Autism is a condition affecting how a person understands and communicates with people and makes sense of the world. It is a spectrum, so the degree to which a child (or adult) is affected by his or her difficulties, and the extent to which they are obvious to others, vary significantly.
Those more mildly affected may be able to lead relatively independent lives, while others may require lifelong support.
All children on the autism spectrum have some difficulty in three main areas: social communication, social interaction and social imagination.
In some cases children have little or no speech. Others (including those with Asperger Syndrome) have good speech and language skills but may tend towards monologue and find conversation hard. Non- verbal communication – for instance eye contact, expressions and gestures – can be very confusing for children with ASD (Autism Spectrum Disorders).
Social interaction can be difficult for children with ASD. They may prefer to spend time alone, or find it hard to make friends. They often have difficulty recognising and understanding the feelings of others.
Difficulties with social imagination can make children with ASD very wedded to routine, and easily distressed by change. They may also have very fixed – and sometimes unusual – special interests and think, do or talk about these a great deal.
In some children there may also be unusual repetitive movements such as spinning or hand or finger flapping or twisting.
Many different names are used to describe types of Autism Spectrum Disorder – which is the umbrella term for the spectrum. These include Kanner Syndrome (or Classic Autism), Asperger Syndrome, High functioning Autism and Pathological Demand Avoidance Syndrome.
There are also a number of conditions which are closely related to the autism spectrum but which do not meet the full diagnostic criteria. These include Semantic Pragmatic Disorder (SPD), which affects the use of language socially, and the far from catchily named, Pervasive Development Disorder – Not Otherwise Specified (PDD-NOS) – a diagnosis which can be made when a child shows some but not all of the behavioural features of ASD.
It is now thought that one in 100 people is somewhere on the autism spectrum, and while misunderstanding and prejudice linger, awareness and acceptance about autism are steadily increasing.
The once stereotypical image of the condition - Dustin Hoffman's Rain Man character in the 1988 film, institutionalised, void of any social skills and mathematically gifted for instance - is being eroded.
In fact children on the autism spectrum may have average, high or lower than average IQ. They may also have other disabilities and learning difficulties but this is not necessarily the case (it is much more common in children most severely affected by autism).
Autism is diagnosed more frequently in boys than girls (conservative estimates suggest at least twice as many cases are in boys). In recent years though there has been increasing research into and awareness of how the condition may manifest itself differently in girls. (It has been suggested that girls may be better at learning techniques to mask their social difficulties.)
What is Asperger Syndrome?
Asperger Syndrome is a form of autism usually associated with a milder level of difficulty than classic autism. Children with Asperger Syndrome have fewer problems with language, often speaking fluently and early. They may however sound formal or stilted, struggle to make conversation and talk excessively about their own interests.
People with Asperger syndrome are generally of average or above average intelligence and do not usually have the learning disabilities associated with those more severely affected by their autism.
What causes Autism Spectrum Disorders?
The causes of autism are not yet fully understood and there is a huge amount of research going on in the field. However experts believe that autism results from a difference in the way the brain develops and functions as a result of a combination of genetic and environmental factors. Scientists are now trying to find out more about which genes are implicated and how they affect the brain's development.
Children with siblings with ASD are more likely than others to have ASD or other developmental difficulties.
There is no evidence to link autism with the MMR vaccine, and it cannot be caused by bad parenting or upbringing.
Could my child have Autism Spectrum Disorder?
Many parents suspect quite early that their child is somehow different or even that he or she has autism. For others the realisation or diagnosis may come as a shock, perhaps after concerns are raised by nursery staff, teachers or other family members.
Diagnosis is often made around the age of three – when difficulties in communication and social skills begin to stand out - though Asperger Syndrome and High Functioning Autism are often not identified until much later.
There are some signs that a child with ASD may display, though every child with autism is different. Many children will show some of these traits and not be on the autistic spectrum. Other children may not – or not currently – have all these traits and still receive a diagnosis:
Repetitive behaviour, for example repeatedly lining toys up in a particular order, spinning or flapping.
Lack of interest or inability to engage with imaginative play.
Not drawing others' attention to objects or events, for example by pointing at a toy or something that happening nearby.
Resistance to change or doing things differently.
Problems with social skills and interaction. Difficulty in playing with other children and making friends.
