Tag Archives: career

How to address social challenges at work as an autistic adult

Posted on by

How to address social challenges at work as an autistic adult

Introduction

The characteristics of autism include difficulty achieving social reciprocity, reading non-verbal communication and teamwork skills. This can lead to problems at work with social communication. Further difficulties can arise because autistic people tend to be primarily motivated to achieve work goals, for example, getting the job done to a high standard and finalizing the details, whereas typical people often focus to a greater extent on social goals, for example, relating to someone, being liked, receiving compliments, pleasing others etc. Both sets of goals are important and valid in a work setting, but these goals need to be balanced and appropriate for the work environment.

Problems can arise when an autistic person in the workplace does not realize their own role and contribution to social communication breakdowns, and when the work culture does not understand or embrace the characteristics and motivations of the autistic person. It is important at work to recognize that it takes two to make a social interaction successful and that successful social communication requires all participants in a social interaction to understand each other’s perspective, motivation, and social abilities. If you are autistic, or that person’s colleague or line manager, take a moment to consider any social communication difficulties at work. These are some potential social challenges.

What are the social challenges at work that autistic employees face

It is important for an autistic employee to identify their social difficulties at work. They can do this from both their own perspective and from feedback from work performance interviews and comments from colleagues. Social challenges commonly experienced by autistic adults include:

being able to ask for help when needed.

being able to offer strategies for repair of the interaction when communication breaks down.

being able to assertively manage workplace bullying.

understanding another person’s point of view or objectives.

taking a literal interpretation when this was not intended.

responding with conventional empathy.

recognising personal space.

knowing when to initiate and end a conversation.

understanding office politics, interpersonal dynamics, and social hierarchy.

recognising a ‘hidden agenda’ and someone intending to take credit for the autistic person’s work.

Autistic employees may also find other people at work socially challenging when:

they expect socialising beyond the capacity or endurance of the autistic person, e.g., more eye contact, social chit chat, talking about popular topics, self-disclosure etc.

they do not seem to appreciate an honest answer and being corrected.

they interrupt the autistic person’s concentration.

they do not seek to understand the autistic person’s point of view.

How to manage social challenges at work

Once the challenges are identified, the next stage is to create a social support network that may include a trusted colleague, appointed work mentor, line or HR manager, or family member to help see the social communication problem from another perspective and to suggest strategies to acquire specific social abilities.

It is important to decide what to tell each person in the support circle about any social communication difficulties depending on the person’s role in the circle, remembering that a person in the support circle can be invaluable in facilitating seeing the problem from another point of view, which then has good potential to lead to a solution.

Seeking support, advice and knowledge

The first strategy is to seek support. It can be stressful and challenging to experience social challenges at work, and the support and understanding of others can relieve the stress of having to cope alone.

Members of the social support circle may also be able to provide guidance, advice and knowledge. For example, it may help to acquire knowledge on social communication abilities such as learning how to improve the ability to read body language and being a member of a team.

Someone from the support circle may help identify the relevant social cues and context for a situation associated with social confusion or criticism. They may be able to see different perspectives and potential social communication breakdowns that can be repaired or avoided using their social advice. They are social mentors, and it is wise to seek their advice.

Another strategy is to acquire knowledge on social communication skills using the literature and Apps on reading body language. There is also literature on how to be a successful team member. It is not only autistic employees that benefit from improving social communication.

A member of the support team may be able to translate the perspective of the autistic employee to other team members. Autism is a case of double-theory of mind difficulty. Autistic employees may struggle to understand another person’s perspective, and equally the other person struggles to read and understand the autistic person. A translator who understands both perspectives can help.

Social scripts explaining autism

With an insight into problems with social communication and motivation to repair any problems, we have found that it is possible to use social scripts to manage a breakdown in social communication. Social scripts can be useful for most of the social communication difficulties associated with autism.

Consider the following questions based on potential difficulties in social situations, and with a social mentor, creating a script for each situation. It is important to consider how to communicate specific social communication difficulties to different people at work, for example, line manager or work colleagues. A social mentor may be able to provide some insight and advice.

Question 1: How could you communicate to your line manage that you prefer to be alone during lunch breaks and do not want to talk to your colleagues?

