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An Interest Based Account (Monotropism theory) explanation of anxiety in Autism & a Demand Avoidance Phenomenon discussion.

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Abstract

Participatory Autism Research Collective (PARC) held an external stream to the Scottish Autism conference recently held in Glasgow on the 08/11/2018 and 09/11/2018. As part of that stream, the entirety of the 09/11/2018 morning was on an Interest Based Account on Autism, more commonly known as Monotropism. I was invited to do a talk on how this theory explains anxiety in autism due, refining the theory to explain Demand Avoidance Phenomenon (Pathological Demand Avoidance). Each speaker was asked to provide a 15 minute talk and then allow a 15 minute discussion including with the speaker doing a plenary. As previous speakers had described an Interest Based Account of Autism (Dinah Murray) and Flow States (Damian Milton), I did not need to go into much depth on the theoretical background. However, I have expanded the original slides, providing more in depth discussion points and explaining the underlying theory to allow anyone to access the slides. I have recorded an audio file for the first 26 slides only, as the remaining slides are for further discussion, my contact details and a bibliography. I would welcome feedback on the material covered. You will probably need to download the file to listen to each of the audio files. I hope you enjoy the talk.
Richard Woods.
09th of November 2018.
Monotropism: Autism, Anxiety & DAP. 1
An Interest
Based Account (Monotropism theory)
explanation of anxiety in Autism & a
Demand Avoidance Phenomenon
discussion.
Monotropism: Autism, Anxiety & DAP. 2
My Bias.
- This presentation meets its proposed profile,
but that does not mean much.
- Demand Avoidance Phenomenon (DAP); will be
explained more later.
- Sceptical that DAP is an ASD subtype or a
syndrome. Significantly more compelling
research; primarily biomarker evidence.
PERSPECTIVE.
Monotropism: Autism, Anxiety & DAP. 3
Introduction.
- Originally planned to synthesise Monotropism
with Global Instability to explain DAP (Beardon
2012; Beardon 2017).
- After reflection, Monotropism explains Global
Instability.
IN THE BEGINNING.
Monotropism: Autism, Anxiety & DAP. 4
Introduction.
- Advancing Dinah Murray’s latest work (2018).
- Explore how Monotropism explains anxiety in
autism.
-Avoiding the demand of DAP’s main discourse.
- Discussion topics.
IN THE BEGINNING.
Monotropism: Autism, Anxiety & DAP. 5
Monotropism 101.
- Attention is a scarce resource, there is
competition for its use by myriad interests.
- An interest is anything that gains your
attention; from sensory stimuli, thoughts to
emotions.
- Each person can only process a certain amount
of attention resource at any moment.
- Continuum of perceiving attention; One end is
Monotropism and the other Polytropism.
- Autistic persons tend to be monotropic.
- Non-autistic persons tend to be polytropic.
AN INTEREST BASED ACOUNT.
Monotropism: Autism, Anxiety & DAP. 6
Monotropism 101.
- Attention tunnels are made from attention
resource.
- Monotropism is with a single attention tunnel
when entire attention resource is used.
- Polytropism is with many attention tunnels that
have similarly distributed attention resources.
AN INTEREST BASED ACOUNT.
Monotropism: Autism, Anxiety & DAP. 7
Single attention tunnel leads to:
- Interests are processed sequentially in order of
importance.
- Experiencing intense sensations.
- Binaric black and white thinking.
- External information being occluded from
awareness.
- Intensity of our thoughts leave stronger
impression on subconscious.
- More difficult to restart attention tunnels.
AN INTEREST BASED ACOUNT.
Monotropism: Autism, Anxiety & DAP. 8
An Interest Based Account Reading.
- For further reading see (Murray et al 2005):
-https://www.researchgate.net/publication/787
9954_Attention_monotropism_and_the_diagnos
tic_criteria_for_autism
-The Passionate Mind (Lawson 2011).
-Monotropism An Interest Based Account of
Autism (Murray 2018).
CONFLICTING INTERESTS.
Monotropism: Autism, Anxiety & DAP. 9
Flow States
- An optimal experience that is beneficial to our
wellbeing and happiness.
- Experienced when a person is deeply involved
in an activity and nothing else seems to matter.
- Flow states can happen in social interaction.
- Provide stability, e.g. an escape from anxiety.
- Such activities that engage with flow states can
become a compulsion and addictive.
- Additionally aversive to a chaotic life outside of
the person.
- (McDonnell & Milton 2014).
GOING WITH THE FLOW.
Monotropism: Autism, Anxiety & DAP. 10
Clumping Attention Resource.
