered a symptom of my borderline personality disorder.
- Mild autism means the person can live independently, keep a job, etc. This may in fact be the most accurate determiner of functioning, and it has made it into the DSM-IV-TR as one’s axis V GAF (global assessment of functioning) score. The problem with this very raw guess about one’s ability to function in daily life, is that of course someone may function alright in one area and not function at all in another. For example, I am at this point unemployable for reasons related to my autism (of course I am unemployable for reasons related to my lack of education, too, but that is not the point) and cannot live independently, but I can be in a romantic relationship.
- Mild autism smeans needing little structure: this has made it into DSM-5 as the repetitive behavior severity determiner. I got this thrown at me yesterday by the nurse saying I didn’t need ltos of structure. This may be so, in that I do not attend day activities nine-to-five, but this is mostly because I have such severe sensory and cognitive overload issues that I cannot function in a group for any extended period of time. I also avoid needing support a lot by for example staying in bed all day.
- Mild auism means being able to hold a conversation. This is in DSM-5 as the social communicative impairments determiner of severity. I can hold an okay one-on-one conversation, but then again, I’m passive, not active-but-odd.
I do realize that I’m not severely autistic by many of these determinants. This, a gain, however, does not mean needing little support. In fact, on a busy ward like mine, it is required that you actively ask for support when yo need it. That is particularly hard for me, so I’m told I a pretty self-reliant. This inability to ask for support has led to a few pretty awkward situations lately. For example, yesterday night, I couldn’t sleep, but when going to the night staff, I was met with: “So what can I do for yu?” Well, I didn’t know, so I went back to my room and was up all night. When, a few hours later, I was feeling very much on edge, I self-harmed to calm myself because I knew that I didn’t know what else to do and I knew the staff wasn’t going to help me anyway. I haven’t told the staff about my self-harm, because I reckon they’ll chalk it up to BPD-related attention-seeking if I do.