to flex patterns, to think emotionally • about the autistic spectrum

Autism is a phenomenon that is defined as a neurological variation characterized by a group of symptoms related to communication ability, social ability and a positive sense of self. People with autism can be very creative, but you can notice difficulties in understanding emotions or being able to deal with changes in daily routine.

Over the past few decades, there has been significant growth in the understanding of autism. Many studies indicate that the early treatment can lead to significant improvements in the functions of the autistic children. By combining medical, communicative and educational approaches, autistic children and adults can be helped to develop their potential abilities.

Start treating at an early age

The media and education are key elements in the understanding of autism among the general public. There is a positive trend among most of society to better understand the needs of the person with autism and to create a friendlier environment, to create social projects aimed at improving access and expanding the range of opportunities for the autistic community, such as a special recruitment process for the IDF for those who wish to enlist. The flexibility of the templates that autistics need In order to function better in society, society is also required to better accommodate and understand the autistic challenges.

Advanced technologies provide important tools for people with autism and their families. Phone games and designated apps, consulting software and communication tools can contribute to improving the experience of life and help in dealing with daily difficulties.

As of 2022, there are 56,233 Israelis diagnosed on the autistic spectrum in Israel, 92% of whom are Jewish. The prevalence rate of people on the autistic spectrum per 1000 people has increased fivefold over the past 20 years. The Davidson Institute, the educational arm of the Weizmann Institute of Science, explains in an article published on the Institute's website, that the autistic spectrum is an umbrella term for a variety of conditions that originate from the abnormal development of the central nervous system (brain and spinal cord), which is manifested already in childhood.

Davidson Institute:

Disorders on the autistic spectrum are characterized by deficiencies in communication and social skills, and often also by undeveloped language skills, limited interests and repetitive behaviors.

The article indicates various research methods that tried to find symptoms in the structure of the brain. One study in which the circumference of the head was measured and the weight of the brain was calculated, found that in autistic children there is growth of the brain and nerve cells, but in adulthood there is a decrease in the volume of the brain and the thickness of its layers. They concluded that it is important to treat children at an early age.

Another study measured, with the help of imaging, the changes in oxygen consumption in the blood vessels of the brain during guided activity. An active area is assumed to pump more oxygenated blood. It was found that the brain of an autistic person tends to be less synchronized, and there is not always coordination between areas in the frontal lobe of the brain and areas in the parietal lobe.

Additional studies were done on the activity of the parts of the brain whose job it is to process emotional stimuli, and it turned out that the activity there is reduced, which can explain, among other things, the difficulty in social communication in autistic people, and the difficulty in understanding social signs.

The Davidson Institute mentions a study conducted on the appearance of various phenomena in identical twins, to assess whether they are inherited, and it was found that syndromes on the autistic continuum have a genetic component, but no single gene carrying the trait of autism as seen in other phenomena was found. "Because of this, the autistic sequence disorders are considered multifactorial. Mapping studies have so far indicated dozens of genes in which mutations are probably related to autism."

Everything requires conscious thinking

Autism is not a disease. It is a condition that lasts a lifetime, and sometimes in high functioning, it hardly affects the quality of life. Because of the many levels of autism, it is customary to speak of a "spectrum, autistic spectrum" and not of one specific condition.

I talked with Rita Irbach, Educational psychologist, licensed to diagnose autism, one of the top diagnosticians in Israel and has many years of experience. I asked you to explain what it is and how do you know if the child or adult is on the autistic spectrum.

Rita: "Autism is a neurological condition called neuro-atypical. It means atypical, one that works differently. It seems that in fact no one understands it fully. Imagine a thousand-piece puzzle with several pieces of another puzzle going into it. Or a huge library with one volume missing The difference between an autistic person and an autistic person is usually looked for in a certain part of the time and the brain is not aware of the processes all the time.

For example, when we walk down the street, talk on the phone and have to cross a road. We observe while talking on the road and the brain makes an assessment and informs whether to cross or wait. This was done almost automatically, the brain made an assessment and drew a conclusion but we were not aware of the process, we did not stop and ask questions but followed the guidance of the automatic process. It saves energy, you don't have to invest in thinking.

