Intense World Theory

I said I would come back to the Intense World Theory that I discovered, so I am finally here to fulfil that promise. The theory is detailed in a paper by Kamila and Henry Markram, 2010 (Lausanne) and proposes a unifying neural model to explain autistic spectrum disorders. Markram and Markram study local microcircuits in the brain (focussing on the neocortex and amygdala) and propose that they are hyper-functioning in the brains of people with autism, specifically displaying hyper-reactivity and hyper-plasticity. (see Introduction for more detail http://journal.frontiersin.org/article/10.3389/fnhum.2010.00224/full)

Which is a lot of big words. Basically, if I am correct, the researchers think that particular circuits in the brain are working overtime reacting strongly to input and remembering its reactions to inform future preferences. That is a very basic summary: really, you're better off reading it from the source above.

The researchers describe four areas of effects of the hyper-functioning microcircuits which impact how people with autism experience the world: hyper-perception, hyper-attention, hyper-memory and hyper-emotionality.

Hyper-perception
Various circuits (differing from person to person, hence the very individual expresssions of ASC) have a loss of inhibition and are therefore hyper-reactive, leading to "vulnerability to sensory overflow. Consequential behaviour would be panic, aggression and withdrawal."                              

Hyper-attention
This sounds as though the brain gets 'locked into' a circuit, where a circuit is activated and then continues to reverberate, or repeat itself and is difficult to interrupt. This brain activity is clearly linked to difficulties in transition and shifting attention for people with autism, and to fixated attention on matters of interest. Also, autistic people "may seem distracted and disengaged, but are actually hyper-focussed on internal processes."

Hyper-memory
Here it is proposed that early learning is strongly imprinted and not easily over-written. Once something has been learnt it is very hard to unlearn, explaining why people with autism find it very difficult to address problems or tasks in a new way. Also, there may be displayed "idiosyncratic, albeit exceptional memory capabilities."

Hyper-emotionality
Quite contrary to many previous models of autism, the Intense World Theory suggests that in autism there is actually an enhanced sympathetic response to social content as well as to novel or sensory rich content and negatively associated stimuli. This is thought to lead to enhanced fear conditioning and avoidance of high-emotion stimuli (eg. eye contact) as well as avoidance of novel environments "due to fear of surprises that arise from over-generalisation of previous negative associations." Behaviours displayed may seem unpredictable, exaggerated, extreme or inappropriate.

The writers conclude that:

"In contrast to other deficit-oriented theories of autism, the Intense World Theory points out that enhanced brain functioning may lie at the heart of autism. In this light, autistic individuals may in general – and not only in exceptional cases – exhibit enhanced perception, attention, and memory capabilities and it is in fact these capabilities, which may turn the world too intense and even aversive and lead to many of the autistic symptoms including withdrawal and social avoidance".

Obviously this is a painfully tiny summary, and quite possibly not a perfectly true representation of the research, so please go and do some further reading and come back with questions! The theory is still fairly controversial I think, but there are parts of it that seem to make a lot of sense to me.

I would say the reason I avoid emotional stimuli is definitely due to being overly sensitive, getting overwhelmed by people's insides and not knowing what I am supposed to do with that stuff or how I can make someone feel better or show them I am happy with them. Hyper-memory I think also affects me quite strongly: I tend to be pretty rigid in my approach to many things (probably much to the frustration of Mr Peggy!), to the extent that I feel like I am doing something wrong if I deviate from my own expectations. The other two areas also add up with my and many others' experiences, so if you would like any more information/anecdotes/thoughts on any particular areas, just let me know!

Decisions Part II - links and research

When I consulted the oracle Google on the question of whether other people with ASC experience difficulty with decision-making, I was surprised by the huge number of results. Many others in my position had asked the same question on online forums (www.psychforums.com/asperger-syndrome, asperclick.com, wrongplanet.net) and received not unanimous responses, but a high proportion of people echoing difficulties with making decisions and the stress caused by this.

I came across further anecdotal evidence on a couple of good blogs I discovered through this search. https://aspergersandmeblog.wordpress.com/2014/02/20/how-do-i-adult-making-decisions/ has some good tips for people with AS to assist in decisions, and the blog 'Musings of an Aspie' has a whole series on 'What I want' as well as some single posts on decisions that I could have written myself (if I were as eloquent!): http://musingsofanaspie.com/2013/07/29/what-do-i-want/
http://musingsofanaspie.com/2013/02/21/my-no-reflex/
http://musingsofanaspie.com/2012/09/05/when-all-you-can-draw-is-a-blank
And to top it all off, I did manage to find a couple of academic studies in the area. One I sadly couldn't access due to copyright, but was conducted by Lydia Luke, University of Cambridge: 'Decision-making difficulties experienced by adults with autism spectrum conditions'. The abstract states that:

Autobiographical and clinical accounts, as well as a limited neuropsychological research literature, suggest that, in some situations, men and women with autism spectrum conditions (ASCs) may have difficulty making decisions. Little is known, however, about how people with ASCs experience decision-making or how they might best be supported to make decisions for themselves. In this study, we compared the decision-making experiences of adults with and without ASCs (n=38 and n=40, respectively) using a novel questionnaire and the General Decision Making Style inventory (GDMS, Scott & Bruce, 1995). The participants with ASCs reported experiencing several problems in decision-making more frequently than the comparison group, and were more likely to report avoidance of decision-making, as measured using the GDMS. The findings highlight areas of potential future research and inform suggestions for supporting adults with ASCs during decision-making.

