What is autism spectrum disorder?
Autism spectrum disorder (or ASD) is a lifelong developmental disability. The term spectrum disorder is used to describe the group of developmental disorders that includes autism, high functioning autism, Asperger’s Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).

What causes ASD?
The specific cause of ASD is not known however researchers around the world are exploring different theories and trying to identify the specific gene or genes that may cause autism. It is known that there are biological or neurological differences in the brains of people with autism.

There are several outdated theories concerning the cause of ASD; it is not caused by bad parenting and it is not a mental illness. People with ASD do not choose to behave they way they do and children with ASD are not naughty and in need of some ‘old-fashioned’ discipline.

Is ASD hereditary?
In many families, there is a pattern of ASD or related disabilities, suggesting that there is a genetic basis to the disorder. There is some tendency for ASD to cluster in families with the incidence rate amongst siblings 50 times that of the general population.

What are the main characteristics of ASD?
The core features of ASD are impairments in social skills, communication and obsessive behaviour. Not all children display all of the behaviours described here. However to be diagnosed with ASD the child must show all the essential core features of autism and meet certain diagnostic criteria.

Social skills
Children and adults with ASD have difficulty understanding and displaying appropriate social and emotional behaviour such as:

• Lack of or abnormal eye contact particularly when younger.
• Inappropriate use of facial expressions and body language.
• Difficulty in developing and maintaining friendships.
• Difficulty understanding and responding to the emotions of others.
• Apparent insensitivity to the feelings and needs of others.
• Inappropriate and naïve social interactions with others.
• Lack of or difficulty displaying affection.

People with ASD are often described as living in a world of their own; they seem to have different interests and priorities from others. Their interactions with other people are often to meet their needs rather than for the enjoyment of social interaction. Sometimes parents feel that there is something different about the child from a very early age.

Communication
Children with ASD have difficulty with both verbal and non-verbal communication. Language development is usually delayed in onset and disordered in development. Problems in the development of language and communication are manifest by behaviour such as:

• Echolalia, and pronoun reversal.
• Idiosyncratic use of language.
• Repetitive use of language and obsessive talk.
• Difficulty in initiating and sustaining conversations.
• Unusual rhythm, pitch and intonation in speech.
• Relatively poor language comprehension in comparison to expressive language.
• Difficulty understanding and using facial expressions and body language.

Interests, activities and behaviours
Autism is also characterised by restricted, repetitive and stereotyped patterns of behaviour and interests. These characteristics are manifest in behaviours such as:

• Impaired creative and imaginative play, eg. prefers non-toys or lines up objects.
• Insistence on sameness and resistance to change.
• Ritualistic behaviours, eg. insisting on taking the same route to places.
• Obsessive preoccupation with interests, activities or objects often with things that are unusual for the child’s age, eg. power lines.
• Inappropriate attachment to objects.
• Unusual body use, eg. hand flapping, finger wiggling, grimacing, toe walking, rocking, odd gait and body posturing.

What other features are associated with ASD?
The following features are not part of the core diagnostic characteristics but are sometimes seen, particularly in younger children.

Difficult & Unusual Behaviours

• Excessive temper tantrums.
• Mood swings.
• Unexplained periods of distress or giggling/laughing.
• Aggressive/destructive behaviour (in a minority of cases).
• Unusual fears or phobias, eg. very frightened of certain TV ads.
• Self-injurious behaviour, eg. hand biting, head banging.
• Sleep disturbances, eg. needs very little sleep and is active at night.
• High stress and anxiety levels.
• High activity levels and short attention span except in interest areas.
• Some children are very strong willed and resist compliance with other’s requests.
• Primitive or bizarre sense of humour.

Sensory Motor Development

• Apparent deafness, eg. the child seems to ‘tune out’.
• Distress at hearing certain sounds, eg. panics when the vacuum cleaner is used, or intensely dislikes loud noises.
• High tolerance to pain and insensitivity to heat and cold.
• Light gazing, unusual use of peripheral vision, looking at objects at odd angles, etc.
• Spinning objects or self and high tolerance to becoming giddy.
• Resistance to being touched or intolerance to the feel of materials on their skin but enjoys rough and tumble play.
• Self imposed unusual and restricted food preferences.
• Delayed toilet training and some times fears and phobias related to the toilet.
• Unusual sniffing or smelling of objects or heightened sense of smell.
• Inconsistent motor skills.

