AUTISM

Autism Spectrum Disorder 

Autism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour. It includes Asperger syndrome and childhood autism.

The main features of ASD typically start to develop in childhood.

In the UK, it's estimated that about one in every 100 people has ASD. There is no 'cure' for ASD, but a wide range of treatments including education and behaviour support can help people with the condition.

CAUSES

The exact cause of ASD is unknown, but it is thought that several complex genetic and environmental factors are involved. In some cases, an underlying condition may contribute to ASD.

In the past, some people believed that the MMR (mumps, measles and rubella) vaccine caused ASD, but this has been investigated extensively in a number of major studies around the world, involving millions of children, and researchers have found no evidence of a link between MMR and ASD.

Risk Factors

Factors thought to increase the risk of developing ASD, known as ‘risk factors’, can usually be divided into five main categories:

Genetic factors – certain genetic mutations may make a child more likely to develop ASD.

Environmental factors – during pregnancy, a child may be exposed to certain environmental factors that could increase the risk of developing ASD.

Psychological factors – people with ASD may think in certain ways that contribute towards their symptoms.

Neurological factors – specific problems with the development of the brain and nervous system could contribute to the symptoms of ASD.

Other health conditions – certain health conditions associated with higher rates of ASD

SIGNS & SYMPTOMS

ASD can cause a wide range of symptoms, and there are many different ways those symptoms can be grouped.

Signs of ASD in Pre-School Children

*Spoken Language*

Delayed speech development (eg - not speaking at least 10 different words by the age of two) or not speaking at all

Frequent repetition of set words and phrases

Speech that sounds very monotonous or flat

Preferring to communicate using single words, despite being able to speak in sentences

*Responding to Others*

Not responding to their name being called, despite having normal hearing

Rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)

Reacting unusually negatively when asked to do something by someone else

*Interacting with Others*

Not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space

Little interest in interacting with other people, including children of a similar age

Not enjoying situations that most children their age like, such as birthday parties

Preferring to play alone, rather than asking others to play with them

Rarely using gestures (such as pointing) or facial expressions when communicating

Avoiding eye contact 

Having repetitive movements such as flapping their hands, rocking back and forth or flicking their fingers

Playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something

Preferring to have a familiar routine, and getting extremely upset if there are changes to their normal routine

Having a strong like or dislike of certain foods, based on the texture or colour of the food as much as the taste

Signs and Symptoms of ASD in School-Age Children

Preferring to avoid using spoken language

speech that sounds very monotonous or flat

Speaking in pre-learned phrases, rather than putting together individual words to form new sentences

Seeming to talk ‘at’ people, rather than sharing a two-way conversation

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

Reacting unusually negatively when asked to do something by someone else

Not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space

Little interest in interacting with other people, including children of a similar age, or having few close friends despite attempts to form friendships

Not understanding how people normally interact socially, such as greeting people or wishing them farewell

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

Not enjoying situations and activities that most children their age like

Rarely using gestures or facial expressions when communicating

Avoiding eye contact

Having repetitive movements such as flapping their fingers, rocking back and forth or flicking their fingers

Playing in a repetitive and unimaginative way, often preferring to play with objects rather than people

Developing a highly specific interest in a particular subject or activity

Preferring to have a familiar routine, and getting extremely upset if there are changes to their normal routine

Having a strong like or dislike of certain foods, based on the texture or colour of the food as much as the taste

ASD can cause a wide range of symptoms, which are often grouped into two main categories:

Problems with social interaction and communication, including problems understanding and being aware of other people's emotions and feelings. It can also include delayed language development and an inability to start conversations or take part in them properly.

Restricted and repetitive patterns of thought, interests and physical behaviours, including making repetitive physical movements, such as hand tapping or twisting, and becoming upset if these set routines are disrupted.

Children, young people and adults with ASD are often also affected by other mental health conditions such as attention deficit hyperactivity disorder (ADHD), anxiety or depression.

About half of those with ASD also have varying levels of learning difficulties. However, with appropriate support many people can be helped to become independent.

DIAGNOSIS

Autism features can often be recognised in children before the age of two or three years. However for many, the signs will often only become more noticeable as they get older.

See your GP or health visitor if you notice any of the symptoms of ASD, or if you’re concerned about your child’s development. It can also be helpful to discuss your concerns with your child’s nursery or school.

Parents usually notice the symptoms of ASD when their child is around two or three years old.

In some instances, mild cases may not be detected until adulthood.

Diagnosing ASD in Children

The health professionals that can help with diagnosis could be:

A psychologist – a health professional with a psychology degree, plus further training and qualifications in psychology

A psychiatrist – a medically qualified doctor with further training in psychiatry

A paediatrician – a doctor who specialises in treating children

A speech and language therapist – a specialist in recognising and treating communication problems

Some local health authorities now use multidisciplinary teams. These are made up of a combination of professionals who work together to make an assessment.

Assessment

There are no individual tests to confirm a diagnosis of ASD, a diagnosis is instead based on the range of features your child is showing. The type of assessment carried out often depends on things such as access to additional information (for example nursery or school records) and the skills of the professional or team seeing your child.

