Autism and Asperger Syndrome

Autism and Asperger syndrome are both part of a range of related developmental disorders known as autistic spectrum disorders (ASD). They begin in childhood and last through adulthood.

Autistic spectrum disorders (ASDs) can cause a wide range of symptoms, and there are many different ways that those symptoms can be grouped.

It is useful for parents to know the signs and symptoms of autism and Asperger syndrome that are related to their child’s stages of development.

Early signs of ASD: 6–18 months old

Although they can be difficult for parents to detect, the signs and symptoms of ASD begin to show between 6 and 18 months of age in most children. These signs and symptoms include the following:

•Your baby often avoids or has limited eye contact (gaze aversion). They may prefer to watch people out of the corner of their eyes or watch them in a mirror, rather than directly.

•Your baby does not follow your gaze. For example, when you look at your watch, a baby without ASD would copy you and look at your watch as well. Alternatively, your baby does not look at objects that have been pointed out to them.

•Your baby has no happy expression when they look at you.

•Your baby does not "babble" (respond in a "back-and-forth" manner when you talk to them).

•Your baby does not seem to recognise or respond to your voice, yet is aware of other sounds, such as a bell ringing or a dog barking.

•Your baby shows little interest in drawing your attention to things by pointing to them or pulling your hand towards them.

•Your baby rarely or never makes gestures such as pointing or waving.

Signs of ASD in pre-school children

The signs and symptoms of ASD usually become more apparent as your child gets older.

Problems with language will become more noticeable. It is likely that your child will begin to have difficulty interacting socially. They will also show unusual patterns of behaviour.

The signs and symptoms that often develop during this age are explained below.

Language development

Your child's speech development may be delayed or they may not speak at all. Most children can construct two-word sentences, such as "ball ... want" or "me … drink", by the age of two.

Delayed language development does not usually affect children with Asperger syndrome, but their speech may be affected in other ways. For example, it may sound very monotonous, flat or unusually fast.

Although children with ASD may have difficulty understanding long verbal instructions, they are often good at visual clues and instructions. This can be used to help them understand things such as visual timetables at school and at home, or picture exchange communication systems (PECS).

Playing

Your child may have little interest in playing with toys in an imaginative way, yet they may play in a repetitive manner.

For example, rather than pushing a toy car across the floor, your child may concentrate on spinning one of the wheels on the car. Or, rather than using blocks to build an object, they may line the blocks up in order of size or colour.

Children with ASD often prefer to play with household objects such as string, pens or keys, rather than toys. They are happy to play alone for hours without needing supervision or attention.

Social interaction

Many children with ASD often appear to look straight through someone. They have little or no awareness of other people.

Your child may have little interest in other children of the same age, or taking part in shared activities.

Some children with ASD may try to form friendships with children but then behave inappropriately, such as suddenly kissing or hitting another child. Or they may be unable to understand concepts such as taking turns.

Behaviour

Many children with ASD develop a repetitive pattern of physical behaviour. These patterns are known as sterotypies.

Examples of sterotypies include:

•flicking their fingers

•flapping their hands

•rocking back and forth

•persistent and unexplained sniffing

•licking objects

They also often enjoy visual stimulation and may be seen waving shiny paper, such as a crisp packet, in front of their eyes or rocking backwards and forwards in front of a pattern of vertical lines, such as metal bars on a fence.

They may sit close to the TV because they like the patterns they can see close up. Their visual skills are often revealed by their ability to do jigsaws or construction toys at an early age, or with a much greater ability compared to their other skills.

Many children with ASD develop strict routines, such as having to watch a certain cartoon at a certain time, or having to watch their favourite DVD from beginning to end, including all of the end credits. If these routines are disrupted, the child may have a severe temper tantrum or act in a self-harming way by banging their head or biting their skin.

Children with ASD often seem unaware of pain and injuries that would prompt other children to seek their parent’s attention. Many parents whose children have ASD notice that they have a cut or a bruise, yet seem happy.

