When Does a Difference Become a Disorder?

By Inés Lawlor, author of Max and Me, a story about sensory processing.

Some time ago, I came across a YouTube clip of Dr Temple Grandin speaking at a conference about brain function and personality traits common in Autism. In this clip, Grandin asked the question “When does a difference become a disorder?” Grandin, T (2014) “The Autistic Brain: Thinking Across the Spectrum” [Video file].

Retrieved from https://www.youtube.com/watch?v=IA4tE3_2qmI

It surprised me to realise that I had never given this perspective much thought. As an Occupational Therapist working with children in various healthcare and school settings, I accepted that there were criteria for particular disorders and if the child met the criteria then the appropriate diagnosis was given. I heard the term ‘disorder’ used frequently; Autism Spectrum Disorder, Sensory Processing Disorder, Attention Deficit Hyperactivity Disorder and didn’t really consider what it implied or the impact it might have on the child receiving such a diagnosis.

The term ‘disorder’ implies ‘deficit’. It suggests that there is a ‘minimum standard’ (of a particular skill or behaviour) that the child can’t achieve. In fact most standardised tests used to assess children’s functioning are based on ‘norms’ for the average population, and so reflect this perspective too.

However, it is a perspective. It has been my experience, with all the children I’ve worked with and in particular those who are sensitive to sensation, that they often have skills in other areas not covered or highlighted by standardised tests. For example, when considering visual memory many children with Autism would score very well, thus neurotypical children may be considered to have a ‘disorder’ from this perspective.

Depending on the environment and the demands of the activity, some ‘deficits’ could be considered ‘advantages’. An obsession may become an area of expertise – an example of this is Temple Grandin herself, where she can visualise environments for cattle before they are constructed, thus becoming the leading expert in her field. Albert Einstein was also thought to have Autism. I imagine Mozart probably needed extremely sensitive auditory skills to compose his music too!

In an ideal world, children and adults could choose the most suitable environment and routine to match their sensory preferences and skills. The term ‘disorder’ then may not be necessary and perhaps we could talk about ‘diversity’ instead.

The vision I had for my book ‘Max and Me – a story about sensory processing’ was to begin to introduce the idea of sensory diversity in all children. Through educating children about their sensory system and using the modulator analogy in the book each child could talk about their own ‘modulator’ making it a neutral subject, such as whether a child is left or right handed or has green or blue eyes. In this way there is no ‘normal’ hence there is no ‘disorder’, just differences and diversity instead!

For more information on Max and Me – a story about sensory processing Click here