Socially constructed

 Dubbo Weekender/Alexandria Kelly
Psychologist Tony Attwood: “ Diagnosis is like a 100 piece jigsaw where 80 pieces makes the diagnosis. There’s never anyone with all 100 pieces." Photo: Dubbo Weekender/Alexandria Kelly

Everyone has a little bit of autism according to leading psychologist Tony Attwood. Weekender was fascinated by a discussion which could change the face of humanity.

Autism Spectrum Disorder (ASD) is the next stage of evolution.

That’s according to Dr Tony Attwood, who was in Dubbo this week for a two-day conference to explain the new diagnostic criteria for the condition.

As one of the world’s leading experts in his field, Attwood has more than 40 years’ experience in the study and treatment of ASD after deciding to become a psychologist at age 14.

Introducing DSM 5, the updated Diagnostic and Statistical Manual of Mental Disorders which replaces DSM-IV-TR, Attwood is somewhat critical of the changes which he says are likely to have a negative impact on prognoses and funding support for ASD – described by Autism Spectrum Australia as “a lifelong developmental disability that affects the way an individual relates to his or her environment and their interaction with other people”.

Studies completed since DSM 5’s introduction in May 2013 show that 81.2 per cent of DSM-IV children achieved a DSM 5 diagnosis, indicating that almost 20 per cent of existing cases went undiagnosed.

In the future, Attwood says, “one in five is not going to be diagnosed, not because of magic but because they’ve changed the goalposts”.

“It’s not a dramatic decline but cases will drop through the cracks,” he says.

Asperger’s Syndrome is no longer officially recognised, added instead to the ASD range, and “there will be fewer people diagnosed in the Asperger’s range” according to Attwood.

“They’ve abandoned Asperger’s because they don’t like hyponymies. Asperger’s will now be known as ASD Level 1 without intellectual or language impairment. Officially it’s gone from the diagnostic criteria.”

He doesn’t approve. “I need to know where they are on the spectrum to determine their level of severity.

“However, academics in their determinations are rather detached from reality – they don’t see patients – while I still run clinics twice a week.”

In Attwood’s eyes, under the new model, there will be “less government support and services will focus on a smaller number of people”.


In Australia, one in 100 people in Australia is affected by ASD, and listening to Attwood describe some of the signs gave me an overwhelming sense of self.

Perfect pitch, an uncanny ability to spot grammatical errors and an incorruptible sense of honesty and integrity.

I wondered briefly if perhaps I was among that percentage of the population with undiagnosed autism.

However, Attwood says there are people who may not be on the spectrum but still possess some of the qualities.

He points out that a person has ASD if they display a majority of the tendencies which experts in the field refer to as Asperger quirks despite Asperger’s being dropped from the medical lexicon.

“There’s nothing in ASD that’s totally unique,” Attwood says.

“Everyone has a little bit but it doesn’t affect quality of life.

“There’s no clinical test. Diagnosis is like a 100 piece jigsaw where 80 pieces makes the diagnosis. There’s never anyone with all 100 pieces.”

These facts are included in the wealth of information conveyed by Attwood following the release of new research, and he also says more adults, particularly women, are now being diagnosed with some form of autism. Another statistic shows that 10 to 15 per cent of childhood cases would not be recognised in adulthood, due in large to support and recognition of the disorder.

In the move from DSM-IV to DSM 5, Attwood says the key differences are the three recognised domains being reduced to two and a shift from categorical to dimensional concepts, along with the level of severity and the distinct specifiers of ASD.

“There used to be three domains – social, language and repetitive behaviours,” he explains. “We are losing the language domain. Although I personally believe there are five – social, emotional, sensory, cognitive and motor.”

Criterion A of diagnosis shows persistent deficits in social communication and interaction manifested by deficits in social-emotional reciprocity, non-verbal communicative behaviours and developing, understanding and maintaining relationships.

“Their brain is not ordered to process social customs.

“In life behaviours, ‘Aspies’ have found something more interesting than socialising – I call it Frank Sinatra Syndrome – ‘I did it my way’.

“You also see withdrawal and isolation or in your face, extroverted cases of ASD that want to do it but do it badly. They are like Italian drivers where people’s faces are the traffic lights and it is difficult to read thoughts and feelings to know what to do.”

According to Attwood, when you consider that humans have 400 different facial expressions, it’s not surprising people with ASD “process things linguistically rather than looking at your eyes to process your thoughts”.

“Eye contact only adds confusion, not clarity,” he says, citing one client who closed his eyes during a consultation and said, “Why would I want to look at you when I know where you are.”

Making friends can be a difficult process too, with parental influence and family structure having a lot to do with social behaviours.

“Dad is likely to be in Information Technology or an accountant or engineer, with a lot of technical knowledge while Mum is likely to have a career where caring is a major factor.”

By this reckoning, it would seem the nature versus nurture argument could come into play and Attwood says brain development is the major factor in ASD and the causes are both genetic and circumstantial.

