SOME COMMON DIFFICULTIES
Historically, society has viewed autistic people as 'impaired' when it comes to communication. Autistic people are labelled as having social deficits. The problem with this is that it stems from a neurotypical person's point of view, or, a from a Medical Model view of disability which does not consider autistic styles of communication ('The Double Empathy Problem')
Autistic people experience high levels of generalised anxiety on a daily basis. Navigating a neurotypical world which isn't set up for neurodivergent people can be paralysing. As an autistic person, I commonly re-play interactions over and over in my head. I go to great lengths to not come across as rude, awkward, and try to make eye-contact. Autistic people already face sensory challenges which impact hugely on our social interaction (loud music in shops, people talking, crowds, hot buses, smells). But add on the pressures of appearing 'normal' can be overwhelming.
Literal understanding of language
Autistic people can have difficulties understanding abstract language / figurative language such as: idioms, metaphors, double meanings, sarcasm... And despite me being a Speech and Language Therapist, I'm someone who can be VERY literal and it often causes me to experience misunderstandings and breakdowns in communication - mostly when I'm interacting with non-autistic people who have different communication styles. Often there are many different interpretations of what people might mean when they communicate using body language, sentences and words (this is known as pragmatics - see below). Differences in NT and autistic communication styles often lead to misunderstandings because it's common for NTs to speak in indirect ways which lack clarity and concreteness.
A note on pragmatics...
This is what's frequently labelled as impaired in autistic people. Pragmatics is the 'use of language'; so understanding body language, using gesture, knowing when it's your turn to speak in conversations, how to initiate interactions, how to ask questions, how to comment - so basically adhering to NT social norms. Pragmatics involves inferring information and 'reading between the lines'. Whilst it is common for autistic people to struggle with this, it's worth looking at pragmatics through a neurodiversity lens because it's all about perception. Pragmatics is a field of SLT that is based on NT social norms. It is built upon subjective NT experiences of interactions.
Eye-contact can be physically painful for an autistic person. The myth that 'if you can make eye-contact then you can't be autistic' is hugely inaccurate (remember many of us have trained ourselves over the years to force eye-contact, as a conditioned response to years of social rejection: (see 'masking'). Some autistic people avoid it altogether, some can do it but it's fleeting, and many force it to appease the other person. Why is eye-contact painful?
Research shows that despite neurotypicals perceiving a lack of eye-contact as rude, in reality, eye-contact increases anxiety for an autistic person due to excessive arousal / overactivation in parts of the brain (Hadjikhani, 2017; Dalton et al., 2005; Madipakkam et al., 2017). So forcing an autistic person to make eye-contact can cause them harm. It can be exceptionally hard to make eye-contact during times of stress, meltdown, or if we are trying to verbally explain something and we're focusing so hard on all the executive functioning demands.
Hadjikhani, N., Åsberg Johnels, J., Zürcher, N.R. et al. Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Sci Rep 7, 3163 (2017). https://doi.org/10.1038/s41598-017-03378-5
Dalton KM, Nacewicz BM, Johnstone T, Schaefer HS, Gernsbacher MA, Goldsmith HH, Alexander AL, Davidson RJ. Gaze fixation and the neural circuitry of face processing in autism. Nat Neurosci. 2005 Apr;8(4):519-26. doi: 10.1038/nn1421.
Madipakkam, A.R., Rothkirch, M., Dziobek, I. et al. Unconscious avoidance of eye contact in autism spectrum disorder. Sci Rep 7, 13378 (2017). https://doi.org/10.1038/s41598-017-13945-5
Working memory helps us store information in our brains temporarily. It helps us remember spoken instructions, map directions, a shopping list, and multiple pieces of information. It helps us answer multi-part spoken questions (like in a job interview). A common difficulty for autistic people is keeping hold of multiple pieces of information in our heads. Example: a child being told "go upstairs, brush your teeth, put your toys away". By the time they've heard the 3rd piece of information they've already forgotten the 1st. But this is frequently misunderstood as "you're not listening", forgetfulness, or bad behaviour.
Another example - an autistic adult is in a job interview and they've been asked a multi-part question e.g. "tell me a time when X, what you learnt, and how you can bring that to this job". For neurodivergent brains it can be too much information to hold. Another example - you're in a cafe with friends and you offer to take everyone's orders and go to the till - when you get to the counter you've already forgotten what they said and have to come back and ask. This is why writing things down can be such supportive strategies for autistic people, because it makes things concrete and hellps the information stick around longer.
It can take autistic people much longer to process language and spoken information. This can be down to auditory processing / language processing / language difficulties and sensory processing. Autistic people need PLENTY of processing time. If someone speaks too fast, uses too much language, gives too much information in one go, asks too many questions or doesn't give enough time to respond, it can lead to dysregulation, frustration, anxiety, sensory overload and meltdowns. If the person is in distress then their ability to access / process spoken language is significantly reduced.
What is alexithymia? Alexithymia is a personality construct first coined in the 1970s by psychiatrist Peter Sifneos. Alexithymia literally means "no words for feelings" and is characterised by: difficulty identifying emotions, expressing emotions, describing emotions, identifying physical sensations associated with emotional states. Alexithymia is very common among autistic people and has also been found in psychiatric populations e.g. frequently co-occurs with anorexia and personality disorders. Alexithymia can be assessed using a self-report measure (TAS-20, Bagby et al., 1994).
The ability to express emotions requires linguistic level processing and it is suggested that shows a proportion of people with Language Disorder / language difficulties also show features of alexithymia. People with alexithymia show difficulties with emotion vocabulary (Suslow & Junghanns, 2002). Interpersonal relationships tend to be more difficult due to the struggle of talking about emotions.
Sifneos, P., Apfel-Savitz, R., & Frankel, F. (1977). The Phenomenon of 'Alexithymia': Observations in Neurotic and Psychosomatic Patients. Psychotherapy and Psychosomatics, 28(1/4), 47-57. Retrieved April 16, 2021, from http://www.jstor.org/stable/45114843
R.Michael Bagby, James D.A. Parker, Graeme J. Taylor (1994) The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure, Journal of Psychosomatic Research, Volume 38, Issue 1 - https://www.sciencedirect.com/science/article/abs/pii/0022399994900051?via%3Dihub
Suslow, T., & Junghanns, K. (2002). Impairments of emotion situation priming in alexithymia. Personality and Individual Differences, 32(3), 541–550. https://doi.org/10.1016/S0191-8869(01)00056-3
Hobson, Hannah & Brewer, Rebecca & Catmur, Caroline & Bird, Geoffrey. (2019). The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. Emotion Review. 11. 10.1177/1754073919838528. - Link