Children with autism usually experience difficulty in three main areas: social interaction, social communication and imagination and cognitive flexibility. Each of these diagnostic features can be present in different forms and varying degrees.
Difficulties with social interaction can include not understanding the subtleties of social situations, recognising and interpreting other people’s feelings, managing emotions or making and maintaining friendships.
Difficulties with social communication tend to encompass problems with using and understanding verbal and non verbal language, such as modulating tone of voice and gestures.
Children with autism also tend to present with difficulties with creative play, intense interests and lack of flexibility.
What causes autism?
The exact causes of autism are still not yet fully understood.
Research seems to suggest that there is a genetic influence that increases the child’s risk of having autism. For example, if one child in a family has autism, a sibling has a three to five per cent chance of also having the condition or a related problem, such as a language disorder. This is a much higher rate than in the population as a whole.
There are also many other theories about possible causes of autism, however none of these have been proven by scientific research. For example, autism has been previously linked with MMR vaccination, but several large research studies investigated this in depth and have not found any such link.
The possible impact of diet has also been suggested to be one of the causes, but again this has not been proven to be the case when this was investigated further.
A concern has been raised about the increasing rate of children being diagnosed with autism now as compared to the 1980s. However, it is believed that this is likely to be due to increased awareness and better recognition rather than a genuine increase in the number of children.
What are the signs and symptoms of autism?
The onset of autism is usually apparent prior to or around three years of age.
However, for children who might have more subtle difficulties or are very able, the symptoms may be recognised only when they are older.
This is because some children are very well supported in their home and nurseries and their difficulties are not so apparent until they are expected to be more independent.
People also sometimes think that children will ‘grow out of it’, or their difficulties tend to be attributed to their personality or other issues, such as shyness or ‘being naughty’.
There are a range of early signs that parents tend to report. These include a child’s avoidance of eye contact, a child’s different way of communication, for example the child may not be sharing their interest or curiosity with others, although they may be able to request what they want.
Young children with autism spectrum may also have reduced non-verbal communication, and may not point or gesture. Some parents notice that their child’s play may be different to that of their peers, for example lacking in creativity and imagination.
Many children with suspected autism may have difficulty in joining with other children and may prefer to play alone or with adults. Children with autism have delayed development of language, which tends to be one of the most frequent causes for concern.
The world can be confusing for children with autism. They often have trouble understanding the subtleties of how to ‘read’ and relate to other people. This might mean they may not pick up social cues, or may behave in ways that are considered to be socially inappropriate.
Many autistic children find change upsetting and often prefer familiar routines, which enable them to understand and know what is going to happen every day. In school, this may lead to a child being seen as uncooperative or difficult. They might, for instance, become very anxious when ask to sit on a different place in class.
Some children will develop intense interests, which they prefer to engage with most of the time and can become distressed if interrupted.
Sensory sensitivities are another common problem. This can mean a child’s sense of sight, sound, smell, touch or taste is intensified (hyper-sensitive) or under-sensitive (hypo-sensitive). For example, some children can find certain sounds (such as vacuum cleaner) or textures (eg certain fabrics) very uncomfortable, or even distressing.
However, it is also important to recognise specific strengths that children with autism often present with.
They can have much better attention to detail, may be very precise, trustworthy and reliable. Some people report that a child with autism would never lie or break a promise they have given.
It is also possible to help children to channel their intense interests into developing useful skills.
How is autism normally diagnosed?
Getting a diagnosis for a child can be helpful, as it enables parents, as well as others, to understand and support the child better.
Diagnostic assessment can also help to clarify if a child requires any extra support or resources for their special needs. Support from voluntary organization and opportunities to meet parents of children with similar difficulties can also be a source of great support.
The assessment of autism tends to be conducted at child developmental centres or by child and adolescent mental health services by professionals such as paediatricians, psychologists, speech and language therapists or psychiatrists.
It usually involves detailed interviews with the child’s parents/carers concentrating on the child’s early development and current behaviour, direct play assessment with the child as well as collecting information from the child’s nursery or school.
The child’s GP can refer them to an appropriate specialist.
How is autism normally treated?
There is no known cure for conditions on the autism spectrum. However, there have been many useful approaches and programs developed to help the child with specific difficulties which may be impacting on their quality of life or which may be in the way of their optimal development.
Some of these programs tend to focus on helping the child to develop communication, such as PECS (Pictorial Exchange Communication System).
Other approaches may be based on more traditional behavioural techniques designed to teach basic learning skills, such as ABA (Applied Behavioural Analysis), or on implementing clarity and predictability children with autism tend to thrive on, such as TEACH (Treatment of Autistic and Communication Handicapped Children).
Children with autism can be very effectively supported through people around them having an increased awareness of their condition, their support needs and their unique profile of their strengths and difficulties.
Families of children with more severe difficulties may also require some practical support or access to specialist resources to help them to support the child.
There is no ‘best’ intervention for children with autism. An intervention that helps one child may not be suitable for another, so parents should always seek professional guidance.
Parents are advised to be cautious about any treatment that claims to ‘cure’ autism.
What happens next?
Autism affects every child in a different way.
Many children with autism may develop a range of coping strategies and grow up to lead relatively independent lives. Others may need long term support to help them lead fulfilling life.
When children are younger it can be difficult to predict how their particular difficulties will develop as they get older.
There can also be specific times in life when their difficulties may be more apparent, for example during puberty or transition to secondary school or adulthood.
It is helpful to be aware that young people with autism are at increased risk of developing other difficulties, such as anxiety, depression or behavioural problems. These conditions are not part of autism and are often treatable, so it is important to seek professional advice if concerns arise.
While it is beneficial to help children with areas of difficulty, it is equally as important to support children in the areas of their strengths. It is often the child’s strengths that increase their quality of life, help them to achieve their potential and contribute to society.