There’s also high level of autoimmune disorders such as Coeliac and Chrohn’s Disease linked to families with ASD.

Criterion B reflects restricted repetitive patterns of behaviour, interests or activities manifested by stereotyped or repetitive motor movements, use of objects or speech; along with insistence on sameness and inflexible adherence to routines, a high level of fixation on certain interests and increased sensitivity to sensory input.

“Criterion B are primarily strategies to cope with a high level of anxiety. They are behavioural coping mechanisms,” Attwood outlines.

“Aspies have a natural ability to line up patterns or find repetition. And gathering knowledge helps to overcome fears.

“And Aspies will align with well-known people who remind them of themselves – Dr Who, Doc Martin, Sheldon Cooper, Susan Boyle.”

Criterion C, as part of the DSM 5 model, explains that symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies later in life.

The best examples of this category are girls, more of whom are now being diagnosed. Traditionally, there are four times as many boys as girls with ASD. Attwood attributes this to girls being better at covering their tracks, socially speaking.

In social situations, he says, they are clever at hiding their true selves.

“They don’t want to be noticed and only after they have watched and analysed a situation, will they join in.

“They have a script of life, of others’ fears...and the ability to mimic, absorb and become another person.”

In this regard, many adults are now being diagnosed too, as more becomes known about signs and signals of ASD.

“What we are getting is a deluge in adults being diagnosed for the first time who never had the understanding when they were growing up,” Attwood says.

Of course, there are different indicators.

For a four-year-old, it’s playing alone in the sandpit. For a 44-year-old, it might be the collapse of significant relationships in their life.

Criterion D shows that symptoms cause clinically significant impairment in social, occupational, or other important areas of social functioning.

Criterion E are disturbances not better explained by intellectual disability or global developmental delay.

The DSM 5 specifiers are with or without accompanying intellectual or language impairment, association with a known medical or genetic condition or environmental factor and association with another neurodevelopmental or behavioural disorder. One of these is catatonia, in the sense of distinct movement, a slowness in movement or freezing of motion.


Attwood points out that the more that is known, the more work can be done in this area. He is now also looking at the recurrence rates among relatives.

“One in five of the families I see has more than one child on the spectrum,” he points out.

“We’re looking at the characteristics for early diagnosis and intervention.”

There’s no clinical test for ASD and it’s more about an accurate prognosis and ongoing support and management and there are recognised levels of need.

“Types of onset are gradual, at birth or dramatically. A hallmark characteristic is losing speech but it’s coincidental not causal.”

In the future, Attwood is prone to agree with psychology student Joshua Muggleton, who also has what was formerly diagnosed as Asperger’s Syndrome.

“I would like psychological therapy designed by Aspies, conducted by Aspies, for Aspies,” he says.

Like everything in life, increased understanding is achieving results in this field. It’s all about public perception and greater support.

“Friendship, acceptance by parents, teachers and advocates is the key. And personality, by accepting rather than raging against it; self-acceptance and understanding on the journey of life.”

What is ASD?

Autism Spectrum Disorder (ASD) is a lifelong developmental disability that affects the way an individual relates to his or her environment and their interaction with other people. The spectrum describes the range of difficulties that people with ASD may experience and the degree to which they may be affected. Some people may be able to live relatively normal lives, while others may have an accompanying learning disability and require continued specialist support.

The main areas of difficulty are in social communication, interaction and restricted or repetitive behaviours and interests.

People on the autism spectrum may also have:

  • Unusual sensory interests such as sniffing objects or staring intently at moving objects;
  • Sensory sensitivities including avoiding everyday sounds and textures such as hair dryers, vacuum cleaners and sand;
  • Intellectual impairment or learning difficulties.

Source: Autism Spectrum Australia

>> Guiding Hands is an Autism Support Group in Dubbo which meets on the last Wednesday of each month in the Community Health Building in Palmer Street at 7pm. Contact Pauline Bourke 0407 937 773 or Jeannine Farrell 045 7856 767. They also have a Guiding Hands Facebook group.

The Dubbo Autism Group, a group for people with autism and their loved ones is also on Facebook.

There is also an Autism and Asperger’s morning tea held on the second Monday of each month at Sticks and Stones in Macquarie Street between 10am and 12pm. Contact Sharon on 6881 3700 or Debbie on 0409 762 136.

For further information and support, visit or call 1800 277 328.

>> Tony Attwood has an Honours degree in Psychology from the University of Hull, a Master’s degree in Clinical Psychology from the University of Surrey and a PhD from the University of London. He is currently adjunct Associate Professor at Griffith University in Queensland and runs a clinic from his Brisbane home. He first became interested in what is now called Autism Spectrum Disorder in 1971 when he worked as a volunteer at a local special school in Sutton Coldfield. After meeting two young children with autism, he felt a deep connection and compassion for the challenges they faced, leading him to a career in the field.