Potential script: To improve my work performance, I need to be refreshed by solitude during the lunch break. Socialising is not refreshing for me.

Question2: How could you communicate to your colleagues that you sometimes interrupt others during their conversation, but you do not mean to be rude or disrespectful?

Potential script: Sometimes I annoy people by interrupting them. It is because I have difficulty recognising the ‘not now’ signals. Please give me a hand signal to wait until you are ready to listen to what I have to say.

It will be worthwhile creating and rehearsing the social script for a specific social situation. This can clarify the intention of the communication so that it is clear and succinct and to consider appropriate facial expressions, tone of voice and body posture. It is also important after using a social script to debrief with a social mentor.

Sometimes using a script does not have the desired effect, and the social communication problem continues, we highly recommend using someone in the social support circle to determine further strategies. Sometimes someone outside the problem may be able to help develop further self-insight or insight into the problem, as well as develop a new idea about what to do. In other cases, a mediation process at work may be helpful.

In summary

A core characteristic of autism is difficulties with social communication which can affect aspects of successful employment. It is important to identify the specific social challenges at work and to create a social support network. The social support network can provide support, knowledge and advice. One member of the team may assist by serving as a translator between autistic and neurotypical cultures at work. With clarification of points of misunderstanding, scripts can be developed and rehearsed to avoid future misunderstandings.

Employment resources for autism

We have applied our extensive experience of autistic adults to create a seven stage plan to facilitate successful employment in our new book:

Garnett, M.S. & Attwood, T. (2021). Autism Working: A Seven-Stage Plan to Thriving at Work. Jessica Kingsley Publishers. www.jkp.com

With our colleague Barb Cook, we have created a presentation on autism and employment to be webcast on the 4th of March with more information at www.attwoodandgarnettevents.com This webcast will include aspects of social communication and be of great interest to:

Employers

HR Managers

Line Managers

Team Members

Mentors and employment agency staff

Autistic employees, and

Autistic adults looking for and maintaining employment.

Partner, parents and carers of an autistic adult

Autism working

Posted on by

Autism working

Introduction

Achieving and maintaining employment can be difficult and stressful for autistic adults. Parents and partners also have their concerns, as they often provide employment support and employers, line managers and co-workers need guidance in how to work successfully with an autistic employee.

Unfortunately, many autistic adults who have a job are under-employed, that is, their job does not match their abilities, qualifications, and aspirations or their duration of employment is less than anticipated. This is despite autism being associated with qualities that are sought by employers such as:

ReliabilityAccuracy and precision
PersistenceAttention to detail and a perfectionist
Liking routines and proceduresCreativity and innovative thinking
Problem solvingFactual and technical knowledge
Sense of social justice and compassionNot letting socializing be a distraction
Talent in identifying patterns and systemsIdentifying and correcting errors
Enjoy cataloguing and recalling informationHonest and loyal
Working logically and systematicallyPassion for their chosen career

Having a successful career will significantly improve self-worth and self-identity, provide structure and purpose to the day, an opportunity to make friends, increase income and greater financial independence, and be an effective antidote to low self-esteem and depression.

Career choice

From our extensive clinical experience, we consider that no job or career would automatically be viewed as impossible due to autism. This can include the expected careers in engineering, information technology, science and accountancy but also a career in the arts in terms of being a fine artist, musician, actor or author. We have also known autistic adults who have been successful in the caring professions, from nursing to psychology and caring for animals such as being a vet or zookeeper. There is no automatic restriction on choice of career.

How to choose that career? The first option may be to see if there are employment prospects related to a special interest or talent that is associated with the person’s profile of autism and personality. A childhood talent with LEGO® that develops during adolescence into an intense interest in the design of machines could become the basis of a successful career in mechanical engineering. A determination to understand people may develop into a career in psychology and the caring profession, and a difficulty expressing inner thoughts and feelings using speech may lead to a talent in self-expression and perception in the arts.

We highly recommend that autistic adolescents have a detailed assessment of vocational abilities during the high school years to identify whether a talent or interest could be the foundation of a potential career. There will also need to be an assessment of vocational abilities that need improvement, such as teamwork abilities and coping with changes in job expectations. This information is then included in the high school curriculum. Autistic adults will need similar assessments, careers guidance and improvement of employment skills which could be provided by an employment agency.

