Monday, 13 May 2019

Autistic People. So, new Research. Different social skills, not broken ones.

Two people sitting side by side at a park bench table.  We can only see part of them. There are cups of coffee.



For decades, autistic people have been told that our way of socialising and co-operating is a broken version of the 'real thing',

Many autistic people have been put through endless coercive techniques to correct this alleged set of problems.  Children have been put through year after year of exhausting therapies to make them co-operate and collaborate exactly like so-called Normal Children.  Yet, curiously, we weren't seeing good outcomes.  We are seeing deeply concerning rates of mental health difficulties including worrying links to suicide and PTSD.  So, what's been going wrong?  Why aren't autistic people any better off after all this enforced normalisation?  Weren't we supposed to be happy and integrated now, with better jobs and better social lives?

What went wrong with the theory?


This year, at the international autism conference, INSAR 2019, a session and poster by a team of well respected researchers at the University of Edinburgh who dared to question this idea that autism  = broken social skills.  They are presenting their research at various events.

https://infogram.com/diversity-in-social-intelligence-participant-summary-1hnq41ppmyvk43z?live

"In essence, what we are demonstrating for the first time is that autistic people's social behaviour includes effective communication and effective social interaction, in direct contradiction of the diagnostic criteria for autism. We have, for the first time, uncovered empirical evidence that there is a form of social intelligence that is specific to autistic people."

In other words, different social skills, not broken ones. We have our own social signalling and can co-operate and interact effectively....with each other. Likewise, non-autistic people can generally co-operate and interact effectively...with each other. But put one of each group together, and they both tend to misunderstand one another. They don't feel rapport with one another, that sense that you just 'click' with someone and understand them.

This isn't a new theory, of course. Dr Damian Milton has been discussing Double Empathy theory for a while now. https://kar.kent.ac.uk/62639/1/Double%20empathy%20problem.pdf  

Shall we take a moment to shuffle uncomfortably in our seats, reflecting on the endless books, articles,training programmes and materials describe autistic people as deficient in social understanding? All recommending that it's the autistic people who do 100% of the changing?

Actually, autistic people generally understood each other well.  We always have.  The problem is that the non-autistic people didn't understand us.

And we didn't understand the non-autistic people.

So, may I invite researchers, writers and trainers to take a deep breath, and decide to look anew at autistic people?

What's needed is interpreters and social language experts.  Those who can skill both groups in the 'language' of the other group.  Those who can meet people from the other group and say, "You are wonderfully different.  I would love to learn your natural communication style, as a new language, a new way of interacting.  And I would love to show you our own way of communicating, which is different.  Together, we can learn not to misunderstand one another, and both of us can learn to communicate more effectively with one another.  Together, we can both learn how to be friends, colleagues, and do great things together."

Can we do that? 

I think we can.

Thank you for reading.

Sunday, 5 May 2019

Primary School Age Child - Might They Be Autistic?



Some professionals and parents have been given autism 'checklists' that are 20 years out of date. Not at all useful when trying to make a decision about whether a child needs a diagnostic referral. The checklists were full of language so inappropriate and humiliating for any child that one must hope that there is a push to do an updated list, very fast.Autistic people are of every age, gender, personality type, e.g. extrovert or introvert, and of all ethnicities.  Autism is difference from birth onwards, for life, not a disease or deficit.  There are strengths for many, as well as a need for support with some things, for others.

This is an informal guide, intended to help professionals consider whether a  child may be autistic. 

It is not intended to be used alone, but to help professionals recognise a pattern of differences in social and communication skills, together with intense focus on topics of interest,  differences in sensory processing, and a need for structure and routine. It is important to be working with parents and carers, and asking good questions of the child, either using spoken language or any other preferred communication method for that child.  A decision can then be taken as to whether to refer on for formal diagnosis.


Social Communication:


Autistic children may use social communication in different ways. There may be a different use of eye contact, preferring to look at a person using indirect gaze rather than direct gaze, in order to minimise sensory distraction.  


