The term Autistic Spectrum Disorder (ASD) is used to describe a range of behaviours which are identified by observation of a child, young person or adult. Common difficulties in social behaviour are observed particularly in the following areas: communication, social interaction and imagination. These are commonly referred to as the Triad of Impairments.
The term Autism, High-Functioning Autism (HFA), Asperger Syndrome (AS) and Pervasive Developmental Disorder not otherwise specified (PDD-NOS) are all terms that come under the umbrella of Autistic Spectrum Disorders (ASD). For most children suspected of having an ASD the diagnostic team assessing the child can make a clear diagnosis. However there are a few children where diagnosis can be difficult as they may exhibit some difficulties in some areas but be competent in others and so a clear diagnosis is not always possible in the first instance and they may be monitored over time before a final decision is taken.
The Autistic Spectrum encompasses a wide range of intellectual ability with no two children being the same. Some children who are profoundly affected are described as low functioning and display significant difficulties in all areas of the triad and often have additional learning difficulties; other children are very able and are only mildly affected in some of the areas of the triad and are often described as high functioning.
Autism is described as a lifelong developmental disorder that affects a person’s ability to communicate in a social context. Research continues to determine the exact nature of the causes and specific area of the brain affected. It is likely that no single cause will be identified. It is recognised that the core difficulties experienced by the person with autism is qualitative impairment in social communication, social interaction and social imagination and behaviour
With very young children identifying specific behaviours that may be attributable to autism can be very difficult. It is thought that observed difficulties with social interaction and play and the lack of verbal communication may be reliable indicators in the very young child.
There is no common pathway for all children with ASD many have difficulties with one or more aspects of each of the three areas in the Triad at a given time and will develop new aspects within the impairment and move away from others over a period of time. Not everyone will have the same difficulties to the same effect. For some children there is movement within the spectrum – developmental stage, intervention, environment, personality all play a part. Some children initially diagnosed as Autistic may move within the spectrum and as they mature and develop the description of Asperger Syndrome may be considered.
The difficulties described in the Triad of impairments can show themselves in many different ways in the young person. The young person may not understand that language has a purpose and so does not understand the need to communicate or have any desire to communicate with those around him. The development of language skills varies greatly amongst those with ASD. For many there is delay in language development, with some children never developing functional language. Other children appear to develop good language skills but may have difficulties using their language in a social context. It is recognised that if the child is going to develop functional language then it should be evident by the time the child reaches five years of age.
People with autism usually have difficulties with non-verbal aspects of communication – facial expression, body language and tone of voice. They have great difficulty interpreting and understanding these non-verbal clues to communication which typically developing people do instinctively. They often miss-read the signals and make mistakes by taking what is said to them literally. This can often cause confusion and even distress. They may not understand sarcasm or idioms. The person with autism also has difficulties using non-verbal aspects of communication when communicating with others. Some children with autism may have an expressionless face, be unable to express excitement or sadness or may speak in a monotone with no expression in their voice.
People with autism often develop echolalia, where the person repeats back phrases or chunks of spoken language they have previously heard, sometimes using the same accent or tone of the original speaker. The echolalia may be an instant response or it may be delayed. Echolalia may be transient and be apparent for a few months or it can continue for many years.
Children can make up there own words for things or use words to mean other things. ‘Texta’ could mean pencil; ‘Fallen sun’ could mean a fried egg; ‘Coat’ could mean I want to go for a walk. These words or phrases may stay with them for life.
Social interaction for the person with autism is difficult. The interaction style of many people with autism is often described in one of the following ways.
The person who opts out of any social interaction and withdraws into his or her ‘own world’ preferring to be on their own is sometimes described as being aloof. Others who appear to be happy to be with other people but who make no attempt to interact with them are described as passive, while others who actively seek out other people but do so in an awkward way may be described as active but odd in their attempts at interaction.
