What is an autistic spectrum disorder (ASD)?
Autistic spectrum disorders (ASDs) are lifelong, developmental disabilities that affect the way a person communicates and relates to people around them.
'It's as if your child's brain has been wired up in a different way to usual. This doesn't change, but the ways in which it shows itself, and the extent
to which it shows itself, do change. ''It's really easy to think that the autism is like a shell around your normal child, and that if you try hard enough you'll get that outer shell off, and
your child will be free to get on. But you have to realise that it's not something in the way of them being normal, it's part of them.'
'It's nothing that you've done. A child doesn't become autistic. It's in them already. They don't learn to be autistic.'
Children with ASDs are affected in a huge variety of ways and to very different degrees. This is why it's called 'the autistic spectrum'.
Autism can affect children with any level of intellectual ability, from those who are profoundly learning disabled, to those with average or high intelligence.
So, having an ASD doesn't necessarily mean that you have learning difficulties. The more seriously affected children at one end of the
spectrum have learning difficulties as well and require high levels of support. At the other end of the spectrum, some people with Asperger's
syndrome or 'high-functioning autism' are very intelligent academically. They may go on to be successful in their chosen field. However, they still
experience significant social and communication difficulties.
Some children have other difficulties which are not directly related to their ASD, such as hypermobility, dyspraxia, dyslexia or attention deficit
hyperactivity disorder (ADHD). It's important to seek an assessment of any other conditions, as this affects the sort of support that will best meet your
child's needs.
What are the signs and characteristics of autistic spectrum disorders?
Children with ASDs have significant difficulties relating to other people in a meaningful way. Their ability to develop relationships is impaired, as is
their capacity to understand other people's feelings and the social rules of communication.
Everyone with an ASD has difficulties in three main areas. These are known as 'the triad of impairments', or 'the three impairments':
* social understanding and social behaviour
* social communication (verbal and non-verbal)
* rigidity of thinking and difficulties with social imagination.
All children with autism have impairments in all three of these areas.
However, the ways in which these three impairments manifest themselves vary enormously.
When they are born, most babies seem ready to become sociable and
develop communication skills. Young children just seem to know that other
people are important to turn to for comfort, to share moments of pleasure
with, to look to for guidance and to learn from. Children with ASDs find
this all very difficult. They may seem less interested in people. They find it
hard to see things from another person's point of view. They often seem
trapped in a world of their own. Some may like being sociable and
tactile but don't seem to understand how to do these things. A young
child with an ASD can't make sense of people, and may find them
frighteningly unpredictable. They may:
* seem to relate better to objects than people
* only tolerate approaches from very familiar people
* only be receptive to approaches from people they know well
* not want to be comforted in distress
* seem to use people as a means to an end - for example, by taking
someone's hand to obtain something out of their own reach
* seem to be unaware of social rules and conventions.
Social communication (verbal and non-verbal communication)
Children with ASDs may not be eager to communicate. They may not be
ready to learn things that other children learn naturally and therefore don't
have the chance to tune into language in the same way. They find it very
hard to make sense of the things that happen around them. Words may
mean very little to them and they may be unable to link what they see
with the things being said to them.
Young children with ASDs not only have difficulty making sense of words
but also with reading non-verbal messages in facial expressions and
gestures. This makes it difficult for them to learn what is expected of them,
and to recognise when someone is happy or upset and what that means.
A young child with an ASD may:
* develop speech in a way that is slow, disrupted or disordered - or may
not develop speech at all
* often use words out of context and without communicative intent
* use language correctly but not really understand what they are saying
* echo words other people say - straight away, or later (this is sometimes
called echolalia)
* use words and then 'lose' them
* not use eye contact as a natural part of communication
* rarely understand or use gesture
* develop a pointing gesture, but use it to indicate need rather than to
share an experience.
'The concepts of physical and mental impairment are fairly easy for
people to grasp, but the idea of social impairment is much more difficult
to understand (and to explain).'
Rigidity of thinking and difficulties with social imagination
Imagination helps us understand the world and predict and see the
perspective of other people. Children with an ASD are unable to do this
to any great extent. When pretend play begins to appear in children who
don't have an ASD, it's a sign that imagination is beginning to develop. In
children with ASDs this process occurs very slowly, in unusual ways, or
not at all.
Problems of imagination show themselves in different ways. Some children
never seem interested in what a toy is or what it represents. They may
focus on the features of the toy such as the wheels of the car or the box
the toy came in. Other children may run the toy car in and out of a garage,
but don't act out more complex stories. Some children seem to act out
stories or take on particular characters, but the story turns out to be an
imitation of a video or book. This doesn't mean that children with autistic
spectrum disorders don't have any imagination, it just means they tend to
have less ability in this area and they tend to be less interested in sharing
their imaginative ideas than other children.
Some children with ASDs learn to talk easily, but find it hard to understand
communication that is not literal. Expressions like 'I laughed so much I
nearly died', or 'If you eat any more you'll burst', can be very frightening
for them. They may have difficulties understanding that a story is not real.
