What ‘the Good Doctor’ Can Teach Us About Autism And Sarcasm
The Good Doctor is a medical drama set in a California hospital. The star of the show is a genius surgical resident on the autism spectrum, Shaun Murphy, who is played by actor Freddie Highmore. The show contains some great illustrations of how life can be for people on the autism spectrum. In this article I will look at the difficulties many people with autism and Aspergers have when it comes to understanding sarcasm.
Early on in the series there is clear tension tension between Dr. Murphy and his boss Dr. Melendez, a cardio-thoracic surgeon played by Nicholas Gonzalez. Melendez is a hotshot surgeon with a major ego to match, and hes skeptical, to say the least, about what Dr. Murphy can bring to his team. He believes that while Dr. Murphy is clearly very bright, he doesnt have the qualities to be a successful surgeon.
Dr. Melendez likes to use sarcasm in his role as supervisor for Dr. Murphy and several other surgical residents. When Dr. Murphy is late on his very first day on the job, he tells Dr. Melendez it was not his fault. The bus was late, so it was the fault of the driver. Melendez turns to him and sarcastically says, We made a real good choice hiring you.
But its not impossible. A later scene in that first episode of The Good Doctor shows this well. In the scene, Dr. Murphy turns up for work on time. He says good morning to Dr. Melendez and his colleagues.
Challenges With Nonverbal Autism And Communication
Sarah brought her child into the childrens ER in Jacksonville. She had already been to her sons primary care physician and he had sent her to the childrens ER for further testing. Due to her son not favoring the body parts that were hurting and the nonverbal nature of her child, his symptoms were largely dismissed.
Her sons low energy levels and lack of eating were also deemed to not be of significant enough concern. This was day 12 of a low grade temperature.
It took another 6 weeks of doctors appointments before finding out that the child had strep throat.
This is something that could have been treated much earlier on if his autism had been more thoroughly understood, leading to both understanding the range of possibilities of what could be wrong with the child as well as understanding the context of the concern of the parent better.
In many cases the caretaker for someone with autism is going to be the best insight into what is normal for that child or adult. Autism by nature varies significantly by person, so just because a doctor has seen numerous patients with autism that does not mean that a new patient will be similar to previous patients.
This is one of the biggest reasons why proper training on autism is so important across medical and non medical staff alike. Autism is a spectrum, and how people are treated needs to reflect that.
They Are Not Tied To Social Expectations
If you’ve ever bought a car, played a game, or joined a club to fit in, you know how hard it can be to be true to yourself. But for people with autism, social expectations can be honestly unimportant.
Who cares if someone you’ve never met rolls their eyes when you mention your interest in Disney movies even when you’re a grown-up? What matters is true liking, shared interests, kindness, and the desire to spend time togethernot keeping up with or being as similar as possible to the Joneses.
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What Causes Autism Spectrum Disorder
No one knows exactly what causes ASD. It probably has something to do with DNA the genes passed down from your parents and other things, like infections or toxins that change the way the brain develops. Problems during pregnancy and around the time of birth raise the chance of getting autism.
Vaccines do not cause autism.
What Is It Like To Be A Therapist With Autism
What would be the challenges and benefits of a psychologist when it comes to working with patients if they themselves have a mental diagnosis? Im particularly curious what the challenges and benefits would be of various conditions like ASD, ASPD, NPD, etc. when it comes to working with patients.
I have high-functioning autism. Fifteen therapists missed it, as well as my medical doctor. In the end it was diagnosed because a person who I recently became friends with who has high-functioning autism suggested I might have it, so I proceeded with the process of getting diagnosed.
I occasionally tell patients, and they are always surprised. If you met me you would find me friendly, good at conversations, caring about you, fun to be around, and deeply empathetic and if I told you I had ASD you would tell me, You dont seem like you do.
I am very good as a therapist for a number of reasons:
My patients like me, they get better, my schedule is fully booked, and I get all of my referrals from word of mouth. This I believe is an indication of the benefits of working with me a therapist with ASD.
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Learning More About Adults With Asd
Dr. Croen launched several Kaiser studies to learn more about the needs of patients and doctors. “We have a large number of pediatric patients with ASD who are becoming adults each year and transitioning from pediatrics to adult medicine. We wanted to know about the health status of adults with autism, their health care utilization patterns, and what the adult providers knew about autism,” she said. Meanwhile, some adults who suspected they have autism had asked Kaiser how they could be tested for ASD.
Society is struggling to understand autism beyond childhood, explained Nancy Cheak-Zamora PhD, assistant professor of health sciences at University of Missouri. “Our society as a whole has not caught up with the increase in diagnoses of autism and our understanding of what autism is and how it progresses throughout the life course. People have to understand that autism doesn’t stop at childhood,” she said.