For many children with autism the world they live in is an unpredictable and frightening place. They may have difficulty understanding other people. Many do not know that other people do not share their thoughts. They don’t realise that others around them have different thoughts from them and so for the child with autism others are seen as unpredictable when they don’t do what the person with autism is thinking of doing. The person with autism copes best with predictability, structure and routine and will often develop routines or repetitive actions to relieve stress and impose order on an otherwise chaotic world. And so children with autism often have restricted interests; they may ‘play’ with the same toy over and over following the same play patterns or they may not use toys functionally. Other children may find it difficult to play with the child with autism as they may resist interference in their ‘play’ by the other children. They may have specific or unusual interests; Thomas the Tank, telephone directories, washing machines, road signs which can for some become self absorbing.
Some young people with autism may switch lights on and off, line up their cars in a particular order, touch objects in a set order when they enter a room, sit at the same place at the dinner table, have to be first down the stairs in the morning, or some may flap their hands, bounce up and down or twirl objects. By creating order within the chaos they perceive is around them, they relieve the anxiety and stress they feel. If anxiety or stress cannot be managed then outbursts of temper and aggression can often result. Some parents describe how difficult things can be at home as their child finds difficulty coping with changes in routine or family events. Birthdays, Christmas and holidays can be particularly difficult for some families.
Some children with autism have sensory difficulties. They may be over or under sensitive to one or more sensory stimulus e.g. noise, smell, vision, pain, and temperature. If the child is under sensitive to pain there are implications for illness and injury and parents need to be aware of this. For those children who are over sensitive to different stimulus the following difficulties may arise.
- A restrictive diet due to their inability to cope with some textures of food.
- An inability to tolerate different sounds e.g. washing machine, hair dryer, fluorescent lights, hoover, kettle etc.
- A preference for certain clothes can result from discomfort to certain materials.
- Find gentle touch like cuddles unbearable but will enjoy rough and tumble activities.
Some children use their senses in unusual ways by smelling or licking objects presented to them.
Like Autism, Asperger Syndrome is viewed as a lifelong developmental disorder.
AS describes people who are of average or above average intelligence and who share underlying deficits in social interaction and communication. These deficits are expressed by those with AS in a different way from those with autism. Children with AS, although they may be socially isolated, do show a desire to engage with others. However as they do not understand the social skills required for social interaction this is a difficult area for them and often they are unsuccessful in trying to engage with others. People with AS usually develop a good range of vocabulary and have correct sentence structure, they are often described as being able to talk before they can walk. However this apparent ability often masks the true difficulties they have with the communicative aspects of their language development, how they use their language to engage others in social interaction. This has repercussions for their social development and difficulties can sometimes arise for children with AS at school. A social skills programme may be helpful to enable the young person with AS to participate in the usual playground games and activities.
Children with AS are often seen as clumsy, having varying degrees of difficulty with motor control. They may have difficulties with fine motor and or gross motor skills. Some children with AS shy away from writing in the early stages because they know they cannot make their written work look that same as the printed word or the teachers writing. Others avoid climbing frames, riding their bike and may avoid sports days if at all possible.
Many children with AS have an intense fascination with unusual topics, drain covers, lamp-posts, train timetables, locks, space and washing machines are a few of the more common interests. Others have the ability to absorb and recall numerous facts about their special interest. About 10% of people on the Autistic Spectrum (mainly people with AS) have a savant skill and are gifted usually in music, art, mathematics or computers. For some people with AS there is a tendency to adhere to strict routines which can make family life difficult at times.
Like children with autism, children with AS can have difficulty understanding non-verbal responses and emotions of others. They in turn don’t always use non-verbal signs to help them to be understood by others. They may use a flat voice tone and limited facial expressions.
Many children with AS cope well with some of the academic aspects of schooling, as the structure and predictability of school routines and the logic of certain subjects particularly suit them. Some may show particular interests in the areas of mathematics, IT- information technology, science, music or art. It is the social aspects of school life which can often pose the greatest challenges for them. It may be difficult for some young people with AS to form relationships, to make and keep friends. Other people can sometimes view them as being loners preferring their own company, which is sometimes the case. As they get older some young people with AS begin to notice that they don’t have friends and may ask why. With support many young people with AS can develop a better awareness and some understanding of social rules and can be taught strategies to cope better in social settings.
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