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Ms. Violeta Kulik talks about developmental disorder covering many areas of a person’s functioning with Dr. Anna Pieszkowska from the Institute of Psychology at the University of Silesia in Katowice, whose research interests include: self-stigma and minority stress in risk groups social exclusion and well-being of people with autism and cognitive-behavioral psychotherapy .

Violeta Kulik: Doctor, autism is not a disease or a behavior, so what is autism?

Dr. Anna Pieszkowska: The autism spectrum is a form of neurodiversity – that is, the functioning of the human brain, which translates into a specific way of perceiving the world and reality. People with autism receive and encode more stimuli than neurotypical people, which is why they often perceive the world as overwhelming, which translates into their emotions and behavior. Often, the main cause of suffering is not the symptoms resulting from the autism spectrum, i.e. sensory overload, difficulties in communicating and understanding social contexts, behavioral disturbances, but the lack of adaptation to the environment. Very often I hear in the psychotherapy office that the main problem is not the symptoms of autism themselves, but the lack of understanding of the environment, low skills in dealing with emotions, excessive social pressure or demanding oneself to behave neurotically, i.e. as a majority. I am convinced that it is very important to make this clear on Autism Awareness Day: many times the problem is not “autism”, but an environment that does not understand or support autism.

Violeta Kulik: Why don’t people with autism need “therapy”?

Dr. Anna Pieszkowska: The autism spectrum is not a disease, so the idea of ​​a “cure” is inappropriate and harmful. It is listed as a disorder in psychiatric classifications because the severity of symptoms causes suffering and affects daily functioning. Naturally, we can reduce the symptoms that cause suffering – for example those related to social difficulties, sensory hypersensitivity – but what is crucial in working with people with autism is learning specific skills that will help with daily functioning. With this in mind, therapeutic work with autistic people is not about making them “less autistic,” but about acquiring the necessary social, communication and behavioral competencies that allow them to live fulfilling and dignified lives. In this approach, psychotherapy or psychological and pedagogical assistance aims to work with a particular person on his specific needs, and not on the diagnosis that this person has received, taking into account of course the specific way of working. As I mentioned, in the psychotherapy office I often meet adolescents or young adults with autism spectrum disorder who report that their problem is not “autism per se,” but a lack of understanding of others or low satisfaction with life or relationships – problems, which are universal for each of us, Regardless of neurodiversity.

Violeta Kulik: Who diagnoses autism? What are the criteria for autism according to the ICD-11 classification?

Dr.. Anna Pieszkowska: The diagnosis of autism spectrum disorder is based on the presence of: 1) persistent social and communication deficits (marked deficits in verbal and non-verbal communication; lack of social reciprocity and understanding of theory of mind; inability to develop). and maintaining age-appropriate relationships with peers); 2) Persistent interests and repetitive behaviors (eg, motor stereotypes, need for uniformity and pattern, heightened sensory sensitivity). Symptoms must occur early in development and have a significant impact on the social functioning of the individual. The key is that autism symptoms should be visible at every stage of development, but their full expression can only occur during the period of socialization. Therefore, autism is not a disease that someone “afflicts” with, but rather a kind of basic operating system for a person’s brain. Diagnosis is made through a diagnostic interview and psychological examination (most often using the ADOS-2 observational interview). Formal nasal diagnosis is performed by a psychiatrist based on the results of psychological tests.

Violeta Kulik: Why is autism diagnosed in adult men (as well as in children) four times more often than autism in women?

Dr. Anna Pieszkowska: This is due to a very harmful stereotype, which finds its source in the activities of the pioneers of autism research in the 1930s and 1940s: due to social and political conditions, only boys were tested at that time, so we still use the resulting autism spectrum diagnostic criteria About research conducted on men. According to most statistics, men receive a diagnosis four times more often, but that does not mean that the spectrum is four times more common among this population, just that they go to diagnostic offices more often. Due to stereotypes and a slightly different form of expression of autistic symptoms in women, girls are less likely to be diagnosed, because the disturbing symptoms in boys (withdrawal, difficulties in relationships and behavior, sensory sensitivity) in girls are treated as an element of socialization (“girls in Ultimately, shy/sensitive. In addition, an important element in the work of women and girls on the autism spectrum is the use of so-called social camouflage, that is, hiding the symptoms of autism by imitating the behavior of others without understanding their rules. This causes enormous burden, misunderstanding of personal identity and lowers self-esteem. Fortunately, we are currently observing an increasing trend of diagnosing adult women who meet all the diagnostic criteria for Autism Spectrum Disorder, but which is not specifically noticed by parents or teachers because of the belief that “it doesn’t apply to girls.”

Violeta Kulik: How can we help people/students with autism on a daily basis?

Dr. Anna Pieszkowska: The key is to open up and expand the social understanding of the “norm”: no matter what we call someone, first of all, we are just people and different needs matter to each of us. That’s why we need to ask directly what a person needs and not be afraid of it – sometimes it seems to us that it is “inappropriate” to ask about needs or expectations, but for most people on the spectrum it is a sign of care and respect. However, this does not change the fact that there are some universal rules that are worth implementing in communications with autistic people: predictability, adherence to established rules, ensuring sensory comfort (for example, reducing noise, bright lights or smells, ensuring) . Possibility of taking care of mobility needs and taking breaks (e.g. making sure you can walk around the room, leave it if you feel overloaded, etc.). At the University of Silesia, people with autism can benefit from Individual Adaptation for Studies (IDS) and attend a support group for students with autism.

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