Autism
Developing Our Understanding
Part One
Definition, Causation and
Prevalence
APA Diagnostic Statistical Manual DSM-IV (1994)
‘Onset before three years of delayed or abnormal function
in at least one of: social interaction, language for social
communication, symbolic or imaginative play.’
WHO’s International Classification of Diseases
ICD 10
‘Impaired or abnormal development must be present
before 3 years of age, manifesting the full triad of
impairments.’
Autism: A definition
A behaviourally defined
neurological condition
• What are the implications derived from this definition?
• Problematic – diagnosis, treatment, management
• Subjective – prevalence
• Contentious – aetiology
What we do know is …
• It accommodates a broad spectrum
• It is complex, messy, ill-defined – there is no satisfying neatness
• Our understanding is dynamic, evolving – we need to be open
• It is an unhelpful notion for people seeking fixed definitions
What causes autism?
• Not known for sure
• Described as ‘multiple aetiologies’
• Increasingly strong evidence of genetic causative factors
• Environmental factors
What we do know …
• A number of factors cause an abnormality in brain
development which leads to difficulties in particular areas
of human functioning
• It is not caused by upbringing
• It is not a psychiatric condition
Prevalence
• Estimated half a million people in the U.K.
• 1:100
• Gender bias:
Classical Autism = 4 boys to 1 girl
Asperger’s Syndrome = 9 boys to 1 girl
• Increasing prevalence
Better identification
Neo-natal care
Part Two
Models of Understanding
The Triad of Impairments
– Social Understanding
– Social Communication
– Imagination
The Triad of Impairments
Social Understanding
Social Communication
Imagination
Mind-blindness
• People with autism lack a Theory of Mind
• Theory of Mind is the ability to appreciate
the mental states of other people
• Evident from about age four onwards
• Theory of Mind is essential for forming
social groups
Central Coherence
The ability to …
– see the bigger picture
– understand the context
– get the gist
Executive Function
Enables us to …
1. switch our attention from one thing
to another
2. prioritise
3. make decisions
4. plan strategically
The Senses
•
Visual – what we see
•
Auditory – what we hear
•
Olfactory – what we smell
•
Gustatory – what we taste
•
Tactile – what we feel
•
Vestibular – where we are in relation to the world (balance)
•
Proprioceptory – where we are in relation to ourselves (coordination)
Sensory Issues
• Hyper or hypo sensitive – do not easily
filter information
• Mono-processing
• Difficulties with focusing on what neurotypical thinkers consider salient
information
• Attention channel – incredible knowledge
and detail in this
Recap
• Triad of Impairments
• Mind-blindness
• Central coherence difficulties
• Executive function disrupted
• Sensory Issues
Part Three
The Impact of Autism
Three Waves of Impact
Effect of the condition
Behavioural issues
Attitudes of others
The First Wave of Impact
The Effect of the Condition
Social Impairment
• to read social situations
• to understand social codes and expectations
• to interpret facial expression and body language
• to appreciate other people’s feelings
• to engage other people through social ‘devices’ (smiles and small
talk)
• to determine the important components of social interaction
• to organise actions into orthodox patterns
Communication Difficulties in a
Communication Jungle
• to comprehend much of what is said
• to adequately express thoughts, needs, emotions, wishes
• to discriminate who language is intended for
• to discern a person’s tone of voice and what it might mean
• to understand humour, idiom, sarcasm
• to initiate communication
• to recognise the need to reciprocate communication
Inflexible Thinking
• to engage in pretend play
• to project themselves into future situations
• to comprehend a world outside their experiences
• to access learning which relies on imagination
• to understand deception
• to think how others might think or feel how others might
feel
The Second Wave of Impact
Behavioural Issues
Behavioural Issues
• Fear
• Flight
• Fight
Fear
For many people with autistic spectrum conditions
fear can be a dominant and often overpowering
state of being.
This stems from profound difficulties in understanding the
world around them.
Flight
• Enables us to escape danger or discomfort
• Most of us have sophisticated ways of doing this
• For the person with ASC this is problematic
Types of Flight
• Running away
• Refusal
• Self-absorption
• Obsession
Fight
• Result of frustrations and fears
• Immediate effect on the environment
• Therefore it is addressed whereas other
elements of the individual’s behaviour are
ignored
• Fight can be the consequence of missing
lower impact behavioural issues
Addressing the Difficulty
• Imperative these issues and the
underlying issues are addressed
• Limited repertoire of skills means that fight
will be used increasingly and increasingly
effectively
• Real danger we only ever deal with
symptoms and not underlying causes
The Third Wave of Impact
The Attitudes of Others
Attitudes to Autism
• Occurs as a result of the interaction between people with
autism and other people
• It is the area we can most readily affect by increasing our
knowledge and sharing our understanding
• Parents
• Peers
• Professionals
Summary
• Autistic spectrum conditions are lifelong conditions which
show themselves in the child’s behaviour.
• Several useful conceptual models which help us
understand the condition.
• Three waves of impact on the person with autism.
• Established approaches which are proven to be effective
for many people with autistic spectrum conditions.