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 DiseasesICD 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 girlAsperger’s Syndrome = 9 boys to 1 girl

• Increasing prevalenceBetter identificationNeo-natal care

Part Two

Models of Understanding

The Triad of Impairments

– Social Understanding

– Social Communication

– Imagination

The Triad of Impairments

Social Understanding

ImaginationSocial 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

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.