With grateful thanks to the National Autistic Society for their help in compiling this article.
All people with autistic spectrum difficulties (ASD) have some degree of social and communication difficulties. Autism is a lifelong developmental disability. Some people have accompanying learning disabilities, others have average or above-average intelligence.
People with ASD have difficulties with some or all of:
- Language - speaking and understanding
- Independence skills
- Personal development
- Attention-deficit or obsessional attention paid to a small number of limited, often repetitive tasks
- Developing wider interests
- Problem solving
- Motor skills
- School work / intellectual development
- Social skills
- Heightened sensory awareness - they may for example find certain foods difficult to tolerate, need to touch things, be exceptionally sensitive to noise and/or be overstimulated by a busy primary school classroom.
How ASD affects people
Children with the more narrowly defined condition of childhood autism develop language later than average children; signing and visual prompts may encourage communication with non-verbal children. In contrast, children who have Asperger’s syndrome develop language at the same time as other children, but their language use is often unusual. They may use rather formal words and phrases, which make them seem old-fashioned and different from their peers, or they may speak in a stilted or monotonous way.
The difficulties in social interaction pose very particular problems.
Children with an ASD find it difficult to read social cues and non-verbal signals about what other people are feeling. For instance, a person with an ASD may not be able to spot when a companion is upset, angry or bored.
Characteristics of children with autism:
- They come across as lacking in empathy for other people’s feelings, which could be interpreted by someone not aware of their disability as wilful self-centredness.
- May show no interest in what other people are doing.
- Avoid joining in games with their siblings, peers or parents.
- Parents often describe them as being engrossed in a world of their own.
Children with Asperger’s syndrome often show a desire to be sociable, but their attempts to make friends may be thwarted by their lack of comprehension of the social nuances of negotiating friendships.
Routines and repetition
People with an ASD often say they like ‘sameness’. They dislike things that upset their routines, because routine gives them a sense of security. Children with autism often repetitively perform the same actions and show no signs of developing imaginative play. Others may become fascinated by a particular topic, for example dinosaurs, and become extremely knowledgeable about it, but be uninterested in branching out to other related subjects.
The close focus they give to their chosen interests may help in certain disciplines, for example in some aspects of maths and science.
Impairment of imagination does not mean that people with an ASD are necessarily uncreative; some are very creative. It is more that lack of flexibility of thought, the inability to foresee the consequences of their actions, and inability to put themselves in another person’s place and understand their point of view are all likely to cause difficulties for them.
Autism is characterised by impairments in three areas: social interaction, communication, and imagination (shown in difficulties in the development of play, flexibility of thought, or restricted or repetitive interests). This ‘triad of impairments’ is found in varying degrees and forms, so the concept of the autistic spectrum has been developed, and the term autistic spectrum disorder (ASD) covers a wide range of abilities and disabilities. This ranges from childhood autism at the less able end of the spectrum to Asperger’s syndrome at the more able end. Autistic spectrum disorders are not rare; it is estimated that about 1 in 110 people have an ASD.
Semantic pragmatic disorder (SPD)
Often associated with the autistic spectrum disorders, semantic pragmatic disorder (SPD) is a communication difficulty, usually identified between 18 months and two years. Semantic refers to the meanings of words and sentences and pragmatic to understanding language in context.
Children with SPD find it more difficult to extract the central meaning or the saliency of an event. They tend to focus on detail instead, for example they may find the duck hidden in the picture but fail to grasp the situation or story it portrays.
Current thinking is that children with SPD have many more problems than just speaking and understanding words; the underlying difficulty may be in the way they process information.
Typically a child has good hearing, but few if any real words, and has problems with comprehension (but responds well to speech therapy).
By school age the child appears ‘different’ – sometimes appearing to follow very little conversation, while at other times giving a detailed explanation of an event.
Difficulties associated with SPD:
- Frequently chidlren will have difficulty in processing all the information from a situation.
- They will have problems understanding when and how to speak and respond appropriately, often with little regard to others.
- In school they are often good at maths, science and ICT, but have great difficulty in writing a coherent sentence or playing with other children.
- May have difficulty with sharing and taking turns.
- Can appear aggressive, selfish, bossy, over-confident, shy or withdrawn.
- In school, they may be misdiagnosed as children with behavioural problems.
Diagnosing autistic spectrum difficulties
Autistic spectrum disorders can usually be diagnosed from about two years. Children with Asperger’s syndrome usually learn to speak at the same age as typically developing children, so their disability may not be picked up quite so early.
Diagnosticians most commonly interview the parent about the child’s development and observe the child in a number of situations to arrive at a diagnosis. If you think your child may have an ASD, you should go to your GP and request a referral to a consultant or diagnostic team with an understanding of the condition.
Those most severely affected by ASD will benefit from the use of a specialised programme such as those offered by TEACCH, or applied behaviour analysis/verbal behaviour (ABA/VB). Some at the extremes of the spectrum may cope well with the demands of academic study - including at the very highest levels.