Sounds interesting. The other research I found was conducted by Lee A. Wilkinson (http://bestpracticeautism.blogspot.co.uk/2013/01/decision-making-problems-in-adults-with.html)

The results indicated that compared with their neurotypical peers, the participants with ASD more frequently reported difficulties in decision making. Decisions that needed to be made quickly, or involved a change of routine, or talking to others, were experienced as particularly difficult, and the process of decision-making was reported to be exhausting, overwhelming, and anxiety-provoking. The participants with ASD reported significantly higher levels of anxiety and depression and were more likely to believe that their condition interfered with rather than enhanced the decision-making process. Not surprisingly, the participants with ASD were also more likely to report that they avoided decision-making.

...

These findings are consistent with previous autobiographical accounts, known features of the condition, and previous studies of decision-making in ASD... Despite limitations of the study (e.g., self-reports), the results are consistent with suggestions from the literature relating to decision-making for people with ASD. Importantly, they also have some practical implications for supporting more capable adults with ASD. For example, it may be useful to: (a) provide additional time to reach a choice, (b) minimize irrelevant information, (c) present closed questions, (d) offer encouragement and reassurance, and (e) address general issues around anxiety. Understanding how adults with ASD experience decision-making is especially relevant for family members and professionals who are involved in providing support to help these individuals achieve greater self understanding, self-advocacy and improved decision-making in lifespan activities such as employment and personal relationships.

It seems I am definitely not alone then, and that this issue may well be part of the AS, not just me being mindless and pathetic. Bit of a relief, really. Now how to explain this problem or get people to support me in it without telling them about AS... that could be a tricky one. After an issue last week, I am wondering whether I should tell work, but I'm not sure how they'd take it - it seems to be a fairly "fend for yourself" environment, and my colleagues are very aware of severe needs so may discount my milder problems. Will have to ponder on that one.

The D word

Anybody who knows me knows I have a problem with making decisions. It's far more long-standing than my diagnosis of AS and has left me with many rather embarrassing memories.

It tends to go something like this:
Somebody asks a very simple question, such as "do you want to go for first dinner break or second?", or "what do you want to do?", or I have to decide what food to buy in a cafe. Basically, anything where a decision is required on the spot, I don't know the answer and somebody is waiting for it.

Now, strangely, the less I mind about the answer, the harder this sort of situation is and the more stressed and anxious I get. Inside, I start to get worried as soon as the question is put or I see it coming. I start frantically searching for the 'right answer.' Here I am considering all the possible minute implications of each possible decision (to the routine of my day, to my companion's feelings, to my finances, to what is good for my body, to whether Great Aunt Gertrude would put her pink hat on if I chose option x, and whether that would have an impact on llamas in Peru etc etc). If I find a 'right answer' (some kind of deciding factor, eg. "I really fancy that toastie", or "that's the cheapest and I'm poor at the moment", or "the other person will want the big piece of cake so I'll take the small" or "that's got the highest specifications so is the best version") then everything is fine. The choice is made and we all carry on as if nothing had happened.

But if there is no deciding factor to find a 'right answer', we run into trouble. My heart starts pounding and my breathing gets faster, I go bright red (I assume by the feeling in my face anyway!), I start to get panicky and my eyes might dart around. At this point if there's no way out of the decision my eyes are prone to leak. This is very embarrassing in public when you are a grown up! I also might start tapping my fingers together quickly, or wiggling my toes, possibly before the crying stage. I will most likely be very quiet while this is going on. If we're lucky I might manage "I don't know." I'll be feeling very scared and vulnerable. The most recent couple of times I noticed I started flapping my hands and stepping my feet quickly on the spot, or sucking a finger. One time my mouth muscles did a weird thing I couldn't even stop when I tried.

As an aside, these last few have worried me a bit as normally I don't do things outwardly that would make people think there was something wrong, so I don't really know what's going on. I could just be becoming more aware of myself, but I'm reasonably sure I didn't used to do them or people wouldn't find it surprising that I have AS! Since changing jobs I seem to have been experiencing more 'AS symptoms' so I don't know if it's related to that, but I certainly hope it goes away. Any ideas welcomed! Just had a thought: perhaps this could be because in certain situations crying is not an option, like at work, so maybe the excess is coming out in a different way. Any thoughts?

I have observed a few factors which seem to compound the situation when it happens:

• time pressure
• the person reiterating that I need to decide rather than them
• thinking someone will not be happy with me if I don't make the decision (or if I make the wrong choice)
• when I'm hungry
• when I think a particular answer is expected or desired and I don't know what it is

If you think I'm in this situation and want to help, the very best thing you can probably do is to give me a hug (but only if you know me) and ask if I want you to decide. I'll probably nod. It doesn't matter what you choose: the reason I'm like this is because I don't know what I want. If I don't want you to choose, I might just need some time and space. If you can, take me somewhere quiet where we can sit down. I'll probably start to talk to you about it after a while. 

Anyway, until a week or two ago, I thought this was just me being bad at making decisions, but then I watched a documentary that got me thinking. It was the fourth episode on David Eagleman's series 'The Brain' and was titled 'How do I decide.' It looked at how both logic and emotion are needed to work together for decision making and showed a case of a lady with a brain injury where these links had been compromised and how she now finds even the simplest decisions incapacitating and can get emotional over it. I wondered if it could be at all related to AS, thinking about how the brain works differently with emotions and things, so had a look on the internet, and it looks like I'm certainly not the only one.

More to follow on what I found!