Tag Archives: Executive Functioning

Detailing My Support Needs

Last week, I wrote about wondering why I seem to have high support needs. The painful truth is, I may never know the answer. After all, most neuropsychological tests that would show executive dysfunction, performance IQ tests and such cannot be administered to me because I’m blind. Even tests that can be administered may not show my actual performance in daily life, because a one-on-one testing situation is different from for example day activities in a group.

In 2013, we had the Center for Consultation and Expertise (CCE) write out my support needs in order to hand those to the local authority once I’d leave the institution so they could decide on care funding accordingly. All my needs were written down really vaguely, particularly those for day activities. I needed a place where I could do creative activities for at least four mornings a week. No detail was given to how much support I’d need doing those creative activities.

As it turns out, the CCE is unwilling to even see me again, as they judged from a phone call with my community psychiatric nurse that the main problem is my blindness. As such, I guess no-one will ever be able to help me detail my support needs, so I am going to write them out myself here. I will include the supports my husband provides me.

During a week day, I can get up, shower and dress myself without assistance. Usually, I eat yoghurt with muesli for breakfast, which I can prepare myself with some difficulty. However, when I spill food doing so, I usually either don’t notice or don’t remember or know how to clean it up. This is a source of irritation with my husband, as he doesn’t know whether I’m just too lazy to clean up after myself or there’s some genuine issue preventing me from doing it. I can’t put my finger on exactly what the issue is either, at least not when I do remember that I need to clean up. When I forget, I honestly don’t know what the issue is either, as I am not known to have a bad memory according to tests. All I know is that all the “rules” that I have to remember regarding proper cleaning up, feel incredibly overwhelming.

I take my morning meds without reminders, but my husband has to put them in my medication box. He does this once a week. My evening meds, I often forget even with a reminder. I have set an alarm at 8PM on my phone for them, but when I can’t drop what I’m doing at that moment and run right to my medicine box, I often forget to take them later.

I have finally learned within the last year to brush my teeth without reminders each morning and evening. I still have an aversion to the feel and taste of toothpaste, but have learned to tolerate it now, though I can’t manage to brush for two minutes. I often spill toothpaste everywhere. I do try to clean it up, but often I don’t see where I’ve spilled the toothpaste (on my face, my clothes, etc.). My day activities staff often remind me to clean my face and sweater even though I’ve tried to before leaving for day activities.

I arrive at day activities at around 8:45AM. Usually, the cab driver or a day activities staff helps me to my group’s room, though I think I could navigate the building independently if I really needed to. My day activities staff gets me a cup of coffee. At home, I can make a cup of Senseo coffee myself.

At day activities, I run into several different issues. First, I find it hard to decide for myself what I’m going to do when it’s free time or the staff are busy caring for another client. When I have something to do, for example an activity on my phone or a sensory activity that I can do independently, I’m usually fine unless I get distracted, ovelroaded or frustrated.

I can navigate my group’s room and the day center with some assistance. For example, when I need to go to the bathroom, I can usually find it by myself but need some assistance when for example someone has moved the toilet paper. I can sometimes go to the snoezelen (sensory) room independently, but usually a staff takes me there so they can see if I can find all the supplies I need there. At home, I move through the house without any assistance and without my white cane. I cannot navigate the backyard though and after nine months of living here still need some directions finding my way to the front door from the cab or my husband’s car.

My husband prepares my lunch for me, as this is bread with sandwich spread or peanut butter, which I can’t prepare myself. I need no other assistance during lunch time. During dinner, my husband puts the food on my plate. As of this week, I have a curved sppon, but I’m as of yet undecided as to whether it is easier to eat with it. I still spill a lot of food. Regarding drinking, I can sometimes pour myself a soft drink (depending on the weight/size of the can). I can if I really need to make myself a cup of tea, but for safety reasons I prefer to have tea only when my husband or support staff are with me. I can get water independently, but often forget to drink enough of it despite my husband having given me a one-liter bottle.

My husband cooks and does the cleaning. I sometimes, when I spill something in my own room, try to clean it up, but I tend to at least feel rather awkward doing so. I don’t have any idea as of how often to clean my room or whatever. This again annoys my husband, as he says I can do it.

The hard part is, I learned to do a lot of the things I now need assistance with independently when I was in blindness training from 2005 to 2007. It may be tempting to say the problem is my blindness and I just need more training. Here we come back to the beginning, which is that for whatever reason, it feels completely overwhelming, but I don’t know why.