When there is a history of failed employment experiences, this can provide valuable information on what skills or employment accommodations are needed and which jobs or workplaces to avoid. It may take several employment experiences before finding the right job with the right employer.

When searching for a job that matches abilities, interests, qualifications, and personality, it is important to find as much information as possible about the social and sensory aspects of the job. This can include personal space such as an open plan or single person office space, working independently or in a team, and sensory aspects such as sounds, lighting, clothing, and scents. It is also important to consider the understanding of autism of the line manager and colleagues and their willingness to learn about autism. Autistic people can sometimes have a ‘sixth sense’ to quickly appraise the social atmosphere of a new situation, and a positive or negative attitude can become apparent on meeting the staff prior to or during the interview. We recommend trusting that intuition.

Job interview

There will probably be a need for guidance in completing the job application form and, deciding whether to disclose the diagnosis. There are no clear rules on disclosure when applying for a job, and it is sometimes a personal decision based on whether disclosure would facilitate or inhibit achieving an interview or being employed. It is also important to decide what to wear for the interview and to rehearse how to answer the anticipated questions during the interview. If autism has been disclosed in the application, it may be an advantage to prepare a brief brochure on autism and associated qualities in relation to the position. The brochure can be attached to the application or given to those conducting the interview.

A job interview is a complex social ordeal. There is an expectation of accurately reading the body language of those conducting the interview, and succinctly and honestly answering their questions. An autistic candidate may have difficulty knowing the non-verbal signals and social conventions in an interview. We highly recommend practice and rehearsal in interviewing techniques and having an informative portfolio of relevant work experience that can be the focus of the interview. If those conducting the interview know that the person has autism, it will help to describe some of the difficulties associated with autism, but that these are significantly less than the qualities required for the position, and that there are strategies to facilitate successful employment.

Starting the job

There are potential employment issues associated with autism that will probably become apparent when starting a new job. These include the social aspects of the work, executive functioning abilities, sensory sensitivity, changes to job expectations and stress management. We have described these issues in some detail and provide strategies to overcome them in our recent publication Autism Working (Garnett and Attwood 2021) These are some of the issues and strategies.

Social aspects

The characteristics of autism include difficulty achieving social and conversational reciprocity, reading non-verbal communication, understanding different perspectives, developing teamwork skills, and following conversational rules. Workplace social communication challenges can also include discussing confidential and personal topics at work and respecting co-worker/employee boundaries. There can be difficulties knowing the social expectations and engagement in social events such as a celebration party and a vulnerability to being bullied and teased.

Strategies to reduce social communication difficulties include having a work mentor to explain the workplace social dynamics and protocols and developing social scripts to explain autism and seek support. Examples include how to communicate a preference for solitude during breaks, end a social conversation and return to work and reading the signals when a colleague or line manager does not want to be interrupted.

Executive functioning

This can include a propensity to be distracted by detail, organizational and planning difficulties, time management, prioritizing, and self-monitoring. We have also noted difficulties regarding unorthodox work routines and coping with errors, both personal and colleague’s errors. The autistic employee may need more supervision and guidance regarding executive functioning abilities than other employees. It is important that the line manager discuss strategies to minimize such difficulties and to have regularly schedules meetings to provide feedback on performance, workplace accommodations and areas for personal improvement.

Sensory sensitivity

The most common sensory sensitivity associated with autism is to specific sounds, but there can also be sensitivity to tactile experiences, light intensity, and aromas. Autistic adults often describe some sensory experiences as painful; the anticipation of such experiences creates anxiety and becoming hypervigilant. There is also the potential for sensory overload which is extremely distressing.

Coping mechanisms include explaining the sensory sensitivity to colleagues and line manager and requesting accommodations such as working some distance from the sound of the hand dryer or fridge and if possible, having natural rather than fluorescent lighting.

Changes to job expectations

A characteristic of autism is a difficulty coping with change and the unexpected. It is inevitable that there will be changes in the work environment, but it is important that the autistic person is given as much warning as possible and provided with an explanation of why there is a change of plan and expectations. This will enable the autistic person to create a new mind set.

It is also important to be aware that while promotion is considered a reward for the quality of work, there can be difficulties if the new role requires greater social and teamwork skills. It is important to consider social communication challenges in career and promotion planning.

