Autism Spectrum Disorders

1. Autism Spectrum Disorders An introduction to ASD including a brief history, profile, implications and opportunity for discussion

2. 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.

3. 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 his fingers, crossing them about in the air. He shook his head from side to side...humming the same three-note tune. He spun with great pleasure anything 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)

4. Autism Spectrum Disorder Background / History Hans Asperger (Austria) Physician Identified similar group. 1944 – published dissertation on ‘autistic psychopathy’ in childhood. Published in German and in middle of Second World War - it took nearly 50 years before it was translated (Wing 1981) Many similarities with Kanner – use of ‘autistic’

5. Autism Spectrum Disorder Background / History Lorna Wing – research with Judy Gould (1979) Identified ‘threads of commonality’ amongst group of children referred for psychiatric help who were socially impaired. Wing’s ‘Triad of Impairments’ 1988 ‘The Autistic Continuum’ 1996 ‘The Autistic Spectrum’ – broader classification

6. Triad of Impairments Social Relationships Social Communication ASD Rigidity of Thought, Behaviour and Play (Social Understanding)

7. 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.

8. 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

9. Social 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)

10. Social 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!)

11. 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

12. 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

13. Beyond the Triad of Impairments The 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—

14. The Sensory World of Autism The Five Senses • Touch (includes balance and body awareness) Tactile: relates to touch ,pressure, pain, hot/cold Hypo- Holding others tightly High pain threshold Self-harming (biting, gouging etc.) Hyper- Finds touch painful/uncomfortable (Social aspect) Sensitivity to certain clothing/textures • Dislike of having things on hands/feet

15. The Sensory World of Autism The Five Senses • Touch (includes balance and body awareness) Vestibular: informs where body is in space Hypo- The need for rocking, swinging,spinning Hyper- Difficulties in activities which include movement (sport, dance) Difficulties in stopping quickly or during an activity

16. The Sensory World of Autism The Five Senses • Touch (includes balance and body awareness) Proprioception: where & how body is moving Hypo- 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.

17. The Sensory World of Autism The Five Senses • Sight Visual: helps to define objects, colours, space Hypo- Peripheral vision (central vision blurred) Poor depth perception (throwing/catching) Hyper-Fragmentation of images (too many sources) Focussing on particular detail (rather than whole).

18. The Sensory World of Autism The Five Senses • Hearing Auditory: informs about sounds around us Hypo- Partial or complete absence of hearing Enjoys noisy places/activities (bangs things) Hyper- Magnification or distortion of sounds Unable to filter out external sounds

19. The Sensory World of Autism The Five Senses • Smell Olfactory: Is the first sense we rely on Hypo- May be oblivious to strong odours May lick things indiscriminately Hyper- Smells appear intensified/overpowering. Toileting problems

20. The Sensory World of Autism The Five Senses • Taste Gustatory: Informs about various tastes Hypo- Likes very spicy/salted foods May eat anything (soil, grass, material etc) Hyper- Prefers bland (white) food Texture of food may be problematic (lumps)

21. The National Picture Estimated population of ASD (whole spectrum) in the UK National Autistic Society estimated the prevalence 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

22. 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

23. Discussion Points • Implications for education • Implications for families • Support networks (schools) • Support networks (families) • Any other questions?