Sourced from http://www.nhs.uk/Conditions/Autistic-spectrum-disorder/Pages/Symptoms.aspx
Autism spectrum disorder (ASD) is the name for a range of
similar conditions, including Asperger syndrome, that affect a person's social
interaction, communication, interests and behaviour.
In children with ASD, the symptoms are present before three
years of age, although a diagnosis can sometimes be made after the age of
three.
It's estimated that about 1 in every 100 people in the UK
has ASD. More boys are diagnosed with the condition than girls.
There's no "cure" for ASD, but speech and language
therapy, occupational therapy, educational support, plus a number of other
interventions are available to help children and parents.
People with ASD tend to have problems with social
interaction and communication.
In early infancy, some children with ASD don’t babble or use
other vocal sounds. Older children have problems using non-verbal behaviours to
interact with others – for example, they have difficulty with eye contact,
facial expressions, body language and gestures. They may give no or brief eye
contact and ignore familiar or unfamiliar people.
Children with ASD may also lack awareness of and interest in
other children. They’ll often either gravitate to older or younger children,
rather than interacting with children of the same age. They tend to play alone.
They can find it hard to understand other people's emotions
and feelings, and have difficulty starting conversations or taking part in them
properly. Language development may be delayed, and a child with ASD won’t
compensate their lack of language or delayed language skills by using gestures
(body language) or facial expressions.
Children with ASD will tend to repeat words or phrases
spoken by others (either immediately or later) without formulating their own
language, or in parallel to developing their language skills. Some children
don’t demonstrate imaginative or pretend play, while others will continually
repeat the same pretend play.
Some children with ASD like to stick to the same routine and
little changes may trigger tantrums. Some children may flap their hand or twist
or flick their fingers when they’re excited or upset. Others may engage in
repetitive activity, such as turning light switches on and off, opening and
closing doors, or lining things up.
Children and young people with ASD frequently experience a
range of cognitive (thinking), learning, emotional and behavioural problems.
For example, they may also have attention deficit hyperactivity disorder (ADHD),
anxiety, or depression.
About 70% of children with ASD have a non-verbal IQ below
70. Of these, 50% have a non-verbal IQ below 50. Overall, up to 50% of people
with "severe learning difficulties" have an ASD.
Symptoms of autism spectrum disorder
The main features of autism spectrum disorder (ASD) are
problems with social communication and interaction.
See your GP or health visitor if you notice any of the
following signs of ASD in your child or if you’re concerned about your child’s
development.
Signs of ASD in pre-school children
Spoken
language
•delayed speech development (for example, speaking less than
50 different words by the age of two), or not speaking at all
•frequent repetition of set words and phrases
•speech that sounds very monotonous or flat
•preferring to communicate using single words, despite being
able to speak in sentences
Responding to others
•not responding to their name being called, despite having
normal hearing
•rejecting cuddles initiated by a parent or carer (although
they may initiate cuddles themselves)
•reacting unusually negatively when asked to do something by
someone else
Interacting with others
•not being aware of other people’s personal space, or being
unusually intolerant of people entering their own personal space
•little interest in interacting with other people, including
children of a similar age
•not enjoying situations that most children of their age
like, such as birthday parties
•preferring to play alone, rather than asking others to play
with them
•rarely using gestures or facial expressions when
communicating
•avoiding eye contact
Behaviour
•having repetitive movements, such as flapping their hands,
rocking back and forth, or flicking their fingers
•playing with toys in a repetitive and unimaginative way,
such as lining blocks up in order of size or colour, rather than using them to
build something
•preferring to have a familiar routine and getting very
upset if there are changes to this routine
•having a strong like or dislike of certain foods based on
the texture or colour of the food as much as the taste
•unusual sensory interests – for example, children with ASD
may sniff toys, objects or people inappropriately
Signs and symptoms of ASD in school-age children
Spoken language
•preferring to avoid using spoken language
•speech that sounds very monotonous or flat
•speaking in pre-learned phrases, rather than putting
together individual words to form new sentences
•seeming to talk "at" people, rather than sharing
a two-way conversation
Responding
to others
•taking people’s speech literally and being unable to
understand sarcasm, metaphors or figures of speech
•reacting unusually negatively when asked to do something by
someone else
Interacting with others
•not being aware of other people’s personal space, or being
unusually intolerant of people entering their own personal space
•little interest in interacting with other people, including
children of a similar age, or having few close friends, despite attempts to
form friendships
•not understanding how people normally interact socially,
such as greeting people or wishing them farewell
•being unable to adapt the tone and content of their speech
to different social situations – for example, speaking very formally at a party
and then speaking to total strangers in a familiar way
•not enjoying situations and activities that most children
of their age enjoy
•rarely using gestures or facial expressions when
communicating
•avoiding eye contact
Behaviour
•repetitive movements, such as flapping their hands, rocking
back and forth, or flicking their fingers
•playing in a repetitive and unimaginative way, often preferring
to play with objects rather than people
•developing a highly specific interest in a particular
subject or activity
•preferring to have a familiar routine and getting very
upset if there are changes to their normal routine
•having a strong like or dislike of certain foods based on
the texture or colour of the food as much as the taste
•unusual sensory interests – for example, children with ASD
may sniff toys, objects or people inappropriately
The exact cause of autism spectrum disorder (ASD) is
currently unknown.