Stress management

When work demands exceed an autistic individual’s resources and abilities, stress is the inevitable result. It is important that the autistic employee knows their personal signs of work-related stress, which work situations create significant stress, and that stress levels are communicated to the line manager.

High levels of stress will affect work performance and could lead the autistic person to resign. There may be strategies to reduce stress at work such as having a quiet retreat area to reduce stress and restore energy, using relaxation strategies and an opportunity to de-brief at work or home.

In summary

Autistic adults often have difficulties getting and keeping a job, despite having many qualities that employers seek. We need to assess an autistic person’s employment attributes and challenges, enhance their employment qualities, and address their employment issues. We also need to educate the workforce in how to accommodate and benefit from an autistic employee or colleague.

Employment resources for autism

We have applied our extensive experience of autistic adults to create a seven stage plan to facilitate successful employment in our new book Autism Working and with our colleague Barb Cook, created a presentation on autism and employment to be webcast on the 4th of March with more information at www.attwoodandgarnettevents.com This webcast will be of great interest to:

Employers

HR Managers

Line Managers

Team Members

Mentors and employment agency staff

Autistic employees, and

Autistic adults looking for and maintaining employment.

Parents and carers of autistic adults

Reference

Garnett M. and Attwood T. (2021) Autism Working: A Seven-Stage plan to Thriving at Work Jessica Kingsley Publishers, London.

Exploring autism 1971-2021

Posted on by

Exploring autism 1971-2021

The historical context

Tony Graduating from The University of Hull in July 1973

Tony Graduating from The University of Hull in July 1973

In 1971, I had completed my first year studying psychology in England. During the summer vacation I became a volunteer at a special school in my hometown of Birmingham. It was at this special school that I first encountered autism as expressed by two young children. Russel was 7 years old and Sarah five years old. They were both agile and alert, but mute and preferred to engage in solitary play. Neither used gestural communication to replace their lack of speech and both were extremely sensitive to specific noises. They were frequently distressed by changes to their daily routine and the social, sensory, cognitive and communication experiences in the classroom and playground. They seemed in a world of their own, and other children were not invited into that world. However, I was determined to make a connection and to see the world from their perspective. Gradually and carefully, I became accepted, as a temporary but welcome visitor to their world.

The experience was profound emotionally and intellectually, and I decided that my career as a psychologist would be to explore and understand autism. In the autumn of 1971, I returned to University determined to read all I could on autism. There were only around a hundred published journal articles on autism, and perhaps two or three academic books and biographies written by parents of autistic children. Within a few weeks I had read all the relevant literature published in the English language. There are now over 7,000 journal articles on autism published each year and a corpus of research papers of over 70,000 studies of autism. Today I cannot keep up with the explosion of scientific knowledge on autism and tend to read the papers on the aspects of autism that intrigue me, and the papers of my colleagues and leading authorities on autism.

Changing concept of autism

In the early 1970s autism was conceptualized as an expression of schizophrenia that was caused by defective parenting and treatment was psychoanalysis of the child and their mother. However, during the late 1970s research studies and clinicians began to change this conceptualization to be replaced by autism being perceived as a neurodevelopmental disorder with a distinct profile of social, cognitive, linguistic, and sensory abilities that can be apparent in early infancy. This is the autism ‘signature’ that we seek in a diagnostic assessment and the core structure of our formal diagnostic instruments such as the Autism Diagnostic Observation Schedule or ADOS. My extensive experience as a diagnostician has led to supplementing the formal diagnostic instruments with activities to examine aspects of autism such as Theory of Mind abilities, the concept of self, alexithymia and interoception, and adaptations to autism that affect the clinical presentation and prognosis.

In the early 1970s our conceptualization of autism was that it was a rare but conspicuous and severe disability. The trajectory was for the child to attend a special school and eventually to be admitted to an institution due to high support needs in daily living skills and challenging behaviour.

