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Autism and higher education don’t mix

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In this article I will place the disproportionate, even exorbitant numbers of diagnoses in a broader and also social framework. Because the group of highly intelligent people is overrepresented, extra attention is paid to this group. Then I will examine the possible consequences of misdiagnosis and make suggestions for turning the tide.

1.Causes and Symptoms of Autism

The autism syndrome, like other syndromes, has a history when it comes to understanding the disorder. Before 1940, autism was only diagnosed in people with very low intelligence and hardly any language development.

This form is referred to in the spectrum as classic autism. In the 1940s it was recognized that autism can also be associated with normal to supernormal intelligence and in conjunction with language development and speech. This form is called Asperger’s Disorder in the DSM4 after Hans Asperger, who first described it. (see footnote *1)

Autism is a serious, congenital disorder that has far-reaching consequences for a person’s functioning. In essence, autism is an information processing disorder: the senses do not adequately process internal and external stimuli. The disturbance of perception can be severe or less severe and affect several senses, including hearing, touch and taste.

The consequences of this translate into a range of symptoms. Neurological research points to brain abnormalities, but these studies do not yet provide a sufficient basis for determining the disorder in this way. Gene research is also being done, of which it can at least be said that autism is not hereditary.

In early childhood development, the perception of one’s own body forms the basis for further development. Stimuli affect the child from within, such as body sensations such as fatigue and pain. If there is a case of not feeling well tired or in pain, then we see in the autistic child the inability to feel the pain threshold in himself and, by extension, of the pain threshold in others.

Incentives also affect the child from the outside. If perception is disturbed during early development, this has consequences for body image and body awareness.

Body image is knowing the relationship between the parts of one’s own body. It develops because the child perceives its body: for example, it studies its hands, puts its toes in its mouth. It also develops through exploration of space and everything in it; think of handling all kinds of objects. A good body image gives people the opportunity to perform all kinds of actions without thinking about it.

If the body image is not well developed, because the sensory perception is not good, this can have consequences for, for example, eye-hand coordination. Sensory stimuli are forwarded to motor receptors, also called sensor motor skills. Disruption of this has consequences for, for example, the speed or the smooth course of actions.

The basis for body awareness is skin contact and touch in infantry. As a result, the child literally learns the limits of his body. Body awareness ensures that people know how they relate to space and what is in it: think of, for example, above and below, or distance and proximity. A disturbed body awareness, because the child cannot properly experience skin contact, is reflected in the autistic child’s inability to adequately deal with distance and proximity in personal contact.”

A poor body image and body awareness therefore have consequences for movement, orientation in space and time, actions and the relationship with oneself and others.

A few examples:

  1. Development of a sense of time is related to orientation in space; think of having something “behind” and having something “before you”. Ordering and planning are skills based on this, among other things.
  2. The autistic child has difficulty making coherent wholes based on different details because perception is fragmented and parts merge with other parts. If we think of the constant changing of people’s faces, it becomes understandable that the child tries to shut himself off from this ongoing, confusing and frightening change:

the child makes poor eye contact. As a result, the child does not learn, or learns with difficulty, to read emotions on faces or to express emotions non-verbally. Nor does it learn to properly discern its own feelings; it lacks the mirror needed for that. We therefore see in autistic people a lack of insight into their own emotional movement and difficulty in empathizing with others.

  1. Giving meaning to objects is difficult, if it is difficult to see the object in its entirety, or separately from other objects. It becomes even more difficult when different objects still have the same name. Concept formation and abstraction and thus the understanding of symbols and figurative language cause problems. We see a first expression of this in the autistic toddler who does not make the transition to pretend play.
  2. A child who has to find his way in life with this disability will be anxious and react angry and frustrated when his world is disrupted. Rituals, routines and repetitions should then allay the fear.

In summary, you can say that the problems with perception as described above form the basis for problems with movement, orientation in space and time, order and planning. The ability to learn is limited by the difficulty with meaning and abstraction. Social-emotional development is slow and difficult. Autism therefore has consequences for thinking, feeling and acting in the broadest sense of the word.

