What is Autism Spectrum Disorder?
Autism spectrum disorder or ASD is a broad term used to describe the range of developmental disabilities on the autism spectrum, including autism, high functioning autism ,Asperger’s Syndrome and PDD NOS (pervasive developmental disorder not otherwise specified) .
ASD typically appears during the first three years of life, although it is often not diagnosed until much later, especially in the case of high functioning autism and Asperger’s Syndrome.
Girls with ASD are also typically diagnosed later as they present with slightly different symptoms to boys.
Autism is not a disease, but a neurological disorder that affects the functioning of the brain. Although the cause is unknown, research indicates it is possibly a combination of genetic and environmental factors. Three out of four children diagnosed with ASD are male.
The difficulties experienced by people with ASD fall into three main areas, commonly known as the ‘triad of impairments’.
These impairments are in the areas of
Communication, Social interaction, and Imagination. In addition to the triad impairments people with ASD almost always have difficulty with sensory processing- dealing with the input received through their senses.
Each person on the autism spectrum has a varying degree of difficulty in these three areas, depending on their personality, intelligence and place on the spectrum.
People with ASD have disordered or delayed language but the degree of impairment varies greatly. Some people remain non-verbal throughout their life. Others have limited skills, but only use speech to communicate their needs. Children with limited language skills can be assisted to communicate using sign language and pictures to reinforce spoken words.
Echolalia, the repetition of words or phrases, is frequently seen in early childhood. It can indicate that the child has not fully understood what is being said; it may also be a calming strategy. It should not be discouraged as children can be taught to use language in a more functional way. Lower functioning adults can still display echolalia.
People with high-functioning autism or Asperger’s Syndrome appear to have good language skills. Although they might sound quite articulate, their ability to understand language and use it in a social context is impaired. They might talk exclusively about their own interests, and have difficulty starting and maintaining a conversation. The way in which they interpret language is very literal and their speech can lack expression, speak in a monotone or have an unusual pitch.
Many people on the spectrum find it difficult to understand non-verbal communication and use it in a way that is natural and spontaneous. Non-verbal communication includes eye contact, facial expression, use of gesture and body language. Expressions that are very l;iteral such as “pull your socks up” or expressions that have two meanings can also be very difficult for people with ASD to interpret and can make social situations very difficult.
Social interaction skills also vary greatly from one person to another.
Some children with ASD don’t know how to interact with others, so they appear withdrawn. If they do interact, they might do so inappropriately. For example, a child with ASD might hit another child or snatch a toy instead of saying, “Can I play?”
Sometimes children with ASD seek social interaction but their attempts are naïve and awkward. There is little understanding of unspoken social rules and cues. For example, they might stand too close to someone when talking, avoid eye contact or hug someone they have just met.
Many people with ASD have trouble taking on the perspective of another person, which leads to difficulty with turn taking, imitating, empathising and understanding the thoughts and feelings of others.
The social difficulties experienced by people with ASD can cause difficulty making friends and keeping them; this can result in frustration, distress and social isolation.
Young children with ASD typically have limited play skills, with a lack of creative and imaginative play. Many children enjoy repetitive activities such as lining up toys or objects. Some repetitive play activities give the impression of imaginative play, but often the child is copying a scene from a favourite television program.
There is usually an obsessive preoccupation with one or more interests, objects or activities. New interests will develop during different life stages. Involvement in daily activities can be ruled by these obsessions, placing great stress on parents, siblings and teachers. However, these obsessions can be used to motivate the child to participate in learning tasks.
Other elements of this lack of flexible thinking are resistance to change and insistence on sameness. There can be ritualistic behaviours, such as having a specific bedtime routine or insisting on always taking the same route to places. Children with Autism also lack the ability to predict what will happen next which causes anxiety and can be a major cause of behaviour problems .
People with high functioning autism can learn some things quickly and easily, but sometimes they learn by rote. This means there is little understanding of what they have learnt and how this information might be used in different situations. There is limited ability to recall past experiences. It is not that their memory is poor; in fact many people with ASD have excellent memories for things like dates, facts and figures. However they seem to lack a meaningful framework to store and access their memories, particularly those relating to personal experience.
For example, if you ask a child with ASD a question such as ‘What did you do on the weekend?’ they will often reply, ‘I don’t know.’ However if you ask, ‘Did you go to the park or the beach on the weekend?’ they are more likely to tell you what they did because the question has provided them with a prompt to retrieve the information from their memory.
In addition to the ‘triad of impairments’ people with ASD have difficulty processing what they sense.
Sensory processing is perhaps the most confusing aspect of ASD because it is so hard for other people to understand these difficulties.
Sensory processing difficulties vary greatly from one person with ASD to another. People with ASD may not process sufficient sensory input or are unable to filter out excess sensory input so that they can focus on what they need to in their environment. They may seek or avoid sensory stimulation. They may be overly sensitive or very slow to register sensory input. This can be in the areas of tactile, visual, auditory, taste, smell, body movements and positions.
Some children become distressed at hearing certain noises, such as the sound of a dog barking or telephone ringing. Others may have a high tolerance to pain or seem insensitive to heat or cold. Some children will only eat food of a certain colour, texture or taste.
Sensory processing difficulties cause a great deal of stress and anxiety for people with ASD. It is also a major factor in challenging or unusual behaviour.
