By Professor Tony Attwood
One of the central characteristics of autism in DSM 5 is a deficit in social communication and social interaction. The social and interpersonal aspects of life are a challenge, so how does the person who has autism adapt to these challenges?
Clinical experience suggests there are three potential adaptations: the introvert, the “intensive” extrovert, and the “camouflaging” extrovert.
The more easily recognized adaptation is that of the person who could be described as an introvert. The child (and subsequent adult) actively minimizes or avoids social engagement, recognizing that social interaction is indecipherably complex, overwhelming, and stressful. This conspicuous adaptation, therefore, is to choose (where possible) to be alone to accomplish things while not necessarily feeling lonely.
But we are increasingly recognizing those people with autism who are extroverts and highly motivated to socialize. For these people, there are two potential adaptations that facilitate social engagement.
The “Intrusive” Extrovert
The first of these two adaptations is to actively seek social experiences, even though the person may not be able to read all the subtle social signals that regulate and moderate the intensity of social engagement. Due to impaired theory of mind, those who have autism often have difficulties reading the nonverbal communication used in a social interaction. Their social behavior is then perceived as intrusive, intense, and irritating. A metaphor to describe this adaptation to autism is that of a driver who does not see the traffic signals (nonverbal communication) or abide by the traffic code (social conventions). They are unable to accurately read social situations and therefore act inappropriately. While there is considerable motivation for social interaction and making friends, these experiences may nevertheless be ended prematurely by the social partner. The consequence is that the person feels bitterly disappointed that conversations, friendships, and relationships are short-lived, and social popularity remains elusive. Another issue is that once friendship is achieved, the person can become possessive, idealizing their new friend with an intensity that is overwhelming. When the friendship or relationship ends, there can be intense despair and feelings of abandonment, betrayal, and of being misunderstood.
The “Camouflaging” Extrovert
The second adaptation for the person with autism who is an extrovert is to recognize their difficulties in reading nonverbal communication and in making and keeping friends. With this insight, they acquire successful social and interpersonal abilities by keenly observing peers and people in general, analyzing their social behavior, and interpreting and abiding by social rules and conventions, thus effectively camouflaging their social difficulties. The person creates a social “mask.” This third adaptation to autism—camouflaging—which was first recognized as an adaptation to autism by girls and women, but which we now recognize as also occurring with males.