In an autistic child with cognitive abilities and language development, the symptoms of the disorder are less severe, because he has relatively more possibilities to organize his world and to establish contacts. However, the basis of the disorder remains the same and limited use can be made of the potentially present intelligence. (see footnote *2)

When making a diagnosis, the symptoms must be traced back to the central cause: a disorder in sensory information processing.

PDD-NOS is an autism-related disorder. It is characteristic that there are insufficient symptoms to really speak of autism. In PDD-NOS there are serious problems in social interaction and with verbal and non-verbal communication. Children with this disorder compulsively adhere to rules and certain activities. That way they feel less anxious. The cause of the disorder has not yet been sufficiently investigated.

  1. The increase in the number of clients diagnosed with ASD and PDD-NOS in the context of social, socio-cultural and scientific developments.

In the 1960s a process started that puts the individual and personal development more central. People break free from old patterns and social ties. Self-examination and self-development become important items.

People ask questions, also about the development of their children and look for answers. In this way, mental health care is becoming more and more commonplace, and so is research and treatment. This research into possible developmental delays also has a downside. There is less waiting and more presumption of a disorder.

The emancipation of specific groups in society is also getting underway. Client groups or parents of clients organize themselves and stand up for their rights. For parents of children with an autistic disorder, this means that they can finally draw attention to good help and good treatment methods. They do this successfully. Autism, previously a relatively unknown condition, is receiving a lot of attention. Here too we see a downside, as will become apparent from the next section.

There is a change in general interaction, which is sometimes described as the transition from a culture of command to a culture of negotiation. There is room for the influence of the individual. Self-reliance and, in conjunction with this, communication and cooperation are becoming important competencies. In education, reflecting society, students increasingly rely on these skills. There is cooperation on projects, the study house is introduced.

Coinciding with the cutbacks in education from the eighties, but also linked to the emancipation of the disabled in the nineties, the “Together back to school” project is introduced.

It aims to accommodate children who previously attended special education schools in regular education. Teachers are trained in recognizing disorders in children. “Back to school together” considerably increases the burden on teachers. There are children with different problems in full classes.

As a result, the need for explanations in the sense of a disorder increases; ADHD, dyslexia and autism are disorders to which specific attention is paid in courses. When learning to recognize a serious disorder such as autism in a short course, you can ask questions. The teacher is taught which symptoms to watch out for. The result can be compared to knowing different ingredients for a raisin bread, without ever having seen or tasted a raisin bread.

As a result of all this, children who, for whatever reason, behave less socially and communicatively than average, are soon seen as possibly autistic. This is then the first step towards getting the label ASS, or PDD-NOS.

From the point of view of efficiency, the GGZ sets up special teams for diagnosis and treatment during this same period. A child who is sent from education to the GGZ will, if autism is considered, end up with the special team for autism. In the 1960s it was already shown in scientific research that where a specific disorder is screened for, this disorder is also often found.

Applied to autism: there is a good chance that the autism framework determines what is seen and what is not seen and that tests performed are interpreted from a tunnel vision. In addition, for the anamnesis (the client’s life history), parents are requested to fill in lists, in which they are asked about characteristics that may indicate autism.

However, parents do not know the criterion on which the question is based. The question is asked whether the child has limited interests, but is referred to whether they have one-sided, non-functional interests. Parents fill in “yes” because they think their child spends a lot of time in front of the computer. The often inexperienced care provider interprets this in two ways: there is one-sidedness and the client does not focus on people.

Meanwhile, the child itself occupies itself on the computer with a range of subjects, in which it has contact with people who share its interests. An additional problem concerns the objectivity of parents. It is known that parents can already view their child differently; while one person sees few problems, the other may be very concerned. It’s for the rescuer,

An additional development in the 1990s is the increasing use of the DSM for diagnosis. The DSM is an international classification overview of psychiatric disorders. The aim is to agree on the terminology used. Disorders are described by observable symptoms.

The DSM does not look at the cause of symptoms or at the relationship between them. However, these are important conditions for establishing a correct diagnosis. For example, poor eye contact as an expression of shyness is quite different from making little eye contact to avoid the constant change of facial expressions.

If there is little eye contact, social interaction is difficult. When the cause is shyness, it doesn’t have to be permanent; in case of autism the interaction will always be problematic. The use of the DSM as a diagnostic tool means that less careful research is done into the backgrounds of symptoms, while this is essential for proper interpretation.

