The “Triad of Impairments” in Everyday Life

ImageThe triad of impairments model, (so named by Wing and Gould, 1979) is an overview of the deficits that define autism.  But how do these translate into everyday life?  The list of deficits provides an explanation of what we find difficult or challenging, but to the layperson (and perhaps even the clinician), it doesn’t tell you what it’s like, or give examples of how it affects a person.  So based on the list in the pictured triad (courtesy of the NAS), I will attempt to explain.

Social and Emotional

Friendships – many people on the spectrum struggle with friendships.  We are not often good at small talk and gossip, the very things that NT’s use to strike up conversation or keep it going.  We can learn the sorts of things NT’s chat about, but it always feels awkward and requires cognitive effort.  We struggle with uncomfortable lulls in conversation, perhaps feeling like we are meant to fill them and thus talking too much or about random things which may not fit the conversation.  This makes for a stilted conversation and can be a key time for the blurting out of inappropriate things.  Having trouble with conversation can make it difficult to get friendships off the ground.  Also, even if we manage to start a friendship, we can then struggle with reciprocity.  It can result in the NT friend doing all the calling up to make arrangements and ending up dropping the friendship, because they misconstrue that the autistic person doesn’t care about maintaining it.  Then there is the socialising itself, how much is the right amount?  Someone on the spectrum can struggle knowing if things are “their turn” too.  Many on the spectrum need little socialising time for a variety of reasons, and the other NT party in the friendship can find this boring or frustrating and therefore the friendship can flounder.

Managing Unstructured Parts of the Day – Having free time can be difficult for an autistic person.  We like order and routine, and if we’re left to our own devices, if we have no special interest or task to keep us occupied, we can waste a lot of time through not being sure what to do with ourselves.  For this reason, break-times at school can be very difficult for the autistic child, coupled with their difficulties socialising with their peers.  This is one of the reasons many parents of autistic children find visual timetables useful, so the child can see what is coming next and is not left to figure it out for themselves.  Unstructured time can cause anxiety, and people with autism often need someone to instruct them on what needs doing so that they don’t forget, our brains are so busy whizzing with other thoughts and processing sensory input, we often need to-do lists to remind us and enable us to keep some structure we need.

Working Co-operatively – People with autism often work really well alone, in fact working with others can actively hinder us.  We can concentrate intensely on things (hyperfocus) and also, can have unique ways of approaching problem-solving.  We also can have issues with empathy, the art of knowing what others are thinking or feeling in a situation, so we can be very one-track minded in our own ways of doing things.  When you marry that with socialising problems, working as part of a team can be very difficult.  If I have realised the best way to do something, no-one can persuade me otherwise and if someone else insists on a different way, I am very unlikely to want to do it their way.  Autistic children often have trouble playing games with others, because they want to play it by their own rules, or even to make up the rules which they insist everyone else must follow.  This way of thinking and behaving, can make an autistic person very unpopular!

Language and Communication

Difficulty processing and retaining information – For me, this is mainly verbal information.  Speaking to people means I have to put a lot of cognitive effort into what they are saying, as I have to try to understand not only concrete information but implications and between the lines stuff.  It is exhausting.  I can forget whole sections of conversation, and they may come back to me a significant time after the event, like random bits of programming code getting thrown out.  Written information is much easier for me, but even that, I may need to re-read several times to ensure I have understood it correctly.  Some things may be taken literally and need time to register.  The more people are in a conversation that I am taking part in, the more likely it is that I will lose meaning and struggle to hear what is being said and hence remember the content.  Note taking is absolutely vital when listening to information verbally.

Difficulty understanding jokes and sarcasm; Social use of language; Literal interpretation; Body language, facial expression and gesture – These are pretty self-explanatory, but I wanted to explain that literal interpretation doesn’t mean that none of us understand or can learn metaphors.  The age-old idea that we believe “it’s raining cats and dogs” means we all think that dogs and cats are literally falling out of the sky, is simplistic and far from being always the case.  I have learned a lot of metaphors and I won’t lie, often I do get a funny visual of the scenario being quoted, but for me literal interpretation is a lot more general in conversation.  It could mean for me, that e.g. if someone says “I’ll call you in the next couple of days” and they don’t call within 2 days, I will think they have broken their word.  Or I will take rules and instructions very seriously and not understand that it isn’t a problem if the exact thing stated doesn’t happen.

I can understand obvious jokes (even if I don’t always get the punchline) but if people make deadpan jokey comments, I usually won’t understand they are joking.  I get this with my NT husband a lot, he’s always joking but it doesn’t sound like jokes to me and I can be indignant at what he says and he will have to remind me he was joking, I never learn that he is joking, it’s the same every time.

I have failed to understand people were being sarcastic to me many times, which I guess is about tone of voice rather than gestures.  I have problems with subtle body language, not with obvious gestures.

Flexibility of Thought (Imagination)

Coping with Changes in Routine; Empathy; Generalisation – People, (even clinical people), often assume this means autistic people have no imagination.  This is absolutely incorrect, it is social imagination we have problems with.  Many autistic people are very creative and imaginative.  In fact, Tony Attwood speaks about Aspie children often living deeply in an imaginary world.  Social imagination means having a good understanding of what is expected in situations or what peoples’ intentions are, and this is something we do have trouble with.  We often like to know what is happening next and don’t like unexpected surprises, which is why routines are important to us.  We plan ahead in our minds based on what we expect and if that changes, it becomes stressful.  Empathy, I have written a whole post about further down my blog.  There are different types of empathy and ‘affective empathy’ (sympathy) is usually intact in autistic people.  The type of empathy we struggle with, is understanding that other people might have different feelings to ourselves, or different viewpoints, or their reasons for behaving a certain way.  Although if we have been in that particular situation ourselves before, we can understand the other person’s behaviour more.  Generalisation is anathema to an Aspie.  We are often very specific and want to know the details.  if someone gives a generalised answer we will want to question them on the exact specifics.  Likewise, if someone asks a very general or open question of us, we will not be sure how to answer it, we will need an exact question to answer.

My thought for the day:

“We are so much more than a triad of impairments”.

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