Autistic Spectrum Disorders Awareness Raising Information for health professionals

1 in 100 people have an ASD Many remain undiagnosed or misdiagnosed ASD is commonly found together with other medical conditions Identification and treatment of additional conditions should be given consideration

This is often referred to as the ‘triad of impairments’ - impairments in social interaction impairments in social communication impairments in social imagination All individuals with an ASD have impairments in the same three areas.

speechgestureseye contacttone of voice language

People with ASD may struggle to recognise and appreciate sarcasm. People with ASD may not be able to use or understand easily tone of voice, gesture and eye contact. Speaking in a monotone voice maybe lead to emotions being misinterpreted by others. Someone with ASD may not be able to use gesture or interpret others gestures. People with ASD may interpret language literally and so may misunderstand understand idioms (“pull your socks up”) and metaphors (“my head was spinning”). Avoiding eye contact maybe interpreted as the individual being rude, it is not.

building and sustaining relationships sharing giving and receiving compliments enjoying conversation showing concern for others understanding humour Individuals with an ASD have impairments in social interaction. The way in which the person is affected varies. These impairments can include difficulties in :

Children may find it difficult to play with other children. People with ASD find it difficult to develop and maintain friendships and relationships. Children with ASD may find turn taking and sharing difficult. People with ASD may not enjoy conversation in the same way, and therefore prefer to discuss factual issues rather than enjoying the interaction with another. People with ASD have difficulty in understanding the rules of social relationships. Children and Adults with ASD may find it difficult to show empathy, this can make them appear ‘cold’ to others.

predicting reactions and events relating to othersplanningproblem solvingcreative activitiescoping with changes

When problem solving, we rely on our social imagination to predict possible outcomes. This is difficult for someone with an ASD. People with ASD find it difficult to predict how others may be feeling or how they will react. People with ASD find planning difficult and often rely on calendars or planners to help them with this. Coping with changes can be difficult. People with ASD usually prefer routines to unpredictability.

(touch) tactile (movement) vestibular (body position) proprioceptive (looking) visual (hearing) auditory (smell) olfactory (taste) gustatory Many people with an ASD can have sensory issues. The individual with ASD’s perception of the senses can be heightened or decreased. All the senses can be affected :

decreased feelings of pain sensitivity to lighting difficulties around noisy areas inability to tolerate certain smells dislike of certain colours distress / anxiety in busy environments sensitivity to touch

repetitive and stereotyped behaviours such as spinning, flapping hands, counting, touching objects special interests interests in specific subjects, collecting items routines preference for routine, difficulties with changes in routine

Many people with an ASD find accessing primary healthcare services difficult. Here are some tips on how to help.

Making an appointment is often difficult for patients with an ASD – here is how you can help: Highlight on the patient’s file that the patient in question has ASD Arrange an appointment at the beginning or end of the clinic Allow extra time for the appointment Speak slowly and clearly When speaking make sure that they understand about what time, place and with whom the appointment has been made and follow up in writing if possible Be flexible, you may need to adapt current booking systems

Busy receptions and waiting areas can cause problems for patients with ASD, the patient with an ASD may struggle to understand social rules. Here is how you can help: Please do not make judgments, if the person appears unconventional and don’t think they are rude Start your conversation by using the person’s name to make sure you have their attention Direct them to a quieter available space for them to wait Areas with dimmer lights and less noise may be more comfortable Keep the patient informed of any delay in appointment times as soon as possible Allow parents or carers to stay with the individual if appropriate

Start every conversation by saying the patient’s name Using general questions may produce misleading answers, ask specific questions It can be useful to use pictures to help the individual point out areas of their body where their pain or problem is. Gain information from parents and carers where you have consent to do so Speak in a calm, clear voice, and pause frequently Allow a longer time for a response and repeat if needs be Provide literature that the individual can read at home

Physical examinations may be distressing to your patient with an ASD, here’s how to help: Find out about any sensory issues in advance, and make allowances Discuss any examinations or procedure with the patient before starting, use of pictures if necessary enlisting the help of a parent or carer to explain may be useful Use clear language, to make sure you are understood, don’t reply on facial expressions and body language Avoid using idioms, metaphors and analogies (hop on the scales, etc) Be willing to repeat yourself and explain things in a different way if needs be

Explain any referrals made clearly, and describe the process Give the onward service as much information as you can about your patient’s ASD