[This article originally appeared at the Behavioral Scientist]
At a speech at the United Nations, writer and activist Steve Silberman noted that “society is on the brink of a major transformation in its understanding of autism and other developmental disabilities.” Silberman is right.
For years, the story about people with Autism Spectrum Disorder (ASD) was about the things they lacked. Principally, they were seen as lacking empathy and “theory of mind.”
But emerging research suggests that the social difficulties found in people with ASD are far more nuanced. We’re now understanding what people on the autism spectrum have rather than what they lack. Even Simon-Baron Cohen, who originated the social-deficit hypothesis, has broadened his view to include autism’s strengths.
A closer look at ASD has revealed that rather than an inability for sociality, people with ASD tend to have an unconventional social style. For instance, people with ASD process social information more slowly, focus attention elsewhere than the eyes, and report trouble understanding the social cues relating to sports and physical play. People often mistake these social responses for disinterest, which can affect the potential for making friends. But it’s also becoming quite clear that people with ASD do crave connection, and do care about others. People with ASD report desiring friends, and when you ask them how much they would care about hurting someone else, they care deeply about how their actions affect the feelings of others—what is called “affective empathy.” Again, this is not an inability: When those with ASD are given the information that allows them to understand the point of view of others, they have as much concern and compassion as do people without ASD.
We’re now understanding what people on the autism spectrum have rather than what they lack, and what they have is social creativity and an unconventional social style.
But even though perceptions of autism are changing, there’s a deeper problem. This research presupposes that there is a correct way of socializing with others, and that the interpersonal styles of people with ASD are somehow “failed versions of ‘normal.’” This assumption influences how we help children with ASD. Most well-meaning interventions for children with ASD try to increase their social knowledge by teaching them the “correct” way of responding to situations. For instance, a child may be taught that when a person says, “Hi, how are you?” you respond with, “Fine, thank you. And yourself?”
But is this really helpful? A recent review investigated the effectiveness of social skill interventions for youth with ASD, most of which promote social knowledge. While the youth with ASD reported improvements in their social knowledge as a result of the intervention, they didn’t perceive themselves as actually improving in social skills. This split between social knowledge and actual social skills suggests that the field’s most prominent framework isn’t working.
Perhaps the problem isn’t with the interventions but with the whole model that presupposes a normal. After all, if such social interventions were given on typically developing youth, the intervention would rightly be criticized as reductionist and simplistic. The social world is so much more complex and dynamic than learning a social script for every interaction. Perhaps instead of viewing people with ASD as “socially awkward” individuals who need to be “fixed,” we should instead conceptualize them as socially creative. They may not do things the “right” way, but they do them their way.
Instead of viewing people with ASD as “socially awkward” individuals who need to be “fixed,” we should instead conceptualize them as socially creative. They may not do things the “right” way, but they do them their way.
In a clever study, Matthew Lerner and his colleagues assessed the social creativity of 31 adolescents with high-functioning ASD (in other words, they all had average to exceptional levels of IQ, and all met criteria for ASD). In the social creativity task, they were asked to come up with novel solutions to social problems. They were also given a standard social knowledge task that asked them, in given social situations, “What is the right thing to do?” For example, the adolescents may be given a scenario in which they are trying to get another child to play with them. A response such as, “I would ask them to please play with me,” would score very high in social knowledge but low in social creativity. In contrast, a response such as, “I would pretend to call forth aliens to mind control the kids to play with me,” would score very high in social creativity but low in social knowledge.
Their findings were elucidating. First, they found that social knowledge and social creativity were uncorrelated with each other, as well as with measures of IQ. Knowing correct social responses is different than being able to generate novel, creative responses to those solutions; neither are accounted for by simply having a high IQ.
They also found that participants with ASD did not differ much from their typically developing peers in terms of the range of social creativity and social knowledge. What’s more, only social creativity but not social knowledge correlated with ASD symptoms. Finally, they found that social creativity but not social knowledge was correlated with prosocial behaviors observed during free play. It seems that knowing the rules for effective prosocial behavior does not actually relate to using those rules.
These findings are key because they suggest that social interventions that focus solely on “getting it right” are not actually addressing the key skills that could help people with ASD not only increase their friendships, but also increase their helping behaviors (which is sure to also increase their friendships). According to Lerner,
“What emerges from the research is that rather than think about the task of understanding social cognition of people on the spectrum and also how to treat them, teaching them to behave in a way that better approximates the way other people are doing it, it becomes more incumbent on us to understand people on the spectrum, and meet them where they are, and really try to understand how they are experiencing a situation. What are the skills, features, tendencies, passions they are bringing to the table, and how can we use those to make this social world they seem to want to access? How can we make it accessible and rewarding?”
Indeed, a growing number of “Naturalistic Developmental Behavioral Interventions” for children with ASD are taking this approach—from the Early Start Denver model, which teaches social strategies to toddlers at home during their already ongoing daily activities, to Connie Kasari and her colleague’s worklooking at opportunities for joint engagement and play with children with ASD, to the emerging class of “drama-based group interventions,” which are applying drama-based techniques in a group setting. For instance, one such intervention, led by Matthew Lerner and his colleagues, aims to promote social creativity. Rather than teaching social skills as rote knowledge, it uses improvisation to teach ways to respond to unexpected social scenarios. The idea is that if individuals with ASD can get comfortable with the exaggerated and ridiculous situations of improv comedy, then in the real world answering the question “Hi, how are you?” will be a breeze.
The emerging, novel approach to autism—which meets individuals with ASD where they are instead of trying to “fix” them—is transforming how these individuals think of themselves in the world, and what they are capable of becoming.
The activities are designed to be not only fun but also to provide shared joy and connection among the participants. For instance, in one of the activities, called “Gibberish,” one person speaks in nonsense sounds instead of words while attempting to explain how to perform an everyday task like baking a cake. Another person must watch and translate the gibberish into words for the rest of the participants to understand. Participants are encouraged to integrate humor into the activities. Games like this shift the focus from rote responding to sensitive and spontaneous reacting to non-verbal cues, and also promotes perspective-taking and flexible social cognition skills.
This emerging, novel approach to autism—which meets individuals with ASD where they are instead of trying to “fix” them—is transforming how these individuals think of themselves in the world, and what they are capable of becoming. Framing matters. In one online discussion forum, a number of those with high-functioning autism and Asperger’s discussed their creativity, giving hope and support to each other. One forum participant called snarkysparkly wrote, “So happy to read this post. I had wondered if being creative and imaginative disqualified me from being an Aspie… And now I also get to hear from real, everyday Aspies that you can be EXTREMELY creative and still be an Aspie!”
Indeed you can. In fact, although many youth with ASD do show difficulties with spontaneous “pretend play,” it turns out this is not a sufficient condition to differentiate those with and without ASD. Rethinking autism requires understanding the experience of autism, and seeing beyond the unconventional social behaviors to see who they really are, and what they can really offer. We’d be remiss if we didn’t build off the strengths that already exist among those with ASD. This research is not only revolutionizing how we view ASD, but also how we treat anyone who thinks differently.
Image: J.K. Rofling