During the 1980s we started to explore the range of expressions of autism and prognosis that included children and adults who were severely and conspicuously autistic in early childhood, but who acquired the ability to talk and converse fluently, had intellectual abilities in the average and above average range, and attended a typical school. They appeared destined to become independent of their parents and achieve full time employment and perhaps a long-term relationship. They had progressed to an expression of autism that was more subtle with a quite different prognosis. Lorna Wing in London recognized the progression in abilities to a profile consistent with the descriptions of autism by Hans Asperger in Austria rather than Leo Kanner in the United States. She first used the eponymous term Asperger’s syndrome in 1981 and her colleague and my PhD supervisor, Uta Frith, translated into English his original description of autism, based on the children he saw at his clinic in Vienna. I became a member of a small group of psychologists and psychiatrists in London exploring a new dimension of autism, Asperger’s syndrome. We discovered that there were children with the profile of abilities described by Hans Asperger that had never shown signs of severe autism in early childhood. There were two pathways to Asperger’s syndrome.

The original prevalence of autism was based on the conceptualization of a severe disability and was estimated at around one in 2,500 children. When we included Asperger’s syndrome in the autism spectrum and recognized the wide range of expressions of autism, the current prevalence according to the Centers for Disease Control in the USA is estimated to be around one in 54 children. Autism is becoming increasingly recognized by clinicians, schools, employers, and the public. A recent development is to have an autistic character in television programmes and films and there are many popular autobiographies written by autistic adults such as Temple Grandin.
There have been changes in terminology and diagnostic criteria over the last 50 years, as we increase our understanding of autism. The term Asperger’s syndrome has been replaced in the 2013 Diagnostic and Statistical Manual of Mental Disorders with the term Autism Spectrum Disorder Level 1. There are three levels of autism based on support needs. It is my opinion that we may change the terminology and diagnostic criteria, but the individuals remain the same in their daily challenges and abilities.

My recent research has included the design and development of screening instruments to identify the characteristics of autism in girls and women. The original gender ratio was 4 boys to each girl, but recent research indicates that the true ratio is 2:1. Girls and women can adapt to autism in ways that delay a diagnostic assessment.

Adaptations to autism

One of the central characteristics of autism, according to the DSM 5 diagnostic criteria, is a deficit in social communication and social interaction. The social and interpersonal aspects of life are a challenge to an autistic child or adult. So how does an autistic person adapt to these challenges? My extensive clinical experience suggests there are four potential adaptations based on personality and acquiring coping mechanisms: the introvert, the extrovert, the “camouflager”, and compensation.

The Introvert

The more easily recognized adaptation is that of the child who could be described as an introvert. The child, and subsequent the adult, actively minimizes or avoids social engagement, recognizing that social interactions are indecipherably complex, overwhelming, and stressful. This conspicuous adaptation, therefore, is to choose, where possible, to be alone to accomplish what you want to do without interruption, and not necessarily feeling lonely. The person’s energy is recharged in solitude, as being with people is at times bewildering and exhausting.

However, we are increasingly recognizing autistic children whose personality type is extrovert, being highly motivated to socialize. For these individuals, there are two potential adaptations that facilitate social engagement.

The Extrovert

The autistic extrovert actively seeks social engagement. Unfortunately, due to impaired ‘theory of mind,’ autistic children and adults have difficulties reading the subtle nonverbal communication used in a social interaction that regulate and moderate the fluency, reciprocity and intensity of social engagement. Unfortunately their social behavior may then be perceived as being intrusive, intense, or even irritating. A metaphor to describe this adaptation to autism is that of a driver who does not see the traffic signals (nonverbal communication) or abide by the traffic code (social conventions and context). They are unable to accurately read social situations and therefore criticized for behaving inappropriately.

While there is considerable motivation for social interaction and making friends, these experiences may nevertheless be ended prematurely by their peers. The consequence is that the autistic person feels bitterly disappointed that conversations, friendships, and relationships are short-lived, and social popularity remains elusive. When friendship is achieved, the autistic person can become possessive, idealizing their new friend with an intensity that is overwhelming. When the friendship or relationship ends, there can be intense despair and feelings of abandonment, betrayal, and of being misunderstood.