There may be little or no spoken language, or an unusual tone or accent that doesn’t have another social or cultural explanation.  Speech may have highly focused and technical content on specialist topics.  Some may use repeated phrases as a way to understand content and convey subtle meaning.  Autistic children tend to be direct, and are unworried about social rank and status.

Autistic children may have a different understanding of personal space, and may prefer to stand closer or further away than is the social norm for non-autistic friendship or acquaintanceship. 

Generally autistic children can understand, co-operate and form friendships with other autistic children, but there can be miscommunication between autistic and non-autistic individuals as a result of the social difference, and misunderstanding of autistic moods.  For example others may misinterpret autistic children as angry, when they are using a different tone of voice or volume. Others may also misinterpret autistic distress, meltdown or shutdown as anger or as a direct refusal to co-operate. Meltdown and shutdown are brain events, not choices.  Meltdown may look superficially like a temper tantrum but is entirely out of the control of the child.  Shutdown involves not being able to speak, or possibly move.  Again, out of the control of the child.   

Some non-autistic children may take a fairly instant conscious or unconscious dislike to the autistic child, because of the different social signalling, and refuse to play with them.  Such problematic responses from others are often a significant sign of possible autistic difference.  

Movement and Sound


Autistic children may use body movements, or  repeated noises, to self-regulate, stay focused, and be in touch with their body positioning and balance.  These are called stimming, and are a normal part of autistic life.


Instructions

Autistic children may need very precise instructions, and may understand phrases and words literally, rather than look for ‘hidden meanings’ or metaphors. 

A different way of playing

In play, autistic children tend to focus on learning one particular skill at a time, and will apply intense dedication to doing so. Getting things right is vital, to most autistic children, which can lead to extreme focus to find answers and improve on things that are not 100% correct.  A specialist mindset, therefore.


A different sensory experience

Autistic children tend to have sensory differences that mean they can be very undersensitive or oversensitive to particular sensory input.  For example, sensitivity to flickering fluorescent lighting, the feel of clothing, odours, tastes, textures or to background noise. Spaces that many other children can cope in can be overwhelming and painful to experience for some autistic children.  Eating and drinking can be a sensory challenge that results in anxiety around food, especially in busy noisy spaces.

A different degree of need for predictable social and sensory situations.

Autistic children prefer known situations and known environments, in order to minimise possible sensory and non-autistic social overload, and therefore may reach a state of great distress if pushed into fast changes. Most can adapt to change if given careful explanation including possible sensory or social hazards ahead.



As stated, this is an informal guide. But it will get people a fairly long way towards identifying possibly autistic children, and getting that good diagnostic advice.



Friday, 19 April 2019

Autistic children - Are we helping them after trauma? PTSD. cPTSD.

A sad child looking out of a window

"Currently, there is no evidence based practice for the treatment of trauma [for autistic individuals]".

Those are words from a recent paper looking at ideas for how to help autistic children who have experienced traumatic events.  The paper, by Slack and Lucyshyn (2018), can be found at  https://link.springer.com/article/10.1007%2Fs10803-018-3854-9

I must admit that when I read this, I didn't know quite what to say.

We know that autistic children experience high levels of bullying.  We know that they are seen as a target by predators.  We know that many show distress behaviour, and many express a wish to end their own lives.

We know there is likely to be an autistic child in every classroom, from the most recent research into numbers of autistic individuals.


But no-one knows how to help an autistic child who shows signs of trauma (for example Post Traumatic Stress Disorder or complex Post Traumatic Stress Disorder (PTSD, cPTSD)?).

What are PTSD and cPTSD?
From an online article linked to in the paragraphs below, "PTSD usually develops after someone sees or experiences a terrifying or life-threatening event. After that initial episode, any reminder of it can trigger panic, extreme startle reflexes and flashbacks. Beyond that, however, there’s a wide variety in the way PTSD manifests: It can lead to hypervigilance and anger; it can cause recurring nightmares and other sleep issues; or it can lead to depression, persistent fear, aggression, irritability or difficulty concentrating and remembering things."   cPTSD happens for some after enduring multiple traumatic events or one really long traumatic event, from which there is no escape, for example.