- Where the flow of attention resource is halted
due to sticking together.
- Can form blockages to prevent attention
resource bringing certain information into
person’s awareness.
- (McDonnell & Milton 2014).
CLUMPING TOGETHER.
Monotropism: Autism, Anxiety & DAP. 11
Biolooping.
-How a person’s mental state affects their
physical state.
- Vice versa.
- A person thinking they are ill, can make
themselves ill.
- Again, vice versa.
- Yoga.
- (Hacking 1999).
IN THE LOOP.
Monotropism: Autism, Anxiety & DAP. 12
Developing Monotropism.
- N = Attention Resource (Murray 2018).
- A = Anxiety.
- F = Flow states. Duration and intensity of a
flow state.
- R = Stored N. Depleted by persons using N
DEVELOPMENTAL TRAJECTORY.
Monotropism: Autism, Anxiety & DAP. 13
Developing Monotropism.
-C = Capacity: N that is available for use after
automatic cognitive processing; forming the
perception based on sensory inputs and any
intrusive thoughts that consume R before it
can be used for day-to-day tasks (Murray et al
2005).
- Higher F = Higher N and Lower A.
- Higher F Higher C.
- Higher F Higher R.
DEVELOPMENTAL TRAJECTORY.
Monotropism: Autism, Anxiety & DAP. 14
Monotropism and anxiety.
- All humans (and animals) need stability.
- Points of interest can be stability points.
- Black/ white thinking style. Either have
certainty/ uncertainty on a subject.
- Obscure other thoughts that are linked to the
subject of interest; obscure & reduce anxiety.
- Therefore these flow states form fixed points
of stability for autistic persons.
AN ANXIOUS MOMENT.
Monotropism: Autism, Anxiety & DAP. 15
Monotropism and anxiety.
- Autistic persons engage with subjects that
interest them.
- Requires significant N to engage with
uninteresting matters.
- Explains autistic social communication issues.
- When a person has no N and an attention
tunnel is violently disrupted, an autistic person
can lose control; go into meltdown/ shutdown/
panic attacks.
- Autistic persons will tend to have higher
anxiety levels due to black and white thinking.
AN ANXIOUS MOMENT.
Monotropism: Autism, Anxiety & DAP. 16
Monotropism & Anxiety.
- Autistic persons being 1-2% of population and
not interested in non-autistic social norms;
they have different sources of stability.
- Polytropism easily engages in social
interactions; thus forming flow states from it.
- Non-autistic benefiting from lower anxiety and
increased R.
- Non-autistic stability also comes from
understanding non-autistic social interaction
and being able to rely on this consistently.
REMEMBER, JUST BREATHE.
Monotropism: Autism, Anxiety & DAP. 17
Flow state Example & Implications.
-Autistic person’s breakfast routine, allows
person to function for rest of the day.
- Autistic person is in a flow state from that
routine.
- Benefiting from reduced anxiety and increased
N. If it is a flow state present from the
routine, it would be a fixed point as explained
by Monotropism.
- Regular low levels of R and C over extended
time periods can lead to trauma and anxiety.
REMEMBER, JUST BREATHE.
Monotropism: Autism, Anxiety & DAP. 18
Polytropism & Anxiety.
- Non-autistic persons can experience
inconsistent social interaction.
-Some staff also find it anxiety provoking to
spend extended periods of time with another
person who is anxious and has mood swings.
This group of pupils can be very intense to
work with, which is tiring” (Fidler and Christie
2019, p. 140).
- Anxiety here can also be explained by masking
(Goffman 1963).
REMEMBER, JUST BREATHE.
Monotropism: Autism, Anxiety & DAP. 19
Wider Discussion Points.
- How does anxiety interact with tunnels
formation?
- How does anxiety interact with tunnels
maintenance?
- How does anxiety affect N depletion?
- How does anxiety affect N generation?
- What happens if the interest causes anxiety,
particularly in relation to C?
STOP, HAMMER TIME.
Monotropism: Autism, Anxiety & DAP. 20
Autism + DAP Traits criteria.
- Continues to resist and avoid ordinary demands
of life.
- Demand avoidance can use social strategies.
- Surface sociability, but apparent lack of sense
of social identity, pride, or shame.
- Liability of mood & impulsive.
- Obsessive behaviour, often focused on other
people.
- Comfortable in role play and pretending (Green
et al 2018a; Newson et al 2003).
TIME TO PROFILE YOU.
Monotropism: Autism, Anxiety & DAP. 21
What Could DAP be?