Ideally, Ms. Gladstone said, medical and therapy practices would be better versed in adult autism. They would understand that she may not be able to provide a “20-second answer” to their questions, and would let her communicate by email as necessary. They would provide several appointment reminders, among other accommodations.
You Are Often Focused On Small Details Rather Than The Big Picture
The autistic brain is good at certain things and not at others. It’s exceptionally detail-oriented, able to pick up on a lot of tiny information at once, but it finds it harder to put together into a big picture. A 2013 study from NYU indicated that autistic brains process information in a different way than non-autistic ones, possibly because of lower levels of oxytocin, which both influences our social bonding and helps our brains sort and prioritize information.
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Autism Prevalence In Healthcare Practitioners
Recent prevalence data indicates 1.1% of the UK population is autistic, although this is widely held to be an underestimate. While we do not yet have prevalence rates for autistic doctors, 1% of GP responders surveyed on this topic by the RCGP clinical priority group indicated that they were themselves autistic, so informing their care of autistic patients.
Public awareness campaigns, medical literature, or the diagnosis of a family member are prompting a lost generation of autistic healthcare professionals to recognise their autistic traits, but it is likely that the majority of autistic doctors remain undiagnosed. Those who have been diagnosed, or who self-identify as autistic, face significant challenges around disclosure. Fearing discrimination, many remain undercover. But now they are finding each other, and this growing community of autistic doctors challenge the assumption that being autistic is incompatible with a medical career.
They Live In The Moment
How often do typical people fail to notice what’s in front of their eyes because they’re distracted by social cues or random chitchat? People on the autism spectrum truly attend to the sensory input that surrounds them.
Some see the beauty that others miss, though they pass by it every day. Many have achieved the ideal of mindfulness, even if they don’t have the tools to communicate their state of mind to others.
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How Is Autism Spectrum Disorder Treated
There is no cure for autism, but treatment can make a big difference. The sooner treatment starts, the better. With therapy, people with autism learn language, improve in school, and build social skills. Many kids with ASD are in special education classes or get special education services.
A treatment program might include:
- speech therapy to help with talking and language skills
- occupational therapy to help with everyday tasks, like dressing and playing
- behavioral therapy to help improve behavior
- social skills training to help with relating to others
- special education to help learning
- medicine to help with things like sleep, paying attention, and hyperactivity
Were Not All White Men
Some autism awareness campaigns want you to Light It Up Blue because they say that autism disproportionately affects boys, but the fact that white heterosexual cisgender boys are more likely to be diagnosed with autism doesnt mean that theyre more likely to be autistic. There are autistic people of every color, creed, and class. Recent studies suggest that we might be more likely to be transgender than the allistic population.
The stereotype that autism is primarily a white male thing negatively affects everything from the way the rest of us are treated in society to what kind of care we receive to the age at which were diagnosedand whether we are able to receive a proper diagnosis at all. Which, in turn, perpetuates the idea that autism is for white boys.
Autistic People May Act In A Different Way To Other People
Autistic people may:
- find it hard to communicate and interact with other people
- find it hard to understand how other people think or feel
- find things like bright lights or loud noises overwhelming, stressful or uncomfortable
- get anxious or upset about unfamiliar situations and social events
- take longer to understand information
- do or think the same things over and over
If you think you or your child may be autistic, get advice about the signs of autism.
Interventions For Feeding Problems Including Restricted Diets
- Feeding problems, including restricted diets, can result in nutritional deficiencies that may have serious consequences.
- Assess for any feeding, growth or nutritional problems, including restricted diets. Monitor and refer if needed.
- As part of a full nutritional assessment and monitoring, blood tests to check for nutritional deficiencies may be required.
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Pharmacological And Dietary Interventions
The management of ASD is essentially non-pharmacological. However, certain drugs may be considered for the management of coexisting psychiatric or neurodevelopmental conditions and may occasionally have a short-term adjunctive role in alleviating core symptoms of ASD. Any pharmacological intervention should only be undertaken by doctors with appropriate training in the care of people with ASD.
Do not use the following interventions for the management of core features of autism in children and young people: antipsychotics, antidepressants, anticonvulsants, exclusion diets .
Not All Of Us Can Talk But We All Have Something To Say
Depending on your source, perhaps 20-30% of autistic people are estimated to be nonverbal. But talking is only one way to communicate. Some of us type. Some of us use sign language and/or AAC . Even behavior is a form of communication. So the problem isnt that autism cant speak, its that the rest of you need to learn how to listen to us.