Spectrum Sunday

Describing My Limitations

Many years ago, an online friend of mine was part of a disabled people’s ministry that explored what it meant to be disabled. She wanted to get me involved too, but at that point, the ministry was closing down, so she started her own discussion group. The first question we got was to introduce ourselves without mentioning our disabilities. I don’t know whether I did this with my last post, but I don’t want to do things over again. The second question was to describe your limitations. We could mention diagnoses, but the focus was on how disability limited us. I am now trying to answer this question in this post.

My first disability is blindness from retinopathy of prematurity. My vision is measured as light perception only. Technically, this means i can see the eye doctor’s flashlight when it’s brought into my visual field but I cannot tell what direction it comes from. This commonly leads to the misconception that people whose vision is measured as light perception only, are essentially completely blind. In truth, I can orient to light – just not the eye doctor’s flashlight. I can visually locate windows and see whether a light is on or off. With that last one, I do often need to check twice to be sure and I often find it easier to memorize the position of the switch than to depend on my vision.

Then it gets hard. I used to have a diagnosis of autism, but since that was removed, I now have to describe my limitations without depending on a catch-all label. Let me try. I have sensory processing difficulties. I am oversensitive to sounds and textures. With regards to taste, I am a sensory seeker, in that I crave spicy food. I can also be a seeker in the vestibular sense. I used to love to swing and when the movement therapist at my old institution had a trampoline set up, I was over the moon.

I may also have auditory processing issues. I have trouble understanding speech sometimes, especially in a crowded place. I haven’t had a hearing test in forever, so can’t be sure that it’s processing and not my hearing itself. Sometimes though, I do hear something, ask the other person to repeat it and then before they repeat themselves, I process what was said.

I also have social difficulties. I can keep a reasonably normal-sounding conversation but it takes me a lot of energy. I have trouble with reciprocity, in that soetimes all I do is listen and sometimes all I do is talk. I can’t do group conversations, because I get overwhelmed.

I have mild communication issues too. Sometimes, when anxious or overwhelmed, I go mute or stutter or have trouble finding the right words. I remember going mute in high school too, but not sure whether I had these issues before that. It could be anxiety, since I also have that. My psychologist is considering diagnosing me with generalized anxiety disorder, which basically means you worry to an extreme degree about all sorts of things. There are also additional symptoms, like difficulty concentrating, physical tension, etc.

I have cognitive issues too. This may sound stupid, because I have a high IQ. Maybe executive dysfunction is a better word. I appear lazy sometimes, because I get easily overwhelmed by relatively complex tasks and then end up not doing them at all. I also feel anxiety when people ask me to do things, but when I take the initiative, I feel more confident. I wrote earlier that this could be pathological demand avoidance. However, when for instance my husband asks me to do something, i’m fine with it unless it’s a complex task.

Then I have emotion regulation difficulties. I used to have a diagnosis of borderline personalty disorder, but that can’t co-exist with the brain injury I suffered from a brain bleed and hydrocephalus. I don’t have the relational instability that many people with BPD have. Mostly, my emotions are extreme. In this sense, I relate more to the profile for multiple complex developmental disorder (McDD) than to that for BPD. I have never been psychotic, but I do have some delusion-like thoughts.

Lastly, I have motor difficulties. I saw a physiatrist till I was about eight, but was too young to remember the diagnosis. I have a much weaker left side than right, although I recently found out that my grip strength is equal in both hands. The fact that I use my left hand much less could indicate mild hemineglect (lessened attention to one side of the body, usually left). I also have and have always had a lot weaker muscles than most people. I have however learned to live with that. I mean, what do you need to reach your toes for when in sitting position? I do have significant balance and coordination issues. MY gait is very wobbly. I recently learned that healthy people can climb stairs without even holding onto the railing. In my home, where the staircase has only one railing, I need to hold onto the railing with both hands and wobble sideways.

These are the limitations I can think of now. I have some others, but this post has been long enough. When I feel like it, I will answer the next question I remember, which was about adaptations for coping with your limitations.

Teaching Your Child Organizational Skills

Organizational skills are very important in learning for children and adults of all ages. When they are lacking, a person struggles in unstructured tasks or in completing work independently and efficiently. Usually, a child develops better organizational skills as they age, being able to meet age-appropriate expectations. Still, children with even the best of organizational skills may struggle with major transitions, such as the transition from elementary to secondary school.

