Triad of impairments, executive functioning and sensory processing
				in High functioning Autism

	Close your eyes for a minute and imagine walking into a bright room with buzzing, flickering fluorescent lights that make it difficult to see.  You look down in an attempt to shield your eyes.  As you watch your feet, you notice that if you step only on the black spots on the checkered laminate floor, you walk like a knight on a chessboard. Doing this feels calming, so you continue. Two forward, one over.  Coming to an abrupt stop, you notice that the room is crowded, and you’re standing merely inches away from another person.  A few select words are yelled as they back up- you assume angrily, but you can’t tell for certain. Your head turns to them, but your eyes wander, because looking into their eyes is too intense.  Remembering that it’s rude to stand too close, you try to apologize before a couple more choice words are mumbled at your expense, and they walk away, leaving you standing there lost in thought. The above situation is the normal experience for someone who lies on the autism spectrum. There are many aspects and variations of autism, some more severe than others. We're most familiar with the severe, low functioning form, but very few know about how “high functioning” autistics get by in a world that doesn't fully understand them. Sometimes one is diagnosed with Aspergers Syndrome instead, if there was typical speech development.  High functioning autistics struggle with many situations that neurotypicals, or those without any neurological disorders, handle with ease.
	Those on the autism spectrum are said to have difficulty in three main areas, sometimes known as the triad of impairments. The triad of impairments is composed of social communication, social understanding, and flexibility of thought. Additionally, autistics have difficulties with sensory processing and executive functioning. Sensory processing can be manifested in either intensified (over-sensitive) senses or underdeveloped (under-sensitive) senses, or a craving for more stimulation (seeking). Executive functioning includes planning, organization and management of time and space. Those on the higher functioning end of the spectrum struggle with these things, but may appear to be less affected because they often learned the ability to hide or mask it. Others end up shunned from their peers and seclude themselves away, resulting in solemnity and frequently, depression.
The first impairment under the triad is social communication difficulties. The autistic person may find it difficult to express their emotions using words. As a young child, their main speech may be echolalia (repeated words/phrases without intent of communication), they may only understand things in a literal sense, and may speak very formally. Some impairments of communication include explaining things in greater detail than is needed and long replies to questions spoken as if learnt from a book (Gatewood, 2010).
	The second impairment is social understanding. This can cause issues with understanding nonverbal cues, such as body language or tone of voice. They might not recognize that bumping into someone could cause them to be angry, and so they fail to understand why that person would be upset. “Understanding their gestures, facial expressions, body language, and articulation are considered to be the main challenges” (Gatewood, 2010). They might not choose suitable topics to discuss, and find small talk difficult. The autistic person may take what people say very literally and have problems understanding double meanings in teasing, irony and sarcasm. Imagine taking the phrase “raining cats and dogs” literally.
	The last section under the triad is problems with flexibility of thought. This does not mean that they lack creativity, but rather have difficulty with putting themselves in another’s position. This is what is meant by a lack of empathy. “One of the characteristics of autism is the inability to play or create imaginative activities. A toy truck becomes a play thing only in as much as the spinning of the wheels provides stimulation” (Gillson, 1999). This flexibility of thought is also where routines come into play. Autistics all over the spectrum have trouble with routines being broken or changed without prior notice and warning.
	Sensory processing issues can occur frequently in those with high functioning autism or Asperger’s Syndrome.  “Some adults with Asperger’s Syndrome consider their sensory sensitivity has a greater impact on their daily lives than problems with making friends, managing emotions and finding appropriate employment” (Attwood, 2006). The most common sensitivity is sound, but all eight senses can be affected.  Most people only know of the initial five, but there are three other senses which are frequently affected as well. Those three senses are proprioception (senses the position, location, orientation and movement of the body), vestibular (balance), and interoception (the sense of internal body function). A person who is over responsive to sound will express extreme discomfort when a specific sound occurs, such as the squealing of brakes. “The first category is sudden, unexpected noises…The second category is high pitched, continuous sounds… The third category is confusing, complex or multiple sounds such as occur in shopping centers or noisy social gatherings” (Attwood, 2006).  It may be difficult to empathize with these people because these sounds are not as intense in the typical person, and often are not as unpleasant. Temple Grandin, an autistic woman famous for her biographical movie “Temple Grandin”, developed a “hug machine” used to calm over responsive autistics.
	People with Asperger’s Syndrome and High Functioning Autism frequently have difficulty with executive functioning. Executive functioning controls the inhibitions (ability to think before you act) and makes it possible for a person to generalize, or apply knowledge gained in situation A to situation Z regardless of how different the two are. People whose executive functioning is impaired are not adept at responding to situations or tasks in an organized, efficient way (Romanowski, & L., 2005). When executive functioning issues are present, the autistic person may not know how or where to start when given a vague directional start. If told to do their homework, they may sit there with the homework in front of them but not know how to begin. They may need prompting to gather their necessary materials. Often they seem behind their peers in simple tasks such as beginning breakfast, or arriving at school/work with everything needed in their bag. Encouraging and reminding them can help build their skills gradually, as well as placing it all into a routine.
	With all the above in mind, it’s still a surprise to see how often people on the higher functioning scale tend to slip by undiagnosed, or mislabeled. That person who accidentally stands too close to you, but doesn’t back up, may not understand the nonverbal cues saying ‘Back up before I get angry’. The person who watches their feet as they walk may be over sensitive to the beams of light coming from the fluorescent bulbs above. When the person is concentrating on a ritual, such as a pattern of walking, it can also be helping to block out noisy background sounds that may otherwise send them into an overload. Next time someone averts their eyes when talking with you, give them the benefit of the doubt- maybe it’s too intense for them to keep the stare. The child who sits there staring at his homework may have executive functioning issues- not laziness. It is a spectrum for a reason- when you’ve met one autistic person; you’ve met one autistic person. Each person is different in how it affects them.