There's more information on PTSD and cPTSD at https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/complex-ptsd/#.XLlvvOhKjIU

What does PTSD or cPTSD look like, in an autistic child?  We don't know.  No, really, we don't know.    This is explored in this article, which also lists some of the common ways that PTSD is experienced.  https://www.spectrumnews.org/features/deep-dive/intersection-autism-trauma/

Why don't we know what PTSD looks like in autistic children?  Why don't we have a clear idea how many are experiencing it?  I sense that this is because of the deeply problematic core belief in society that autistic distress is a 'problem behaviour' that is to be trained out of us.  Looking at that list, anger, depression, aggression, irritability, panic, hypervigilance.... I'm mindful of how many behavioural-intervention checklists I see where those items are listed as 'autism symptoms' and the individual is relentlessly trained and rewarded for making their internal terror invisible to outsiders.

In a quest to find something, anything, helpful, I followed a link to Shaffer et al's recent paper (2018) proposing a new treatment regime (in part ABA based) for emotional regulation, which some believe is a way to treat trauma. The link is here  https://link.springer.com/article/10.1007%2Fs10803-018-3727-2

It looked at 34 children with combinations of diagnoses of autism, or ADHD, or conduct disorders, or depression. In other words, so varied that any results would have been impossible to unpick, I suspect.  26 male, 8 female. Age 8-12.  The parents were asked about the child's angry or defiant behaviour, and the parents were asked about their own quality of life.  Then an intervention was done, and the parents were asked to rate the child's behaviour and whether it improved the parent's own quality of life. A brief clinical improvement score was also given (the CGI-I). We are not told whether the clinicians had any deep modern understanding of autism.   The CGI-I's general use is discussed here :  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880930/   It's a basic measure designed mostly for illness, and is around 'is the patient better than last week'?  No mention of sensory needs or adaptations, just behavioural and psychological interventions.  One could question whether a medical checklist is appropriate for a neurodiversity, also.  Better than what?  From whose perspective?  If we train gay people to act straight, are they 'better' than they were last week?

Can anyone see the problems here?

Everything is related to a caregiver's or professional's observation of external behaviour, and how happy the caregiver is, not the child. It's irrelevant to hear the child expressing whether it's worked as a therapy or not.  The actual feelings, experiences and self-determined outcomes of the child aren't evaluated, it appears.  I'm pretty shocked, if so.

If the child learns not to show their distress, hey, the therapy's worked...?  Really?

As a professional in the field of autism, I am deeply concerned about all of this.  It appears that we are not even off the proverbial starting-blocks in the race to understand autism and trauma, with children.  We don't know what it looks like, we don't know how to treat it, and we are told by behaviourists that a quiet child means a happy child?


I do not agree.  From personal perspective of 20 years in autism work, I sense that by encouraging traumatised children to never show how they feel, then not even asking them, we are internalising the trauma and potentially setting the children up for very bad outcomes indeed.

I am not a therapist.  I would very much like the therapeutic communities to do some work on this, because clearly this is a desperate situation for autistic people of all ages.  It's not just children who experience traumatic events.  We see an increasing number of autistic adults who are being diagnosed with PTSD or cPTSD, and an increasing number of therapists desperate for some clues, some strategies.

What would my advice be, right now, as a professional who specialises in autism training, enablement of autistic lives, safeguarding, and cultural interpretation?


