Autism is a spectrum, not a stereotype

Dr. Keith Roach M.D.

DEAR DR. ROACH: Are people with autism spectrum disorder normal functioning? I'm thinking of "Rain Man," and I don't know how to behave around a friend who has this diagnosis. -- R.S.

       ANSWER: Autism and related disorders are much more commonly diagnosed now compared with years ago, probably due mostly to better recognition of the condition -- and the movie "Rain Man" has had something to do with that. Although the portrayal of the autistic man in "Rain Man" accurately captured some typical features of autism, this was a Hollywood script and a skilled actor, not a person with autism. Very few people with autism have savant abilities, such as amazing memories or calculating abilities, for one.

       More importantly, people with autism are indeed on a spectrum. By definition, people with autism have deficits in language, difficulty with social interaction and restricted, repetitive patterns of behavior. A subtype exists with no language difficulties. This is often still called Asperger's syndrome, despite the new definition which does not specifically name it. As a consequence, people with autism spectrum disorder do not always follow typical social interactions. This can make people uncertain how to behave. Even people who have extensive experience with a family member with autism may feel at a loss when meeting a new person with autism whose "normal" behaviors are completely different. Likewise, the person with autism may struggle to meet societal expectations when interacting with a new person. You very likely have friends who are diagnosed (or could be so) as autistic who you weren't aware of, because some people with autism have learned to behave in the way that society expects.

       You will notice that cognitive and other abilities are not discussed in the definition, and people with autism may have below-normal, normal or above-normal intelligence, and may have other skills (particularly visual and special skills) that are remarkably adept.

       If I were to give you advice, I would say to remember that a person with autism is most importantly a person. If you try, you may find some areas of common interest that can allow a relationship to grow. It isn't always easy, and some people with autism struggle to make new friendships and even acquaintances. Nonetheless, respectful persistence, and recognizing that an autistic person's normal behaviors vary widely, may lead you to a rewarding relationship with your friend. Meet your friend where they are, and ask how you can be the best friend for them.

       DEAR DR. ROACH: I recently got my second shingles shot and the pharmacist asked if I had gotten my pneumonia shot. I think I did, but I honestly can't remember. I'm 66 and diabetic. As such, I'm at a higher risk for COVID. Would it hurt to get a shot a second time if I already had it? I also saw that there are two types of pneumonia shots. Will these help with the severity of COVID, if we happen to contract it? -- D.S.

       ANSWER: There are two types of pneumonia shot, called the PPSV23 (Pneumovax) and the PCV13 (Prevnar). Both of these provide protection against a specific type of bacterial pneumonia, caused by Streptococcus pneumoniae. If your doctor and pharmacy really can't find a record of you getting it, I would recommend both vaccines, given your age and diabetes. You should discuss this further with your doctor.

       Neither provides any protection against the lung infection from COVID-19, which is mainly caused by the body's overvigorous response to the viral infection.