Mental Health Across Borders:  How Autism is Treated and (Mis)Understood in Scotland and the U.S.
Autism has been highlighted in the general discourse of mental health in recent years. The increase in those diagnosed with Autism Spectrum Disorder has caused confusion as to what constitutes autism, and what may cause it. The most widely used guide for professionals to reference for diagnostic criteria is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The American Psychiatric Association, serves most helpful in providing the manual as a guide for mental health practitioners in diagnosing and treating mental health conditions. Updates to the manual, coincide with our world’s inevitable growth. As our culture changes and evolves, so do the mental disorders that permeate within our society. According to the DSM-5, the diagnostic criteria for autism includes: 
  1.   Persistent deficits in social communication and social interaction across multiple contexts, as manifested by deficits in social/emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction, deficits in developing, maintaining, and understanding relationships (professionals are then asked to rate severity according to a new severity scale)
  2. Restricted, repetitive patterns of behavior, interests or activities, as manifested by at least two of the following: 
    1. Stereotyped or repetitive motor movements, use of objects, or speech 
    2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior
    3. Highly restricted fixated interests that are abnormal in intensity or focus
    4. Hyper or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (pain/temperature/specific sounds/textures/lights movement,)
  3. Symptoms must be present in the early developmental period
  4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  5. Disturbances are not better explained by intellectual disability or global developmental delay.









Symptoms of Autism present in America & Scotland
The newest version of the DSM has put previously acknowledged related-disorders like Aspergers Syndrome under the umbrella of autism spectrum disorder. Autism is becoming more incorporated into mainstream media with shows like Atypical, documentaries like Louis Theroux: Extreme Love – Autism and movies like Rainman. Symptom presentation cross-culturally, might manifest as behavior that indicates being visibly overwhelmed in response to a loud noise. This can be a siren, or perhaps even a loud instrumental noise used in a concert. This may result in the individual showing overt displays of distress, curling up in a ball, or trying to block out the sound however they can. Symptom presentation in America may look like a highschool student being ostracized for “strange behavior” or having a very particular sense of humor that other adolescents avoid because they don’t understand it.  Symptom presentation in Scotland may not look all that different, but another example might look like the inability to maintain eye contact, or even the struggle to create and maintain relationships with peers due to a lack of understanding basic social ‘rules’. 
Treatment in America and Treatment in Scotland
It may come as no surprise that treatment in America comes down to what one can afford based on private health insurance. The main difference between treatment in the two countries, is how treatment is acquired. Both countries have similar issues in terms of accessibility to treating, despite the systems being privately owned and publicly owned respectively. Cognitive Behavior Therapy (CBT), is a therapy often used to remediate symptoms of Autism Spectrum Disorder. CBT, provides mutual benefit for both the individual with Autism, and those close to the individual who offer support. In doing so, the therapy provides a guide of in and out of office techniques in navigating the autistic behavior or outbursts in a way that is both effective for the autistic individual and those affected in a secondary way.  One tactic that many Cognitive Behavior Therapists use is exposure therapy to help the person with autism deal with the anxiety and extreme sensitivity that accompanies symptoms of the disorder.
Scotland point of view (I’m outlining mental health services here first and need to do a bit of research on what’s different in Scotland and America in symptoms, as so far I don’t believe there is any difference) I also am not skilled at all in writing, so I apologise for the lack of eloquence in my bit 
  • in Scotland the majority of the population uses the NHS (National Health services) although there are lots of arguments that we should be getting rid of it 
  • The waiting times for assistance with anything in the NHS is unbelievably long, at the end of the day all the services are free (doctors appointments, surgeries, hospital rooms, etc) but the argument is is this worth it if you’re waiting for months for any assistance 
  • For better waiting times, you’d need to go private (privately funded doctors, therapists, etc.) however for most this is too expensive 
The mental health services provided to those who have been diagnosed with Autism, or are seeking professional opinion on whether or not they have autism, would first and foremost be through the NHS. The NHS is funded by taxes, and arguably needs reforming. While the NHS would be able to provide support and guidance for those seeking diagnosis or have been diagnosed, the reality is that they would have to wait months for these services. Similar to that in America, CBT would be available to those with autism, however as previously stated the waiting time is unimaginable, prompting the search for other alternatives.  While most residents in the UK, and Scotland, do use the NHS as it is free, there are also those who choose to go what is referred to as simply ‘private’. This would mean, they would pay for the same or similar services that are provided through the NHS, but with little or no waiting time, and more focus on the individual. For example, a company called CASPA requires a weekly fee for autistic children to use, but provides multiple services to better the quality of life for kids with autism, and to provide socialising with others who have a better understanding of the struggles of living with autism as a child. 
Examples of Impairment in American/ Scottish Media 
We could argue that tv shows like the good doctor and atypical being made available in both scottish and american media could result in similar outlooks in both countries 
  1. Portrayals of autism in media do not portray the full spectrum. Most media portrayals depict a person with Autism as socially awkward but exceptionally smart. This is showcased in shows such as “Atypical” and “The Good Doctor”. It is shown that persons with Autism living relatively “normal” lives were they have a friend group, have a girlfriend/boyfriend, have a job, and go to a normal highschool. What isn’t shown on television is the people who struggle to find/hold a job and the specific schools built for persons with Autism. 
  1. Despite these tv shows being american made, evidence being that none of them have scottish accents only american, their viewers are worldwide. This doesn’t limit the positive portrayal of Autism to just the U.S. but also scotland 
  1. Although Sheldon Cooper in “The Big Bang Theory” claims he is not autistic, many viewers have placed him on the spectrum given multiple tendencies he displays throughout the show. Like other depictions of individuals with autism, Sheldon is a beloved character by others in the show and audience members alike. 