With autistic people, almost everything requires conscious thinking, and it takes a lot of energy. This is the difference between intuition and cognition. When a non-autistic person enters a room, they intuitively sense the atmosphere in the room. It's not mystical. The brain automatically checks and evaluates, draws conclusions and informs us of the result. This is called flexible social intuition, an automatic assessment of the brain that tells us whether the situation in the room is nice, tense, calm or stressful. When an autistic person walks into a room, they have no way of automatically receiving information from the brain about social situations. He has no social intuition and to explain situations he uses cognition - intelligence.

If he is asked what the atmosphere in the room is, he will activate a conscious cognitive process in which he will process the information he sees according to his understanding: people standing on the right side stand with their backs to those on the left side and stand between them. The people on the left point to those on the right and no one crosses the room in the other's direction. From this he will conclude that there is tension and an unpleasant atmosphere.

An autistic person thinks the world more and expresses less if he feels it. Thinking all the time consciously is tiring and takes a lot of energy. Constantly doing processes of processing information, of collecting and mentally analyzing the data. When you are with many people, there is too much data and it is difficult to process all of them, therefore autistic people have a tendency to reduce contact and exposure to the environment, in order to conserve energy."

Do not understand intentions and do not translate expressions

Many times people on the autistic spectrum will not notice facial expressions and behaviors that imply feelings or reactions, and the social signs that are obvious to anyone else, will not be obvious to them.

Rita: "The higher the function, the more one has the ability to learn to recognize emotions by facial expressions. A small child recognizes his mother's intention by behavior and facial expressions. If she is smiling or angry, tired or happy. You don't need to teach him that, he picks up Intuitively this information from a very young age. For an autistic child it is not intuitive, he does not naturally know how to translate facial expressions and has to learn it like learning a language.

In some Korean cartoons, manga and anime films, they teach to distinguish between different facial expressions and their meanings, many children are attracted to these series and videos because it is not implicit but clear and teaches the language of facial expressions.

Autistics also have difficulty interpreting intentions. For example, when a person is asked if they have a watch, a neurotypical person, a typical person, will understand that the intention is to know what time it is. A neuro-atypical, atypical, autistic person will not understand this intuitively, except when the intention is explained to him."

The autistic spectrum has many levels and a number of characteristics, among them abnormal reactions to sensory stimuli such as sounds, touch, smells, tastes or sights, difficulty coping with changes, difficulty understanding social signs and expressions. By and large, everyone needs to have their intentions explained in order to understand the social language and the situations. Rita tells about a highly gifted child who was diagnosed with autism when he was 5 years old.

"When he entered my room he said to me: Rita, how fat you are! His mother was ashamed, and told him not to say that, so the boy said with great sadness: Rita, don't you know you are fat? Another example. At one of the events there were drinking bottles on the table In different sizes. A 13-year-old boy said that the bottles were beautiful for his creation. He was told yes and took the bottles. He didn't understand that the message was conveyed non-verbally, in an indirect way : After you drink take, or pour the drink into another container and take the bottles. They told him yes, so he took."

There is low-functioning autism, with cognitive impairment, and there are high-functioning ones who can be gifted. There can be retardation, with a mild communication disorder, those who communicate and smile and create connections with the environment, and on the other hand, there can be a gifted person with a severe communication disorder, a child who can study but is locked in his room, all day on the computer, does not communicate with anyone and does not leave the house. It varies, and is therefore called a spectrum.

There is autism with normal or borderline intelligence, children who talk, communicate and want contact, and especially want to be listened to because it is sometimes difficult for an autistic person to accept the other as a subject, meaning as an independent being. Many times the autistic person accepts the other as an object, like an object that has a use in life. The mother for every baby is an object, she is the feeding teat, and at a later stage she becomes a subject, meaning a person with her own needs and desires.

Rita: "The autistic person has difficulty seeing the other as a subject. He does not develop the other's theory of thought - what the other feels, thinks and needs. On the other hand, he can be very sensitive to animals. For example, many years ago I visited the animal corner in one of the hospitals in the center of the country, there were animals who survived abuse and were afraid of humans. The autistic children knew how to approach them without scaring them."

Weird behaviors and hypersensitivity

How can parents notice if the child is autistic? "The identification in small children is usually the identification of behaviors such as waving hands, not making eye contact, not responding to appeals, lagging lips, and other signs that show that a diagnosis is needed because the child is not developing like his peers.