Professionals and teams working with children
need to become aware of the ways in which girls
can mask their difficulties, and need to move
away from using the DSM as a “bible”. Stating
that someone does not fulfil criteria, when these
criteria are based on upon a “male” presentation
of a disorder, is short sighted in the extreme
(Eaton 2018, p176).
Such things can be said of using the DAP profile…
ASSUMPTIONS?
Monotropism: Autism, Anxiety & DAP. 22
What Could DAP be?
ONLY FOOLS AND HORSES?
Medical Ontology. %
Autism. N/A.
Autism subtype/ PDD. N/A.
Autistic Trauma. N/A.
Female Form of Autism. N/A.
Form of Attachment Disorder. N/A.
Form of Catatonia. 12 to 18
Form of Personality Disorder. N/A.
Heterogeneous Spectrum Condition. N/A.
Monotropism: Autism, Anxiety & DAP. 23
What Could DAP be?
ONLY FOOLS AND HORSES?
Medical Ontology. %
Symptoms of ASD & ADHD. 28 to 44
Symptoms of ASD & Anxiety. 42 to 56
Symptoms of ASD & Anxiety Disorders.
About 40
(children)
Symptoms of ASD & Conduct Disorder.
3.2
(children)
Symptoms of ASD & Depression. 12 to 70
Symptoms of ASD & ODD. 16 to 28
Symptoms of ASD & Schizophrenia. 0 to 6
References are at the end.
Monotropism: Autism, Anxiety & DAP. 24
A suitable name is?
- As DAP could be any of these & some DAP
traits are hard to identify reliably (Garralda
2003).
-Dr Gould pointed out that features of PDA
can be found in children and young people
across the autism spectrum” (Christie et al
2012, p 187).
- DAP has no specificity (no trait or behaviour is
unique to it).
ONLY FOOLS AND HORSES?
Monotropism: Autism, Anxiety & DAP. 25
A suitable name is?
- For other factors see: Green et al (2018a);
Green et al (2018b); Milton (2017); Woods
(2017); Woods (2018a); Woods (2018b).
- It is extreme and unethical to favour any one
of these ontologies over another; Demand
Avoidance Phenomenon.
ONLY FOOLS AND HORSES?
Monotropism: Autism, Anxiety & DAP. 26
Options for discussion.
1) DAP criteria.
2) Steph’s Two Girls quote.
3) Judy Eaton observation.
4) Fidler and Christie matching the dials concept.
LET’S ROLE PLAY.
Monotropism: Autism, Anxiety & DAP. 27
Autism + DAP Traits criteria.
- Continues to resist and avoid ordinary demands
of life.
- Demand avoidance can use social strategies.
- Surface sociability, but apparent lack of sense
of social identity, pride, or shame.
- Liability of mood & impulsive.
- Obsessive behaviour, often focused on other
people.
- Comfortable in role play and pretending (Green
et al 2018a).
READY PLAYER ONE?
Monotropism: Autism, Anxiety & DAP. 28
Steph’s Two Girls Example.
For years now, Sasha has controlled the music in
the car, and we have one CD on repeat for weeks
or months at a time. From any one CD, there is
usually only a handful of songs at most which can
be selected; I think I've become immune to the
repetition but am sure others would find it
unbearable if they joined us regularly on our
journey. It's become apparent in the last few
days that Sasha now needs to listen to certain
songs at a certain time in the journey(Curtis
2018).
TAKES TWO TO TANGO.
Monotropism: Autism, Anxiety & DAP. 29
Judy Eaton’s Controlling Food Intake.
- Often go into meltdowns etc. when pushed to
follow anothers direction.
- These persons are externalisers.
- Punished for displaying clear emotions/ making
mistakes.
- Internalise their anger & frustration.
- Thus to prevent further social isolation, person
control their food intake (behaviour) instead of
other persons to manage their anxiety.
- (Eaton 2018, pp. 146-147).
THREE’S A CROWD.
Monotropism: Autism, Anxiety & DAP. 30
Fidler & Christie, Matching The Dials.
- Person has a threshold capacity to demands,
determined by their anxiety levels.
- There are 2 dials.
-First for a person’s tolerances to demands.
-Second for person’s levels of experienced
demands.
- If first dial is high, demand and expectations
can be raised.
- If first dial is low, demand and expectations
should be lowered.
- Synchronise dials as much as possible.
- (Fidler and Christie 2019, pp. 26-27).
THE FOUR CASE.
Monotropism: Autism, Anxiety & DAP. 31
The End Game.
- Contact Details:
richardwoodsautism@gmail.com
- Twitter handle:
- @Richard_Autism
- My blog, Rational Demand Avoidance:
https://rationaldemandavoidance.com/
- Any questions?
