What can autism look like for someone:
-Challenges with communication and interacting with others
-Repetitive and different behaviours, moving their bodies in different ways
-Strong interest in one topic or subject
-Unusual reactions to what they see, hear, smell, touch or taste
-Preference for routines and dislike change
-Autism can affects the way that individuals interact with others and how they experience the world around them.
Every Individual on the Autism Spectrum is Different
‘If you’ve met one person on the autism spectrum, you’ve met one person on the spectrum.’
Prof Stephen Shore
No two people on the autism spectrum are alike. All people on the autism spectrum are different and will experience autism in different ways.
Secondary Conditions and Difficulties Associated with Autism
Some people on the autism spectrum may have other conditions as well, such as:
-speech and language difficulties
-anxiety and depression
-difficulties with fine and gross motor skills
There are other conditions that are associated with autism, including Fragile X Syndrome, Tuberous Sclerosis and other genetic disorders.
Understanding the Autism Spectrum
Autism can cause individuals challenges in understanding how to relate to other people and to their environment.
There is no physical marker for autism, so individuals on the autism spectrum look no different to anyone else. Parents sometimes report that others might think that their children are badly behaved and that they lack parenting skills, based on different behaviours, however this can be very unhelpful for a family.
Adults on the autism spectrum may struggle with social situations and ‘small talk’, thus appear rude or say things that others would not say. However, as social interaction is fluid and constantly changing, people on the autism spectrum may have challenges in keeping up with the verbal and non-verbal messages that are begin communicated.
Autism Spectrum Facts
-Autism affects around 1 in every 100-110 people.
-Autism is diagnosed in around four times as many males as females.
-Autism is a lifelong condition and there is no cure.
-Unemployment rates for individuals on the autism spectrum are around 65% compared with only about 6% for the whole population.
-Individuals on the autism spectrum are over-represented in the homeless population and in the justice system.
-On the positive side, early intervention can have tremendous results in helping those affected to live to their full potential.
-For older individuals, timely and meaningful support, advice and information can also be critical to quality of life outcomes.
Common Names for the Autism Spectrum
The term “Autism Spectrum Disorder” includes Autism/Autistic Disorder, Asperger’s Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS). These specific terms are often required for funding purposes.
Other terms you might hear are “high functioning autism”, “classic autism”, “Kanner Autism” or “atypical autism”.
Note: the latter terms are not thought to be very useful for diagnosis and treatment, and most diagnosticians tend to use the term Autism Spectrum Disorder to describe the varied presentation of individuals on the autism spectrum.
What are the Causes?
There is no known cause of autism. Much research is being done to try to find out more. At this point it is believed to result from changes to the development and growth of the brain, which may be caused by a combination of factors, including environmental and genetic ones.
There is an increased chance of having another child on the autism spectrum if there already is a child in the family who has a diagnosis, but no specific genes have yet been proven to cause autism.
Autism is not caused by parenting or social circumstances.
Autism is not caused by vaccination or other medical treatment.
Working with individuals on the Autism Spectrum
GPs and the Autism Spectrum
The general practitioner is usually the first port of call for an individual or a parent/carer the is concerned about the development of their child.
GPs need to have a good understanding of the autism spectrum (including Autistic Disorder and Asperger’s Syndrome), what common traits to look for and what the next steps are.
Find out more about the Autism Spectrum
As general awareness of the autism spectrum improves, the medical community is better able to recognise the signs, and diagnosis in pre-school children is increasing, with improved early intervention therapies providing a high level of assistance.
However, there are still individuals who do not receive a diagnosis until they are at school, at high school, or later in life. This is often the case where characteristics are less severe, where speech is not delayed or in girls and women, where the autism spectrum is not as likely to be the suspected.
Funding is provided through DSS, DOHA and DEEWR and support is available to children who have a DSM-IV diagnosis of Autistic Disorder, Asperger’s Disorder or, Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) or a DSM-5 diagnosis of Autism Spectrum Disorder (ASD).
Maternal and Child Health Nurses, Practice Nurses & School Nurses
As with GPs, nurses are well placed to notice developmental and behavioural differences in children, especially those who have the time to observe children regularly, as is the case in schools, local practices and child health centres.
It is therefore important to have a good understanding of the autism spectrum and to be able to identify characteristics that may signal the presence of it, and to refer parents to their GP or to a paediatrician for further assistance.