The statistics speak of 4 times more autistic boys compared to girls, partly because girls are more difficult to diagnose. The autistic girl can give you something and immediately want it back. The child wants to tell you something and he is not interested in what you say. Children with high communicative function, who play on the computer, sometimes play with other children, but the connection is only around the game. There are no connections beyond that. Even if they are loved and invited, they avoid because they are overwhelmed.

If the children are functioning and have normal intelligence, then how do you see that they are autistic? "Starting to recognize behaviors that seem strange. Sensory sensitivity, for example sensitive to smells. Can't stand the smell of something so will stay away from others. Intolerant to the noise of chewing, not willing to wear clothes with a painting or a certain color. Sometimes looking for a strong stimulus like a lot of itching. There are cases of very high intelligence, but low communication.

The boy sits on the bench in the yard and when another boy comes to sit next to him on the bench, he starts screaming. Why? Because someone was sitting on his bench. In the same class is a girl with borderline intelligence and higher functioning communication, and when she sits on a bench in the yard and someone sits down next to her, she smiles at him. Intelligence and communication are two seemingly separate parts.

"An autistic boy with a very high intelligence, only studies 5 units of math and 5 units of English. Why? Because he doesn't need to. He stopped going to school because he learns better at home. They tell him about the compulsory education law, it's not possible, so he says - no problem , let's leave to another country where it is allowed.

His mother tries to explain to him that it is impossible because there are brothers in the army here, she has a job here, so he says work from the computer abroad, and you don't see your brothers all the time anyway because they are in the army. He responds according to pure logic what should be done to serve the His needs. It's not selfish. It's not understanding the feelings and desires of the autistic. Telling an autistic child that the socializing element is important, he can play on the computer for long hours With friends from all over the world, but when they start talking about topics other than the game he says - we came to play not to talk.

"In order to diagnose autism, you need 5 out of 7 criteria according to the DSM-5 diagnosis book, the current edition of the American psychiatric diagnosis book, which aims to diagnose and classify disorders according to symptoms. All kinds of disorders including communication and concentration disorders, depression, anxiety, learning disorders with disabilities in reading and writing By the way, there is a tendency in some countries, such as England, not to treat autism as a disorder and not as a problem, but as a condition, and therefore they ask that the person not be defined as "suffering from autism" or "dealing with autism" but as autistic.

Three of the criteria are related to communication: a disability in emotional social reciprocity, a disability in non-verbal communication behaviors that are used in social interactions - gestures, facial expressions, etc., and the third: a disability in the development, preservation and understanding of relationships, appropriate to the developmental level, meaning relationships as appropriate for the person's age. These three criteria must be met.

The other index is related to behavioral symptoms: uncoordinated, intense repetitive behaviors such as walking around, waving hands, arranging objects in a certain way, insisting on a verbal pattern that is repeated, rigid thinking patterns and significant difficulty coping with changes, as well as very narrow areas of interest. Another characteristic is difficulty in sensory regulation, sensory hypersensitivity or hyposensitivity. Another criterion is that the difficulties appeared in early childhood but they are more noticeable as the child grows and there is a gap in his functioning in relation to his peers.

One of the criteria says that the combination of the symptoms impairs the person's daily functioning. Because if the person or child is autistic and it does not interfere with his functioning, he does not need a definition. The fifth final criterion is that the difficulties a person has cannot be explained by an intellectual disability, a developmental problem, or anything else.

By the way, in none of the criteria does the issue of maintaining eye contact appear as a necessary measure, this is because making eye contact is part of social language. This is not a necessary criterion. An anxious child will not maintain eye contact either. A child with ADHD may not maintain eye contact because he will be distracted. Many things can cause the child not to make eye contact, not necessarily autism.

Einstein, Andy Warhol and Jerry Seinfeld

After many years of waiting for this, in 2013 DSM 5 was released, the book of diagnoses and statistics of mental disorders, and there the old definitions of autism were changed. Combine the definitions that were separated in the past and leave, among other things, high, medium and low functioning autism, and create a new category called for autistics who do not have autistic behaviors but have difficulties in social understanding. The word "Asperger's" left the diagnoses. It still appears in the European criteria, ICD11 which is similar to the American one.

In the film Rain Man with Dustin Hoffman, it is told about an autistic with retardation, lacking the ability to solve problems but with one increased ability in card counting. Dustin Hoffman who plays the autistic, clings to fixed patterns. Must eat at fixed times and the certain food, must watch a certain TV program at a fixed time. He built a clear world for himself that has fixed points.