  • That we get excellent modern training on autism, from autistic specialists and allies. Training that acknowledges the humanity and difference of autism, rather than framing it as deficit and disorder.  The books of Dr Luke Beardon are an excellent start for this, for example. So is the work of Dr Damian Milton on double empathy.
  • That we stop seeing all 'behaviour' as defiance, or as 'autism'. Think - could this be trauma?
  • That we stop assuming that all distressed autistic people will show 'challenging' behaviours.
  • That we stop interpreting quietness as a success or as a sign of happiness.
  • That we acknowledge that repeated deprivation of sensory and other needs for autistic children may be traumatising, and that we investigate and take seriously the endless personal accounts of those needs, by autistic individuals.  It should not be routine to take everything autistic children need away from them, to 'normalise' them.  
  • That we start asking autistic children and young people about their actual experiences.  Yes, some do not use spoken language.  This is where working with autistic specialists as interpreters, and working with the individual using different communication methods, is important. Good SALT teams are allies here.  It is not enough to say, "Well it was too hard."  Our job is to communicate effectively with people, not just ask others for their opinion on them.  That's not a proper evaluation.
  • That we commission balanced, autistic-informed and led research into all of this, as a matter of priority, and look at ways to fund the resulting therapies properly and fully. 
  • And mostly, that we acknowledge the damage done to too many autistic children, and indeed adults. Whether accidentally or deliberately.  Instead of blaming autistic people for every single thing they do or say and calling it a 'deficit', we need to acknowledge the deep humanity and integrity of most autistic people, and acknowledge the potential for trauma to be at the heart of their distress responses.  


This is a topic that needs to be on every key organisation's agenda, putting together the best of the best.  We need to be working with the autistic professionals and general autistic population at every level,  finding out how to identify trauma in autistic people, how to safeguard against it, and how to improve the lives of those enduring it in ways meaningful to the person.

Autistic people deserve lives of safety, of thriving, and of caring, enabled to be their authentic autistic selves.  That is a set of societal and therapeutic outcomes we should all be seeking.

Thank you for reading.


Monday, 1 April 2019

Autism, Age, Wisdom

A photograph of a group of older people of various ethnicities, smiling

In an online poll this week, autistic people were asked whether others mistook their age.  Perhaps thinking they were older than they actually are, or younger.  The results are interesting.


A screenshot of a Twitter poll as described in the text
Out of nearly 900 votes on Twitter thus far, the big majority say they are told they look younger than they are.  I wonder if this is part of why we think autism is to do with young people?

It's a challenge, autism and ageing.  Partly because we have almost no research on autistic older people.  Thus, the general - and incorrect -  view of society is that we're best represented by children, teenagers or young adults.   Partly, the myths that we are all 'childlike' to use a phrase, based on the idea that because some have a deep focus on (say) collecting things, it must mean that we're stuck in a child-like phase of life, unable to match adult responsibilities.  Some have had their IQ measure with the wrong test, leading to the conclusion that lots have a low IQ when they they do not.  It's all been a mess.

All of this leads to some very wrong conclusions about autistic people.  That we are foolish, incompetent, 'little more than children' in the way we think.

For a start, I can safely say that after decades of working with and alongside autistic people of all kinds, I've never met a wiser group of people, in general.  I'll continue to generalise:  Instead of being focused on pleasing the majority, the autistic quest for fairness and social justice is a constant theme.  Instead of thinking everyone must show sophisticated interests suitable for some 'high society' magazine, in order to display a high social and intellectual rank, many autistic people have found joy in any number of wider interests.  Those deep interests lead some to become the world's experts in those topic, whether it's forming world-leading and important collections, deep knowledge of subjects that benefit all of humanity, or a singular joy in a favourite topic or hobby.

If we look at the UK at the moment, our young people are facing one of the worst crises of any 'first world' nation.  The NHS 2017 mental health survey for children and young people found that 1 in 8 now has a mental health difficulty.  Around 1 in 6 of the oldest of the teenagers. Figures that are rising year on year.  Many say that the pressure on them to be sophisticated, fashionable, slim, fit, academically excellent, has driven them to absolute despair.

I think we forgot to let our young people be young.
I think we forgot the value of joy in more simple things.
I think we pressure everyone to be 'normal' or better.  Academically, in terms of looks, in terms of their interests.

And I think we forgot the deep wisdom to be found, not in academic centres of learning, (some of which frankly have driven this nation to the brink of disaster at present  - think of the Eton situation and senior leaders in society getting picked mostly because they went there) but in those who are amongst the most marginalised and seem to be the most 'unsophisticated'.

We've been looking for wisdom in the wrong places.  

There is much to be gained from spending time with autistic people.  Re-learning what is also important.  Re-listening to what also matters.  Re-understanding what it is to have a different culture and communication style, a different set of priorities.