Behaviour of concern
What causes behaviour of concern in people with ASD?
Some of the behaviours include:
Self-injurious behaviour such as biting or hitting themselves in the head
Aggressive behaviour towards others
Some of the probable causes are:
– difficulty with sensory processing,
– receptive language and language processing difficulties,
– social language difficulties,
– difficulty coping with change,
– depression and other mental health issues, and
– difficulty coping with frustration, stress and anxiety.
These difficulties can manifest as repetitive behaviours, such as rocking, hand flapping, finger wiggling, self-injury. These behaviours are most commonly seen in young children, although they can continue into adulthood in those more severely affected, particularly where the person has little or no speech.
People with ASD do not cope well with stress and anxiety, and this can lead to outbursts of frustration or tantrums. The teenage years may be a particularly stressful time for young people with ASD.
Routines, a need for sameness and obsessive interests may seem a bit odd or eccentric, but are in fact a coping mechanism that provides stability to people with ASD in a world that they find changing and unpredictable.
Other difficulties experienced by people with ASD
Children with ASD frequently have poor self-help and organisational skills. Toilet training may be delayed, and there is often a resistance to personal care issues such as brushing teeth and washing hair. In adolescence, the child may lack the motivation to maintain a socially acceptable standard of personal hygiene. Sensory sensitivity or avoidance are major factors in these difficulties.
A lack of experience in a variety of play situations impacts on the development of fine motor skills. Young children can have difficulty with manipulation of small objects, such as buttons and fasteners. Handwriting is a particular problem for many children with ASD.
Gross motor deficits include clumsiness, poor coordination and motor planning; many children also have poor ball handling skills. An odd, shuffling gait is frequently seen in people with Asperger’s Syndrome.
Other genetic and medical conditions are often present, with higher than average rates of anxiety disorders and depression, obsessive compulsive disorder, attention deficit hyperactivity disorder, bipolar disorder, Tourette’s Syndrome and cerebral palsy.
About 30% of children with ASD also develop epilepsy. Children with a severe intellectual disability are most likely to develop epilepsy.
Autism and intellectual disability
Approximately 70% of people with ASD have an IQ of 70 or below, which places them in the intellectually disabled range. Children with ASD and intellectual disability typically have an uneven cognitive profile, instead of an even delay across all areas of development. This means that some can perform at or close to their developmental level in some areas, but show major impairments in other areas, such as language comprehension, problem solving and skill generalisation. Some children with ASD and intellectual disability can even perform above their developmental level in certain areas.
Many children with ASD and intellectual disability attend specialist schools and require ongoing assistance with daily living skills.
High Functioning Autism and Asperger’s Syndrome
In recent years there has been an increase in the number of children diagnosed with high functioning autism or Asperger’s Syndrome. This is likely to be a result of greater awareness of autism.
Children with high functioning autism and Asperger’s Syndrome have intelligence in the average to above average range; they generally look just like any other child. The difficulties experienced by these children seem to be far more subtle. However, their need for support can be just as great as those who also have intellectual disability.
While people with high functioning autism and Asperger’s Syndrome perform less well at tasks highly dependent on language, they can perform exceptionally well at tasks involving problem solving, visual processing, visual perception and discrimination. They often have a knack for rote learning, such as times tables or number patterns, however they may have difficulty transferring this knowledge to practical applications. For example, a child who can recite his times tables may be unable to answer “How many legs are there on 3 cats?”
Children with high functioning autism and Asperger’s Syndrome can be successfully included in mainstream schools where there is support and understanding of their individual needs in order to maximise their learning potential.
How do these difficulties affect children at school?
The core characteristics of ASD and other associated difficulties may result in the following issues at school:
– poor attention and concentration,
– withdrawal or ‘meltdown’ due to sensory overload and social demands,
– understanding words but not the complex or underlying meaning,
– lacking awareness of others, and lacking tact,
– insisting on rules and following them rigidly,
– difficulty generalising skills they have learnt to other situations,
– difficulty making choices, organising time and personal belongings,
– difficulty with subjects that require imaginative thinking, such as creative writing,
– difficulty making and keeping friends, talking at people rather than with them,
– learning things by rote, with little understanding of how this knowledge can be applied,
– becoming dependent on prompts or routines to do certain activities,
– becoming distressed by their mistakes, being a perfectionist,
– becoming a victim of teasing or bullying, and
– an inability to ask for help.
How do these difficulties affect families?
The effect of autism on families can vary,
Some families will cope better than others, depending on the family’s resilience, financial resources, and ability to access supports such as respite and early intervention.
Parents can suffer an enormous amount of grief, stress, worry and the daily functioning of the family can be significantly affected. Siblings can also suffer grief, social isolation and other issues.
Access to support and information is critical for all families to be able to effectively function and cope with their child with autism, and to support them to have the best outcomes in life.
While they often share common features, every person with ASD is unique. Each has particular strengths and individual requirements for support throughout the various stages of their life.
The key to providing this support lies in taking the time to get to know them, understanding their difficulties and how they impact on learning and behaviour. This will provide a strong foundation for implementing the practical strategies and support that people with ASD require, which will enhance wellbeing, improve life skills and self-esteem.
People with ASD need services and supports that are unique and tailored to their needs and are consistent with the life goals of the person and their family. Many people with ASD go on to further study, successful careers and to have loving relationships and families of their own.