The Camouflager

The autistic “camouflager” is very aware of their difficulties in reading nonverbal communication and in making and keeping friends. With this insight, they are initially detached from their peers, but keenly observe their social interactions and the social behaviour of people in general. They seek to learn social ‘systems or rules and determine, interpret, and abide by those social rules. Their social abilities are achieved by intellectual analysis rather than intuition. Thus, effectively camouflaging their social difficulties. There is the creation of a social “mask.” We know that 70 per cent of ASD level 1 adults consistently use camouflaging in social situations. Research shows that autistic females tend to be better at camouflaging than males, and more likely to use this adaptation strategy in a wider range of social situations. However, some autistic males can use this adaptation.

The teenage autistic girl may have effectively camouflaged her autism, to “fly under the autism radar” and not have been considered for a diagnostic assessment with comments such as, “You’re too social to have autism.”. Every day at school (but probably not at home) she has acted the role of a typical schoolgirl, so much so that she should be awarded an Oscar for her social performance with her peers. She has a superficial sociability that is effective, but superficial and exhausting. She also has a lack of social identity, other than being the person that others expect her to be. Camouflaging can delay a diagnostic assessment for autism until the late teens or adult years which will also delay access to appropriate support and therapy.

There can be performance anxiety in social situations, as though she has been continually “on stage.” Like Cinderella at the ball, she can maintain the pretense for a while, but then becomes totally drained of mental energy and must return home to recover in solitude. She is likely to ruminate on her social performance in her bedroom and the high level of stress may evolve into an anxiety disorder or depression and self-harm.

The consequences of camouflaging autism can be a lack of knowledge of the inner and true self, with some adult women saying, “I don’t know who I am.” This may lead to a lack of self-identity, low self-esteem, and prolonged self-analysis. She recognizes that her friendships and relationships are based on deceit, where she has presented a “false” identity. This increases her feelings of deep inner loneliness. She yearns to find, and be able to be, her authentic self, but is aware that when her true self is revealed, she may be rejected and despised.

Psychotherapy needs to focus on the negative long-term consequences of camouflaging, encourage self-acceptance, and facilitate ways to explain the characteristics of autism to friends and colleagues so that others can accommodate and appreciate those characteristics to facilitate social acceptance and inclusion

Compensation

A fourth adaptation to autism is to create a lifestyle that minimizes the characteristics of autism. The autistic girl may prefer the company of boys, whose social dynamics are relatively simpler to decipher than girls. Boys may be more accommodating of someone who is socially clumsy, but who clearly enjoys and is relaxed in their company.

Compensation can also be achieved by developing an interest and talent in science, the arts and computer games, becoming an author, artist, musician, singer, multi-linguist, scientist and games designer. Social eccentricities are accepted and accommodated due to being valued by peers who recognize and admire a particular talent.

Another compensation strategy is to develop an interest in fictional heroes and superheroes and to have friendships based on shared interests, such as cosplay and Comic-Con, providing defined and recognized roles and achieving an alternative persona. The autistic girl may seek social assimilation by studying psychology and avidly reading books on body language and friendship or a career that does not involve much social engagement, such as becoming a wildlife ranger.

Other compensation strategies can include engaging in part-time schooling and employment to reduce the effects of exhaustion and having a social network of friends and colleagues who have autism—that is, people who accept and encourage the person’s autism. There is a much-valued sense of connection and authenticity.

Co-occurring conditions

We now recognise that there is an association between autism and anxiety, with approximately 80% of autistic children and adults feeling mildly anxious for much of their day, and for most of their life. They often experience intense anxiety in specific situations, such as when there are changes in routine or expectations, uncertainty in what to do or what is going to happen, fear of imperfection and making a mistake and specific sensory experiences. There can also be anxiety in crowded places such as a shopping mall on a Saturday. Research has confirmed that an anxiety disorder is the most common mental health problem for autistic adults. Sometimes, the level of anxiety experienced may be perceived as actually more disabling than the diagnostic characteristics of autism.

Research and clinical experience indicate that approximately one third of autistic adults experience cyclical feelings of sadness and pessimism that can evolve into a clinical depression. There are many reasons why an autistic person may become sad and depressed. These include feelings of social isolation, loneliness, and not being valued and understood by family members and colleagues. Another reason for depression is the exhaustion experienced due to socializing, trying to manage and often suppress emotions, especially anxiety, and coping with sensory sensitivity. The person is constantly alert, trying to endure perpetual anxiety whilst suffering a deficit in emotional resilience and confidence. The mental effort of intellectually analysing everyday interactions and experiences is draining, and mental energy depletion leads to thoughts and feelings of despair.

