A helping hand
MY AIM is to describe some of my assumptions and understanding of autism, which influences and assists my work with children and their families.
It is estimated that autism affects one in 150 children. Some recent studies have suggested the actual prevalence may be higher.
Whilst there is much that remains to be understood about autism, it is widely accepted that early intensive interventions can have significant benefits. For some children, this can assist them in being able to attend their local school in the future. For others, it may assist in ensuring that unhelpful or challenging behaviours do not become entrenched. Early detection is important, but diagnosis at any age can be helpful as it assists understanding and points a direction in which data and resources can be gathered from.
I’m using the term autism as an umbrella term for a wide spectrum of disorders, which are referred to as “autism spectrum disorders” (ASD). The most common of these are autistic disorder, atypical autism, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified. There are likely to be some changes in the labels we use for the ASD in the future, moving away from these specific titles and using solely the title “autism spectrum disorder”.
Autism is widely accepted as being a neurodevelopmental disorder as, for reasons that are not yet fully understood, the child’s brain develops atypically, which results in the development of a constellation of symptoms. One symptom (eg, lining up toys) does not make a diagnosis of autism. The diagnosis of ASD can be made by a psychologist, psychiatrist, or paediatrician with specialist training and experience in the diagnosis of ASD, and is best undertaken by a team of professionals experienced with children. It is important that the team have an understanding of the range that is normal for development, as well as an understanding of a range of special needs.
Children with ASD may have a range of clinical needs, including communication difficulties, impaired social awareness, sensory sensitivities, arousal regulation, emotion regulation, and behavioural difficulties. They may have other difficulties that are not part of their autism, but commonly seen with ASD children, such as impaired motor co-ordination, poor spatial awareness, obsessive-compulsive behaviours, attention difficulties, impaired language processing, and dyslexia.
This is why a team is needed to work with children on the autism spectrum, as their needs are complex and require the intervention of a number of professionals.
There appears to be a genetic link with autism, and therefore siblings of a child with autism have a greater chance of being diagnosed with autism spectrum disorder. ASDs tend to occur more often in people who have certain other medical conditions (eg, Fragile X syndrome or Down’s syndrome). There is no certainty about what causes ASD, and research is exploring genetic factors, disruptions or changes in brain development, and the influence of environmental factors on gene function.
The first signs of autism are most often present before the age of three, and some clinicians can identify the warning signs in children at an earlier age. Often, it is about the age of 15 to 18 months that parents first notice either a loss of skills or delays in development.
Autism is characterised by impairments in three areas:
* Social interaction with others.
* Communication.
* Ritualistic, obsessive or rigid/repetitive behaviours.
The signs may be obvious or subtle (for example, the child can speak but chooses not to play with others, preferring their own company), and the symptoms are varied. When an assessment is being carried out in relation to the diagnosis of autism, the clinicians will be considering the child’s overall development, presence of other conditions, and a number of others areas such as family history, life events, and stress.
Depending on the child’s age and their overall abilities, a person with an ASD might:
* Not respond to their name by 12 months.
* Not point at objects to show interest (point at an airplane flying over) by 14 months.
* Not play “pretend” games (eg, pretend to “feed” a doll) by 18 months.
* Avoid eye contact and want to be alone.
* Have trouble understanding other people’s feelings or talking about their own feelings.
* Have delayed speech and language skills.
* Repeat words or phrases over and over (echolalia).
* Give unrelated answers to questions.
* Get upset by minor changes.
* Have obsessive interests
* Flap their hands, rock their body, or spin in circles.
* Have unusual reactions to the way things sound, smell, taste, look, or feel
This description has so far focused on the needs of the child. Within clinical practice, the child is seen with their family. The parents are the ones up in the middle of the night when the child’s sleep cycle is out of sync. It is the parent who has to go home to explain to the child’s siblings what is going on in their brother’s life, whilst their heart is full of anxiety about their child’s future. It is the parents who have to deal with the behaviours whilst their child is on a waiting list for assessment or interventions.
For a child with autism, parenting alone is insufficient to influence development: The child needs a range of interventions and educational supports to teach the child skills that they have been unable to develop innately due to their neurodevelopmental condition. We are still learning ways to teach children, and as our understanding of neurological differences increases (and other aspects of ASD), so too have the interventions that we can provide to children on the autism spectrum.
* Dr Penny Rogers is a clinical psychologist. Parents with concerns about their child should discuss these with a GP. Further information can be obtained from the following organisations: Irish Autism Action; Aspire; Irish Society for Autism; Irishsupport.ie; Middleton Centre for Autism.
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