Autism Spectrum Disorders

An introduction to ASD including a brief history, profile, implications and

opportunity for discussion

Autism Spectrum Disorder• Developmental disorder affecting children from

birth or the early months of life.• Exact cause remains unknown, but generally felt

to be neurological in origin, although recent research points to possible genetic or chromosomal abnormalities as well as viral infections, pregnancy/birth complications and/or other causes.

• May co-exist with other medical conditions e.g. fragile X syndrome, tuberous sclerosis.

• Often accompanied by additional learning difficulties (about 75%).

• No single consistent explanation at the moment.

Autism Spectrum Disorder

Background / History Leo Kanner (USA) Child Psychiatrist

Paper published in 1943 based on study of 11 cases. Resulted in identification of a separate condition – Autism.

He wandered about smiling, making stereotyped movements with hisfingers, crossing them about in the air. He shook his head from side toside...humming the same three-note tune. He spun with great pleasureanything he could seize upon to spin….When taken into a room, he completely disregarded the people and instantly went for objects, preferably those that could be spun….( Kanner 1943)

Autism Spectrum Disorder

Background / HistoryHans Asperger (Austria) PhysicianIdentified similar group.1944 – published dissertation on ‘autisticpsychopathy’ in childhood.Published in German and in middle of SecondWorld War - it took nearly 50 years before it

wastranslated (Wing 1981)Many similarities with Kanner – use of ‘autistic’

Autism Spectrum Disorder

Background / HistoryLorna Wing – research with Judy Gould (1979)Identified ‘threads of commonality’amongst group of children referred forpsychiatric help who were socially impaired.

Wing’s ‘Triad of Impairments’1988 ‘The Autistic Continuum’ 1996 ‘The Autistic Spectrum’ – broader

classification

Triad of Impairments

Social Relationships

Social Communication

Rigidity of Thought, Behaviour and Play

(Social Understanding)

ASD

Communication• Some children may not use spoken language to

communicate, and may use non-verbal means instead, e.g. pushing, biting, squealing, crying

• Even children with developmentally appropriate verbal skills may have problems with their use of language when talking to others (pragmatics). They may have difficulties with their non-verbal communication as well.

• May not understand subtle conversational clues e.g. facial expressions indicating surprise, anger etc. and may therefore not know to look contrite.

• May have difficulties with concepts e.g. more / less, time (including the need to wait)

• Inability to ask questions to establish another persons view point, but may ask repetitive questions e.g. What's your name? This may mask unspoken anxieties in the child or indicate that they have not understood.

Communication

• Some children may use unusual intonation with stereotypical, stilted speech (or a sing-song intonation pattern)

• May have a very literal understanding of speech - therefore may fail to follow a lot of classroom language e.g. "its time to go outside" may mean “take your apron off, get your coat and line up at the door" but a child with ASD may think they can go straight outside and may consequently appear disobedient. Literality can lead to distress e.g. “go to the toilet and wash your hands"

• Repetition of chunks of language heard in other situations/videos - may sound clumsy or odd

Social RelationshipsSocial Relationships• Child may display general awkwardness in social situations• May be unable to interact appropriately with peers• Difficulty in making friends – may initiate and want social contact, but lack understanding and skills to carry through• Unusual facial and/or physical gestures (smiles, grimaces, eye-contact)

Social RelationshipsSocial Relationships• Problems with social “distance”

• Child may have difficulties with conventional turn-taking and sharing. May start/finish conversations abruptly or fail to answer appropriately.

• Child may not see themselves as a part of group• Motivation – may not be rewarded by success at tasks (They are not being lazy or obstinate!)

Rigidity of thought, play and

behaviour • Their play may be learnt and repeated. This means

that initially the child’s play skills may appear appropriate, but over time it is apparent that the child’s play sequences are not extending.