A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders. Having a temporary lighter problem is not enough. Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. The tendency to look at individual symptoms has unfortunately only increased. (see footnote *3) in case of autism the interaction will always be problematic.

The use of the DSM as a diagnostic tool means that less careful research is done into the backgrounds of symptoms, while this is essential for proper interpretation. A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders. Having a temporary lighter problem is not enough.

Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. Unfortunately, the tendency to look at individual symptoms has only increased. (see footnote *3) in case of autism the interaction will always be problematic.

The use of the DSM as a diagnostic tool means that less careful research is done into the backgrounds of symptoms, while this is essential for proper interpretation. A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders. Having a temporary lighter problem is not enough. Mental health care often uses the DSM to determine these disorders.

In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. Unfortunately, the tendency to look at individual symptoms has only increased. (see footnote *3)The use of the DSM as a diagnostic tool means that less careful research is done into the backgrounds of symptoms, while this is essential for proper interpretation.

A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders. Having a temporary lighter problem is not enough. Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum.

The tendency to look at individual symptoms has unfortunately only increased. (see footnote *3)The use of the DSM as a diagnostic tool means that less careful research is done into the backgrounds of symptoms, while this is essential for proper interpretation. A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders. Having a temporary lighter problem is not enough.

Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. The tendency to look at individual symptoms has unfortunately only increased. (see footnote *3) A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders.

Having a temporary lighter problem is not enough. Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. The tendency to look at individual symptoms has unfortunately only increased. (see footnote *3) A final important development in this regard is that health insurers agree with the GGZ that they will only reimburse if there are disorders.

Having a temporary lighter problem is not enough. Mental health care often uses the DSM to determine these disorders. In the fourth version of the DSM (DSM4), fewer symptoms are needed to fall within the autism spectrum. The tendency to look at individual symptoms has unfortunately only increased. (see footnote *3)

In summary, it can be concluded that the need for diagnosis in the form of naming disorders has increased for various reasons. Screening must be done quickly and efficiently and this is at the expense of searching for the backgrounds of symptoms. The autism disorder is popular because it affects social interaction and social communication.

Autism can be used as a diagnosis: it has many symptoms, and not all manifestations need to be present, especially in the lighter forms. PDD-NOS, an equally serious disorder, is equally easier to use, as a minor abnormality. The sting in all this is the word “spectrum”, because it opens the door to stretching the concept of autism wide open.

The exponential growth in the number of diagnoses of Asperger’s Syndrome and PDD-NOS over the past 15 years is therefore consistent with certain social developments in this period.

  1. Autism and giftedness: worlds of difference.

Implications for learning and training.

The diagnosis of an autistic disorder in children with average and above average intelligence has increased explosively in recent years. We currently see that this group is reaching secondary and higher education.

For example, Eindhoven has a school for special secondary education for intelligent children with ASD. At various colleges and universities, there is a significant number of enrollments of autistic students. In response to this, mentors are trained in guiding these students.

Radboud University is starting a project for autistic students: the student gets a Buddy who helps him with all kinds of problems. In the meantime, people are somewhat concerned about whether this group can be properly supervised, but the key question: “What is actually going on here?” does not seem to be asked.

The group of gifted children runs an extra risk of being labeled autistic. People who are gifted and people who suffer from Asperger’s syndrome can have a number of similarities superficially. On closer inspection, however, when looking at causes, there are major differences. I want to take this group as a starting point for my further story.

Gifted children sometimes have trouble with change, not because they wouldn’t be able to handle a new situation, but because there is so much to discover in a situation that they are overwhelmed by everything they notice and want to understand.

Someone with Asperger’s Syndrome finds it difficult to experience his world as a unity, if things change in the situation, he has to pull out all the stops to organize and understand his fragmented world.

The language development of a gifted person is often so advanced that it feels formal. Someone with Asperger’s copies beautiful sentences, but he takes the content literally.

A gifted person often has an eye for details, but does not lose sight of the common thread and has a view of the core of the whole, while the person with Asperger’s Syndrome dwells on irrelevant things. Gifted people can sometimes spend a long time on a subject, someone with Asperger’s constantly repeats themselves, there is no deepening.