AFTER DIAGNOSIS

Parents may react in different ways when ASD has been confirmed. Some parents feel relieved because they now understand the reasons behind their child's behaviour and can begin to treat them. Other parents feel an immense sense of shock and disbelief, as they are naturally worried about what the diagnosis means for their child's future.

However, the diagnosis offers an insight into your child's individuality and personality. In turn, it gives you a chance to guide their development and growth.

When a child is diagnosed with ASD, many parents are keen to find out as much as they can about the condition.

TREATMENT 

There is currently no 'cure' for ASD. However, a range of specialist education and behavioural programmes can be effective in helping children with ASD.

There are many different types of help for ASD and it can be hard to judge which one will work best for your child as each person with ASD is affected differently.

Some types of help can involve hours of intensive work, and this is not always possible for many families because of the practical, emotional and financial commitments necessary

Some methods used to help ASD are:

Social-communication programmes

Your child may be offered a type of programme called a 'social-communication intervention'. This aims to help them communicate and interact with people and make social situations easier. Depending on your child's age, these programmes may take place at school, or with a parent, carer or teacher.

Applied behaviour analysis (ABA)

Applied behaviour analysis (ABA) involves breaking down skills (such as communication and cognitive skills) into small tasks and teaching those tasks in a highly structured way, as well as rewarding and reinforcing positive behaviour while discouraging inappropriate behaviour.

ABA sessions are normally carried out at home, although some programmes can be integrated into schools or nurseries.

An ABA programme usually begins with simple tasks that become more complex over time, which can help your child's development by gradually improving their skills.

TEACCH

TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) is a type of educational intervention that places great emphasis on structured learning by using visual prompts. This is because research has found that children with ASD often respond better to information that is presented visually.

TEACCH is often delivered at special day centres, but you can also have training so you can continue the intervention activities at home.

Parent Education and Training

The parents of a child with ASD play a crucial role in supporting their child and helping them improve their skills.

If your child is diagnosed with ASD, it can be useful to find out as much as you can about life with the condition.

Communication Advice For Parents, Family & Friends

Communication is a particular challenge for children with ASD. Helping your child communicate can lead to reduced anxiety and improved behaviour.

You may find the following tips useful when communicating and interacting with the child:

Use the child’s name so they know you are addressing them

Keep background noise to a minimum

Keep language simple

Speak slowly and clearly with pauses between words

Accompany what you say with simple gestures

Allow extra time for the child to process what you have said

Improving Communication Skills

As well as the social-communication help mentioned above, a number of other treatments may be offered to specifically help overcome communication difficulties your child may have. 

These include:

Speech and Language Therapy

Speech and language therapy (SLT) is a type of skills training designed to improve your child's language skills. This can improve their ability to interact with others socially.

The therapist uses a number of techniques, such as visual aids, stories and toys to improve communication skills. 

Picture Exchange Communication System (PECS)

Some children with ASD find picture symbols helpful in allowing them to communicate more effectively, which is why an approach called the Picture Exchange Communication System (PECS) is sometimes carried out by trained specialists to help children with the condition.

PECS teaches children to communicate with adults by giving them cards with pictures on them. Over time, the child is taught progressively more difficult skills, such as using pictures to make whole sentences. This approach aims to eventually help children learn to initiate communication with others without prompting.

Makaton

Makaton is a communication programme that involves using signs and symbols in support of spoken language to help people with ASD communicate with others.

The signs used in Makaton are based on British Sign Language and each sign has a corresponding symbol. These symbols are simple drawings that can often be used independently of the signs. These signs or symbols can be used with speech to help provide extra clues as to what someone is saying.

Over time, as their speech and language skills develop, many people with ASD will stop using the signs or symbols naturally at their own pace and start to rely more on their speech to communicate.

Makaton can be helpful in improving basic communication in some people with ASD, as well as helping to improve social interaction and the ability to build relationships.

Psychological Therapy

If your child has ASD and a mental health problem (such as anxiety), or if their behaviour is causing problems, a psychological treatment may be offered.

Psychological treatments, such as cognitive behavioural therapy (CBT), involve meeting with a therapist to talk about feelings and thoughts and how these affect behaviour and wellbeing.

If a treatment like CBT is offered, the professionals involved in the treatment should also be aware of any changes that need to be made to the treatment because of the ASD. This might include more written or visual information (for example, worksheets and images), and using plain English.

Medication

No medication is available to treat the core symptoms of ASD, but medication may be able to treat some of the related symptoms or conditions, such as:

Problems sleeping – which may be treated with a medication such as melatonin

Depression – which may be treated with a type of medication called a selective serotonin reuptake inhibitor (SSRI)

Epilepsy – which may be treated with a type of medication called an anticonvulsant

Attention deficit hyperactivity disorder (ADHD) – which may be treated with a medication such as methylphenidate

aggressive and challenging behaviour, such as tantrums or self-harming – which may be treated with a type of medication called an antipsychotic if the behaviour is severe, or if psychological treatments (see above) have not helped

However, these medications can have significant side effects and are usually only prescribed by a doctor specialising in the condition being treated. If medication is offered, your child will usually have a check-up after a few weeks to see if it is helping.