ANY QUESTIONS.
Monotropism: Autism, Anxiety & DAP. 32
Bibliography.
- Beardon, L. (2012). Coping Strategies (University Website). Retrieved from:
https://www.shu.ac.uk/~/media/home/about-us/academic.../coping-
strategies.doc? (Cached, access via a Google search) (Accessed 08 November 2018).
- Beardon, L. (2017). Autism and Asperger Syndrome in Adults. London: Sheldon
Press.
- Belardinelli, C., Raza, M., & Taneli, T. (2016). Comorbid Behavioral Problems and
Psychiatric Disorders in Autism Spectrum Disorders. Journal of Childhood &
Developmental Disorders, 2(11), 1-9.
- Chaplin, E. (2017). Mental Health and Autism. In Milton, D, and Martin, N. (Eds.),
Autism and Intellectual Disability in Adults, Volume 2 (pp. 63-67). Hove, UK:
Pavilion Publishing and Media Limited.
- Christie, P. (2007). The distinctive clinical and educational needs of children with
pathological demand avoidance syndrome: guidelines for good practice. Good
Autism Practice, 8(1), 311.
- Christie, P., Duncan, M., Fidler, R. & Healey, Z. (2012). Understanding Pathological
Demand Avoidance Syndrome in Children: A Guide for Parents, Teachers and Other
Professionals. London: Jessica Kingsley Publishers.
- Curtis, S. (2018). Autism with acute anxiety or Pathological Demand Avoidance?
(Online Blog). Retrieved from: https://www.stephstwogirls.co.uk/2018/10/autism-
with-acute-anxiety-or.html (Accessed 08 November 2018).
NOT THE ONE BIBLE.
Monotropism: Autism, Anxiety & DAP. 33
Bibliography.
- Eaton, J. (2018). A guide to mental health issues in girls and young women on the
autism spectrum: diagnosis, intervention and family support. London: Jessica
Kingsley Publishers.
- Fidler, R and Christie, P. (2019). Collaborative Approaches to Learning for Pupils
with PDA: Strategies for Education Professionals. London: Jessica Kingsley
Publishers.
- Francisca J., Van Steensel, A., & Heeman, E. (2017). Anxiety Levels in Children with
Autism Spectrum Disorder: A Meta-Analysis. Journal of Child and Family Studies,
26(7), 17531767.
- Garralda, E. (2003). Pathological demand avoidance syndrome or psychiatric
disorder? Archives of Disease in Childhood (online only article). Retrieved from:
https://adc.bmj.com/content/88/7/595.responses (Accessed 11 November 2018).
- Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. London:
Penguin Books.
- Gould, J, and Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and
women on the autism spectrum. Good Autism Practice, 12(1), 34-41.
- Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., Le Couteur, A., &
Baird, G. (2018a). Pathological Demand Avoidance: symptoms but not a syndrome.
Lancet Child & Adolescent Health, 2(6), 455464.
NOT THE SECOND BIBLE.
Monotropism: Autism, Anxiety & DAP. 34
Bibliography.
- Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., Le Couteur, A., &
Baird, G. (2018b). Demand avoidance is not necessarily defiance: Authors’ reply.
Lancet Child & Adolescent Health, 2 (9), e21.
- Hacking, I. (1999). The Social Construction of What? London: Harvard University
Press.
- Kaushik, A. (2015). Extreme Demand Avoidance: towards a dimensional approach in
children presenting with complex neurodevelopmental disorders and avoidance of
demands (Conference Paper). Retrieved from:
https://www.rcpsych.ac.uk/pdf/Child%20%20Adolescent%20Psychiatry%202015%20-
%20Conference%20Booklet%20v1.pdf (Accessed 07 November 2018).
- Lai, M., Lombardo, M., & Baron-Cohen, S. (2014). Autism. The Lancet, 2014(383),
896910.
- Lawson, W. (2011). The Passionate Mind: How People with Autism Learn. London:
Jessica Kingsley Publishers.
-McDonnell, A, and Milton, D. (2014). Going with the flow: Reconsidering ‘repetitive
behaviour’ through the concept of ‘flow states’. Good Autism Practice, Supplement
(2014), 37-46.
NOT THE THIRD BIBLE.
Monotropism: Autism, Anxiety & DAP. 35
Bibliography.
- Milton, D. (2012a). So what exactly is autism?
http://www.aettraininghubs.org.uk/wp-content/uploads/2012/08/1_So-what-
exactly-is-autism.pdf (Online resource). Retrieved from: (Accessed 08 November
2018).