Other children have difficulties in organizational skills. Some can learn to overcome these as they mature, while others lag further and further behind. I am an example of the latter. In elementary school, I aced most classes, compensating for my lack of organizational skills by my high intelligence. In secondary school, I still did well because I had learned to read faster. I could therefore read the material being tested once at the last moment and still get a decent grade. Academically, my organizational skills didn’t get the better part of me till I was in college, when one reason I dropped out was my inability to plan my work.

Organizational skills are part of executive functioning. If a child struggles with organizational skills despite adequate parenting and teaching intervetnions, it might be that they have a learning disability or attention deficit disorder, but some kids have executive functioning difficulties without a learning disability or ADD/ADHD.

Here are some tips for encouraging the non-disabled child to develop their organizational skills. Some of these strategies will work to an extent with children with executive functioning difficulties too. At the end of this post, I will give some tips for dealing with kids with executive functioning difficulties specifically.

1. Use checklists. Help your child develop a to-do list. That way, the child will be able to visualize what they stll need to do and what they’ve already done. Have your child carry a notebook with them for writing down assignmnets and household chores. Have the child check off items that have been completed. You may need to monitor that they don’t check off unfinished tasks. You can have your child use step-by-step checklists for cleaning their room, too.

2. Use calendars and schedules. On a calendar, you will put all family members’ important appointments. It depends on you and your child how detailed a calendar needs to be or can be. On a weekly schedule, you list each family member’s household chores.

3. Buy your child a planner. Have them choose one that suits them or buy one for them that appeals to them. The child can put activities into their planner, but you’ll need to help them get their planner in sync with the family calendar to avoid conflict.

4. Involve your child in cleaning and cooking activities. Particurly cooking is a fun way to learn organizational skills. A child will need to learn to read a recipe, check steps they have already completed, assemble the right tools and ingredients, etc. Involve your child in meal planning too, challenging them to help you write a shopping list. Cleaning, while not as fun, is a necessary task that also requires organization.

As I said, many of these strategies will work for a child with executive functioning difficulties too. They may need more support while learning to organize their day. Here are some tips for helping a child with EFD to learn to become the best organizer they can be:

  1. Use written and/or visual step-by-step guides for chores and assignments. Incorporate as much detail as the child needs – I needed every step almost literally spelled out.

  2. Have specific tasks on a specific day of the week. Don’t have too many tasks in one day. For example, Monday is for cleaning the child’s room, while Thursday is for organizing their backpack. That way, the child will get into the habit of performing these tasks.

  3. Discuss new or unexpected situations with your child and help them prepare for what might happen.

  4. Repeat, repeat, repeat. Often, children with EFD have trouble learning to automate a skill, so you may need to help them, instruct them and supervise them for a longer time than you would a non-disabled child. Use the same schedules, reminders etc. for the same tasks over and over again.

It is very important to realize that your child with EFD is not being lazy, but they have a disability that makes it harder for them to organie their work. You may need to provide more support for them to complete their chores or homework than you would a similar-age non-disabled child.

Mommy Needs a Timeout Thursday Link-up

Ten Patches This Autistic Person Could Use

The Golden Spoons

This is my first time participating in the Tuesday Ten. I’ve been wanting to for a while, but usually I found other things to blog about on Tuesday. Either that, or I simply forgot. The theme for this week is “I need a patch for that”, because this is the weird holdiay celebration tomorrow. Lisa of The Golden Spoons, one of the hosts, wrote ten patches every mother needs. I got thinking about that. I’m not a Mom, so I can’t really expand on those. Then I got thinking: what would I like patches for? And here’s a list of pathes this autistic person would need. Some of them can be seen as “cures” for certain symptoms of autism, while others are work-around patches and still others are patches for the social stigma and misunderstanding I encoutner.

  1. An anti-overload patch. Even though traditional autistic advocates say they would never take medication to hear or feel less, I certainly would. The thing about a patch, however, is that I can put it on and take it off again, unlike the daily medication I currently take for overload-caused irritability.

  2. An energy patch. Stole this one from Lisa, but I too think I could benefit from it. Living as an autistic can be quite exhausting, after all.

  3. A tolerance patch. To put on others when they have a strikingly intolerant attitude. Mostly staff, that is, so I don’t know how I’d get them to put it on, given that their attitude would prevent them from seeing they need it.

  4. A translation patch. I usually misunderstand people and, rather than putting on a “communicate like a neurotypical” patch, I’d like a translator that sits between me and the neurotypical.