What is the incidence of ASD?
Studies suggest the prevalence is somewhere between 1 in 200 - 500. In recent years there has been a large increase in the number of children diagnosed with ASD, particularly those in the high functioning category. This is probably due to a broadening of the criteria for diagnosis, and better diagnostics methods enabling detection at a very young age. The high prevalence of ASD makes it one of the most common developmental disabilities, yet many in the community lack an understanding of how individuals are affected by it.

For further information on incidence and results of a review of children with ASD in the Barwon-South Western region of Victoria, click here.

Why does ASD affect more males than females?
Approximately three out of four people with ASD are male. It is not known why this occurs, but this high ratio of boys is consistent, however, with other disorders involving language and learning.

Is there a connection between ASD and epilepsy?
About 30% of children with ASD will also develop epilepsy. The group most likely to develop epilepsy are those children who have a more severe intellectual disability. The onset may occur at any age but most frequently occurs during adolescence.

At what age can ASD be detected?
Autism spectrum disorder is probably present from birth and is usually evident before the child is around three years of age. It is very difficult to diagnose until the child is at least 2 years of age.

How is ASD diagnosed?
Autism is diagnosed by examining the child’s development and behaviours. Sometimes autism can be difficult to diagnose so it is important to have a comprehensive assessment to distinguish ASD from a range of other difficulties.

An assessment by a paediatrician is required prior to an assessment for ASD in order to rule out other factors including medical conditions that may be affecting the child’s development and behaviour. A hearing assessment may also be required.

Autism is best diagnosed by a team of professionals including a psychologist and speech pathologist. They will discuss the child’s developmental history and early behaviour with the family. Often a specialised assessment is undertaken to determine the child’s range of skills and abilities. The assessment team may also consult with other professionals. All of this information is taken into consideration before arriving at a decision about whether the child has ASD or some other communication, behavioural or developmental difficulty.

What is high functioning autism?
About 70% of people with ASD have an IQ within the intellectually disabled range. The other 30% have normal to above average levels of intelligence. This group may be referred to as having high-functioning autism. Individuals with high-functioning autism have lifelong social difficulties, however impairments are not as severe in their communication skills.

Children with high functioning autism tend to have an uneven profile of skills. They may also be gifted in some areas, making it difficult for parents and professionals to recognise that they have a developmental disability.

What is the difference between high functioning autism and Asperger’s Syndrome?
Both disorders lie on the autism spectrum; there is very little difference between high-functioning autism and Asperger’s Syndrome. People with these disorders are at the more able end of the spectrum; that is, they have average to above average intelligence and have fewer language difficulties. They may speak fluently although their speech may sound overly-formal or have odd intonation.

What is an autistic savant?
Characterised in movies such as ‘Rainman’, autistic savant is the term used to describe a person with ASD who has a special skill. Around 10% of people with ASD have special or remarkable skills, even though they may have an intellectual disability.

There is a range of savant abilities. Splinter skills are most common. Typically an individual is very good at committing facts to memory or has an exceptional knowledge of their special or obsessive interest. Talented skills refers to a highly specialised ability such as outstanding artistic ability or calculating complex maths problems in one’s head. The rarest type is prodigious skills. Only a small number of autistic savants have these skills, which may include the ability to play an entire piano concerto after one listen, or making a detailed drawing of an entire city from memory.

There is currently no definitive explanation for autistic savant behaviour. It may occur because the right hemisphere of the brain, which controls such things as memory, is compensating for damage in the left hemisphere.

What is the prognosis for someone diagnosed with ASD?
Autism is a lifelong condition with no cure at this time; the core characteristics will remain to varying degrees. The outcomes are highly variable but are generally dependent on factors such as; the level of intelligence, development of spoken language, personality or temperament, the level of family support and access to appropriate support services. Early diagnosis and support will greatly improve outcomes for the child and the family. The most effective time to teach the child appropriate behaviours is in their early years before problem behaviours become entrenched.

The core characteristics and the degree in which they impact on behaviour tends to change over time. In early childhood, challenging behaviour, social and language difficulties are most marked. Middle childhood is often a more stable period, when social understanding increases, language skills improve and behavioural problems decrease. Adolescence can be a particularly difficult time with increases in behavioural problems occurring in some cases, as well as mental health issues, such as depression. Adulthood is usually a more stable period with continued learning of social, communication and life skills sometimes taking place well into adulthood.

The majority of people with ASD will need some form of ongoing support throughout their life. Some people are able to lead independent lives. They may attend university, be employed in a highly-skilled position, marry and have a family. However, they may experience lifelong difficulties in certain areas, such as social situations, difficulty with intimacy and empathy, communicating with their partner and display perfectionist or obsessive behaviour.

It is very likely that many talented artists, inventors and business people from the past and present are on the autism sepctrum.