As presented in the first part, the medical evaluation of autistic people has been done and is still done based on subjective criteria, issued and interpreted by non-autistic people. Thus, the derivatives and prejudices on autistics have been and are many.
Over time, little by little, the first observations and descriptions of autistics performed by Leo Kanner and Hans Asperger seem to have been lost over the years, which leaves room for much confusion and « false » diagnoses. It would thus be essential to return to the initial criteria in order to separate the prototypical and Asperger autistic, that is to say those with a different cognitive functioning than the autistic syndromes, those having the manifestations of autism (specific interests and social difficulties) but with the same cognitive functioning as neurotypicals. These autistic manifestations are mainly the result of a genetic syndrome and most have an intellectual disability.
An approach that Dr. Laurent Mottron and his team have begun is trying to define more objective and quantifiable criteria. It should be understood that autistics all experience similar difficulties in relation to social interaction and communication and that it is the manifestations and reactions to them that differ. Categorizing autistics according to a level or degree of severity is as absurd as categorizing people with vision impairment. Myopic people do not have a « lighter » problem than people with presbyopia, and color blindness is no more « cumbersome » than myopia.
The similarity and confusion between prototypical and syndromic autism resides in the preverbal period, which can extend into adolescence in some cases.
At this point in time, prototypical autistics appear to have « low functioning » or « severe » autism comparable to intellectual impairment at the verbal level.
However, they have no real intellectual disability and their cognitive potential is extremely promising. They simply choose not to use verbal language as a means of communication since this is not a basic need for them, given the requirements of acquiring a language and responding to their own needs. Instead, they develop their exceptional perceptual abilities. Acquisitions that are reflected in their games as, for example, car ranking by size and color or spinning objects.
In addition, it should not be forgotten that levels or degrees of severity of autism have been established by non-autistic people according to non-autistic criteria. Thus, these qualifiers are a representation of the aptitudes and behaviors prioritized and valued by non-autistic people for socialization. These simply refer to the level of social adaptability that an autistic person has achieved.
Ultimately, it would even be possible to question whether these qualifiers do not represent all the stages of the curing process of autism. Because do not forget, autism was and still is a disorder in the eyes of medicine and like all disorders, curing it is the ultimate goal.
But when this disease is incurable, how can we evaluate the progress of care? Medicine had to create an evaluation scale. On the one hand, there are those who acquire certain social skills and are assimilated by society. On the other hand, there are the « beasts » disconnected and condemned to exclusion, those who represent a social burden. A scale capable of describing the progression of autism towards the « normal » human mind. A recognition of the folkloric and fleeting success of cruel and barbarous therapies to bring a being back to « acceptable human sociability ».
In these terms, nothing seems more absurd than this description of a medical thought and yet, electric shocks, psychotropics, animal training techniques and many other cruel therapies have been used and tested to bring autistic people back into the sociable neurotypical world.
The medical abuses described have all occurred at different times in the case of women, left-handers, homosexuals and various other minorities. They are only the representation of the smallness of knowledge in relation to difference.
This classification of levels increases stigma by helping to increase false beliefs about autism. It also contributes to the division of autistics into two clans and generates a kind of struggle between parents of « severe » autistic children and adults who speak. This classification condemns the autistic person to their autism by believing that they will never be autonomous. This is to the detriment of understanding the inner workings of autistic thinking.
And now, is it possible to start from scratch, to forget the errors and horrors of the past and to consider autistic people as human beings without neurological or social impairment and to include them in this society? Certainly, and this will be the subject of the third part.
A text co-written with Mathieu Giroux and Mélanie Ouimet. Translated from French by Hunter McLean.