  5. An easy text-to-speech patch. While we’re communicating anyway, I’d like to be able to write rather than speak. While text-to-speech apps are already available, I’d like one that I can easily use and that doesn’t make me look like a weirdo. I’d also like it to translate from speech to text (or braille, in my case). I’ve honestly been thinking of wanting a Communicator, which is a device used by deafblind people, but they’re very expensive and I’m not eligible for funds. i’m verbal, after all.

  6. A patience patch. Again, this one is stolen from Lisa, and I’d like to put it on others again, though I could myself use some patience at times.

  7. A perseveration patch. The good thing about patches again is the ability to put them on and take them off. Today, I’ve been looking everywhere for some perseveration, while at other times, I’m totally immersed in my special interest.

  8. An antidepressant patch. I don’t suffer from clinical depression, but I do have days when I’m very depressed. Again, like the anti-overload patch, this would seem like a better alternative to my current daily antidepressant.

  9. A patchwork weighted blanket: Lisa said patches can be any sort, so patchwork quilts are included. I’ve always wanted a weighted blanket, but never took the effort to find myself one.

  10. An executive functioning patch: something like an anti-procrastination patch, but it’ll also break down difficult tasks into smaller, easy-to-follow steps.

Note that every autistic person is different. This is why I referred to “this autistic person” in my post title rather than “every autistic person”. If you’ve met one autistic person, you’ve met one autistic person, after all. If you’d like to contribute what patches you could use in life, write a list of ten and hop over to Lisa’s blog to submit it.

Finding Answers in Disability Limbo

A few months ago, I wrote a post about my need to belong somewhere within the disability community and my possibly intruding upon communities I don’t belong to. One such community is that for brain injury patients. As far as I was concerned, “brain injury” was always followed by “sustained after birth” or preceded by “traumatic” or “acquired”. Yet brain injury can occur at birth too. Only then it’s not called brain injury, right?

Since my autism diagnosis is being questioned again, I’m feeling an increased need to figure out what exactly is wrong with me. In part, this entails putting a name to what I have. Are my motor deficits diagnosable as dyspraxia, mild cerebral palsy, or are they not diagnosable at all? Am I autistic or not? Then again, putting a name to my disabilities is but one of my quests. As I’ve experienced, most communities are open to those with an uncertain diagnosis, so it’s not that I need to have a diagnosis to fit in with a support group.

Back when I was diagnosed with autism, I didn’t want a specific ASD diagnosis. The psychologist, who ultimately gave me an Asperger’s diagnosis anyway, said he wanted to do an assessment of my strengths and weaknesses. I don’t know whether a quick DSM-IV interview amounts to that, but to me, a lot of questions remain unanswered.

It could be my slight neuropsychology obsession, but I want to know why I have issues I do have. I want to understand, in a way, why I can’t function at the level I’m supposed to given my intelligence and verbal abilities. Is it normal to be unable to load the dishwasher but able to write a lengthy blog post? I don’t think a diagnosis, whether it’s autism or brain injury, will answer this question per se, but what will? It is most likely that I have quite bad executive dysfunction, but can this at all be validated? Should it?

It isn’t purely that I’m overanalytical and want to understand my every bit of brain function. It’s more that I’m struggling terribly with being seen as more “high-functioning” than I am in daily life. Not that I want to reinforce the stereotypes surrounding the Asperger’s diagnosis, but my mere existence won’t defeat them either, and I’m sick and tired of having to prove myself.

Executive Functioning Disorder (EFD)

Lately, I’ve mentioned executive functioning problems a lot. Though executive functioning disorder (EFD) is not formally recognized, it is pretty common in individuals with ADHD, learning disabilities and autism spectrum disorders, particularly Asperger’s Syndrome. So what is executive functioning disorder?

First, let me explain what executive functioning is. Executive functioning is a set of mental processes that enable people to connect past experience to present actions. These processes include planning, organization, motivation, maintaining attention, anticipation of alternative consequences, and generalization of what has been learned. People with EFD have impairments in many of these areas. Thogh executive functioning is often related to attention, not all people with EFD also have attention deficit disorder.

