Autism Spectrum Disorder

Autism is a spectrum disorder. This means that individuals with autism often have co-occurring conditions like epilepsy, depression, and attention deficits. People on the autism spectrum differ, e.g. in intelligence, and in their communication patterns—some individuals might struggle to express themselves outside their inner circle, while others with ASD can be talkative, driven by a strong desire to convey their thoughts and passions. People with ASD can have eating challenges such as selective eating, limited acceptable food choices, sensory sensitivities during meals, leading to a restricted diet or mealtime difficulties. There is also a potential for heightened feelings of anxiety and worry among individuals with ASD, often linked to disruptions in routines, struggles with social comprehension, sensory overload, or difficulties in expressing needs effectively. This can culminate in frustration or anxiety in social interactions. These feelings might manifest through repetitive behaviors, withdrawal, or excitement in certain situations.

Autism: a valuable perspective
Individuals with autism often view their condition not as a social handicap but as a unique perspective and a valuable contribution to society. They offer a different way of perceiving and interacting with the world, emphasizing details, justice, and the pursuit of what they consider important. This unique viewpoint can challenge established norms and bring important issues to the forefront, as exemplified by Greta Thunberg's activism on climate change.

The brain's predictive processes
As human beings, we predict what happens in the world. Even before the senses pick up stimuli, the brain is already predicting what the input from those senses will be. Then the senses are used to check the predictions for their usefulness and survival value. The brain does not like prediction errors and either (1) updates its model of the world or (2) intervenes in the world to adjust it to fit the expectations.

Anxiety and depression are related to the brain's predictive processes and body budgeting. Anxiety sufferers have weakened connections in key brain hubs, including the amygdala, leading to difficulties in crafting predictions to match immediate circumstances. This results in unnecessary fear and uncertainty, making it challenging to prepare for the future.

Challenges in predicting for autism 
An autistic brain struggles to assess how much it should rely on its own model versus sensory information. In predicting the world, learning, and updating models of the world, and dealing with sensory information that deviates from those models, an autistic brain seems to be blind to context. In a world where everything is context-bound and relative, an autistic brain deals with models and prediction errors in an absolute manner. For autistic brains, the world is full of prediction errors. People with autism seem to be surprised by EVERYTHING. They give too much weight to exceptions and coincidences. The resulting hypersensitivity is very exhausting. People with autism easily become overstimulated when their brains give too much weight to sensory input. Because people are unpredictable and capricious, they are a major source of uncertainty for an autistic person and very difficult to deal with. When the brain considers prediction errors in a context where they are unimportant as something that requires attention, overstimulation occurs.

Motor clumsiness and prediction
Motor clumsiness (DCD) is also related to the reduced ability to predict. The uncertain and stressed autistic brain is so focused on the external world that there is hardly any space left to monitor the physical state. Individuals may experience gross-motor issues like uncoordinated movement and fine-motor difficulties such as manipulating objects. Coordinating movements between different sides of the body, maintaining posture, and hand-eye coordination can also be challenging.

Resistance to change and sensory overload
Because autistic individuals cannot predict changes in their lives, they resist, for example, a job change, moving to another house, or hospitalization. They desperately hang on to the status quo. Unpredictability is at the core of their sensory overload. Their brain is in a constant state of hypersensitivity because it takes the unpredictability of the world too seriously. An autistic brain has more trust in its own model of the body than in bodily signals. It overestimates its ability to pick up bodily signals. When estimating what other people are going to do, an autistic brain navigates mainly based on the principle of 'seeing is believing'. They need more information to predict people's behavior.

Misinterpretation of social cues
We project emotions onto the faces of others, and autistic people do this unconsciously incorrectly. They take every variation seriously, even when it depends on the context. Every social situation seems like a new situation to them because no two social situations are absolutely identical. The detailed models they have built are practically useless.

The same applies to hearing, reading, and seeing. They unconsciously use the context of a sentence less to predict how sentences may end. They stick to the initially provoked meaning and do not adjust it to the new context of the continuation. They are uncertain and want to check again. An autistic brain is less quick and accurate in predicting what someone is going to say, so it mainly relies on what comes next.

The vicious circle of sensory overload 
On a day-to-day basis, exceptions and differences that are not contextually relevant lead to an update of their own models of the world. This, in turn, leads to more specific models that result in a lot of prediction errors and overstimulation. The sensory overload that people with autism experience is the result of a vicious circle in which their brain has ended up, in which uncertainty, the absolute handling of prediction errors, and the accompanying stress play a key role. Considering sensory sensitivity, dampening the input does not help because then the brain gets accustomed to fewer stimuli and becomes even less tolerant of new stimuli.

Coping strategies
Autistic individuals need more time to think: slowing down, written language, drawings, photos, and diagrams help them. Since perception is a construction of the brain, we should focus on the brain rather than the stimuli. What helps is cognitive behavioral therapy, to counter the absolute thinking in a relative world what's characteristic for autism. During CBT, individuals learn that, e.g.:

• they look at things in absolute, black and white categories,
• they dwell on one negative detail, such as a mistake they made, and ignore all the things they did right,
• they draw conclusions that are not justified by the facts,
• they reason from how they feel.

Self-doubt and burn-out

Self-doubt may develop from past experiences of rejection and invalidation, leading to questioning one's worth. Autistic individuals may experience meltdowns and burnout due to self-doubt. Masking unique traits to fit in can worsen this. Burnout causes avoidance of challenges and a belief that therapy won't work. Rebuilding self-esteem involves self-compassion, accepting imperfection, and taking small steps towards progress. 

The roles of routines and relaxation

In a world of unpredictability, routines and stereotyped activities are oases of calm. Next to CBT, the other thing that really helps is relaxation. It's about creating a context in which one is relaxed, confident, and has a sense of control. By working on well-being and feeling good, one can handle unexpected changes much better and have less need for specific and absolute models of the world. When people with autism feel good, they display fewer autistic characteristics.

Further reading:

• Bervoets, J., Milton, D., Van de Cruys, S. (2021), Autism and Intolerance of Uncertaitny: An Ill-fitting Pair, in: Trends in Cognitive Science, LETTER| VOLUME 25, ISSUE 12, P1009-1010.
  
• Burns, D.D. (1999), Feeling Good - the new mood therapy, New York: Avon Books.
• Feldman Barrett, L. (2017), How Emotions Are Made - The Secret Life of the Brain, London: Macmillan.
• Khan, Sheraz and others. 2015. "Somatosensory cortex functional connectivity abnormalities in autism show opposite trends, depending on direction and spatial scale." Brain,138; 1394–1409.
  
• Sinha, Pawan and others. 2014. "Autism as a disorder of prediction." Proceedings of the National Academy of Sciences, 111(42): 15220-15225.
  
• Van de Cruys, Sander, Kris Evers, Ruth Van der Hallen, Lien Van Eylen, Bart Boets, Lee de-Wit, and Johan Wagemans. 2014. “Precise Minds in Uncertain Worlds: Predictive Coding in Autism.” Psychological Review 121 (4): 649–675.
• Vermeulen, P. (2022), Autism and the Predictive Brain, Routledge.