Problems with imagination make the world a very uncertain place, so
children with ASDs find reassurance in setting up routines and patterns
that they can control. Repetitive behaviours and routines are a common
feature of ASDs. A young child with an ASD:
* cannot easily make sense of sequences and events
* may become distressed if a familiar routine changes
* may impose routines on others
* will often engage in stereotypical body movements (for example, some
children will flap their hands, some may rock back and forth)
* will often resist new experiences, for example trying different foods or
wearing new clothes
* may find it hard to work out what other people are going to do, and
cannot make sense of why other people do what they do - they are
unable to take someone else's perspective
* will only develop symbolic play slowly - if at all (symbolic play is play
which involves being in a particular role and using imagination)
* will often pay particular attention to unusual details and struggle to see
the bigger picture.
Other common challenges for children who have an ASD
This section may look daunting, so it's important to remember that
strengths and challenges change over time and that not all of the
following will be relevant for your child.
'There may be improvements in one area and then issues become more
apparent in another. You look back and see what was a problem then, is
no longer one and vice versa.'
* Sensory difficulties
A significant number of children with an ASD are very sensitive
(hypersensitive) or under-sensitive (hyposensitive) in one or more of their
senses. They may have heightened sensitivity to certain types of sound,
touch, texture, taste of food, light, colour or smell. Something like a clothes
label, for example, might cause a child extreme discomfort. Other
children lack sensory awareness of temperature or pain. Some children
shift between hypersensitivity and hyposensitivity. Sensory difficulties
can have a significant impact on behaviour and communication.
'We thought it was the cabinets (at the delicatessen counter in the supermarket)
but it ended up being, you know, the little lights that tell you the numbers.
Every time they flicked over that bothered her. She could hear them buzzing
and we thought it was the actual light that was on, like you would, the neon
type, but it wasn't and we couldn't understand why she could look at them
but then she'd run away. It was so loud for her and it wasn't until she was a
lot older that she could tell us that. We've only really known that in the last
18 months. We just could never understand why she used to scream at the
top of her voice whenever we were in a place like that.'
* Sleeping difficulties
Children may have problems getting to sleep or may wake periodically
throughout the night. The child may catch up on sleep during the day
or may seem to require much less sleep than the rest of the family.
* Eating difficulties
Children may only eat certain foods, or foods of one consistency or
one colour. Others have rituals, such as insisting different foods never
touch on the same plate.
* Difficulties with toileting
As with eating difficulties, it may be advisable to look into whether there
are other medical reasons for your child's difficulty, such as constipation.
* Bowel problems, which may cause pain
Some children may be prone to constipation or diarrhoea and some
benefit from a special diet. They may experience both, at different
times, or at the same time (if the bowel is blocked, then only liquid
matter can pass the blockage).
* Difficulties developing independence and personal care skills
* Difficulties with motor skills
For instance, they may have unusual difficulty holding a pencil (a fine
motor skill). Some children may be clumsy or have an odd way of
standing or walking (gross motor skills).
* Obsessions
Thomas the Tank Engine is a popular one. Some children with an
ASD insist on certain rituals.
* Fears and phobias
These can include everyday things such as certain advertisements,
pictures in books, specific songs.
* Poor spatial awareness
Spatial awareness is the sense of knowing where you are in relation to
other objects around you.
* An unusual focus on detail
Focusing on minor details and ignoring the main picture - for example,
looking at a spot of dirt on the floor when they are in the middle of a
chasing game.
What are the strengths of children with an ASD?
Every child is unique, but there are particular strengths and skills that
children with an ASD seem more likely to develop than other children.
All of the following are characteristic:
* An ability to focus on detail and to concentrate for long periods of time
on a single activity. Some children can give their sole attention to a
task and therefore achieve a high level of skill and continue to work on
tasks way beyond the point at which other children of the same age
would tire of them.
* A talent for learning facts and skills when they want to, and when they
are presented in a way particularly suited to their learning style, for
example using lots of visual material.
* A very individual way of looking at the world and figuring out how the
world works. For some families, these idiosyncrasies provide a special
source of delight and humour.
'One of the positive things they do is make you look at things differently.
As you get older you're conditioned to think, "You should do this, that
and the other". They do things in such a refreshingly different way. It's
quite nice, really. All children do this, but especially autistic children.
They're so direct and frank. I think that's really nice.'
* A powerful and unusual learning curve. Children may seem to stand
still in their development for a while then take an unexpected leap
forward in their abilities and skills, perhaps after trying a particular
task only once. This pattern of development is usually associated with
learning that requires skills other than language or communication, like
using building blocks, doing jigsaws, memorising facts and figures,
understanding things visually, mimicry, or using a natural musical
ability. A small proportion of individuals with autism excel in one or
several of these areas. Very occasionally a child's general level of
ability will be in very sharp contrast with very impressive expertise
or knowledge in one particular area.
This information is from a leaflet created by the Department of Health and the National Autistic Society