We need to research the lives of older autistic people.  More than that, though,we need realise that society needs the minds, the joys, the deep interests, of autistic people of every kind.

Thank you.

Wednesday, 27 March 2019

Autism Acceptance, not Tragedy

A rainbow coloured infinity symbol
April is a time of Autism Acceptance.

That doesn't sound too controversial, does it.  But, it is.

There's people who say to me, "How can we be positive about autism?  Why aren't you more negative about it all?  Why aren't you talking about the hardships that some individuals and some families go through?  Why aren't you discussing those in greatest need of support, who cannot live independent lives or be in paid employment? Where's the tragedy stuff, Ann?"

I'm glad to explain.  It's simple.

We have now had more than 70 years of portraying autistic lives as tragic.


The end result has been more tragedy.

This isn't a surprise.  Suppose we were endlessly negative about (say) women, saying, "Some women live awful lives.  We mustn't say good things about being female, because that's disrespecting the women who really struggle."  Would this be a good thing?  Would it help any of the women who were indeed struggling, if everyone was trained to see women as a tragedy?

The tragedy-narrative hasn't led to better results.  It hasn't led to better services.  It hasn't led to better care.  It hasn't led to better benefits, or better education.

It led to some schools not wanting autistic children there.  It led to some leisure services deciding that autistic people were too much hard work.  It led to too many employers deciding that autistic people were too costly, too problematic.  And it led to some groups earning themselves a breathtaking fortune from providing abusive 'services' to these tragic autistic people.

Exceptions apply.  Of course there are some good services out there.  But generally, the 'awareness' became 'bewareness'.  Beware!  Autism!  Run!

So, that's the reality of forcing an entire population of autistic people to live, endlessly, as figures of tragedy for the media.  Or objects of pity.  Or objects of charity.

This is why the Autistic Pride networks exist now.  They're led and run by autistic people, and their aim is to boost self esteem.  To celebrate autism and whatever makes that person happy.  To showcase autistic arts, etc.  To enable access to things that are genuinely fabulous.  And to share life, friendship and fellowship with other autistic people of every kind.  Whether verbal or not.  Whether of high, low or medium IQ.  No matter what support needs they may have.

Is it perfect?  Of course not.  But it's like emerging from under an endless burden of negativity, into a shaft of sunlight.  And that acceptance, that friendship, that sharing - well, it enables families to relax, to enjoy, to start to thrive.  It enables schools to think, "Hey, what have we been missing here?".  It enables employers to get involved and see us as the fabulous, varied people we are.   And...it enables people to find some answers for themselves, find new ways round obstacles together.  Whatever their desires for their own lives.

Is every autistic person fantastic all the time?  Nope.  We're all individuals, so some of course are grumpy or sad or any other emotion. Some are in terrible pain or fear, because teams inflict pain and fear upon them, quite accidentally, through ignorance.  Some have awful things done to them that are quite enough to make anyone angry, avoidant or afraid.  Some have multiple disabilities or difficulties, and they are rightly looking for good answers.  So finding those good answers is important.  For them, and for their families.


In the wider work I do, I help ensure that care homes are run safely and well, listening to autistic people who live there.  I help families to find positive ways to help their young people to thrive, and direct them to autism-respecting services that enable skills and autonomy without abusive and controlling methods being used. I train teams to understand and respect autistic people, changing their own attitudes to us.   I do all of this with amazing teams of people, many autistic.  Including our own wonderful Autistic Pride Reading charity team, and the amazing experts in AT-Autism.

Our aim is to ensure that every single autistic person is able to live a life that brings enough joy.  Enough focus.  Enough thriving.

As a parent, I've had a long journey through the perils of schooling that went awry, and a fight for basic services.  I'm not living in some fantasy where all is filled with glitter.  


But, the tragedy narrative has caused too may dead autistic people. Too many have fallen into such depression, such anxiety, that taking their own lives is preferable to living another day of fearmongering and loneliness from all that 'othering'.