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The Challenge: Finding Health Care Providers For Adults With Autism
Cheryl Hammond knew that tone of voice. She would call a new medical office and say something like: “I’m looking for a doctor for my adult son. He has autism.” First a pause, then the voice on the other end of the phone would say, “We haven’t worked with anyone like that before.” As Ms. Hammond recalled, “It’s always with the tone of, ‘I don’t know if we can do that.'”
She wonders why doctors’ offices seem surprised by new patients like her son, 22-year-old Kyle and what they will do about the many who will come after him. “One in 68 children has autism now. What are you going to do in a few years when they are adults?” she asks.
Mr. Hammond was diagnosed when cases began swelling in the 1990s. He is part of the first large wave of people with autism to enter adulthood and an adult health care system that has limited experience with the condition. Most autism experts seem to be in pediatrics, even though children usually do not shed their autism diagnoses on their 18th or 21st birthdays. Are those who treat adults internists, family medicine physicians, psychiatrists, counselors, and psychologists prepared for a growing number of patients like Mr. Hammond?
Unfortunately, many are not. In recent studies, a majority of health care providers themselves reported needing more training in autism spectrum disorder ,1 and having “poor or fair” knowledge and skills in providing care to adults with autism.2
What’s It Like To Have Autism Spectrum Disorder
ASD affects different people in different ways. Some people can’t speak or learn. Their behavior may seem strange they may avoid other people they may pace and move their bodies in unusual ways, like flapping their hands. They may repeat lines from TV shows or movies.
People with less severe ASD are able to talk and learn. But they may have trouble:
- expressing feelings. They may seem cold and distant.
- understanding the feelings of others. They may ignore or misunderstand how other people might feel or behave in a situation.
- reading social cues. They might not understand body language or facial expression they stand too close they ignore signs of boredom or frustration.
- handling sensory information. Loud noises, bright lights, or crowds may bother them.
- handling a new routine. It might be hard for them to sit in a different seat or having a substitute teacher.
Some might get get super-focused on a single topic or hobby, some of which may be unusual .
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How Is Autism Diagnosed
There is no lab test that can detect autism. Talk to your doctor if your child does not behave as expected for their age. If the doctor suspects autism, they may suggest seeing a child psychiatrist or other specialist. A specialist can observe your child to look for signs of autism.
Some children who have autism also are intellectually disabled. This means that their intellectual abilities function well below average. It causes developmental delays. This can make it hard to diagnose autism. Children with autism do not respond to questions the same way other kids do. An expert can give your child special tests to learn more about your childs condition.
Transition To Adult Services
Young people with autism who are receiving treatment and care from child and adolescent mental health services or child health services should be reassessed at around 14 years to establish the need for continuing treatment into adulthood.
If continuing treatment is necessary, make arrangements for a smooth transition to adult services. The timing of transition may vary locally and individually but should usually be completed by the time the young person is 18 years of age.
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Implications For Autistic Patients
Autistic patients commonly report difficulties communicating with their healthcare providers. Anecdotally, communication is enhanced between autistic doctors and autistic patients. This is supported through findings that autistic people generally communicate better with other autistic people than with non-autistic people. It is known that autistic patients face significant health disparities and autistic doctors have a unique perspective on the contributory factors and possible solutions.,
Autistic GPs and scholars contributed to the March 2021 issue of the Australian Journal of General Practitioners, which focused on neurodiversity. Their open representation in this publication highlights the heterogeneity of autism and directly challenges the tragedy narrative of autism pervasive in health care.
Changing the culture within medicine so practitioners may disclose without fear of discrimination clearly has positive implications for autistic patients. It is therefore vital the move towards a strengths-based approach to autism is accelerated the way that autism is framed has a profound impact on outcomes.
Is There A Test For Asd In Adults
Clinicians have developed different tests that can help diagnose ASD in adults. These include diagnostic tests such as ADOS 2 Module 4, ADI-R, and 3Di Adult.
However, it is not clear how reliable these tests are for adults. The reasons for this include:
- Researchers who look at the reliability of ASD tests often use a small number of study participants.
- Not many research studies on testing for adult ASD include enough participants from historically underserved groups, such as People of Color or people who are LGBTQIA+. This means the results of studies looking at ASD testing methods may not represent a true population of autistic adults.
- Many clinicians may not be familiar with the signs of ASD in adulthood. This is especially true if the patientâs symptoms are not severe or if the patient also has other conditions, for example, anxiety.
Autistic people may have of co-occurring conditions, such as anxiety or depression, than those in the general population.
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