-Milton, D. (2012b). On the ontological status of autism: the ‘double empathy
problem’. Disability & Society, 27(6),883-887,
-Milton, D. (2017). “Natures answer to over-conformity”: deconstructing Pathological
Demand Avoidance. In Milton, D. (Ed.), A Mismatch of Salience: Explorations of the
nature of autism from theory to practice (pp 27-38). Hove, UK: Pavilion Publishing
and Media Limited.
- Milton, D. (2018). Pathological Demand Avoidance (PDA) and alternative
explanations: a critical overview (Conference Paper). Retrieved from:
https://kar.kent.ac.uk/67064/1/PDA%20and%20alternative%20explanations.pdf
(Accessed 07 November 2018).
- Milton, D., Heasman, B., & Sheppard, E. (2018). Double Empathy. In Volkmar, F.
(Ed.), Encyclopedia of Autism Spectrum Disorders. New York: Springer Nature.
- Murray, D. (2018). Monotropism An Interest Based Account of Autism. In Volkmar, F.
(Ed.), Encyclopedia of Autism Spectrum Disorders. New York: Springer Nature.
- Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the
diagnostic criteria for autism. Autism, 9(2), 139156.
NOT THE FOURTH BIBLE.
Monotropism: Autism, Anxiety & DAP. 36
Bibliography.
- Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance
syndrome: a necessary distinction within the pervasive developmental disorders.
Archives of Disease in Childhood, 88(7), 595600.
- Woods, R. (2017). Pathological demand avoidance: my thoughts on looping effects
and commodification of autism. Disability & Society, 34(5), 753758.
- Woods, R. (2018a). Critical Reflections on the Pathological Demand Avoidance
debate: A response to The Practice MK blog and discussion. (Online blog). Retrieved
from: https://rationaldemandavoidance.com/2018/05/15/critical-reflections-on-
the-pathological-demand-avoidance-debate-a-response-to-the-practice-mk-blog-
and-discussion/ (Accessed 08 November 2018).
- Woods, R. (2018b). Rational (Pathological) Demand Avoidance: what it is not, what
it could be & what it does (Conference Paper). Retrieved from:
https://www.researchgate.net/publication/325181432_Demand_Avoidance_what_it
_is_not_what_it_could_be_what_it_does (Accessed 07 November 2018).
- Woods, R. (2019). Pathological Demand Avoidance (PDA). In Volkmar, F. (Ed.),
Encyclopedia of Autism Spectrum Disorders. New York: Springer Nature.
THE END TIMES.
... DAP is a behaviourist approach to autism (Milton, 2017 It is acknowledged DAP can be explained by an Interest Based Account of autism -monotropism theory (Eaton, 2018). Nevertheless, the theory views demand avoidance as inherently rational (Woods, 2018b). Also, DAP behaviours can largely be explained as a result of stigma (Woods, 2018a). ...
... has been adapted fromWoods (2018b), with the addition of dyslexia and dyspraxia from the National Autistic Society webpage on DAP (National Autistic Society 2018). Jonathan Green and colleagues note that DAP behaviours can be explained by an unrecognised learning impairment (2018b). ...
Article
Full-text available
This article explores key reasons for justifying the proto impairment of Demand Avoidance Phenomena (DAP), by investigating the integrity and validity of the construct. DAP is aggressively pushed by non-autistic stakeholders as an autism subtype, to date the circularity around DAP’s construction and operation has received little attention. We deconstruct evidence for DAP and contextualise the DAP profile in wider discourses, specifically of medical, ethics and working practices with autistic persons. Crucially, we demonstrate there is no cognitive or behavioural trait specific to DAP. Finally, we present the results of citation survey that indicate the DAP community has formed a community of practice and we discuss the implications this has on the language around the construct. The circular approach to the construct undermines efforts to research it, while providing a misleading picture of current evidence levels and wider debates. We propose that going forward the scientific method and embracing its’ conflicting nature, is the ethical manner to approach DAP.
Conference Paper
Full-text available
This talk is adapted version of this talk: "An Updated Interest Based Account (Monotropism theory) & a Demand Avoidance Phenomenon discussion." Available at the link below: https://www.researchgate.net/publication/332727790_An_Updated_Interest_Based_Account_Monotropism_theory_a_Demand_Avoidance_Phenomenon_discussion I expanded the monotropism section to include a focus on how Trauma, Social, emotional and mental health issues can explain PDA. The talk also provides an update of my current activities. This monotropism talk, details how the theory explains anxiety in autism. Also provides a developmental model that explains PDA in autistic persons. I have left out the slides containing scientific issues with PDA, please see the link above for that information.
ResearchGate has not been able to resolve any references for this publication.