1. Understand how the different and evolving theories about autism reflect the complexity of autistic spectrum conditions Autism is a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them. It is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways. Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support. People with autism may also experience over- or under-sensitivity to sounds, touch, tastes, smells, light or colours. Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or above average intelligence.
They have fewer problems with speech but may still have difficulties with understanding and processing language. Some people live with autism for their entire life without ever getting a formal diagnosis. Often this is simply because autism wasn’t widely known or understood when they were growing up. For adults, a diagnosis of autism can help to explain why they have always found certain things difficult. For children, it can mean that the right support is put in place from an early age. Autism has been described as a ‘hidden’ or ‘invisible’ disability. Although historically associated with intellectual disability, it is now thought that most people with ASC will be within the normal range of IQ. Whatever the label used, the complexity of the autistic spectrum often renders it easier to misunderstand than it is to recognise. These difficulties, which can make access to services problematic, are further complicated by the generic nature of many services and the fragmented way they view and respond to ASC. As a setting we deal with many CYP with ASC, we accommodate these CYP as due to the high level of violence and behaviour difficulties they display ASC units or Schools for CYP with Specific Learning Difficulties cannot or will not accommodate them.
We support our CYP on the ASD spectrum and Asperger’s syndrome to help them achieve their full potential. This is because we have a very highly experienced and motivated team. As a staff team we have outside agencies such as the National Autistic Society and NEAS. We also have involvement from the local authority learning support staff that has worked closely with the CYP with autistic spectrum condition prior to them coming to us, these then come into our setting to give us the big picture on these CYP coming to our setting. These support staff are able to give us a clear picture of the needs and the history of these CYP before they reach our setting. This enables us the meet there needs, and make the transition from others schools and settings run smoothly. We also visit the CYP in their own environment as this gives them an opportunity to meet us in a setting in which they know and feel comfortable in. One of the most important points to understand about autistic spectrum conditions is that each CYP on the autism spectrum is an individual with their own unique characteristics. CYP with autistic spectrum conditions vary enormously in their abilities, needs, strengths, gifts, preferences and interests. No two individuals with a diagnosis of an autistic spectrum condition are the same, so it is essential not to make any assumptions about them. Autistic assignment causes and theories.
Many causes of autism have been proposed, but understanding of the theory of causation of autism and the other autism spectrum disorders is incomplete. The heritability of autism is complex and it is typically unclear which genes are responsible. In rare cases, autism is strongly associated with agents that cause birth defects. Many other causes have been proposed, such as childhood immunizations, but numerous clinical studies have shown no scientific evidence supporting any link between vaccinations and autism.
Autism spectrum conditions are present from birth or very early in life. They include childhood autism, Asperger’s syndrome, a typical autism and PDD unspecified. In practice many of these conditions may overlap with other disorders such as ADHD and affecting more boys than girls. Within my setting most CYP on the ASC spectrum have other conditions many quite complex. Other conditions are such as ADHD, ODD, conduct disorder, speech and language difficulties and Tourette’s syndrome. In practice although the prevalence in girls is said to be underestimated, these conditions are characterised by significant impairments in instinctive social behaviour, communication and a restricted or repetitive repertoire of behaviours and interests.
These ‘core’ features will affect the person’s ability to anticipate the thoughts and actions of others and predict day-to-day outcomes on the basis of normally occurring social cues. This lack of ability to anticipate and predict leads to high levels of stress within our CYP and they have difficulties in relating to others. Such difficulties may be accompanied by other neurological or psychiatric conditions that impact on behaviour and functioning and also on access to services and support. Such conditions include, disorders affecting sensory processing, anxiety, depression and mood, seizures and other medical problems.
Autism has a range of diagnostic criteria. This was described by Wing and Gould (1979) as the Triad of Impairments. The triad consists of: Problems with social interactions
Difficulties understanding and using non-verbal communications Stands to close to people
Unaware of different ways to interact with people
Difficulties initiating and maintaining conversations
Problems with communication
Asks repetitive questions.
Absence of a desire to communicate.
Communicates for own needs, rather than social engagement
Own interest based.
May be non-verbal, or delayed speech.
Problems with imagination
Does not understand other people’s thoughts or feelings – lack of Theory of Mind Does not like change in routines.
Special or focussed interests.
