WHAT IS THE AUTISM SPECTRUM?
An autism spectrum disorder is a complex lifelong developmental disability that affects the way a person communicates and relates to people around them. The autism spectrum includes the syndromes described by Kanner and by Asperger but is wider than these two subgroups (Wing and Gould 1979).
Many people have a mixture of features from these two syndromes but do not fit neatly into either. The whole spectrum is defined by the presence of impairments affecting social interaction, social communication and social imagination, known as the triad of impairments. This is always accompanied by a narrow, repetitive range of activities. A range of other problems is also commonly found in association with the triad but the three basic impairments are the defining criteria. Individuals who are considered to be on the autism spectrum are all very different. The range of intellectual ability extends from severely learning disabled right up to normal or even above average levels of intellect. Similarly, linguistic skills range from those who are mute to those who display complex, grammatically correct speech.
What causes autism spectrum disorders?
The exact cause or causes of autism have not yet been fully established although research is continuing on a number of fronts. It is evident from research that autism can be caused by a variety of conditions which affect brain development and which occur before, during or after birth. They include, for example, maternal rubella, tuberous sclerosis, lack of oxygen at birth and complications of childhood illnesses, such as whooping cough and measles. Twin and family studies suggest a genetic link in autism but the sites of relevant genes have yet to be identified.
Is there an effective treatment?
An autism spectrum disorder is a lifelong disability; children with the condition grow up into adults with the condition. However, with appropriate intervention early in life, specialised education and structured support, a child can be helped to maximise their skills and achieve their full potential as adults. Estimated prevalence rate of people with autism spectrum disorders in the UK is 91 people in every 10,000.
The importance of early diagnosis
It is crucial that an autism spectrum disorder is recognised early in a person's life to enable the most effective intervention and management of the condition. Early diagnosis and intervention is also essential to ensure families and carers have access to appropriate services and professional support. Certainly the signs are there to be recognised. In most cases the triad of impairments emerge in the first two to three years of life - indeed there are often indications of developmental problems within the first year. However, because autism spectrum disorders are complex it is easy to miss important clues. Although the characteristics of autism are generally evident in the first few years of life, the condition can go undetected for many years especially in those who are at the more able end of the spectrum where the signs are more subtle.
Characteristics of autism - The triad of impairments
The items making up the 'triad' can be shown in a wide range of different ways. The manifestations vary with the severity of the disability. Changes occur with age, especially in those with higher levels of ability; different aspects of the behaviour pattern are more obvious at some ages than at others.
Education and the social environment can have marked effects on overt behaviour; in a very structured setting, with one to one attention, the autistic behaviour may not be shown in any obvious way. It should also be remembered that all children have their own personality, which affects their reaction to their disabilities.
Impairment of social interaction
The most severe form is aloofness and indifference to other people although most enjoy certain forms of active physical contact and show attachment on a simple level to parents or carers. In less severe forms, the individual passively accepts social contact, even showing some pleasure in this, though he or she does not make spontaneous approaches. Some children or adults with the triad approach other people spontaneously, but do so in an odd, inappropriate, repetitive way and pay little or no attention to the responses of the people they approach.
Among the most able adolescents and adults, the social impairment may have evolved into an inappropriately stilted and formal manner of interaction with family and friends as well as strangers. It has been suggested that the problem underlying social impairment is lack of the in-built ability to recognise that other people have thoughts and feelings - the absence or impairment of a so-called theory of mind.
Impairment of social communication
A lack of appreciation of the social uses and the pleasure of communication is always present in one form or another. This is true even of those who have a lot of speech, which they use to talk at others and not with them. A lack of understanding that language is a tool for conveying information to others is another typical example of the communication impairment. Some are able to ask for their own needs but have difficulty in talking about feelings or thoughts and in understanding the emotions, ideas and beliefs of other people.
Many are unable to convey or comprehend information by using gesture, miming, facial expression, bodily posture, vocal intonation etc. Some more able people do use gestures but these tend to be odd and inappropriate. Those with good vocabularies have a pedantic, concrete understanding and use of words, an idiosyncratic, sometimes overly formal choice of words and phrases, and limited content of speech. Some verbal people with autism are fascinated with words and word games but do not use their vocabularies as tools of social interaction and reciprocal communication.
Impairment of social imagination
In children, inability to play imaginatively with objects or toys or with other children or adults is an outward manifestation of this impairment. A tendency to select for attention minor or trivial aspects of things in the environment instead of an imaginative understanding of the meaning of the whole scene is often found (eg attending to one earring instead of the whole person, a wheel instead of the whole toy train). Some of these children display a limited range of imaginative activities, which may be copied, for example, from TV programmes, but they pursue these repetitively and cannot be influenced by suggestions from other children. Such play may seem very complex, but careful observation shows its rigidity and stereotyped nature. Some watch soap operas or read particular types of books, such as science fiction, but the interest is limited and repetitive.
Some confuse fiction and reality and tell rambling stories they seem to believe are true. Some do not know the difference between dreams and reality. Many lack understanding of the purpose of any pursuits that involve comprehension of words and their complex associations, eg social conversation, literature, especially fiction, subtle verbal humour (though simple jokes may be enjoyed). There is a consequent lack of motivation to indulge in these activities, even if the necessary skills are available. In adults, the proper development of imagination is shown in the ability to use past and present experiences (both ones own and other peoples, the latter from personal social communication and books, plays and films) in order to predict consequences of actions and make plans for the short and long term future. This aspect of the mature imagination is conspicuously lacking in people with autism spectrum disorders, whatever their level of ability. The consequence of the impairment of imagination is a very narrow range of repetitive activities or special interest. These can take simple or complex forms. Children of higher levels of ability tend to show more complex routines. The following are only some examples of stereotyped activities. The possible variations on this theme are endless.
Com a colaboração: The National Autistic Society