So, yes, I won't be talking about autism as a tragedy, because we're not tragedies.  We're a group of truly fantastic people.  Once we embrace a deep understanding of autism, and accept, include and enable each other, all of us benefit.

If you are looking to do something positive, donate to an autistic-owned enterprise.  Come along to our public days.  Buy goods and services from autistic people.  Make sure you're not 'lighting it up blue' (a campaign started by a very problematic foreign organisation which doesn't like autistic people at all).  Use symbols like the one at the top of this page, showing autism acceptance.  Red and gold versions exist too.

So, autism acceptance, in April.  We're reclaiming it and making it our own.  

Get to know more about us, and enjoy.

Wednesday, 20 March 2019

Autism: The Perils of Some Online Training


A man with dark hair, in a business suit, looking at a laptop computer, in a shocked way.  There are three exclamation marks.


Not much time?  A problem to trek to a distant training course?  It becomes tempting to look for online training.

Training on autism is certainly available online.  I've seen, and taken, a few such courses.  

Some are reasonable.
Some, frankly, are very worrying.

So, I wanted to share a few important thoughts, for those making decisions about how their staff are trained.  And, of course, to people considering taking online training.

One important thing about autism training is removing prejudice.  Prejudice exists.  It not only exists, but is a major barrier for autistic people.  It leads to terrible outcomes for some.

There has been a very recent study looking at prejudice against autistic people.  It showed that the best way to stop it is for non-autistic people to spend time with autistic people. To get to share life with us for a while, to meet us as friends, neighbours, colleagues, parents, students, volunteers, artists, craftspeople, musicians, etc.  To get to see a few of us, in all our variety, and of course to learn good, accurate information.

Online training courses don't allow for that personal interaction.  People never get to meet us.  So, there is a concern about whether such courses can do much for overcoming prejudice.  That research showed that, for some, just knowing people are autistic makes the prejudice worse, not better.  It needs a trainer's skill to overcome some of that.

Worse still, some online courses show every stereotype imaginable.  Endless photos of a youngish white male, dressed in clothing that looks like it has come from a charity shop, perhaps sitting aimlessly on a bench somewhere.  Or being 'looked after' by some smiling perfect professional.  It's depressing and inaccurate stuff.  Most of us are not male, for a start.  I'm quite serious about this.  If we start looking properly for all the autistic people who do not identify as male, it adds up to more than half the autistic population.  Surprisingly few of us are in care home settings.  Quite a number are business professionals, as likely to be dressed in a corporate suit, or other workwear, as a tracksuit.

Some online training also tends to be filled with myths.  Myths about '1 in 100' being autistic, when that's a figure from decades ago.  Myths about lack of empathy, myths about lack of awareness of others, myths about our communication and culture. Myths about dangerous behaviour, when most of us are safer than other people to be around.

There's another problem with some of the online training.  We don't know who's taking the course.  Unless they are sitting in the room with the 'examiner', it could be absolutely anyone who fills in the answers.  As a HR person or manager, you've no idea if Employee X did indeed get 95% on the assessment, or whether they asked a mate to do it for them.  You also do not know if they simply screen-shotted all the answers and then wrote them out in the assessment bit, without taking in a single bit of knowledge.

But now, they have a Certificate that says they know about autism.  Out into the world they go, looking for these shabbily-dressed young men sitting on park benches  - and perhaps making a right old mess of every encounter thereafter.  It forces autistic people in your organisation to hide, because those stereotypes are simply humiliating for them and in no way represent their own reality.