In additional to the three areas of the triad there are also associated difficulties. These include: Sensory difficulties
This may include hypersensitivities (over-sensitive) or hypersensitivities (under-sensitive). Mood disturbances – linked to the triad:
As there is an array of criteria within the impairments and associated difficulties the disorder is considered a spectrum condition. For individuals considered on the “higher” end of the spectrum the individual may have better, learnt social communication and interaction skills, whereas those on the “lower” end of the spectrum may have significantly delayed communication skills, including a lack of language. As discussed above, sensory and perceptual difficulties are highly common amongst individuals with ASC. These include both hyper- and hypo-sensitivities. See table 1.1
2 .Be able to promote to others positive communication strategies for individuals with an autistic spectrum condition. Autism is a varied and complex disorder which can affect individuals in a number of ways. ASC affects not only the individual with the diagnosis, but their whole family – parents, siblings and others close to them. Below are examples of how ASC can affect different people:
Individual diagnosed with ASC. Individuals with Autism Spectrum Condition’s lives are affected by a wide range of factors including: difficulties with communication, social interactions, sensory difficulties, flexibility. This impacts significantly on everyday functioning, whereby an individual may not be able to communicate their needs effectively, may have difficulty in social situations, may find everyday sensory input distressing , and changes in everyday life difficult to deal with, which then increases there anxiety level. As a setting we set out an action plan directed to every CYP’s individual needs, both in the school setting and residential setting. Each class/staff team have a copy of the plan and this helps us to deal with the individual needs of each CYP.
This enables us to prevent the CYP getting too anxious or distressed in situations. In the case of one of our CYP with communication difficulties, and also has autistic spectrum condition the action plan is a key concept in the day to day education and understanding for the young person involved, and also professionals and peers . If the CYP is not understood because of language barriers he becomes extremely frustrated and this has a detrimental effect on his behaviour. He will then display very disruptive and dangerous behaviour. We also use things like feelings cards so that the individual can express how they feel, rather than them get frustrated or get to a point and then become anxious.
When looking at how an individual on the autism spectrum are impacted within their lives it is important to look at the impact of factors such as gender, ethnicity, social, cultural and religious influences. For example, those from an Indian culture are very nurturing with family members with disabilities and autism. This means that the individuals’ need are met however there is not necessarily any progression or development. In another example, those from an Orthodox Jewish religious background can feel that having a person with autism in the family is shameful and as a result the individual is “hidden” from the wider community, this results in a lack of development with the individual with ASC. What further compounds difficulties for those with ASC are stereotyped views, discrimination and lack of understanding about the autism spectrum condition.
The media play a major role in promoting these misunderstandings. For example: There is a misunderstanding around the challenging behaviour associated with autism due to the communication and sensory difficulties in autism. In younger children it is often just seen as “bad behaviour” which should be “controlled” by the parents and the underlying causes are not fully understood. Due to the Film ‘Rain Man’ featuring Dustin Hoffman as an autistic man, many people who have seen the film have the perception that he is a typical person on the autism spectrum and that this is a true reflection. Although Dustin Hoffman’s character does have autism he also has savant syndrome which does not necessarily come hand-in-hand with autism (although 50% of savants also have ASC). Parents of individuals on the autism spectrum have their lives highly impacted upon due to their CYP’s condition, to ensure that a high level of observation is maintained to ensure their child’s safety, which can put huge strain and demand on them. Siblings of those with ASC can also be affected in their everyday lives due to the need of their siblings.
Due to parents having to “focus” on the sibling with ASC, siblings can often feel jealous or “left out” due to not having much attention. They may also feel restricted due to the changes required to meet the needs of their ASC sibling. Others close to those on the autism spectrum can have their everyday lives affected due to the changes required for the individual with ASC. This may be aunts and uncles or grandparents, whom try to give parents a break by looking after the CYP with autism or giving time and attention to siblings of the affected CYP.
* Focus on children – there is an over emphasis on children on the autism spectrum leading to a belief that the condition is child orientated and not a life-long disorder. This disadvantages those adults on the spectrum due to a lack of general understanding or awareness of the condition in adults on the autism spectrum. In supporting understanding about the condition, it is important to ensure that all involved are aware and understand the autism spectrum condition. It is important to assess the level of comprehension and cognition of the individual with ASC and then focus the information sharing about ASC at individuals’ level of understanding. It is important to ensure that parents, carers and siblings are well informed about their children’s/sibling’s condition.
After any review meeting or 6 weekly reviews we inform parents and carers of any progress made or any extra support that needs to be put in to place for our CYP. This is in order to ensure that they are aware of the support needs and intervention strategies to help develop an ASC individual. Further, it is very important to ensure that if an individual with ASC is within a care setting to keep parents and family informed of development so they can support this. Without the ongoing knowledge of the CYP’s progression they will still view their child as being at the same stage of development as they were when they went into the residential setting and as such not be able to support the ongoing development. 654 ~/