Recent research has explored the association between autism and alexithymia, that is the ability to recognize or describe one’s own thoughts and emotions. An autistic person will have genuine difficulty converting their thoughts and feelings into speech. When asked why they may have done something, or to describe their feelings regarding an event, they may simply reply, ‘I don’t know’. This is not their being obtuse or evasive, but an expression of a recognized difficulty with self-reflection and self-disclosure of inner thoughts and feelings through speech. Psychological therapy for mental health issues will need to accommodate the profile of abilities and experiences associated with autism, such as alexithymia, the lifetime experience of extensive bullying and teasing, and sensory sensitivity. We now have psychological therapy manuals specifically designed for adults who have autism and I have been able to contribute with my colleague Dr Michelle Garnett to many of the manuals and therapy programmes. We have designed and evaluated individual and group programmes for anxiety and depression, to build resilience to bullying and teasing, and acquire abilities in the areas from love and romance to employment.

There is increasing evidence that autism is associated with specific learning disorders such as dyslexia and hyperlexia, attention deficit hyperactivity disorder, intellectual disability, and specific language disorders. Thus, the diagnostic journey does not end with confirmation of autism. Conversely, the diagnostic journey for autism may start with the accurate diagnosis of another mental or personality disorder and a detailed developmental history indicates the presence of autism. Research and my own clinical experience suggest that around one in four patients with an eating disorder, substance abuse, gender dysphoria and borderline personality disorder have a dual diagnosis. There is also an association between autism and Tourette’s disorder, sleep disorders and bipolar disorders. Clinicians in all areas of psychology and psychiatry need to be aware of the characteristics of autism in a patient’s developmental history and profile of abilities. When the diagnosis is confirmed, adapt their psychotherapy to accommodate the autistic patient who has a different way of perceiving, thinking, learning, and relating compared to other patients.

While we acknowledge the concept of autism plus, we also acknowledge the concept of autism pure. Around 15 per cent of autistic adults have no additional diagnoses and they often have a different prognosis.

Long-term outcomes

Over 50 years I have been able to maintain contact with autistic children through to their mature years and see retired individuals for a diagnostic assessment. Those who have achieved a diagnosis of autism late in life are often greatly relieved to know why they are different and can now perceive their life through the lens of autism. The diagnosis can help explain why they were bullied and teased at school, their difficulties in making friends and maintaining a long-term relationship and sensory sensitivity.

The majority have described an improvement in their mental health after the age of 50, not necessarily by treatment from health professionals and medication, but discovering strategies themselves through reading, the Internet and experimentation. We are also now exploring the concept of well-being and autism and surveys and clinical experience suggest that wellbeing can be achieved by having time in the day when they are not disturbed within their own private sanctuary, being able to excel in what they enjoy doing, and freedom from sensory pain. These are all achievable.

In my extensive clinical experience, I have known autistic children who have what we describe as autism pure, with no signs of a mood, medical or psychological disorder. By their early twenties they have gradually acquired social abilities to make and keep friends and relationships and achieve successful employment and financial independence. The social puzzle is finally solved. They still have the characteristics of autism, but at a sub-clinical level according to the diagnostic criteria. I estimate that this occurs in about ten per cent of patients on my clinic list. I am prepared to remove the diagnosis of autism, but only with the patient’s agreement and for their benefit. Our new conceptualization of autism is that for a few autistic adults there may be a delay in acquiring specific abilities, not an eternal absence.

Finally, over 50 years I have contributed to the growing literature on autism for professionals, parents, and autistic adults. My original book Asperger’s Syndrome: A Guide for Parents and Professionals was published in 1998 and has sold over half a million copies and been translated into 30 languages. I continue to write guidebooks on autism and books on therapy for anxiety, depression and emotion expression and regulation. There are now hundreds of books published by Jessica Kingsley Publishers in London on many aspects of autism such as catatonia, having an autistic partner and coping with being in prison and aging and autism.

Recently I have been able to provide professional and parent training through live and recorded webinars. These webinars are available at www.attwoodandgarnettevents.com and are a way of passing on my evolving exploration and understanding of autism.