Individuals on the autism spectrum often require the assistance of an occupational therapist (OT), depending on the issues they experience.
The Autism Spectrum is such that individuals may have advanced skills in one area, but very limited skills in another. It is not unusual for an individual, for example, to be able to play a musical instrument, but not to be able to put their shoes on and there are many other similar examples of skills developing at very different rates.
As with all learned skills, it is possible for individuals on the spectrum to learn and make advances, with the right supports.
Occupational therapists assist individuals on the autism spectrum with the following:
-Sensory processing – helping individuals with their sensory and motor skills such as spatial awareness, body awareness and motor planning
-Fine motor skills – such as using scissors, pre-handwriting skills
-Gross motor skills – to improve strength, balance and coordination in physical activities
-Self care skills – such as dressing
-Social skills – play skills and interacting with peers
In addition, OTs may assist with visual perception, cognition, equipment advice and prescription, life skills and recreational advice.
To provide the best possible assistance to individuals on the autism spectrum, we recommend that OTs attend training and read more about the condition.
A major characteristic of the autism spectrum is difficulty with communication.
Some individuals on the autism spectrum are non-verbal whilst others have good verbal skills but difficulties with the social aspects of language, or have good language but lack understanding and their ability to communicate is impaired. Some are able to use alternative communication methods and have good communication skills but struggle with speech.
Another common characteristic of the autism spectrum is difficulty with social skills and this is can be closely allied with speech and communication difficulties.
While some individuals do not learn to speak, there are many stories of individuals making tremendous progress in this area with the right supports and therapies. Often, techniques such as signing and other communication methods, assist with speech development.
A speech pathologist is part of the multi-disciplinary team that makes a diagnosis of autism.
Speech pathologists work with individuals on the autism spectrum in the following areas:
-Receptive language – how the individual understands information given verbally or in written form
-Expressive language – how individuals express their needs and wants, thoughts and feelings. This can involve using picture symbols, signs, gestures or communication devices.
-Articulation – how the individual makes the sounds that make up words
-Social skills – understanding the unwritten social rules of conversation
-Cognitive skills – problem solving, making predictions and making inferences
Speech pathologists also assist with stuttering, eating and drinking, saliva control, voice and phonological awareness (such as rhyming skills).
To provide the best possible assistance to individuals on the autism spectrum, we recommend that speech pathologists attend specific autism training and read more about the condition.
Psychologists assist in two main areas with individuals on the autism spectrum:
-Diagnosis and assessment
-Treatment and intervention
Diagnosis and Assessment
Psychologists are part of the multi-disciplinary team that provides the assessment and diagnosis of autism. They will be involved in assessing the individual’s overall level of mental/cognitive development, in assessing the individual’s patterns of strengths and weaknesses, observing behaviour and social interaction, and in interviewing family members about the development and behaviour of the individual.
Treatment and Intervention
Psychologists are able to provide a range of treatments to improve:
-Behaviour strategies – working with individuals and/or their parents, carers, teachers, to encourage appropriate behaviours and reduce or eliminate inappropriate behaviours
-Social skills – working with individuals and/or parents/family members to encourage social skills
-Help with anxiety and mood – working with individuals and/or parents/family members to help with relaxation and mood improvement
-Planning and monitoring – developing a plan that other therapists, teachers and family members implement with the individual
-Support – assistance for other family members including parents and siblings to cope with the demands that living with an individual on the autism spectrum places on the whole family
To provide the best possible assistance to individuals on the autism spectrum, we recommend that psychologist attend training and read more about the condition.
A psychiatrist assesses an individual’s physical and mental health and development and looks for any medical conditions that may be associated with the autism spectrum.
The psychiatrist may order further tests, such as blood tests, to help diagnose certain conditions. Psychiatrists will also ask the individual or their family members questions about their development and the family history to help them to make a diagnosis of autism.
Psychiatrists may also diagnose mental illnesses such as depression or anxiety, which individuals on the autism spectrum may also display. It is important that psychiatrists making a diagnosis have a good understanding of the autism spectrum and other developmental conditions.
After the diagnosis Psychiatrists will continue to monitor their patients’ progress and development. They may make referrals to other professionals, such as psychologists or speech pathologists.
In some case Psychiatrists may prescribe medications for their patients. There are no medications to treat autism, but medications may help with associated problems, such as anxiety, depression, inattention and sleep problems.