Delays with speech and language or unusual use of language, such as frequently echoing phrases from television programmes or other people.
Poor eye contact.
Under or over- sensitivity to sound, touch, taste, smell, light or colour.
How is autism diagnosed?
If you feel your child's development is not following a typical path and you suspect ASD you should discuss your concerns with your GP (or you may prefer to approach your health visitor if your child has one) initially. If the child is pre-school age he or she may use a screening test called CHAT (Checklist for Autism in Toddlers) which does not give a definitive result but will flag up certain traits.
If your doctor feels further investigation is warranted your child will be referred to a specialist paediatrician or clinical psychologist. In some areas autism is diagnosed by a multi-discplinary team. Your child may be seen by a number of professionals including a paediatrician, psychologist, Speech and Language Therapist (SALT) and Occupational Therapist (OT) before a conclusion is reached.
The process of diagnosis may take some time and there may be several appointments as doctors will want to be sure before reaching a conclusion. There is no physical or genetic diagnostic test for autism.
Assessment is based on observation and the use of specially designed tests which highlight autistic tendencies. In the process of assessment you will be asked about your concerns and a detailed history of your child's health and development and your day to day family life will be taken. In addition your child will undertake cognitive tests and games which will highlight their areas of difficulty and strength.
This can be a stressful time and parents may feel their parenting skills and family life are being judged. It is important to remember that doctors are trying to build up as detailed a picture as possible in order to give the child the right diagnosis and support.
In some cases results may be inconclusive and doctors may decide to watch and wait. If a child fits most but not all of the diagnostic criteria for autism they may be given a diagnosis of Pervasive Developmental Disorder – Not Otherwise Specified (PDD- NOS), sometimes known as Atypical Autism.
Is there a cure for autism?
There is no cure for autism and it is a lifelong condition – so children with autism will become adults with autism. Despite this there are a huge number of supportive strategies and therapies which can help children with autism combat the difficulties they face and succeed.
Searching the internet can bring up many claims for autism cures and therapies but many of these are untested, and in some cases experts believe, merely playing on the fears and hopes of parents desperate to do the best for their child.
For expert and impartial advice on treatments and interventions for autism see Researchautism.net.
How can I support my child with ASD?
Despite the fact that no cure for autism exists (and many people with autism are offended by the very suggestion that such a thing might even be desirable) there is much that can be done to help a child fulfill their potential. Choosing the most appropriate strategies will depend largely on the child and their particular strengths, difficulties and personality.
If your child is of pre-school age you may have the opportunity to attend a parenting course run by the National Autistic Society called Earlybird. This involves both group with other parents and individual observations within the home and for many families it is a very useful way to start tailoring family life to suit their child's needs. Children generally respond well to routine, encouragement and an environment in which their sensory needs and sensitivities are considered.
For more details on Early Bird, and for information on many strategies for supporting children with ADHD see the National Autistic Society's website at Autism.org.uk.
Your GP, health visitor or paediatrician should be able to give you details about services in your area and strategies for helping your child. In addition, if it is felt your child would benefit from additional therapies such as Speech and Language Therapy or Occupational Therapy they will arrange this.
Tonyattwood.com.au (the website of one of the leading experts in Asperger Syndrome)
What parents say:
"My oldest son Christian was diagnosed with autism aged three, and my younger son, Lakken, followed suit at the same age. We realised quite early that both boys were different. They were totally non-verbal and had social difficulties and so the diagnosis was not a shock. It is very hard though – you never really expect your children to be different to others - and you feel very alone for a while.
"They are wonderful boys though. I can never really understand when people say parents of children with autism are brave or doing an amazing job. We just do what we need to do because we love them. We have had to adapt our lives for them but it has been so rewarding. I am so proud of every bit of progress they make. They are thriving at their special school and really developing their skills. I have realised that you can communicate so much even without words. Lakken might not be able to say 'mummy', but I know he loves me and that is wonderful.
"Certain things are difficult – going shopping is a nightmare for instance – but I have developed a thicker skin. Occasionally people ask if the boys are all right and I sometimes explain. It feels good to give people information because I think generally society is still very unaware of what autism is and that people with autism are still individuals."
Nikki, mum of Christian, five and Lakken, three.
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