We spoke to Mr Michal Kulasik, an experienced registered mental health nurse and expert witness about autism.
Thank you for meeting with us Michal. Could you start off by telling us what autism is?
Autism, also called autism spectrum disorder, is a neurodevelopmental condition defined clinically in both DSM -V and ICD-11 diagnostic manuals. Autism is the persistent inability to sustain or/and reciprocal social interaction and communication, including sensory difficulties. Autism is not an acquired condition, meaning a person with autism spectrum disorder is born with it and is lifelong. Autism is not a mental health condition; however, many people with autism will have co-morbid conditions, both physical and mental health.
What does autism spectrum disorder mean?
As the name suggests, autism sits on a spectrum. When meeting autistic people, we should acknowledge this and remember that everyone is different, can have their own symptoms/limitations/ difficulties or lack of them and can be high functioning.
What can you tell us about autism and communication?
Understanding how an autistic person wishes to communicate and interact with us or the wider system is important. Sometimes that can mean quiet rooms, no physical contact, no eye contact, or repeated speech. Those difficulties do not mean that person in front of us is any less able or intelligent than us; it just means that they have specific symptoms which can make their life more difficult in specific times or places. Autism is not related to a specific IQ, which may range from low to high. Autistic people also can take and say things literally, and we must remember this and consider this to check if that is what they mean or think.
Could you explain sensory issues and autism?
Autistic people can have a sensory diagnosis as they experience the world differently than the rest of us. Many autistic people would prefer the term neurodiverse as better describing their issues in contrast to neurotypical people who do not have a neurodevelopmental diagnosis. Neurodivergent people can have sensory issues which vary from person to person and include the following:
- Can be overwhelmed, but loud noises
- Can be overwhelmed by touch – and this can be either preference for not touching or a preference for heavy-weight clothing which makes them feel safe.
- Colours and textures
This all can be described differently by people with autism, and it is important that they are appropriately assessed and understood so the person can get appropriate support.
Sensory overload is well-known among professionals and can be misunderstood by laypeople.
When an autistic person is exposed to sensory overload, this can be displayed in many ways, some challenging ways but also as disconnection from the current situation and place to the extent where the person those do not interact with questions or remember them or does not want to answer them because it needs time sometimes days to process it.
Who can diagnose autism?
Historically, psychiatrists and psychologists would assess and diagnose autism. Now, other healthcare professionals assess for autism, including nurses, speech and language therapists, and occupational therapists.
There are approximately 21 approved assessments to diagnose autism; however, in the United Kingdom, ADOS–2 and ADI-R are the most commonly used tools. Although some practitioners use non-structured assessments. Courts usually ask for structured and well-established assessments from experts. We must remember that before we start ASD assessment, we should always exclude other mental health or physical conditions.
Even though symptoms can start at any time, they mostly start before age five. A comprehensive childhood history of problems or difficulties is crucial in establishing the diagnosis.
What does autism screening involve?
Autism screening may be completed before the need for a full assessment is established. Sometimes services use AQ10 to determine quickly if the person meets the criteria for a full assessment. Sometimes services use other validated screening tools like AQ50, EQ and RQ. Getting information from early childhood is always best practice, and most of the time, adults coming for assessment would be asked to provide this information from parents, siblings, friends or a partner. This is to help establish a lifelong history of difficulties which can help towards the diagnosis.
Capacity issues and autism?
Not all autistic people can understand complex social, judicial, and work situations and repeating what was said or confirming received information does not mean they have the capacity to understand this information or what it means in their specific situation; professionals should always establish this.
Courts and police should always consider how autism may affect the investigation or further proceedings and should seek independent advice.