Impairment of Autism in American Modern Society
When analyzing the impairments that autism carries in our modern day society, it is important to also consider the challenges that these individuals face in all aspects of their everyday lives. For those who struggle with the disorder, the challenges that they experience are carried with them from early years of school, into their adulthood and preliminary careers. Individuals with autism generally show symptoms of initial autisitc behavior, “by 12 months to 18 month of age or earlier.” The challenges that children and adults struggling with autism, may encounter through their development may include:
  1. Obstacles in a school setting. Most recently, individuals with autism have been placed in a mainstream class setting. As the disorder can show disruptive behavior and inability to understand social norms, the lack of proper knowledge of the disorder by an educator could prove to be detrimental to the development of the autistic individual and others within the schooling environment. In one study, several teachers were interviewed based on their experience while including children with autism in their classrooms. Many reported, “several challenges including: understanding and managing behaviour; socio-structural barriers (i.e., school policy, lack of training and resources); and creating an inclusive environment (i.e., lack of understanding from other teachers, students and parents). Teachers recommend that more resources, training and support are needed to enhance the education and inclusion of children with ASD.” 
  2. Social barriers and lack of organizational resources in a formal job setting for autistic individuals in a formal job setting. The challenges that are experienced early on for one with autism are likely to similarly plague their adulthood. The obstacles exhibited are not only experienced by the autistic individual but the job setting and other employees. “Individuals in autism-specific employment named formality problems–problems with organizational and practical process-related aspects of the job entry–most frequently while individuals in non-autism-specific employment mentioned social problems–obstacles concerning communication and human interaction–most. In terms of solutions, both groups used their own resources as much as external help, but differed in their specific strategies.” In this setting, the issues appear to lie heavenly on the individual themselves whereas before, in a school setting, the implications of integrating individual with autism were mostly experienced by the educators. 
Overall, the common issues experienced by those who suffer from autism in today’s society, appear consistent in institutional and organizational settings. The environments most crucial to most individuals social and cognitive development, do not show the support that is decisive in supporting those who suffer from mental disorders. 

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