Autism Spectrum Disorder Dr Andrew Greenhill Westminster Adult Autism Assessment and Diagnosis Service

Learning Outcomes What autism is and isn’t How someone with autism behaves Autism and homelessness How to support someone with autism What other help you might get

Why is there so much ASD on telly? Have a think about whether these characters from television might be on the spectrum. What characteristics do they have that suggest ASD? How do the friends and family communicate and manage these individuals?

What is autism? Unusual social communication Difficulty understanding and coping with social interaction and relationships Repetitive/ Rigid Patterns of behaviour and thinking Sensory sensitivities

What is autism Develops from early childhood (4/5 years) Is currently thought of as being caused bio-genetically, rather than through effects of parenting 1: 100 have an ASD, though some recent studies have suggested as high as 1:68

What is autism? Autism “Spectrum” describes the range and variation of the condition From people severely impaired, learning disabled, self-harming and challenging To people who have normal to above normal intelligence, and whose “autism” is more of a personality type

What autism isn’t A learning disability –A–About 50% of people with autism have learning disability –A–And many people with autism have specific, more narrow issues with intellect and cognition –“–“Islands of ability”

A mental health problem Though many people with autism have mental health problems too –Depression –Anxiety disorders –Schizophrenia –Personality Disorder

What is social communication? “Social Communication” currently signifies an absurdly large number of things –Basics of communication both verbal and non-verbal –Ability to manage conversation and interaction in a reciprocal style –Ability to understand people (empathy and theory of mind) and maintain relationships

Non-verbal communication What is it? Why would it be a problem if you struggled to understand it? Why would it be a problem if you couldn’t use it? –Underpins theory of mind and empathy Both intuitive and conscious

Non-verbal communication Eye contact – absence of Facial Expressions – limited and/or inappropriate Gestures – low frequency/ exaggerated Body orientation – too close/ far/ in slightly the wrong place Tone of voice – monotonic, inexpressive, unusual pitch and stress Timing exchange – interruption/ pausing

Non-verbal communication Integration with verbal communication –Used simultaneously with speech to start and stop communication –Regulating conversation and relationships Distance between people Touching Communicates hostility, fear, friendliness Communicates boredom, interest, indifference –Gets the message across

Non-verbal communication For two minutes have a go at conversing with someone sitting next to you about your last holiday, or favourite activity. You aren’t allowed to make eye contact.

Verbal communication Idiosyncratic or repetitive use of words Overly concise – little information offered on which to build a conversation Overly talkative– too much irrelevant, tangential or repetitive information given No speech at all/ “selective mutism” Inappropriate or unintentionally offensive comments “faux pas”

Relationships and social interaction People on the spectrum usually have fewer relationships Knowing when and how to start friendships Not understanding “boundaries” Some people with ASD find social situations unbearably threatening, others are indifferent to it, and others enjoy it, but are baffled by it Some people cope well, and feel no anxiety in front of an audience

Repetitive/ Rigid behaviour Again this can mean many things Coping with change – of expectations for the day, or in the immediate environment Rituals - verbal or behavioural Routines – dependence upon Unusual interests Overly intense interests Repetitive motor mannerisms/ postures

Sensory Sensitivities Unlike PowerPoint presentations it is impossible to change the volume, brightness and movement of the world. Many people with autism can find some sensory stimulation painful or extremely uncomfortable Or find some sensory stimulation extremely pleasant and calming

Sensory Sensitivities Examples include:

Sensory sensitivities

Strengths associated with ASD Attention to detail Determination and strength of will Straight talking from the hip Willingness to take on people Unconventionality and the ability to question received wisdom Communication Social relationships