If you are searching for quality autism training that matches your corporation's ethics and anti-slavery policies, here is your checklist:
  1. Autistic people are involved at every level in the training organisation, as equals with non-autistic people.
  2. Autistic people designed or co-designed this training.
  3. Autistic people lead or co-lead the training, and are paid properly for it, not a book token or for 'work experience'.  Unless of course that was their own personal choice to work for a token amount, or as a volunteer.  Watch out for breaching your anti-modern-slavery policies if you're using companies that coerce autistic people into working for free, when money is paid to others.  It's an embarrassing question to ask, but it's vital to ask it. No good training company should mind affirming that they are responsible about this, and maybe letting you communicate with their autistic trainers about how valued they are.
  4. The materials use respectful language about autistic people.  
  5. It does not use puzzle-piece logos or promote the work of highly problematic groups that wish to see autism 'cured'. (A similar aim to wanting all gay people cured...yikes, no).
  6. It gives trainees an accurate and respectful idea about autistic culture and communication, sensory needs, and the value of passionate interests.
  7. It shows how autistic people can thrive, and how to enable us to do our best.
  8. It has a wide variety of autistic people represented or described, e.g. of different ages, cultures, ethnicities, social groups, genders.
  9. It respects the many ways in which autistic people contribute to society, whether as friends, volunteers, writers, supporters-of-others-online, workers, professionals or otherwise.  But also stressing that all are valued parts of society, all needing lives that are worthwhile, safe and respected, whether in paid employment or not.
  10. It focuses on changing the attitudes and misunderstandings of other people, not changing the autistic people to be copies of non-autistic people.  In particular, it avoids problematic 'behaviour-training' such as ABA to enforce such normalisation. 

And... it enables the trainees to feel relaxed and cheered about meeting autistic people, keen to encounter us and learn more from this fantastic and diverse group.

If you are confident that the training ticks those boxes, use it.

I'm open about recommending my own groups and the groups where family members are trainers.  Plenty of other good ones out there, of course.  And there's work enough for all, respecting one another's contributions.  Here are two starting points.

AT-Autism, offering national and international training (CPD, world experts)   Specialises in training organisations to have a deep understanding of autism, and improve their in-house training.


https://www.aprtraining.org.uk/ Highly respected professionals and leaders, autism-positive charity  Working in the central South of England, encouraging the best of cheerful and practical advice for autistic people and all who share our lives.

Thank you for reading.


Thursday, 28 February 2019

Driving Whilst Autistic - The Research

A picture of a green Jaguar open top sports car

Updated 5 March 2019

Here in the UK, we have been having an interesting set of discussions with the Government driving authority, the DVLA.  There was input from various Police Officers, the National Autistic Society, GPs and other interested parties.  The subject - whether it's compulsory to notify the Government that we're autistic, and get a medical professional to confirm we're safe...when we're already assessed and passed as competent drivers. The subject is raised often for discussion by the DVLA's Panel of Experts, so it is important to be clear about what autism is, and is not.


Let us remember that most autistic people wishing to drive make a choice to have driving lessons, where a highly qualified driving instructor already assesses our competence.

We also have to pass the same tests as everyone else, on eyesight, on knowledge, and on practical skills behind the wheel.  These tests are taking by highly qualified examiners, who test every aspect of competence.  100% of autistic licensed drivers were autistic when they took  - and passed - their test.  It's a lifelong neurodiversity, not a sudden health condition.  Not a mental illness/ 'psychiatric disorder'.  That's a fact, not a judgement of mental health conditions.  See the National Autistic Society for details, for example.

Apparently, someone has told the DVLA that autistic people may be more likely to have driving problems than others.

Aside from the illogic of assuming that this would only be apparent after we've passed a test showing we're competent, let's have a romp through the research on this subject.  Brace yourselves and buckle up, my lovelies, because this is going to be a rough journey.

First up, the paper by Haley Bishop and colleagues, published 2018.  They reviewed whatever competent papers they could find on the subject of autism and driving.

We know that much of what we 'knew' about autism, historically, has turned out to be rubbish, and therefore materials from the last few years are the relevant ones.

Ready?
Away we go.

Almberg et al. 2015.  Forgot to assess whether their autistic people also had ADHD.  Thus cannot tell which characteristics of good or bad are which. Ooops.

Bishop et al. 2017. Autistic participants, "Showed no difference in reaction time between hazard types" (compared to non-autistic ones).   Small sample. But this is hardly a sign of a problem.

Brooks et al. 2016. Minimal performance differences were observed between autistic and non-autistic participants. Nothing of danger here then.