A gifted child can stay in the fantasy for a long time, because in the fantasy a lot is possible and it can thus give shape to his creativity. However, it does know the difference between fantasy and reality. A child with Asperger’s has difficulty making that distinction.

A gifted person is often alone because he is far ahead of his peers and therefore not understood. It is not the lack of being able to sense the other person and therefore inability that is at the root of problems with playing and collaborating, but a lack of connection. Not being understood promotes frustration/anger, but also fear of failure and less development of social skills.

An additional problem is that gifted individuals can lag behind in practical and motor skills, because they do not need concrete action to gain understanding and insight. They also often see in their mind’s eye what the result should look like.

The tendency to perfection then leads to avoidance of such assignments. This can play a role in sports and gym, but also in all kinds of other tasks. A child with Asperger’s, because of his disorder, has more or less permanent problems in these areas, despite therapy.

Gifted people often prefer to work alone: ​​the average level is not challenging and satisfying. On the other hand, someone with Asperger’s Syndrome finds it difficult to put themselves in the shoes of the other person, so there is an inability to work together.

A gifted person may seem to have trouble planning. However, given his analytical ability, it is not the planning itself that causes problems. A gifted person often has so many ideas that he cannot make a choice and therefore does not start.

Or the reverse: he is so engrossed in one subject that he forgets the rest of the world, ie his planning. Sometimes he knows so well what is still missing from the product that he does not consider it good enough to hand it in.

Sometimes he thinks so fast and the result is so unorthodox, that it seems that he is skipping steps and thereby arrives at a wrong result. The planning problems of autistic people can be traced back to organizing problems, to the inability to distinguish main and side issues at a basic level.

Despite their intelligence, people suffering from Asperger’s Syndrome cannot attend HAVO or VWO, let alone attain HBO or university because they lack a number of essential skills. Also a few examples of this:

Someone who seems to have a good understanding of the language, but has difficulty with figurative language and symbolism, cannot take a final exam in Dutch or other languages ​​​​at HAVO/VWO level. Someone who has really limited interests and talks about them rigidly loses the connection.

Someone who thinks in a fragmented way is unable to identify outlines and make summaries, which are necessary for many subjects. Someone who cannot put himself in the shoes of others, cannot put himself in other cultures and times, necessary for just as many subjects.

Fragmented thinking is not the same as analytical thinking, so Science courses also present problems at this level. And finally, someone who is afraid of the unknown and unpredictable cannot fit into the culture of secondary education, where change of teachers and classrooms and changes within those classrooms is normal. (see footnote *4)

Quote from a math student diagnosed with autism: “If it’s true that I only perceive details, I can forget about my studies.”

A number of years ago, successfully completing the VWO was still a contraindication for autism, now the answer to the above in care providers is: “You can also be very slightly autistic, the spectrum is wide, you do not need all the characteristics and autistics can achieve a lot if they are properly guided.” Meanwhile, the “autist” himself is lulled to sleep with the mantra: “Asperger’s is a mild form, which is very easy to live with.”

The question arises: how “slightly autistic” do you have to be to stop being called that? Because even if you don’t really fit into the picture of autism, there is always PDD-NOS or even the possibility of only having “autistic traits”.

4. Consequences or Misdiagnoses

The diagnosis of autism is not only incorrectly made in gifted individuals, but also, for example, in children with unprocessed grief as a result of a traumatic event, in children who behave inappropriately due to parenting problems, or in adopted children with attachment problems. The consequence of a misdiagnosis is, in the first place, that the client does not receive the help that he needs.

For example, a child with unprocessed grief needs to express his emotions. If, however, it is assumed that under his flat emotionless expressions lies inability, then the work is not so much on expressing and processing emotions, but on basic learning to recognize those emotions in others.

The unprocessed suffering remains and can later lead to depression. The child of divorced parents who withdraws, is not taught that he is not responsible for the situation that has arisen, and therefore not that he does not have to feel guilty, if it is assumed that he is autistic.

A diagnosis such as Asperger’s Syndrome, or PDD-NOS, incorrectly made in gifted children, often leads to initial relief; Finally the client and parents know what is going on. The fact that it is something that nobody can do anything about leads to a reduction of feelings of guilt and shame.