• Imaginative and symbolic play begins to emerge at around 2 to 2 ½ years, but for children with ASD their play may be repetitive and limited to specific actions, e.g. lining toys up, moving trains around a track

• May find activities difficult when imagination or pretend skills are needed, e.g. home corner, role play games

• Difficulty coping with adult direction and imposed routines

• Difficulties with understanding changes in routine and new situations

Rigidity of thought, play and

behaviour • Some children exhibit fixed interests and

may become obsessional about these• Attentional problems on tasks chosen by

others• Difficulties with problem solving, e.g. finding

an item that is not in its usual place• Seeing 'part' rather than 'whole' - not the

'bigger picture‘, e.g. focusing on a specific part of a picture

• Rigidity of thinking and behaviour – being a ‘class policeman’

• Perseveration - the need to repeat words, actions, activities etc

Beyond the Triad of ImpairmentsThe Sensory World of Autism

• Senses provide us with the unique experiences which allow us to interact & be involved with others

• Senses play a significant role in determining our responses to a particular situation

• Many individuals with autism experience either an intensification or absence of sensory integration

Hyper— Hypo—

The Sensory World of AutismThe Five SensesThe Five Senses

• Touch (includes balance and body awareness)

Tactile: relates to touch ,pressure, pain, Tactile: relates to touch ,pressure, pain, hot/coldhot/coldHypo- Holding others tightly

(Social aspect)Sensitivity to certain clothing/textures

High pain thresholdSelf-harming (biting, gouging etc.)

Hyper- Finds touch painful/uncomfortable

Dislike of having things on hands/feet

The Sensory World of AutismThe Five SensesThe Five Senses

• Touch (includes balancebalance and body awareness)

Vestibular: informs where body is in Vestibular: informs where body is in spacespaceHypo- The need for rocking, swinging,spinning

Hyper- Difficulties in activities which include movement (sport, dance)

Difficulties in stopping quickly or during an activity

The Sensory World of AutismThe Five SensesThe Five Senses

• Touch (includes balance and body awarenessbody awareness)

Proprioception: where & how body is Proprioception: where & how body is movingmovingHypo- Proximity – personal body space in relation to others.

Navigating rooms – avoiding obstructions.Hyper- Fine motor difficulties, manipulating small

objects (buttons, threading, shoe laces etc).

Moves whole body to look at something.

The Sensory World of AutismThe Five SensesThe Five Senses

• Sight

Visual: helps to define objects, colours, Visual: helps to define objects, colours, spacespaceHypo- Peripheral vision (central vision blurred)

Poor depth perception (throwing/catching)

Hyper-Fragmentation of images (too many sources)

Focussing on particular detail (rather than whole).

The Sensory World of AutismThe Five SensesThe Five Senses

• Hearing

Auditory: informs about sounds around Auditory: informs about sounds around ususHypo- Partial or complete absence of hearing

Enjoys noisy places/activities (bangs things)Hyper- Magnification or distortion of sounds

Unable to filter out external sounds

The Sensory World of AutismThe Five SensesThe Five Senses

• Smell

Olfactory: Is the first sense we rely onOlfactory: Is the first sense we rely onHypo- May be oblivious to strong odours

May lick things indiscriminately

Hyper- Smells appear intensified/overpowering.

Toileting problems

The Sensory World of AutismThe Five SensesThe Five Senses

• Taste

Gustatory: Informs about various tastesGustatory: Informs about various tastesHypo- Likes very spicy/salted foods

May eat anything (soil, grass, material etc)Hyper- Prefers bland (white) food

Texture of food may be problematic (lumps)

The National Picture

Estimated population of ASD (whole spectrum) in the UK

National Autistic Society estimated theprevalence at 1:100 No. of children with ASDs under 18

(est.) 133,500 (based on 2001 census – UK under-18

population of 13,354,297

The Local Picture

October 2006 – Yorks & Humbs ASD Regional Partnership Benchmarking questionnaire. Numbers of pupils in each regional Local Authority with ASDs.

Mainstream & Special School pupils from pre-school to Post 16

Rotherham incidence: slightly higher (approx 650 children with diagnosed ASDs

Discussion Points

• Implications for education• Implications for families• Support networks (schools)• Support networks (families)

• Any other questions?