There is no flexibility and no ability to accommodate changes. Hysteria is full of autistic people who have achieved impressive achievements. It is said that Albert Einstein, Nicholas Tesla, Isaac Newton, Charles Darwin were autistic. So is Andy Warhol the unique artist, and Jerry Seinfeld who claims to have a hard time with social interactions.

There are autistics who do not need support, children and people with special abilities whose concentration cannot be disturbed by events and social interactions. This is the fourth criterion, and it is very important because it seeks to diagnose whether the person's condition, with all the symptoms together, prevents the person from functioning.

A person with anxiety who goes to work and starts a family avoids some things and does the rest. As long as he is functioning normally and knows what to avoid, everything is fine. When the anxiety causes a stop to deal with the developmental tasks of the age, then it is a disorder. The same with autistics.

If the person is autistic but is dealing with developmental tasks of age then he is fine, able to form a group of belonging, has two friends with whom he plays computer games, knows what he wants to do, then he does not have a disorder. But if he shuts himself down and doesn't meet anyone and doesn't want anything to do with it, that's a disorder. Why? Because it prevents him from being independent, doing, working. If an autistic person studies, supports himself, has a relationship with one or two people and copes with chores, this is not a disorder.

There have been cases of teenagers in adolescence, who discover emotional difficulties, feel like strangers, are looking for a definition. In adolescence, which is a stage of self-identity formation, the matter of the Haggadah can be significant. Boys and girls after years of emotional treatments, sometimes also psychiatry to reduce anxiety, children who sometimes stop going to school and all the years are treated by different therapists, discover that the difficulty is actually in social media.

The child can read and tell the parents I think I'm on the continuum, because the children read articles, check their own difficulties. Then they get diagnosed, and when it turns out they are autistic, they say: I knew. It's liberating. It allows the boy to understand himself, not to feel that he is wrong. It gives him room to take care of, to develop from.

Understand that there is no suffering, there is avoidance

Rita: "In my opinion, autism is not a disorder, it is not suffering. It is a fact. We need a definition in order to give the appropriate treatments. I think that working with an autistic person is not to make him not autistic, but to help him flex the patterns, so that it will be easier for him, So that he has less conflicts with the environment. When the patterns are flexible, children find ways to deal with the environment better.

There was an autistic child that I removed from the diagnosis when he reached the age of 17. At the age of two he was walking, waving his hands and banging his head against the wall. He was in media kindergartens, media classes, received all the necessary treatments. He reached the upper division, a bright boy who studied in a regular class. He is a volunteer in the MDA, he had two friends, a driver's license, and he is designated for an elite military unit. He came to me and asked to be removed from the definition so that he could enlist in a normal way and not in the special units for autistics.

The psychiatrist said he no longer met five criteria and sent him for diagnosis, and indeed the guy did not meet the criteria. We finished the diagnosis and I asked him before he left, how did you get over not making eye contact, so he said: I'm looking at your eyebrows. And about waving your hands when stressed? I put my hands in my pockets he said. He flexed the patterns, created solutions and autism doesn't bother him anymore.

A definition should serve the person and not the person the definition. The definition should help the person to get the necessary support so that he can cope in normal society in an optimal way. In the army, there is a program called "Advance", a special program for autistic people. But he didn't want to. If a person lives well and there is no problem, then no diagnosis is needed. Not everyone likes parties and a lot of company. If there are two or three friends and they sit together playing computer games or watching movies, that's enough."

Many parents of autistic children find it difficult to understand that their child does not suffer from a lack of social skills. They talk about how the child avoids, doesn't connect, that he is lonely and poor, but actually it is the parents who feel uncomfortable about their child being without friends and not the child himself.

Rita: "There is a matter of the quality of the suffering. For a person who is not autistic, the suffering from social difficulty is very deep, sometimes a real heartbreak. An autistic person who is alone and has no friends, it is not the same hole in the heart. It is a different suffering, because the autistic person wants someone to listen But it's not like a person who wants to be socially rejected. There is a difference in the quality of the autistic person. He doesn't want to be around friends. He can't be A common language around a computer game, or around dungeons and dragons, but there is no need to do an activity beyond the theme of the game."