For example, an “autistic” child advised another child to go to the RIAGG with the reason: “then you will receive a diagnosis and then you cannot do anything about it yourself and then you no longer feel guilty.””

Parents are told it is a mild form and this is consistent with their experiences. Son or daughter, is full of language jokes, is creative, participates in judo, plays in an orchestra, can have a good say about the problem.

He does have trouble making contact, but not always; there are situations where he “suddenly” isn’t autistic at all! Collaboration and, for example, planning can sometimes cause problems, but it is promised that with the right guidance a lot can be improved.

According to the care provider, it is then possible to live well with the remainder of the disability, especially “because nowadays schools, universities and work situations take the disability into account and guidance in the home situation can also be realized.”

Treatment follows after diagnosis. In psycho-education, the client is offered, below his level, basic knowledge about making contact and understanding the basic emotions. Attention is also paid to accepting the handicap: “as an autist you will always have problems in social interaction.”

If they are stuck in their studies, they look for “what they can still do on the labor market” and they are advised to follow a suitable training course below their level. If they do continue their studies, they are made dependent on help and guidance in organizing and planning their studies, something they could do very well themselves if the real obstacles were removed.

The result is an intensification of feelings of insecurity, resulting in a lack of self-confidence and fear of failure, sometimes resulting in an identity crisis or depression. Primary school children cannot defend themselves against this impairment of who they really are.

From now on, family, acquaintances and neighbors will treat the child as a disabled person, instead of as a child with talents and possibilities. At school, the information from the GGZ is placed in the child’s file. This file will last a school career. Returning from the trap is getting more and more difficult.

Adolescents who are busy developing their identity and who get stuck in their studies and/or contacts can also find it difficult to resist this undermining. Gifted children behave independently from an early age. Early on they have their own opinion that often goes against the prevailing norm or thought, they also often have a good social insight and therefore a sense of what is ethical and just.

They don’t conform if they don’t see what that’s good for. They break that independence if they go their own way too much; they get stuck in contacts and in their studies. With that experience in mind, this adolescent, in response, tends to eventually conform too much, especially when promised help.

they get stuck in contacts and in their studies. With that experience in mind, this adolescent, in response, tends to eventually conform too much, especially when promised help. they get stuck in contacts and in their studies. With that experience in mind, this adolescent, in response, tends to eventually conform too much, especially when promised help.

It is not easy for someone with a diagnosis that is not correct if he wants to avoid that diagnosis. Aid workers, school, parents, family and acquaintances and the person concerned jointly maintain the judgment.

Observations that allow doubt about the diagnosis are invalidated by labeling them as irrelevant, doubts on the part of the client and whether parents are counted as not yet accepting the disability. The client behaves more and more according to the role that he has been assigned.

The people he trusts most no longer expect him to develop normally. If you are constantly being told that you can’t learn something or can only learn something, where would you get the strength and courage to show the opposite? This way the stigma can last a lifetime.

5. Turning the tide

If something is to change, it must first be recognized that the current increase in the number of clients with ASD and PDD-NOS cannot be right. Secondly, the consequences of current practice will have to be examined and taken seriously.

There are high costs associated with this policy, which instead of being profitable, cause a lot of damage; personal damage, but also social damage, for example in the form of talent that is lost.

Having a disorder, as a condition for getting help, distracts from real dialogue. If, during the research, the concrete situation of each person is examined more deeply, if people really listen to what someone has to say, then more often possible solutions emerge from this story. Any tests should complement this conversation, not the other way around.

Giving a label too quickly gives a false sense of security and obscures the perception, which is just so necessary for good help. Without these premature labels, teachers and caregivers can reflect much more on their observations and adjust their interventions accordingly. Finally, an example to illustrate:

a teacher from the school for autism in Eindhoven is impressed by her “autistic” gifted student; he has suggested explaining a math problem better than she did herself. She finds that he is smart.

If you look at what this student actually does, namely empathize with other students on both a feeling and a level of thought and contact the teacher about this, you already know that this student cannot be autistic.

An autistic child would only improve the sum according to his own understanding. Without a label, this boy could be told that he takes such good care of his fellow students and is therefore very sociable. In this way he could build self-confidence in making contacts.

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