Here are a number of characteristics of executive functioning disorder:

  1. Difficulty ad/or apparent lack of interest in setting goals.

  2. Difficulty initiating a task or generating ideas independently.

  3. Difficulty comprehending how much time a task will take.

  4. Troulbe telling a story (in spoken or written language) because of difficulty organizing details.

  5. Inability to stop and think of a strategy to solve a problem.

  6. Continuing to use the same strategy to solve a problem, even when it’s ineffective.

  7. Difficulty following instructions that consist of multiple steps.

  8. Swinging from impulsivity to rigidity.

  9. Difficulty handling change.

  10. Inability to reflect on past experience to plan for the future.

  11. Past consequences don’t effect future behavior.

  12. Little awarness of or interest in learning about personal limitations or weaknesses.

  13. Mood swings and emotional instability. May react to emotions rather than verbalizing feelings.

  14. Seeing personal problems as externally caused; inability to see one’s own contribution to a problem.

  15. Difficulty taking another person’s perspective.

  16. Risk-taking or thrill-seeking.

There are a number of situations in which a person’s executive functioning disorder may interfere with their academic, social and daily living skills. In the area of time management, I have a lot of difficulty thinking of what to do during the day. This is not because I have few obligations – oh well, that is part of the problem too -, but even when I have a lot to do, I can’t seem to organize or plan for it. I procrastinate, too, as do most people even without EFD, but in my case, it’s sometimes due to inability to organize an activity. Initiating an activity may also be a particularly hard skill for people with EFD. This is sometiems called inertia.

In the area of problem-solving, I have a hard time following instructions that aren’t spelled out. I don’t have troubl memorizing multiple steps, but they do need to be clearly stated. For example, last week, I was planning on going for a walk. I had my shoes off and the nurse told me to put on my shoes. I did, but I didn’t put on my coat. I am not particularly literal-minded, so that wasn’t really the problem. Now that I think of it, I realize that maybe besides sensory processing difficulties, EFD might contribute to why I have a hard time deciding on which clothes are appropritate for the weather. In school, I had specific rules on what to wear during specific tempetrautres. I have been in situatiosn where it was over 30_C and I was still wearing a sweater because I hadn’t watched the weather forecast.

Emotion regulation problems may or may not be due to EFD in my case, since borderline personality disorder causes these problems too, and I exhibit some stereotypical BPD reactions. Then again, low frustration tolerance, which is not per se a BPD characteristic, is definitely related to executive functioning, and this has always been said to be a core problem of mine.

What Does Mild Autism Mean?

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.

“Autistic Traits”

A few days ago, Jessi over at Deciphering Morgan wrote a post on autistic traits vs. autism. I came across it through a response by Stacey of We Are the Brothers B. Stacey”s son Thomas has “autistic traits”.

What annoys me about the “autistic traits” thingy, is that it often connotes that 1. everyone who is a little socially awkward, has them, and 2. having autistic traits means you’re not as severely disabled as someone with full-blown ASD.

To start off with the first, I am aware that there is something called the broader autism phenotype, which includes people who are socially awkward and a little routine-oriented, but not enough to meet the criteria for an autism spectrum disorder. The important thing is that people on the broader autism phenotype usually do not have disabling symptoms. In both DSM-IV and DSM-5, it is a requirement for an autism diagnosis that your daily functioning is impaired to some degree. In my opinion, just being somewhat of a loner with a couple of friends, is not an impairment. Saying you have “autistic traits” when you’re truly just an introvert, trivializes the impairmetns of those with actual autism or significant autistic traits.

Then on to the second idea, which is pretty much the polar opposite of the first: people who just have “autistic traits”, are not severely disabled. Please realize that you cannot be diagnosed with autisms pectrum disorder in DSM-5 unless you meet all three social/communicative impairment symptoms. Autism is still seen as a social cognitive disorder, and I’m not sure that I think of this, but people who are pretty sociable, cannot be diagnosed with autis under DSM-5. Social development, however, is just one area impaired by autism. I for one am relatively sociable, but I still have severe difficulties in sensory processing and executive functioning, leading to quite severe impairments in self-help skills, significant behavior problems, etc.

Both my former nd current therapist trivialized my autistic impairments by referring to me as having “autistic traits”. I do have a formal diagnosis of an autism spectrum disorder, but havin this diagnosis constantlydownplayed, confuses and irritates me. Sensory processing disorder is not as much of a recognized disorder here as it is in other countries, but even if it were, the connotation is still that SPD is less severe than ASD. Executive functioning disorder is not recognized by most clinicians at all. This leaves a lot of children and adults with severe sensory processing or executive functioning difficulties either getting the wrong diagnosis, or getting less suppor than they need. I am not sure whether I believe adding more labels to the diagnostic manuals, is the solution to this. However, I do believe that children and adults who are having a lot of difficulty functioning in life, should get the support they need.