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Autism Spectrum Disorder

Autism Spectrum Disorder (ASD), sometimes known as Autism Spectrum Condition (ASC) or simply ‘Autism’ is a lifelong neurodevelopmental condition that affects how people perceive the world and interact with others. ASD affects people in different ways but most autistic people see, hear and experience the world differently from other people. Some people with ASD find the world overwhelming and struggle to understand and relate to other people. They are often aware that they are ‘different’ and that people don’t understand them. This leads to high levels of anxiety and affects the way they take part in family, school and social situations.

Top Tip

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Remember that children may need to fidget to be able to focus – allow an appropriate outlet for these behaviours.

ASD is a spectrum condition. This means that while all people with ASD share certain difficulties, it affects people in different ways and people with ASD will require different types and levels of support depending on their individual needs.

The exact cause of ASD is unknown, but it’s thought that several complex genetic and environmental factors are involved. ASD is not an illness and cannot be cured. People on the autistic spectrum learn and develop and, with the right sort of support, can live a fulfilling life. Many people with ASD feel that their autism is a fundamental feature of their identity, shaping who they are.

Approximately 70% of people with ASD will also meet the criteria for at least one other diagnosis which may further impair their functioning, although these are often unrecognised. Some level of Learning Disability occurs in approximately 50% of cases and there is an increasing understanding of the high prevalence of mental health needs amongst people with ASD. Language and communication difficulties are also very common for people with ASD, although language and communication profiles within the ASD population are highly variable. Some people are non-verbal, some have poor language skills, and others have good language skills. An estimated 25% of people with a diagnosis of ASD never develop functional language.

Children as young as two may be diagnosed with ASD, but many do not get a diagnosis until they are older as symptoms become more obvious when social demands begin to outstrip their capabilities. The main diagnostic signs of autism are persistent difficulties with social communication and interaction and restricted and repetitive patterns of behaviours, activities or interests. Sensory sensitivities are also now recognised as a feature of ASD. If these indicators are present to the extent that they limit and impair everyday functioning, a diagnosis of ASD is likely to be made.

Diagnosis is usually made by a multi-disciplinary team, often including a SaLT, paediatrician, psychiatrist and/or psychologist. Information will be collected from parents, school and any other specialist professionals who may have assessed the child.

Prevalence

About 1 in every 100 people in the UK has a diagnosis of autism. More boys and men are diagnosed with autism than girls and women.

What to look for

Children with ASD may develop language skills later than expected and have disordered language development, ranging from mild to profound severity. Their speech may be monotonous and flat, and they tend to have difficulty adjusting their tone according to the social situation. They may struggle to gauge listener interest and monopolise conversations, talking at length on subjects that interest them. Children with ASD often use pre-learned phrases, rather than constructing new sentences and often copy language from stories or television programmes verbatim (echolalia). They may have difficulty with eye contact and may use limited facial expressions and gestures.

They often engage in repetitive activities, for example always playing the same game in the same way or lining up toys in a particular order. They may also exhibit repetitive gestures such as hand flapping or body rocking. People with autism have difficulties with social interaction and social communication. They tend to have poor awareness of other people’s personal space and can be very upset by people entering theirs.

Difficulties

Interacting with teachers and peers
Conforming to school rules
Focus of attention and attention to task, particularly activities chosen by others
Coping with change
Anxiety within unstructured times, especially transitions
Understanding figurative language and implied meaning
Making and maintaining friendships

Myth Busting

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Do people with ASD want to have friends?

Most people with ASD do want to form friendships and socialise; however, the difficulties associated with ASD make it difficult for them to interact with peers successfully and they can often make mistakes. This means that social situations can make people with ASD feel very anxious.

Do all people with ASD have a special skill?

While it’s true that some people with ASD do have a special talent (they are often called

‘savants’), it’s not very common. Most people who have ASD are not ‘savants’ and not every ‘savant’ has ASD. People with ASD will have strengths and weaknesses just as we all do. Even amongst those who do have a special ability – not all of these are ‘marketable’ or valued by others.

Is ASD caused by poor parenting?

Extensive research on this topic has demonstrated that this is not the case – parents do not cause Autism. Many people can be made to feel that they are bad parents because their child does not respond to them in a ‘typical’ way, but the truth is that nobody is to blame for ASD – it’s just how some people are. Parents need support from professionals and their community to help their child cope with the world.

Can people with ASD feel and express emotions? Do they have empathy for other people?

ASD does not make someone unable to experience emotions, it simply means that they may communicate their emotions (and perceive other people’s emotions) in a different way. A person with ASD may find it difficult to recognise your emotions and to express their empathy towards you in a way that you might recognise, but that does not mean that they do not feel empathy or compassion for others. People clearly communicating their feelings can help people with ASD to demonstrate empathy.

Strategies

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Ensure the child realises that they are included as part of the class when giving instructions.
Minimise noise and other sensory distractions (e.g. strong smells) as much as possible.
Use clear language and avoid using idioms or figures of speech or provide explicit explanation of what these mean in context. Check the child’s understanding by asking them to explain what they have understood back to you.
Use consistent visual support strategies throughout the day to support your spoken language.
Make sure that the structure of tasks, lessons and days is clearly explained – a visual timetable will be useful and task management boards can help to break down the steps involved in an activity.
Give advance warning of changes to usual routines and ensure that visual timetables reflect up to date information.
Provide opportunities to prepare the child for new experiences including school transitions.
Ensure that the child has a clear understanding of class “rules”. Try to ensure that your expectations and responses are consistent and predictable.
Give specific feedback to reinforce positive behaviours and provide an immediate reward (this could be something like collecting buttons in a jar, which could lead to earning a bigger, specified reward).
Ensure that the child has a safe place to go if things get too much for them in the classroom and an appropriate way to request a break.

Provide structured support for teaching social interaction skills including the opportunity to practise skills in real-life contexts.

Role of SaLT

SaLTs can be involved at any stage of the care of a person with ASD. SaLTs are typically part of the multidisciplinary team who diagnose ASD, and they can support communication and social interaction interventions depending on the needs of the child. SaLTs may work with people with ASD indirectly, via a consultative model with the key adults who support the child, as many people with ASD learn functional communication and social skills best in real-life contexts, rather than within direct therapy sessions.

If you are concerned that a child may have ASD you should discuss your concerns with the child’s parents. Your SENCo will be able, with parental consent, to make a referral to the appropriate specialist service. A diagnosis provides a context in which to view the child’s difficulties and enables everyone involved to provide the best possible support.