What is ASD?

Autistic Spectrum Disorder (ASD) is a continuum condition. The most widely accepted definition of Autism was formulated by Wing and Gould (1978); they identified a Triad of Impairments in people with ASD.

• Impairment of social relationships
• Impairment of social communication, and
• Impairment of imagination

Autism arises as a consequence of the interaction of these three impairments, therefore all three must be evident to diagnose Autism. The degree to which an individual is affected by each of the three impairments can vary significantly.The impact of the condition on each individual, in how they think, feel and behave is unique to that individual.

Brookdale's services reflect this in individually formulated care and treatment plans.  The term continuum is used because the triad can be present in individuals along the normal distribution curve of intellectual ability. The way that each individual is affected by the triad is also along a continuum, that is, one person may have more deficits in the area of imagination than in social relationships or social communication.

At Brookdale we prefer to refer to our clients as having an Autistic Spectrum Disorder, and recognise within that the commonly identified groups e.g. Asperger syndrome, High Functioning Autism, Kanner's Autism etc. Individuals with average to high intellectual functioning, but demonstrating characteristic features of the Triad of Impairments, are on the Autistic Spectrum but can be described as having Asperger syndrome or High Functioning Autism. Hans Asperger first published his definition of the Syndrome, that bears his name in 1945.

Hans Asperger identified:

• Social impairment - extreme egocentricity
• Speech and language peculiarities
• Repetitive routines
• Motor clumsiness
• Narrow interests
• Non-verbal communication problems

Using the continuum model, Kanner's Autism is most often used to define individuals with more global intellectual impairment; however, as Kanner indicates there is often no immediate way to accurately assess the intellectual or cognitive functioning of someone with Kanner's Autism. Kanner's definition of Autism was first published in 1943 as:

• An inability to relate to people and to situations from early life
• A failure to use language for communication with others
• An anxiously obsessive desire to maintain sameness
• A fascination for objects,or parts of objects, which are handled with skill in fine motor movements
• Good cognitive potential

Brookdale Care provides services for individuals across the Autistic Spectrum. The services are needs led and based on a thorough multidisciplinary assessment of each individual client. Having a diagnosis and assessment of how an individual is affected within the Triad of Impairments is essential, because this information can facilitate access to funding, treatment and effective risk management.

People with Asperger syndrome or High Functioning Autism often have a very complex presentation and getting a diagnosis can have many positive outcomes.

• A diagnosis of ASD verifies that 'odd' behaviour is the result of a pervasive developmental disorder, not mental illness or personality disorder
• Parental guilt may be relieved, enabling them to concentrate on seeking help, rather than wondering what went wrong
• Parents and carers have a reference group available for mutual support
• Placements can be evaluated to see how they can meet the characteristic needs of the condition, as uniquely expressed in each individual
• Communication can be augmented or tailored to most effectively overcome individual problems in information processing
• The individual can be given emotional support and therapy appropriate to the characteristic needs of the condition and their idiosyncrasies
• Behavioural management and risk assessment can be designed to meet the characteristic problems and needs of the condition
• Making the connections between the behaviours we observe and the cause of those behaviours, creates understanding
• Understanding the cause of the behaviour gives us the opportunity to predict, plan for and promote the positive and prevent the negative.
• It enables an individual to gain insight into their difficulties and find ways to manage them more effectively
• Expectations can be realistically structured and practical plans made for the future

The triad of impairment impairment of social relationships

• Aloof - over-formal or stilted in social contact, to schizoid and isolative behaviour, including becoming electively mute and complete withdrawal from interpersonal interactions. In extreme circumstances individuals may neglect all aspects of personal care and hygiene and some decompensate into a psychotic state.
• Active but odd - own needs seen as priority, little ability or desire to live in communal situations with others. Little or no concept of consensus or compromise. Little or no understanding of social rules and societal norms. These difficulties are compounded by deficits in interpreting non-verbal behaviours, abstract concepts and complex language.
• Passive - accepts social approaches with indifference, will often comply with all requests, therefore making them vulnerable to exploitation. May show some pleasure in social contact, but make no spontaneous approaches. Has difficulties dealing with stress and changes in routines.

The challenges posed by ASD impairment of social communication varies:

• People with no form of expressive communication and poor understanding
• People with what appears to be perfectly grammatical speech
• Absence of any desire to communicate
• Echolalic and repetitive speech
• Expression of needs only
• Makes factual comments, often irrelevant to the social situation
• Talks incessantly regardless of response by others
• Displays distortions of the rules of language
• Literal interpretation
• Referring to self in third person impairment of imagination
• Difficulty in understanding that other people see things from a different point of view
• Inflexibility in the application of both written and unwritten rules that govern social behaviour
• Repetitive enacting of roles without understanding purpose
• Difficulties in generalising concepts
• Literal understanding of language
• Difficulties in distinguishing between ‘pretend’ and reality
• Lack of empathy for others.
• Impairment of creative imaginative concepts

Specific cognitive difficulties, including:

• Theory of mind deficits: e.g. inability to attribute thoughts and beliefs to others
• Executive function: e.g. difficulty with sequencing, organising and problem solving
• Central coherence: e.g. understanding cause and effect

Additional areas of difficulty often present in autistic spectrum disorder

• Repetitive and ritualistic activities.
• Inflexible routines
• Resistance to change
• Poor ability to manage anger and frustration
• Problems with sleeping, feeding and toileting
• Additional fears and phobias
• Severe anxiety
• Problems in gender identity
• Inappropriate expression of sexual feelings
• Anti-social behaviour
• Interpersonal violence
• Finding appropriate help and understanding
• Frustration at own difficulties in explaining to others why certain situations create insoluble problems
• Inflexibility in application of social rules, particularly where these apply to themselves
• Awareness of the social relationships normal to others and difficulty in achieving the same relationships
• Wanting to change but being unable to do so
• Insufficient understanding of their own condition
• Difficulty in coping with social demands and situations
• Knowing they are different
• Inability to be tactful - telling the literal truth all the time can make someone very unpopular
• Being very vulnerable to teasing by those who take advantage of their 'oddness' or literal interpretation of language and rules the challenges posed by ASD. Many people on the Autistic Spectrum have a history of unsuccessful placements. Finding the 'right' placement is the key to an individual reaching his or her maximum potential and enjoying the quality of life they deserve. Brookdale Care offers a highly specialist and inclusive service to people with an Autistic Spectrum Disorder. The needs led approach provides individually tailored care packages. Brookdale's staff are well-trained and well-supported by an experienced multi-disciplinary team of Psychiatrists, Psychologists, Speech and Language Therapists, Nurses, Teachers and Complementary Therapists. Brookdale can offer a dedicated and robust service for the most challenging of individuals.
• Remove distractions - emphasise what is relevant
• Keep language clear, simple and delivered in a calm manner
• Use visual guides – do not rely on the person's memory
• Find person's area of interest
• Avoid open-ended tasks or imaginative activities requiring abstract thought or concepts
• Build routines/rituals/ special interests into learning
• Use short tasks with frequent breaks
• Re-teach skills in each new setting
• Keep rules/approach consistent
• Use positive instructions

Brookdale Care has a multi-disciplinary team of specialist professionals, who can provide a thorough diagnostic service. If required Brookdale can provide periods of residential assessment for sectioned and informal patients, within our low secure specialist hospital.