By Professor Tony Attwood and Dr. Michelle Garnett
We have found that an autistic teenager’s sense of self-identity, self-confidence and self-worth is often based on peer rejection and criticism, not compliments and acceptance, as illustrated in these two quotes from autistic teenagers:
I was afraid to be myself because I thought I wasn’t good enough.
I was teased unmercifully because other people just didn’t understand my way of thinking.
Factors contributing to a positive autistic sense of self are crucial, given the potential implications for mental health and well-being and the concealment of autistic characteristics leading to camouflaging or masking the authentic self (Botha & Frost, 2020).
A vocabulary to define a sense of self
When autistic individuals are asked to describe themselves, they tend to define their personality in terms of what they like to do, know, or collect. However, they are less likely to define themselves by their social network of family and friends (Lee & Hobson, 1998). From our extensive clinical experience, we would add that they often use fewer words to describe personality characteristics when describing themselves. When we asked an autistic adolescent to describe his personality and the personalities of people he knew, he replied, ‘I don’t know what the names of personalities are.’
Alexipersona
The term alexithymia was first used in the 1970s to describe a difficulty determining and describing one’s emotions, a characteristic associated with, but not exclusive to autism. We have recently created the term alexipersona to describe difficulty determining and describing one’s personality. An autistic person may need guidance in understanding and describing the personalities of others and, eventually, their personality.
To encourage a positive sense of self, we developed a range of activities to identify personality qualities and strengths in our Exploring Depression and Beating the Blues programme for depressed autistic adolescents and adults (Attwood & Garnett, 2016). The positive personality qualities included a range of personality descriptions such as being kind, helpful, non-judgemental, determined and trustworthy and how they can be an advantage in friendships and employment.
Discovery of autism
As clinicians, we are expected to use the diagnostic criteria for Autism Spectrum Disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (APA, 2023). We are concerned that the diagnostic criteria exclusively refer to deficits and abnormalities and none of the positive attributes of autism. This can contribute to a negative sense of self. During a diagnostic assessment, we explore the positive autistic qualities in the person’s profile of abilities, and we move from diagnosis to discovery. Unlike ‘diagnosis’, the term ‘discovery’ refers to identifying a person’s strengths and talents due to autism.
Camouflaging
Research and clinical experience have confirmed that autistic individuals who have a negative sense of self are more likely to engage in camouflaging behaviours (Botha & Frost, 2020; Perry et al., 2022). When the intention to achieve social acceptance is by acting, using a pre-determined script and designated role, autistic individuals camouflage or mask their social difficulties but are not their authentic, autistic selves. Their personality is determined by their role in a particular situation and imitating those who are successful in a particular situation. An autistic adult who was a retired professional actor said, ‘It was only in my adult years I developed my identity.’ During his childhood through to his young adult years, he did not know who he was other than a repertoire of roles.
Self-critical
Our extensive clinical experience indicates that those autistic individuals who have a negative sense of self are often excessively self-critical, expecting of themselves a level of ability greater than expected by a parent, teacher, or peer. An autistic teenager said: ‘The worst thing about disappointing yourself is that you never forgive yourself fully’. This characteristic can be one of the contributory factors to academic and social performance anxiety and clinical depression.
A recent study of mature-age autistic adults by Ommensen et al. (2023) found that eventually acquiring a positive sense of self was associated with greater well-being. Participants in the research used positive self-talk such as “You can manage this”. They also reflected on how “I can look back now and cut myself a bit of slack” and “I’ve become more accepting of myself.” Being self-critical was associated with a time of a negative sense of self.
Anxiety and depression
Research has confirmed that a positive autistic identity is associated with decreased levels of depression, anxiety and stress (Cage et al., 2018; Maitland et al., 2021; Cooper et al., 2017), and there are higher scores on measures of self-esteem and self-concept with a greater sense of psychological well-being (Corden et al., 2021). These research findings are significant as autistic people are considered vulnerable to poor mental health (Lai et al., 2019). Encouragement of a positive sense of autistic self must be incorporated into treatment programmes for autistic individuals who have an anxiety disorder, depression, eating disorder or other psychological conditions.
Achievement of a positive sense of self from fellow autistic individuals
Two of the ultimate goals in life and psychotherapy for an autistic person are to understand and accept who you are. Some autistic children and adults appear to have achieved this without formal therapy. An autistic adult said to the authors of this blog,
‘I no longer wish normal. I embrace my autism, I want to share my joy at being me.’
An autistic woman wrote in an email to us,
‘I am what you might call one of the idiosyncratic members of society. I am one of the unforgiven. I have been referred to as a space cadet and a freak. Or, depending on your generation, a nerd, a geek, a spaz or a dweeb. But what’s in a name? I am Autistic. Of all the names I have been called in my lifetime, I like Autistic the best because it means that I am in good company.’
A 12-year-old autistic boy wrote an e-mail to us stating,
‘I would like to see ASD children accepted with our funny ways. I find tiring and stressful and annoying spending so much time watching what you do. Sometimes I just want to be me and I’m glad to be me.’’
In her autobiography, Donna Williams explained,
‘It seemed that other people’s ‘normality’ was the road to my insanity’ (Williams, 1992).
Perhaps the last comment on a positive sense of self is by Nita Jackson (2002), a young autistic woman who gives wise advice to fellow autistic people:
You’ve got to accept yourself for who you are – however tough this may be. Being in denial will only hinder you. Acknowledge your syndrome, research it, and remember that anyone who is unkind to you because of your difference isn’t worth it in the first place. This is easier said than done I know – I’m not completely there yet! Accepting yourself, therefore, is the key to personal success… And, most importantly, be true to yourself…
Where to from here?
Our online course Developing a Positive Self-Identity covers each topic discussed in this blog in greater depth and describes strategies for autistic individuals, parents and professionals to develop a positive sense of autistic self. The course was designed for autistic adolescents and adults, parents and health and educational professionals.
References
APA (2023) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision American Psychiatric Association.
Attwood and Garnett (2016). Exploring Depression and Beating the Blues London, Jessica Kingsley Publishers.
Botha and Frost (2020). Society and Mental Health 10,
Bury et al. (2022) Journal of Autism and Developmental Disorders 52.
Cage et al. (2018) Journal of Autism and Developmental Disorders 48.
Cooper et al. (2017) European Journal of Social Psychology 47
Corden et al (2021) Frontiers in Psychology 12.
Crane et al. (2021) Journal of Autism and Developmental Disorders 51
Crompton et al. (2020) Autism 24,
Davies et al. (2023). Autistic identity: A systematic review of quantitative research. Manuscript submitted for publication. https://doi.org/10.31219/osf.io/74k6m
Ferenc et al. (2023). Autism 27.
Jackson (2002) Standing Down Falling Up: Asperger’s syndrome from the inside out. Bristol: Lucky Duck Publishing.
Lai et al. (2019). The Lancet Psychiatry 6
Lee and Hobson (1998). Journal of Child Psychology and Psychiatry 39.,
Maitland et al (2021) Autism 25
Nguyen et al (2020) Frontiers in Psychology 11.
Ommensen, B. (2023) PhD Thesis, University of Queensland.
Perry et al. (2022). Journal of Autism and Developmental Disorders 52.
Williams (1992) Nobody Nowhere: The remarkable autobiography of an autistic girl. London: Doubleday.
