Autism Developing Our Understanding

Part One Definition, Causation and Prevalence

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.’

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

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

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

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

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

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

Part Two Models of Understanding

The Triad of Impairments – Social Understanding – Social Communication – Imagination

The Triad of Impairments Social Understanding Imagination Social Communication

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

Central Coherence The ability to … – see the bigger picture – understand the context – get the gist

Executive Function Enables us to … 1.switch our attention from one thing to another 2.prioritise 3.make decisions 4.plan strategically

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)

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

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

Part Three The Impact of Autism

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

The First Wave of Impact The Effect of the Condition

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

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

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

The Second Wave of Impact Behavioural Issues

Fear Flight Fight

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.

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

Types of Flight Running away Refusal Self-absorption Obsession

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

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

The Third Wave of Impact The Attitudes of Others

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

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.