Children with ASD may suddenly become upset and distressed at certain sounds, such as a vacuum cleaner or a motorcycle, or the sudden appearance of bright lights.

Children with ASD often develop a strong dislike for certain foods. This is usually based on the texture or colour of the food rather than the taste. For example, they may refuse to eat soft foods that dissolve in their mouth, or white or beige food such as rice, potatoes and pasta. It is also common that they insist food is separated on the plate and does not touch, which may mean using an airline-style plate to help cope with this.

Signs and symptoms of ASD in school-age children

Some children with mild to moderate ASD may see an improvement in their symptoms as they grow older. Sometimes, attending school gives them an opportunity to learn the social and communication skills that come naturally to children without ASD.

Children with more severe ASD may find the school environment increasingly stressful. This can trigger episodes of disruptive and difficult behaviour.

Signs and symptoms that can develop in older children and teenagers are explained below.

Language

Although most children with autistic disorder or PDD-NOS improve their language skills, specific difficulties with language may persist, such as:

•referring to themselves as "you", "she" or "he" rather than "I"

•repeating words and phrases, "parrot fashion", that they have just heard or have learnt from watching a film or TV programme

•speaking in pre-learned phrases, such as "I want it now" or "Where are we going?" rather than putting together individual words to form new sentences

•an unusual rhythm, stress or tone in their speech

•being unable to start or join in with a conversation unless it is about specific topics that interest them, such as dinosaurs or trains

In older children with Asperger syndrome, problems with their use and understanding of language often become more apparent. They include:

•talking "at" somebody, rather than having a two-way conversation

•being unable to adapt the tone and content of their speech to different social situations, for example speaking very formally at a party and then speaking to total strangers in a familiar way

•taking people’s speech literally and being unable to understand humour, sarcasm, metaphors or figures of speech

Social interaction

Older children with ASD often have additional problems at school because they do not understand how to interact socially.

This lack of understanding occurs in a variety of ways. For example, they may not realise that people usually relate to their teacher differently from how they relate to their classmates.

A child may have little interest in issues and activities that are popular with other children, such as music, fashion, sport or going out.

Many children with ASD are not aware that they are intruding into other people’s personal space. However, they can become extremely upset if they feel that their own personal space is being invaded.

All these factors often make it difficult for your child to make friends with children of the same age. However, some children with ASD do manage to form relationships with younger children or adults.

Behaviour

A child with ASD is likely to need strict routines as they get older. Many children with ASD develop a highly specific interest in a particular subject or activity, which usually involves collecting, numbering or listing.

This can range from a usual childhood activity, such as collecting football stickers (though children with ASD often pursue the interest much more intensely than other children) to activities or subjects not normally associated with childhood, such as an interest in train timetables or reading old computer manuals.

Children with ASD may move on from one intense special interest to another after a few months or years. They may wish to hold their special interest toy all the time, and even take it to bed with them rather than a cuddly toy.

Children with ASD prefer rigidity and predictability. Changes, even small ones, may result in major tantrums. This could include not being able to wear the socks they've worn for a week, or having a trip to the park suddenly cancelled for a trip to the swimming pool.

Tantrums are common and it's often difficult for parents to work out what has caused them. However, they usually occur because something they weren't expecting has happened or because the adult wants to make a change to the routine.

Children with Asperger syndrome often do well at academic subjects that involve facts, figures and logic. But they may struggle with subjects that require abstract thought, such as English Literature or Religious Education.

There is currently no cure for ASD. However, a wide range of treatments, including specialist education and behavioural programmes, can help improve symptoms. Read more about treating ASD.

In England, it is estimated that 1 in every 100 children has an ASD. The conditions are more common in boys than girls. Boys are three to four times more likely to develop an ASD than girls.

Types of ASD

The term "spectrum" is used because the symptoms of autistic spectrum disorder (ASD) can vary from person to person and range from mild to severe.

