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A first scientific study of compensatory strategies – camouflage techniques of autism – reveals that they have positive and negative results, reinforce social integration, but can also lead to poor mental health of autistic people and could be a barrier to the diagnosis.
For the first time, the compensatory strategies used by people with autism have been studied and collected in a qualitative study using an online survey of 136 adults, published in Lancet Psychiatry newspaper. The study concludes that the use of compensatory strategies is badociated with positive and negative consequences. Compensation improves social relationships, increases independence and employment, but can also be badociated with poor mental health and delayed diagnosis. Preliminary results highlight the need for increased awareness of clinicians for these strategies and increased support for those who need them.
Autism spectrum disorders are characterized by social communication disorders and repetitive and limited behaviors. There is little understanding of why some people with autism seem to have neurotypical behavior, despite cognitive difficulties or differences related to autism.
Compensation is an adaptive process by which new behaviors are generated in order to avoid negative outcomes. This is different from masking, where alleged undesirable behaviors are hidden or halted. In the case of people with autism, people can use the experience or logic of the past to respond to social situations in order to increase opportunities and "integrate" into society . However, they continue to be autistic at a neurocognitive level, which can lead to problems of diagnosis and management of individuals.
Lucy Livingston, lead author of the study from King & # 39; s College London, UK, said: "This study points out that compensation is an adaptive response to external pressures from society." This finding is consistent the research that autistics are, despite the negative impact on their well-being, determined to meet societal expectations of behavior.A neurotypical society could do more to accommodate people with disabilities. autism, which we believe could reduce the need for compensation. " [1]
The authors announced that they were recruiting participants for their study via social media and with the National Autistic Society. 136 adults were invited to complete an online study. Of the participants, 58 had a clinical diagnosis, 19 self-identified without formal diagnosis and 59 undiagnosed or self-identified, but reporting social difficulties. The study examined the compensatory strategies used by the participants, whether the strategies used were similar in the diagnosed and undiagnosed, and how the compensatory strategies affected the diagnosis.
Participants were asked to self-report their autistic traits by answering a questionnaire of ten autism spectrum questions, followed by a series of open questions about their social compensation strategies. They also reported the success and fatigue of their strategies and the likelihood that they will recommend them to others in social difficulty.
The team identified several strategies used by people with and without autism diagnosis (including behavioral masking, such as holding true thoughts or suppressing atypical behaviors, superficial and deep compensation such as planning and repeating conversations or learning rules about verbal and non-verbal behaviors, and coping strategies such as going out of your way to help – for a complete list, see [2]), which were used equally by people with an official diagnosis of autism and those who were not.
Superficial strategies such as laughing after jokes were common among participants who reported more autistic traits and were related to the negative consequences of the compensation. Above all, these superficial strategies are more difficult in stressful or tired situations.
Participants used their intellectual and planning skills to regulate social behavior and follow social norms – making eye contact – preparing social revelations – asking questions about them – and switching between social rules. These strategies were more difficult when they were distracted or stressed, but most importantly, they did not reduce the internal social cognitive difficulties of the participants.
The use of these strategies was motivated by many motivations, including social motivation and the desire to develop meaningful relationships. One participant said: "With pay, I have a job where people respect my work and ask for my help and my opinions … My colleagues and my friends like me … I did not live to the limit , lost and alone, as I could have … I've been super super lucky.
There was also a perception that neurotypical individuals could "see through" these strategies. One participant said: "If you are careful, there are obvious flaws, I repeat myself or I use TV / film expressions and sometimes I say things that are out of place." And another said: "I have the feeling to act most of the time and when people say that I have a feature, I feel like a fraud because I have make this feature appear. " (See the paper sign for quotes from other participants).
The use of these strategies was linked to poor mental health, and diagnosis and support related to autism also seemed to be affected. 47 of the 58 participants diagnosed were diagnosed late in adulthood. The other 11 were diagnosed before the age of 18.
External environments have been found to affect compensation and it is possible that people with autism present themselves as neurotypical in some situations but not in others. Clinicians need to be aware of this when they measure compensation and diagnose autism. Recent evidence suggests that only 40% of British general practitioners – the first point of contact for people seeking a diagnosis – have confidence in the identification of autism spectrum disorders.
Lucy Livingston said: "So far, no study has directly focused on the compensation strategies used by people with autism in social situations and we provide evidence of their existence and modulation by various people. Because they are a barrier to diagnosing autism, they increase awareness of compensation strategies, and we hope this study will refine the diagnostic manuals, which currently contain limited guidance on strategies. compensation for autism and concomitant mental health problems. " [1]
The authors note some limitations, including that their sample included a high proportion of participants, women diagnosed late and well educated. Due to self declaration, subconscious behaviors may not have been captured. Future research should take into account these two limitations, using more representative population samples and quantitative measures. Moreover, the role of other factors influencing social pressure, such as the multiple identities that intersect and their role in compensation, could be studied in the future.
In a commented article, Julia Parish Morris, of the Autism Research Center of the Children's Hospital of Philadelphia, USA, states: "While many people make up for it during a social interaction, this exercise can be particularly exhausting and painful for people with autism.This finding raises the question: Should subjective distress be included in the diagnostic criteria for autism spectrum disorder? DSM-5 could be modified as follows: "Symptoms cause clinically significant impairment in the social, occupational or other domains. current operation [-including subjective distress]. "
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NOTES TO EDITORS
This study was funded by the Medical Research Council and the National Institute of Health Research. It was conducted by researchers from King's College London and the University of Bath.
Labels have been added to this press release as part of an Academy of Medical Sciences project to improve the communication of evidence. For more information, please visit: http: // www.
[2] See Supplementary Table 3 in the Appendix for a complete list and description of strategies, including examples.
Peer Review / Survey / People
** Participant Quotes and a complete list of available compensation strategies **
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