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Autism

Autism (sometimes referred to as Autism Spectrum Disorder) is a disorder of neural development, occurring in about 1 - 2 per 1,000 people, and affecting approximately 4 times as many males as females. It generally becomes apparent in the first 2 years of the child's life, and once established, symptoms tend to continue through adulthood, although their severity may decrease with age. The exact cause is unknown, but autism is believed to have a strong genetic basis. Sometimes the syndrome is categorised into low, medium, or high functioning autism, with the latter sharing similarities with Asperger's Syndrome (AS). However, unlike the child with AS, the autism sufferer is more likely to have delayed language development, greater socialization deficits, and greater problems in terms of daily living skills. For example, unlike sufferers of AS, those with autism tend to lack awareness of, and interest in, social interaction such as the desire to fit in. People with autism often 'isolate', showing more interest in objects than in people. Other learning difficulties may become apparent in the child's early development.

Diagnosis can be difficult because the variety and severity of symptoms and behaviours can differ greatly from one individual to the next. However, generally it can be said that people with autism have in common: difficulties in social interaction; impairments in communicating, and restricted interests and repetitive behaviours. Autistic children don't develop the social and language skills in the way that their normal peers do, and so often find relating to others difficult. Difficulties in social interaction include - not understanding unwritten social rules; preferring to spend time alone than with others, and having difficulty expressing or responding to emotions. They may fail to make attachments, and tend not to seek comfort from other people when distressed.

Impairments in communicating include features such as difficulties in understanding verbal and non-verbal language, and failing to respond to others. They may understand literal aspects of language, but not be able to read facial expressions or tone of voice. People with autism may have some language skills, but find it hard to understand the give and take nature of conversations, while other sufferers may have very limited speech, or may not speak at all. About 30% - 50% of autism sufferers do not develop enough language skills to meet their daily communication requirements.

Restricted interests and repetitive behaviour may typically include hand flapping and body rocking. Ritualistic behaviour such as carrying out an unvarying pattern of daily activities is common, and a change in routine, or exposure to unfamiliar situations can cause considerable distress. The autistic child often shows a limited interest in what is going on around him or her, and may become excessively preoccupied with one particular object to the exclusion of other activities or people. Self injury such as head banging and hand biting is not uncommon. Other symptoms include under or over-responding to sights and sounds, for example; poor motor co-ordination, and in some cases 'splinter skills' such as a rare talent for memorising trivia.

Autism is a lifelong condition for which there is no 'cure', but some sufferers are able to live relatively everyday lives. Early diagnosis is key, so that appropriate services and support can be put into place suited to the needs of the given sufferer. Behavioural and cognitive interventions, for example, can help the autistic child to learn skills in communication and in self care. Whilst core difficulties generally remain, other symptoms may improve with time, with some adults able to improve their social skills and achieve a reasonable level of independence. People can, and do, develop and learn with the right kind of support.

Symptoms and Behaviours

The following is a guide to some of the more commonly occurring symptoms and behaviours, although these may vary greatly from one individual to another.

Difficulties in Social Interaction

  • less responsive to others, such as acting as if they are deaf and ignoring verbal cues
  • smile and look at other people less often
  • prefer to play and spend time alone than with other people
  • difficulties understanding other people's feelings, as well as expressing their own
  • difficulties in forming friendships, and understanding social rules

Difficulties in Communication

  • a lack of ability to start conversations, or to take turns in conversation
  • difficulties with verbal and non-verbal communication, such as ability to read facial expressions and body postures, or make eye to eye contact
  • may have limited speech, or may not be able to speak at all
  • difficulty in understanding meaning in spoken and written language

Restricted Interests and Repetitive Behaviours

  • repetitive movements such as hand flapping and body rocking
  • ritualistic behaviours, such as an unvarying pattern of daily activities, that are resistant to change
  • self injurious behaviour such as head banging and hand biting
  • narrowly focused interests, such as excessive preoccupation with certain objects, to the exclusion of other activities or people

Other Symptoms

  • over or under responsiveness to stimuli such as noise or touch
  • poor motor co-ordination, and difficulty with physical activity
  • changes in mood, such as tantrums, and crying and laughing for no apparent reason
  • difficulties with daily living skills such as self-care, and poor organisational ability
  • storing up of trivial facts, and a strong focus on detail

Assessment & Diagnosis

Usually, children with autism get diagnosed between the ages of 18 months and 3 years. If you notice symptoms, consult your GP who is then likely to refer your child to a specialist such as a paediatrician or a child psychiatrist, to diagnose whether autism is present. A variety of screening instruments are used to test different facets of the condition, and assessment generally involves a multi-disciplinary team. You and your child may need to see a range of professionals including a speech therapist, an occupational therapist and an educational expert. To arrive at a diagnosis of autism, several of the above mentioned symptoms must be observed, across a variety of settings; degree of severity will also be assessed. Typically there will be severe impairment in communication and social interaction, as well as repetitive behaviours and restricted interests. Early diagnosis will ensure that the right interventions for your child are put in place, such as appropriate educational services and support.

Intervention

Intervention will need to be tailored to the individual as sufferers vary greatly in the number and severity of symptoms they experience. Most interventions will be aimed at children, and these can take place in a variety of contexts, from schools to specialist centres. Whatever the treatment setting, professionals will work to improve your child's social and communication skills so that they are able to become more self-sufficient, as well as becoming more effective in interacting with others.

Medications may be prescribed in the short-term (e.g. anti-depressants or stimulants) to reduce symptoms such as hyperactivity and agitation; however the core symptoms of social and communication difficulties tend to remain, and therefore behavioural therapies and special educational programmes will be required to address these. Such interventions aim to improve social deficits, and to increase quality of life, and independence in daily living skills. They aim to decrease the severity of symptoms and reduce unhelpful behaviours.

Behavioural therapists will observe the child's behaviour in different settings, and then reward good behaviour with praise (for example), whilst also having a structured way of dealing with challenging or self-injurious behaviour. Parents should also receive support and training so that they can use the behavioural techniques in the home to help the child to achieve good outcomes. Cognitive Behaviour Therapy (CBT) may be used to help your child to challenge negative thoughts which in turn can improve mood and behaviour. Other professionals that may be involved are speech therapists who will help your child to communicate better; and occupational therapists who will help them with daily living skills and dealing with the environment. At school, all children need an educational assessment and special educational support, whether this be in the context of a mainstream, or a special school. Activity structuring will be important, as well as rules, particularly as people with autism are often uncomfortable when things change or become unpredictable.

Although autism is a lifelong condition for which there is no 'cure', outcomes for sufferers are improving as more effective interventions and appropriate resources are developed. Some people may require lifelong support, whilst others may be able to live fairly independent lives.