Paediatricians who specialise in the Autism Spectrum are part of the multi-disciplinary team that makes a diagnosis of autism in children and adolescents up to 17 years old.
Paediatricians assess children’s health and development and look for any medical conditions that may be associated with the autism spectrum. They may order further tests, such as blood tests, to help diagnose these conditions. Paediatricians will also ask parents questions about their children’s development and the family history, to help them to make the diagnosis.
It is important that paediatricians making a diagnosis have a good understanding of the autism spectrum and other neurodevelopmental conditions.
After the diagnosis paediatricians will continue to monitor their patients’ progress and development. They may make referrals to other professionals, such as psychologists or speech pathologists. In some case they may prescribe medications for their patients.
There are no medications to treat autism, but medications may help with associated problems, such as anxiety, depression, inattention and sleep problems.
The Autism Spectrum is a neurodevelopmental condition and it may be the case that individuals with certain characteristics of the autism spectrum are referred to neurologists for assistance.
Neurologists may also be asked to conduct tests such as EEGs and MRIs on individuals with the autism spectrum to assess for the presence of any underlying or associated brain abnormalities or to make a differential diagnosis between the autism spectrum and other conditions that may have similar symptoms.
While there are no specific neurological tests for the autism spectrum, neurological conditions such as epilepsy can be present in individuals on the autism spectrum. Neurologists need to be aware of the characteristics of individuals on the autism spectrum that may make it more difficult for them to cope with or cooperate with neurological testing.
One of the characteristics often present in individuals on the autism spectrum is a difference in their responses to sensory stimuli – individuals may be hyper-sensitive or hypo-sensitive. This can make a visit to the dentist a lot more of an issue than it is for the general population.
If you are notified that your patient is on the autism spectrum, you can familiarise yourself with the condition so that you know how to help them. You may not be notified that your patient is on the autism spectrum, or you may be told that they have sensory issues. It is a good idea to find out as much about the specific sensory issues as you can from the patient or their parents/carers.
Schools and Education
The Autism Spectrum is very broad: some children attend mainstream schools, others attend specialist development schools, whilst others attend a mixture of both.
It would be unusual for any school not to have students on the autism spectrum present.
Therefore, the better prepared the school is, the better the experience for students on the autism spectrum, their teachers and other students.
Individuals on the autism spectrum have certain needs, which require understanding. Teachers, school nurses, welfare staff and education support staff are well placed to notice developmental and behavioural differences in students. Whilst parents are only familiar with their own child or children, you will have experience of many children, and differences may be more obvious to you.
Autism can make the world a very confusing place and an individual on the autism spectrum may experience high levels of anxiety. If they are unable to express this, it may manifest as a ‘meltdown’ or inability to cope with the situation.
Strategies for Students on the Autism Spectrum
Many of the typical strategies that assist students on the autism spectrum work very well with all students.
For example, a student on the autism spectrum may have difficulty choosing from multiple activities: instead, if they are offered just two choices, the decision can be easier to make. This same strategy works equally well with all students, especially young children.
Routine and Interruptions
Children on the autism spectrum like order and routine and find it very difficult when their day is disrupted or changed without notice.
For example, if an emergency teacher takes their class, they may find this extremely upsetting. Whilst for other students, this might be an enjoyable change, for a student on the autism spectrum, it can lead to high anxiety levels and stress.
This can be helped greatly by warning the students that there will be a different teacher, giving as much time as possible for them to take this in. Once again, this is something that not only helps the individual on the autism spectrum, but helps all students.
Preference for Visual Learning
As with the general population, the majority of students on the autism spectrum have a preference for visual learning: comprehension of visual information is understood better than verbal (auditory) information.
Visual timetables and visual representations of classroom rules are often a great help for students on the autism spectrum, and once again, help many other students as well.
Supporting the student
Education support staff may be employed to assist individuals on the autism spectrum: however, there is often little training provided.
Autism is a spectrum condition that differs from individual to individual, so it is important to understand the diad of impairments and sensory sensitivities that individuals on the autism spectrum are likely to experience.
We strongly recommend that you find out as much as you can about the student you are working with, from the child’s parents as a start. The parents know their child better than anyone and can tell you about their specific support needs. We also recommend that you undertake training and read as much as you can about the condition.