The Nature of Autism and Autistic Spectrum Disorder
These notes were prepared to provide a brief introduction to the characteristics of Autism and ASD and their management for inclusion in the LEA Handbook on Special Educational Needs.
The current definition of Autism refers to a pervasive disorder involving severe impairment in the areas of social interaction and communication, stereotyped behaviours, and a preference for sameness.
Autism was first described in the 1940s and three particular disabilities have been defined as core and characteristic (the "triad") …..
The concept of "spectrum" indicates the wide range of levels of difficulty or of permutations of symptoms that may apply to all children diagnosed with autism, but these core characteristics will be observable to some degree in all cases. At the level of marked or severe difficulties, the children are likely to need specialist educational provision, but children towards the higher end of the spectrum will probably benefit from mainstream provision.
Asperger Syndrome, also first described in the 1940s, may be differentiable from high functioning autism in some specific ways, but is usually perceived as a less severe form of the condition whose characteristic signs include marked and sustained impairment in social interaction or play, restricted and repetitive behaviours and activities, particular interests to the exclusion of all others, and a strong dislike of changes to routine. Motor delays or clumsiness are commonly associated with this syndrome.
However, children with Asperger Syndrome have adequate vocabulary and expressive language, may have cognitive scores in the average range or above, and do not commonly experience additional learning difficulties. Consequently, diagnosis may be delayed until the difficulties with social interaction become evident, and the children are at increased risk for emotional or stress-related disorders as a result of the "invisibility" of the condition and the inappropriate expectations that may be applied.
Approximately 4 times more boys than girls are affected by autistic spectrum disorders.
Many of the (social) anomalies characteristic of autism may reflect a deficit in Theory of Mind in that the individual cannot readily appreciate the feelings, beliefs, or knowledge held by other people (and perhaps cannot fully recognise or interpret his or her own thought processes). Therefore, there will be stilted communication, a lack of self consciousness, and weakness in understanding or entering social situations.
Stimulus Over-Selectivity refers to the trend to respond only to part of a stimulus rather than the whole object or to the whole social setting. This may explain why some individuals with ASD are not confused by optical illusions or why they may be unusually proficient at tasks like copying patterns since they are able to examine the stimulus in small bits at a time.
Along the same lines, there may be a limit in Central Coherence which implies an inability to use context to make full sense of what is presented (eg words with similar appearance but different meanings and pronunciations like " There is a tear in my shirt /There is a tear in my eye " may present problems because of the lack of rapid scanning of the whole phrase or sentence to identify how to deal with the given word).
Executive Functioning, ie the ability to plan ahead, or to bring together bits of information from different sources, and to generalise or learn for experience, may be limited.
ASD is noted for idiosyncrasies in Attention. In very young children , the lack of capacity with regard to gaze monitoring and, therefore, to sharing attention may explain some of the social interactional problems. The absence of shared attention by around 18 months of age is a diagnostic pointer. Further, the individual with ASD may be able to focus well upon certain activities, especially those that he or she has chosen, but will probably have problems in shifting attention from one task to the next, especially if the type of attention required is also changing. For example, to move from some individually-pursued and quiet task to a whole class activity involving verbal interchange will be challenging.
Literalness or Concreteness in receptive language implies that nothing can be taken for granted in the individual’s understanding of instructions that are not specific, and humour or figurative speech will be very confusing. A request such as " Would you like to finish that writing now ? " may only evoke the answer "No" …. (and this might be wrongly interpreted by the teacher as provocative when this was not intended).
Further, this style might underlie the weaknesses in imaginative play so that, eg, a cardboard tube is a cardboard tube and not a telescope ; and there is a common need to see some direct purpose in activities so that certain games, such as football involving rushing to one end of the playground only to rush back again, would be seen as pointless by many ASD children.
Intervention and Management
A common theme still concerns the need for early diagnosis and for equally early intervention, and a range of approaches is available to use with young children with ASD. Significant components in such programmes include the understanding of, and involvement of the parents or carers in, the goals and strategies, consistency of application, and the capacity to generalise the skills learnt to different settings and occasions.
Early provision and structured support may not lead to a cure for autism, but they can enhance progress, reduce pressure and stress upon the child, and limit the incidence of maladaptive behaviours.
Mainstream inclusion is a viable prospect for those children with higher functioning autism or Asperger Syndrome, but flexibility of approaches and raised awareness of autistic "style" among staff (and, perhaps, peers as well) is required.
The major issue is concerned with reducing any stress in the children which might otherwise stem from some uncertainty over what is expected or from communication breakdown, and which might be reflected in what appears to be non-compliant or challenging behaviour.
The programme for any given child will be based upon individual observations and assessments, but basic strategies could well include some or many of the following :
A child with ASD can be successfully included within mainstream classes but this will depend on the willingness to adopt a whole-school approach whereby all staff are aware of the child’s needs and style, and can pursue shared targets and approaches.
The child is not going to be made ordinary so that it may be necessary long term to individualise the programme for social and scholastic progress … ie seek to modify the environment rather than the child.
All the above are available in hard copies from the Educational Psychologists working within Surrey Children’s Services, pending their accessability on line.
M.J.Connor September 2003
© Mike Connor 2003.
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