What is Autism?
Autism & Asperger Syndrome are on the Autistic Spectrum, this is a developmental condition affecting the way the brain processes information and how a person communicates and relates to others.
People with Autistic Spectrum Disorders have difficulties in three main areas within their lives; this is referred to as the 'triad of impairments' (Lorna Wing and Judith Gould):
The Triad of Impairments:
- Impairment of Social Communication
- Impairment of Social Imagination
- Impairment of Social Relationships
However, how and to what extent each person is affected is unique and has resulted in the saying “once you have met 1 person with autism – you have met 1 person with Autism”.
- People with autism have difficulty understanding verbal & non verbal communication, they are unable to 'read' facial expression, gestures and social cues.
- People with Asperger Syndrome may have good expressive verbal communication but they may have difficulties in a two-way conversation, they may talk at you and have no interest in others opinions if they are not their own beliefs. They may talk obsessively on a topic of interest to them and be unable to draw the conversation to an end independently. Despite often having good expressive language skills people with Asperger Syndrome can take the spoken word literally, this can lead to confusion and misunderstandings.
An example of the challenges posed by an impairment of social communication:
- 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
- People with autism have difficulties forming relationships; they often appear aloof and indifferent to other people.
- Many people with Asperger Syndrome want to be sociable, but may lack the social skills to interact in a conventional way. They find it hard to understand non-verbal signals, including facial expressions, which make it difficult for them to form and maintain social relationships with people who are unaware of their needs.
- Difficulty understanding the ‘rules of society’ and identifying what is expected behaviour in different situations.
- People with autism have limited development of interpersonal play & imagination. This limited range of imaginative activities may be pursued rigidly and are often repetitive, i.e. lining up toys or repeatedly watching the same video.
- Also may have difficulty comprehending time and predicting the future or what may happen.
- People with ASC will lack the Theory of Mind meaning that they find it difficult to imagine what other people are thinking, to empathise or see how their actions might affect another person.
- Will often develop obsessive interests, hobbies or collections, with encouragement these interests can be developed positively into areas of study or employment in their favourite subjects.
- People with Asperger Syndrome often excel at learning facts and figures, but find it hard to think in abstract ways.
- People with Autistic spectrum disorders often find change difficult to manage and even upsetting. They often prefer to order their day according to a set pattern, which provides continuity and stability for them. Any breaks in routine can cause immense anxiety and or panic attacks where daily functioning becomes, at worst, impossible.
People with autism will often have an accompanying learning disability, but people with High Functioning Autism and Asperger syndrome will generally have an above average intelligence.
People with High Functioning Autism have similar traits to those with Asperger Syndrome, although people with Asperger Syndrome generally have an awareness of their disability and that they are 'different' from others, coupled with a desire to 'be like everyone else' i.e. have friends, a girl/boyfriend or a job - this awareness and desire can often cause problems for the individual.
Kanner's ‘Classic’ Autism
Using the continuum model, Kanner's Autism is most often used to define individuals on the autistic spectrum with a higher degree of Learning Disability.
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
People with Kanner's Autism can be described as being severely affected by the Triad of Impairments, which can have a dramatic and detrimental effect to their quality of life. See Triad of Impairments for more information.
Individuals on the autistic spectrum with average to high intellectual functioning, 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
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.
People with Asperger Syndrome or High Functioning Autism often have a very complex presentation: getting a diagnosis can have many positive outcomes.
- A diagnosis of Autistic Spectrum Disorder makes it clear 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 in regards to 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, 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.