It is also common for children with ASD to have symptoms or aspects of other conditions such as:

•attention deficit hyperactivity disorder (ADHD)

•Tourette's syndrome or other tic disorders

•epilepsy 

•dyspraxia (developmental co-ordination disorder)

There are three main types of ASD:

•autistic disorder, sometimes known as "classic autism"

•Asperger syndrome

•pervasive developmental disorder – not otherwise specified (PDD-NOS), also known as "atypical autism"

Autistic disorder

Children with autistic disorder usually have significant problems with language, social interaction and behaviour. Many children with autistic disorder also have learning difficulties and below-average intelligence.

Asperger syndrome

Children with Asperger syndrome have milder symptoms that affect social interaction and behaviour. Their language development is usually not affected. However, they often have problems in certain areas of language, such as understanding humour or figures of speech ("It's raining cats and dogs", for example).

Children with Asperger syndrome usually have intelligence within the normal range. Some children have particular skills in areas that require logic, memory and creativity, such as maths, computer science and music.

Pervasive developmental disorder – not otherwise specified

PDD-NOS is diagnosed in children who share some, but not all, of the traits of autistic disorder or Asperger syndrome.

Most children with PDD-NOS have milder symptoms than children with autistic disorder, but they do not share the language skills and normal range of intelligence associated with Asperger syndrome.

Autism in children

Autism can normally be diagnosed in children at around the age of two. However, it can be difficult to diagnose as the symptoms will often only become more noticeable as they get older.

See your GP if you notice any of the symptoms of ASD or if you’re concerned about your child’s development. You can discuss your concerns together in depth before deciding whether your child should be referred for a specialist assessment. Read more about diagnosing autism.

If your child is diagnosed with ASD, there will be many things to consider as a parent, including coping with daily life at home and choosing the right school. Read a parent's guide to autism for more information about coping with your child’s diagnosis.

Autism in adults

Some people with ASD grow up without ever being diagnosed, sometimes through choice. However, getting a diagnosis of autistic spectrum disorder (ASD) as an adult can often help people with ASD and their families understand the condition and work out what kind of support they need.

A range of autism-specific services is available to help adults with ASD find advice and support, get involved in leisure activities and find somewhere they are comfortable living.

Some adults with ASD may also have difficulty finding a job because of the social demands and changes in routine that working involves. However, they can get support to help them find a job that matches their abilities and skills.

Read more about living with autistic spectrum disorder (ASD) as an adult.

Are rates of autism increasing?

The number of diagnosed cases of ASD has increased over the past 20 years, but this does not necessarily mean that the condition is becoming more widespread.

Some experts argue that the rise in diagnosed cases may be due to health professionals getting better at diagnosing cases correctly. In the past, many children with an ASD may have been incorrectly labelled as "slow", "difficult" or "painfully shy", and not given the treatment they needed.

Some campaigners believe that the rise in cases is due to the MMR (mumps, measles and rubella) vaccine.

The MMR vaccine has been investigated extensively in a number of major studies around the world, involving millions of children. Researchers have found no evidence of a link between MMR and ASD.

In 2009, one of the country's leading ASD charities, the National Autism Society, released a statement supporting the claim that there is no link between MMR and ASD.

In the US, a compound containing mercury called thiomersal, which is used as a preservative in some vaccines, has also been claimed to cause ASD.

Thiomersal has been extensively studied and no evidence of a link to ASD has been found. Furthermore, thiomersal was removed from vaccines in the US after 1999, yet the rates of ASD have continued to rise.

Read more information about the causes of autistic spectrum disorder (ASD).

Outlook

Children with moderate symptoms who have average or above-average intelligence often grow up to be independent adults with jobs, long-term relationships and children.

Children with more severe symptoms who have below-average intelligence are likely to find it difficult to live independently as adults and may need additional care and assistance. However, there is no reason why they cannot enjoy a good quality of life.