People with autism give up easily

Autistic people are just different

Not all autism is the same. A whole range of different behaviors belong to the so-called autism spectrum disorders.

People with Asperger's Syndrome - famous examples are entrepreneur Elon Musk or climate activist Greta Thunberg - can have extraordinary talents. These are often staged in a media-effective way or their story is the basis for a film. One of the most famous is the film ‘Rain Man‘ from 1988.

In the film "Rain Man" Dustin Hoffman plays the autistic Raymond

Dustin Hoffman plays the autistic Raymond, who can remember tons of numbers but is unable to cope with his everyday life and who lives in a home for people with disabilities. The film is based on the life of Kim Peek. The American had a so-called island talent and, according to his own statement, knew the contents of 12,000 books almost by heart.

She herself looks after such a gifted patient, says Professor Hannelore Ehrenreich. She heads the Clinical Neurosciences Department at the Max Planck Institute for Experimental Medicine in Göttingen.

"If you ask him what's in the phone book on page 923 in the middle column, he can tell you without any problems. But he doesn't manage to get dressed in the morning. He puts on his shoes first and then his pants. That means, he needs help."

His disorder could well be classified as a disease. "One definition of illness in adults is not being able to look after yourself and being dependent on help," says the neurologist.

One of the most important characteristics is that autistic people have difficulty communicating with other people, making contact with them.

Typical symptoms

An autistic person can find it difficult to put himself in the shoes of others, to understand rules that others grasp intuitively. But adapting to changes and finding your way in unfamiliar situations can also be a problem for autistic people.

Recognizing and interpreting other people's posture or facial expressions is often not possible for autistic people. This type of non-verbal communication sounds like a foreign language to many with a pronounced form of autism. You can't do anything with it.

It is often particularly important to observe rituals. For example, the pencil must always be in the same place and at a certain angle to the eraser. Nobody is allowed to change this order.

Rituals often play a large role in people with autism

"There are autism spectrum disorders in which all autistic symptoms occur in a very strong form. These also include the so-called syndromic autistic disorders. They are often based on severe developmental disorders, which then lead, among other things, to the symptoms typical of autism," says Ehrenreich.

"Autism is an extremely complex disorder. The research on it has to come from different fields," she says. Important pillars are psychiatry and neurology, but also genetics and neurobiology. This is the only way to develop effective therapies for certain forms of autism. This may be necessary, for example, if there are other serious problems.

These can be neurological development disorders, difficulties in fine motor skills or pronounced, repetitive movements. "This is the case, for example, when a child is always sitting in the corner and constantly shaking his head or wringing his hands, making so-called ring movements."

Better to be autistic than schizophrenic

The diagnosis of 'autism' must definitely be made by people who are well versed in this subject. "There are various instruments and tests that help and underpin the diagnosis. Specialists can carry out these tests in appropriate centers," says Ehrenreich. It is not enough to be a psychiatrist or a neurologist. In order to be able to determine whether it is really autism and which form it takes a lot of experience and specialist knowledge.

"About half of the people who are sent to us with suspected autism have no autism at all. The diagnoses are simply wrong. In addition, autism has become a kind of fashion diagnosis," explains Ehrenreich. Most would rather be considered autistic ‘than accept a diagnosis of 'severe personality disorder' or 'schizophrenia', although schizophrenia can now be treated with medication.

There are no special medications for autistic people with severe disorders. None of the potential drugs have led to a breakthrough, such as the body's own messenger substance oxytocin, which works directly in the brain. "Oxytocin is a hormone that enters the body via the bloodstream. It has been shown to be able to improve social interaction in autistic people in the short term. However, it has no lasting effect. But it could be autistic through this new experience that do it, stimulate one to begin behavioral psychotherapy. " First, however, a diagnosis that is as well-founded and unambiguous as possible must be made.

Recognizing moods and facial expressions in people is difficult for autistic people

Eye tracking

Based on the observation that autistic people largely avoid eye contact, scientists have carried out so-called eye tracking experiments. A camera records the eye movements. "With this eye-tracking you can see that the autistic person is not looking at the eyes or the mouth of his counterpart, like most people, but in areas of the face that hardly play a role in communication on the cheek, "says Ehrenreich.

Thermography

Another instrument is thermography. It can provide information about the surface temperature on a person's face. "You will see very characteristic behavior of warmth and cold on the face. We were able to show that social stimuli cause a change in the thermal reaction in the face. We can thus distinguish social stimuli from purely cognitive stimuli, that is, from those that affect perception and Thinking is based independently of social interaction, "explains Ehrenreich.

"Such examinations lead to a relatively objective yardstick for a diagnosis because they can show how great the stress is that an autistic person experiences when interacting with others." Such a test can help clinicians and researchers better understand the mechanisms and causes of autism.

Collected knowledge

There is now an extensive database. Ehrenreich started it in 2004. Not only autistic people are registered here, but also people with schizophrenia. With the help of this database, the scientists can recognize and describe so-called phenotypes. These describe the set of all characteristics that an organism has, including behavioral characteristics. This is precisely what is essential for understanding autism.

An extensive database should help to better understand autism

"When I started this database, I was not always taken seriously. Many thought that one could find just about anything with the help of genetic tests or blood tests. But today we know that we need to know a lot about a person in order to to understand where certain disorders and problems originate. "

The database is intended to help classify test subjects as correctly as possible. Among other things, it is about how severely individual test persons are affected and whether they can be grouped into groups with similar characteristics. "Our goal is to extract more information about autism and its biological causes from this heterogeneity."

In severe cases, this can also lead to more targeted therapies. "If I know what the biological cause of a disorder is, I can treat it better," summarizes Ehrenreich. Genetic causes in particular come into question for this. However, environmental factors that act very early on, for example infections during pregnancy, i.e. in the uterus, can also play a role in the development of autism.

Autism often also means loneliness

The autistic in us

"Autistic traits are not always a disease, but part of the normal human behavioral repertoire," emphasizes Ehrenreich. Only in extreme cases does this result in a disorder or illness. "If we took the whole population and measured each individual's autistic traits, then we would get a very broad spectrum. We would probably find a whole lot of people who have clear autistic characteristics," speculates Ehrenreich.

For example, when she walked through the corridors of the Max Planck Institute, she kept coming across people who were staring rigidly at the floor, completely immersed in their own data world and in no way happy to communicate. "But that also has its advantages. As a scientist, it's great when you don't party, but work intensively on your research."

(This article was updated on May 10th, 2021)

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