Autism

1. Autism Developing Our Understanding

2. Part One Definition, Causation and Prevalence

3. APA Diagnostic Statistical Manual DSM-IV (1994) ‘Onset before three years of delayed or abnormal function in at least one of: social interaction, language for social communication, symbolic or imaginative play.’

4. WHO’s International Classification of DiseasesICD 10 ‘Impaired or abnormal development must be present before 3 years of age, manifesting the full triad of impairments.’

5. Autism: A definition A behaviourally defined neurological condition • What are the implications derived from this definition? • Problematic – diagnosis, treatment, management • Subjective – prevalence • Contentious – aetiology

6. What we do know is … • It accommodates a broad spectrum • It is complex, messy, ill-defined – there is no satisfying neatness • Our understanding is dynamic, evolving – we need to be open • It is an unhelpful notion for people seeking fixed definitions

7. What causes autism? • Not known for sure • Described as ‘multiple aetiologies’ • Increasingly strong evidence of genetic causative factors • Environmental factors

8. What we do know … • A number of factors cause an abnormality in brain development which leads to difficulties in particular areas of human functioning • It is not caused by upbringing • It is not a psychiatric condition

9. Prevalence • Estimated half a million people in the U.K. • 1:100 • Gender bias: Classical Autism = 4 boys to 1 girl Asperger’s Syndrome = 9 boys to 1 girl • Increasing prevalence Better identification Neo-natal care

10. Part Two Models of Understanding

11. The Triad of Impairments • Social Understanding • Social Communication • Imagination

12. The Triad of Impairments

13. Mind-blindness • People with autism lack a Theory of Mind • Theory of Mind is the ability to appreciate the mental states of other people • Evident from about age four onwards • Theory of Mind is essential for forming social groups

14. Central Coherence The ability to … • see the bigger picture • understand the context • get the gist

15. Executive Function Enables us to … • switch our attention from one thing to another • prioritise • make decisions • plan strategically

16. The Senses • Visual – what we see • Auditory – what we hear • Olfactory – what we smell • Gustatory – what we taste • Tactile – what we feel • Vestibular – where we are in relation to the world (balance) • Proprioceptory – where we are in relation to ourselves (co-ordination)

17. Sensory Issues • Hyper or hypo sensitive – do not easily filter information • Mono-processing • Difficulties with focusing on what neuro-typical thinkers consider salient information • Attention channel – incredible knowledge and detail in this

18. Recap • Triad of Impairments • Mind-blindness • Central coherence difficulties • Executive function disrupted • Sensory Issues

19. Part Three The Impact of Autism

20. Effect of the condition Behavioural issues Attitudes of others Three Waves of Impact

21. The First Wave of Impact The Effect of the Condition

22. Social Impairment • to read social situations • to understand social codes and expectations • to interpret facial expression and body language • to appreciate other people’s feelings • to engage other people through social ‘devices’ (smiles and small talk) • to determine the important components of social interaction • to organise actions into orthodox patterns

23. Communication Difficulties in a Communication Jungle • to comprehend much of what is said • to adequately express thoughts, needs, emotions, wishes • to discriminate who language is intended for • to discern a person’s tone of voice and what it might mean • to understand humour, idiom, sarcasm • to initiate communication • to recognise the need to reciprocate communication

24. Inflexible Thinking • to engage in pretend play • to project themselves into future situations • to comprehend a world outside their experiences • to access learning which relies on imagination • to understand deception • to think how others might think or feel how others might feel

25. The Second Wave of Impact Behavioural Issues

26. Behavioural Issues • Fear • Flight • Fight

27. Fear For many people with autistic spectrum conditions fear can be a dominant and often overpowering state of being. This stems from profound difficulties in understanding the world around them.

28. Flight • Enables us to escape danger or discomfort • Most of us have sophisticated ways of doing this • For the person with ASC this is problematic

29. Types of Flight • Running away • Refusal • Self-absorption • Obsession

30. Fight • Result of frustrations and fears • Immediate effect on the environment • Therefore it is addressed whereas other elements of the individual’s behaviour are ignored • Fight can be the consequence of missing lower impact behavioural issues

31. Addressing the Difficulty • Imperative these issues and the underlying issues are addressed • Limited repertoire of skills means that fight will be used increasingly and increasingly effectively • Real danger we only ever deal with symptoms and not underlying causes

32. The Third Wave of Impact The Attitudes of Others

33. Attitudes to Autism • Occurs as a result of the interaction between people with autism and other people • It is the area we can most readily affect by increasing our knowledge and sharing our understanding • Parents • Peers • Professionals

34. Summary • Autistic spectrum conditions are lifelong conditions which show themselves in the child’s behaviour. • Several useful conceptual models which help us understand the condition. • Three waves of impact on the person with autism. • Established approaches which are proven to be effective for many people with autistic spectrum conditions.