Cox et al. 2017.  Only bothered looking at novice drivers in a computer simulation of driving, which isn't evidence of anything in particular.  Small sample. 


Factor, 2016, looked at young adults in a computer driving simulator again, which - as for Cox, above, isn't evidence of on-road driving ability.  The autistic people had less driving experience than the non-autistic participants, also.

Reimer et al. 2013 looked at 10 young male autistic people, and..used a computer simulator, not real driving.

Sheppard et al. 2016 looked at a small group of young male autistic adults, and noticed that slower reaction speed was related to IQ, not autism. None actually had a driving licence.

Wade et al. 2015 looked at 6 autistic teenagers.  I don't think I need to say more about this, do I.

We have had concerns about 'executive function'  - the ability to plan and do something.  But the most recent research shows that autistic adults have practised tasks well enough that this isn't any more of a problem, generally, than for any other adult group.  


The research on ADHD, a group also affected by DVLA random rule changes, seems no better.  For example Aduen et al. (2018) who put drivers with ADHD into their own cars, equipped with monitoring technology, and counted how many accidents they had. Then compared that to non-ADHD drivers, also in their own cars, also monitored.  Except...the drivers with an ADHD diagnosis were generally younger, with less education, less overall driving experience, less money to buy a car that had anti-crash technology in it.  They were not comparing like for like.  They hadn't even considered that the car was an independent variable.

Back to autism, where Chee et al (published 2019 in Disability & Rehabilitation) looked at 17 autistic drivers, of which one was female. (I'll let you think about that...).  All were put into a driving simulator.  The autistic drivers had on average 500 hours less driving experience than the non-autistic participants, but the researchers decided that greater error rates were because of autism.  Autistic people were better at not tailgating, but this was framed as a potential deficit of our spatial awareness.  What is this stuff?


Well.  Mmm.  Older drivers? No.  Experienced drivers? No.  Women drivers?  No.  In fact, no thought at all to the usual groupings of any kind.

Most autistic people are adults.  Most are over age 30.  Around half are not male.  Many are from minority ethnic groups, or the Professions.  Some are serving Police, Fire Crew, Ambulance and Paramedic staff.  Doctors, Nurses, professionals of every kind.  Where is the evidence of incompetent driving for those latter groups? There is none.


Do you understand how depressing it is to be in a world where this research passes as 'evidence' of anything at all?

Our young people deserve a future where their competence is taken as seriously as it is for everyone else.

If they pass a test, they have been assessed as competent.  If that test does not test for competence, improve the test.  Do not punish those taking it.

After hard campaigning and shocked outrage in the UK, the DVLA changed its guidance back to a need to report only 'if it affects your driving', and issued an apology.  This is good.


But...the episode has left behind a trail of damage.  Autistic people who had been shocked and afraid.  Afraid of losing their car, their freedom, their jobs.  Afraid of going forward for support or diagnosis in case someone did indeed remove their licence for Driving Whilst Autistic.  After all, if they are not diagnosed, they wouldn't have had to report in to the DVLA.  All of this happened, it seems, on sheer misunderstanding.  That is an error we cannot afford.  


Any Panel meeting to discuss such a life-changing, financially devastating move should convene only with the finest and best members & facts.  Openly and transparently.

There should be:
Evidence heard directly from those affected, in ways that enable, without exhaustion.  Research commissioned from those with a good modern understanding of autism, using a participatory model that fully involves autistic professionals and colleagues in its inception, methods and implementation. 
At meetings, the top specialists from affirming and enabling charities and groups, with many autistic specialists amongst them
.
Similar Panel aims should happen for any other affected group such as ADHD, of course.

The autistic communities have had quite enough of having things taken away from us, and quite enough of meetings about our lives being held without reference to us.  It is really not OK.  We need better than groups whose only experience of autism may have been to watch Rain Man, or meet one of us in a prison.


Meantime, lovely autistic people, continue to drive safely and wonderfully. Do follow legal requirements at all times.  Just like you already do.

Or, if you don't feel driving is for you/something you can do safely, take full advantage of whatever other means of transport exist.  Just like you already do.


Thank you for reading.