Autism and Asperger's Syndrome

Family Therapy UK

Autism Spectrum Disorder (ASD) now encompasses previously distinct diagnoses such as Asperger's Syndrome. According to DSM-5 and ICD-11 criteria, ASD is characterized by persistent deficits in social communication and interaction, along with restricted and repetitive patterns of behavior. Severity levels help tailor support to individual needs.

Peace

Autism is three to four times more prevalent in boys than girls. It is characterised by an emotional and intellectual detachment from people and the world around them.

There is some evidence to suggest that girls tend to be more seriously affected. It becomes apparent before the age of three years and it occurs in 2 to 5 children per 10,000. About three quarters of affected children have severe general learning disabilities. It is characterised by abnormal functioning in the areas of:

• Social interaction

• Difficulties with speech, language and non-verbal Communication

• Restricted, repetitive patterns of behaviours.

• Difficulties with imagination and inner language

Current research suggests autism has a strong genetic basis, with multiple genes likely involved. There is no evidence linking autism to vaccines or parenting style. Autism is a neurodevelopmental difference, not a disease.

Difficulties in socialisation

Autistic children have very poor awareness of the normal rules of social interaction. They miss the subtleties of normal conversations and behaviour. They are not aware of other people's emotions and can act in a way that appears inappropriate and out of place in the situation they are in. They often ignore other people and pay little more attention to their own parents than they do to strangers. They often shy away from touch and do not respond in a warm and positive way to hugs. This can be very difficult for parents. They can appear unfeeling and cold because they lack the ability to appreciate the effect of their behaviour on others and do not recognise the emotional signals that other children of a similar age have learnt.

Communication difficulties

Because of these difficulties, their communication is poor, often lacking in emotional content, sounding flat and without colour. Many autistic children are mute or find it difficult to hold a conversation or understand simple questions. They give the impression of being somewhere else and not connected to what is going on around them. They find it hard to develop their imagination and do not develop the normal world of make-believe that other children do. Often what they say, and the way they react, does not match the situation they are in.

Restricted and repetitive behaviours of behaviour

These children have restricted and repetitive patterns of behaviour. They can become rigid in their behaviour and find changes of routine very difficult to cope with. They find change of any sort difficult to cope with. For instance, having to change clothes, dealing with a change in the position of furniture, or ornaments or a favourite toy can be very hard for them to accept. They can develop rituals and become over interested in dates, objects, smells, ordering and collecting things. They can throw huge tantrums when confronted with change or a demand to stop a repetitive behaviour such as characteristic hand flapping, finger snapping, rocking and swaying.

Autistic children often develop fears and phobias. They can develop problems with eating and sleeping. They can develop aggressive behaviour and are prone to throwing tantrums. Where there is severe learning difficulty, there may be associated self injury such as biting or head banging. They can be hypersensitive to noise, smells or pain.

This condition stays with a person throughout their life, though it may show itself in different ways as the person matures and develops and their social situation changes. The characteristics of poor socialisation, communication and restricted and repetitive behaviours continue. Sometimes, these obsessions and interests can develop into genuinely useful skills such as mathematics, music or drawing, but this only tends to happen in the less severely affected.

These children can be very demanding emotionally and physically. They will benefit from your love and understanding, but will also need clear boundaries and rules, with constant gentle reminders to complete tasks. It is important to praise all children when they are doing well. If there are two of you parenting, try to share the load. If there are other children, be aware that they can become "helpers" or feel neglected. It is difficult for other children to complain about being neglected when they know how serious their siblings condition is. If you are struggling as a family, seek out help from your doctor and social services or a family therapist. Try to spend some separate time with your other children.

Some children with autism may be managed at home when they are young, but become too difficult for parents to cope with when they get older. In adolescence, sadly many symptoms become worse. Many young people lose the language skills they have developed and there can be more hyperactivity and aggression. About one in ten of these children can live independently, another 15% semi-independently whilst two thirds remain totally dependent. Most autistic adults live in institutions, but many remain at home in the care of their families. As parents age they may find it more difficult to cope, or some other problem or change takes place that makes management difficult. It is important to be honest with yourself. If you cannot cope, discuss your concerns with relevant family members and professionals.

There is no cure for autism, and interventions should focus on supporting autistic individuals to thrive. Recommended supports include structured educational programs, social skills training, and employment support. Biomedical treatments such as restrictive diets or hormone therapies are not recommended by NICE.

Web sites:

The National Autistic Society UK

http://www.nas.org.uk/

Autism UK Frequently asked questions for University Students

http://www.users.dircon.co.uk/~cns/index.html

http://www.cafamily.org.uk/

Dennis Neill

Family Therapist

Family Therapy UK

1st May 2008

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