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such as a tendency to focus on detail over the bigger picture. Therefore, this suggested to us that perhaps these individuals are experiencing similar levels of autistic difficulties and differences as other autistic people but they have greater ability to compensate for them. This is the compensation hypothesis of autism. In our initial study, we refer to these individuals as “high compensators”; somehow they are able to get by in social situations without relying on a theory of mind, at least in the way in which neurotypical individuals do. Further analysis gave us some insight into how this might be possible. These high compensators demonstrated greater intellectual ability, and greater ability to plan and regulate themselves (known as “executive function”), than other autistic people in the study. Perhaps then, these autistic people are able to intellectually work out social rules and so-called “acceptable” forms of social behaviour, enabling them to regularly pass as non-autistic in social situations. Further evidence that autistic people who compensate are nevertheless autistic, and often still require an autism diagnosis and support like other autistic people, comes from some qualitative research. We asked autistic adults to tell us in detail about the strategies they use to compensate for things they find difficult in social situations. We found that many autistic adults work really hard in social situations just to pass as neurotypical, with the experience of socialising often feeling like learning a foreign language or doing complicated mental arithmetic. For example, one person said, “we have a hell of a lot of difficulties and just because we hide them doesn’t mean they don’t exist”. This again suggests that, although it might not always be obvious to other people, neurotypically-presenting autistic people are still inherently autistic, experiencing both difficulties and strengths associated with the condition. “Appropriate” behaviour We also found that there is an array of different strategies autistic people use. These include learning when and how long to make “appropriate” eye contact and modelling neurotypical people’s gestures and facial expressions, as well as using sophisticated internal calculations to work out other people’s thoughts and feelings (for example, facial expression A + gesture B + context C = thinking D). Finally, we found there are both positive and negative consequences associated with heavy use of compensatory strategies. On the one hand, strategies that enable individuals to at least “appear” less autistic on the surface may help them to gain employment and relationships and live independently. On the other hand, compensatory strategies often come at a high cost to the individual, causing high levels of stress, depression and even suicidal ideation. Such individuals are also less likely to receive appropriate support and a timely diagnosis, as their difficulties are often overlooked by doctors and other professionals. One person who received their autism diagnosis in mid-adulthood said, “adults with undiagnosed autism consider suicide, because every day is like a scheduled and definite torture session. Even on a good day, my face and mind is exhausted from the performance that I have to put on”. This is also poignantly reflected in Duncan’s story (below). It is clear that he has reaped both the benefits and significant personal costs from using compensatory strategies throughout his life. Therefore, compensation – which enables you to appear more neurotypical than you truly are – may represent some kind of double-edged sword; as one person put it, “we exist in a harmful no man’s land between disability and normal functioning… we have enough skills to at least do something, but we always skip along that fine line, where at any time we could be rejected, hated or attacked for being different”. Many autistic adults work really hard in social situations just to pass as neurotypical About the author Dr Lucy Anne Livingston is a Lecturer in Psychology at Cardiff University and a Visiting Researcher at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. cardiff.ac.uk/people/ view/1749875- @Lucy_Livingston ■ ...other autistic people have a greater ability to compensate. 27 senmagazine.co.uk SEN 106 Autism