What is it ?
Autism represents a neurodevelopmental disorder in the areas of communication, socialisation and restricted interests. It is generally thought of as a genetic condition [quote style=”boxed” float=”right”]The important word in ASD is Disorder[/quote] and the recent advances in mapping the human genome have resulted in the identification of a number of genes linked to autism. There is absolutely no evidence that immunisations, dietary deficiencies or parenting have anything to do with autism. In a nutshell children with ASD were born this way.
What are the symptoms ?
Sometimes parents will realise that there infant is somewhat different from an early age, but generally diagnosis on average is between the ages if 2 yrs and 4 yrs. For Asperger’s this May be some years later. The main symptoms are communication, socialisations and restricted interests and behaviour.
Communication – in the toddler this will mean delayed language development. There are few words, and communication is rudimentary. Needs such as food and drink are indicated by taking an adult and leading them to a cupboard or the fridge. The toddler will appear to not really enjoy communication, but when they cannot be understood they can become very frustrated and tantrums are commonplace. The older child will have limited expressive language development, and the structure or words and sentences will be unusual. In Asperger’s the language milestones are met but the choice of words and literal pedantic use of sentences is clearly awkward and or unusual. The content will be restricted to certain topics and the conversation will be one sided. Sometimes the child will develop an accent seen or heard on television.
Socialisation – a key feature is the lack of interest in socialisation. Toddlers will have little eye contact and may ignore their name when it is called. They will appear to be in their “own World”. If prompted to play they may explore but under their terms and rules. They will find it hard to share enjoyment, for example they will not be interested in pointing out something that they find interesting, and will not be interested in showing their parents or siblings something they have found or created. Aloofness is common and they will become distressed if placed in socialisation situations. They will not be affectionate and will not respond to affection.
Restricted interests and behaviour – the toddler or child will repeatedly play with the same toy or object. Attempting to divert interest will often result in tantrums. Some children will watch the same DVD over and over and can mimic the vocabulary exactly. The objects of interest maybe unusual such as coat hangers or a broken wheel. In addition there is little pretend play. This means mimicking speaking on the phone or pretending to feed a doll, or making a pretend drink. Older children will have restricted subject interest, and those with Apergers will be science and maths orientated. In some subjects they can be extremely gifted, then appear to fail simpler tasks.
- Stimming – this term describes repetitive movements, such as rocking, walking in circles, twirling, hand flapping, flicking of switches, or repetitive play with an object. This is assumed to lessen anxiety and help children with ASD to focus on something comforting.
- Food Faddism – one of the most frustrating aspects for parents involves food. Children will like the same food, and often on similar plates and ‘not touching’. The child with ASD views food as simply fuel, to be consumed so they can return to their comforting activities. As long as this fuel encompasses the micro and macro nutrient requirements of the child there is no issue with eating the same food each night. It is worth seeing a dietician to have this evaluated and to occasionally check nutrient levels such as iron.
- Sensory issues – certain situations can be very distressing for such children. Traditionally this includes crowded noisy situations such as shopping centres, school assemblies, extended family events. In this situation there needs to be anticipation, planning and an escape option. This sensory overload can dramatically increase anxiety and requires careful management usually by those trained in dealing with autistic children.
- Savant skills – occasionally a child will portray and extraordinary skill. This maybe in maths, science, or the arts. History is littered with autistic ‘geniuses’ who have solved many of the science and maths problems of the World. Sometimes savant skills are found in music or even drama. These skills are seen more in those who have features of Aspergers Disorder.
Other Diagnoses that go along with ASD
Many children will have problems that are best thought of as coexisting. The most common is anxiety and attention deficit disorder. These can also occur together. These conditions will sometimes overide the features of autism and require psychologist support and sometimes medication.
- Anxiety will present persistent stimming, frequent behaviourial challenges, such as tantrums, trouble sleeping, stomach aches, headaches, and communicating distress. School is probably the most stressful period for those with ASD and anxiety is a common problem that requires a great deal of understanding and support from the school. One of the most important reasons for obtaining a diagnosis of ASD is the funding that is provided to schools to help support these children.
- ADD will present with limited focus, inability to complete tasks, distractibility, and poor impulse control. The child will be ‘all over the place’ and require extraordinary parenting above and beyond what their capabilities are. In class they will require one on one teaching to ensure completion of tasks and they can be exhausting and exasperating.
Once the diagnosis is clear there needs to be some goals established, focusing on the most significant ‘disorder of the disorder’. For those who have language impairment, communication support using speech pathologists and educators is a priority. Improving communication will enhance the effectiveness of further therapies. These will include behaviourial therapies, occupational therapy, and psychologist input. In the ideal situation the paediatrician or general practitioner will coordinate allied therapies and also access any government funding that is available as a result of the diagnosis. The Doctor may need to perform some blood tests to ensure the diet is adequate and also see if there are any specific ‘autism gene variants’ found. This is called a chromosomal microarray. There is also a need to consider diagnosing comorbid anxiety, and or ADD, and if warranted consider medication or psychiatric or psychologist support.
For the child who has Aspergers and is bright, finding a supportive school in my experience is probably one of the hardest challenges. This comes down to the individual teachers and their understanding or ‘mis’understanding of the condition. Schools need to be flexible, supportive and focused on the specific needs of the child. Bullying is rife with ASD children and keeping them safe and occupied prevents vulnerable periods. In turn children in the autistic spectrum may be difficult with their behaviour and provide extraordinary challenges for the school, the teachers and the other students. This is where an individual education plan should be developed and revised and periods during the school year where things have gone wrong. Some examples this flexible thinking include –
- Allowing the child early access to computers – many children with Aspergers have problems with fine motor skills and their handwriting is poor. Nowadays it would be more fruitful investing time in teaching typing skills than trying to improve handwriting. There are many free touch typing programs which will make this process enjoyable.
- Ensuring free time – such as lunch and recess are supervised – these vulnerable periods can be particularly damaging. Many schools will have a separate ‘safe’ room allowing access