It's a complex condition and may occur as a result of
genetic predisposition (a natural tendency), environmental or unknown factors.
Genes
Most researchers believe that certain genes a child inherits
from their parents could make them more vulnerable to developing ASD.
Cases of ASD have been known to run in families. For
example, younger siblings of children with ASD can also develop the condition,
and it's common for identical twins to both develop ASD.
No specific genes linked to ASD have been identified, but it
may be a presenting feature of some rare genetic syndromes, including Fragile X
syndrome, Williams syndrome and Angelman syndrome.
Environmental
triggers
Some researchers believe that a person born with a genetic
vulnerability to ASD only develops the condition if they're exposed to a
specific environmental trigger.
Possible triggers include being born prematurely (before 35
weeks of pregnancy), or being exposed in the womb to alcohol or to certain
medication, such as sodium valproate (sometimes used to treat epilepsy during
pregnancy).
No conclusive evidence has been found linking pollution or
maternal infections in pregnancy with an increased risk of ASD.
If appropriate, your GP can refer you to a healthcare
professional or team who specialise in diagnosing ASD, or someone who has
access to such a team.
The specialist or specialist team will make a more in-depth
assessment, which should be started within three months of the referral.
If you're referred to an individual specialist, they may be
a:
•psychologist – a healthcare professional with a psychology
degree, plus further training and qualifications in psychology
•psychiatrist – a medically qualified doctor with further
training in psychiatry
•paediatrician – a doctor who specialises in treating
children
•speech and language therapist – a specialist in recognising
and treating communication problems
Some local health authorities use multidisciplinary teams.
These are a combination of specialists who work together to make an assessment.
Assessment
A diagnosis of ASD is based on the range of features your
child is showing.
For most children:
•information will be needed from your GP, nursery or school
staff, plus speech and language and occupational therapists, about your child's
development, health and behaviour
•a speech and language therapist, and often an occupational
therapist, will carry out an assessment
•a detailed physical examination will need to be carried out
to rule out possible physical causes of your child's symptoms, such as an
underlying condition like neurofibromatosis or Down's syndrome
•the assessment will include a check for any coexisting
physical health conditions and mental health problems
In addition, for some children:
•you may be asked to attend a series of interviews so a
detailed family history and the history of your child's development and
behaviour can be drawn up
•your child
may be asked to attend a series of appointments so specific skills and
activities can be observed and assessed
Once this process is complete, a diagnosis of ASD may be
confirmed.
After
diagnosis
When a child is diagnosed with ASD, many parents are keen to
find out as much as they can about the condition. The National Autistic Society
has an excellent range of resources and advice.
Diagnosing
ASD in adults
Some people with ASD grow up without their condition being
recognised, but it's never too late to get a diagnosis. Some people may be
scared of being diagnosed because they feel it will "label" them, and
lower other people's expectations of them.
But there are several advantages to getting a diagnosis. It
helps people with the condition and their families understand ASD and decide
what sort of support they need. A diagnosis may also make it easier to access
autism-specific services and claim benefits.
It can be difficult to know which intervention will work
best for your child, because each person with ASD is affected differently.
Some types of intervention can involve hours of intensive work,
and this isn't always possible for many families because of the practical,
emotional and financial commitments necessary.
The National Autistic Society website has information about
the many different strategies and approaches available for ASD.
Any intervention should focus on important aspects of your
child's development. These are:
•communication skills – such as using pictures to help
communicate (as speech and language skills are usually significantly delayed)
•social interaction skills – such as the ability to
understand other people's feelings and respond to them
•imaginative play skills – such as encouraging pretend play
•academic skills – the "traditional" skills a
child needs to progress with their education, such as reading, writing and maths
The detailed assessment, management and co-ordination of
care for children and young people with ASD should involve local specialist
community-based multidisciplinary teams (sometimes called "local autism
teams") working together. The team may include:
•a paediatrician
•mental health specialists, such as a psychologist and
psychiatrist
•a learning disability specialist
•a speech and language therapist
•an occupational therapist
•education and social care services
Local autism teams should ensure that every child or young
person diagnosed with ASD has a case manager or key worker to manage and
co-ordinate their treatment, care and support, as well as their transition into
adult care.
The Research Autism website provides details of the many different
types of autism interventions, treatments and therapies.
Parent
education and training
The parents of a child with ASD play a crucial role in
supporting their child and improving their skills.
If your child has ASD, it's a good idea to find out as much
as you can about the condition. The National Autistic Society website provides
useful information and advice for parents, relatives and carers.
The Research Autism website is also a good source of
information and has a section about the different issues that living with
autism presents, including the impact of autism on the family.
Communication
advice for parents
Communication is particularly challenging for children with
ASD. Helping your child to communicate can reduce anxiety and improve behaviour.
The following tips may be useful when communicating and
interacting with your child:
•use your child's name, so they know you're addressing them
•keep background noise to a minimum
•keep language simple
•speak slowly and clearly, with pauses between words
•accompany what you say with simple gestures
•allow extra time for your child to process what you've
said
Parent support programmes
In-depth advice and support programmes are available for
parents of children recently diagnosed with ASD.
For example, the EarlyBird programme provided by The
National Autistic Society is a free three-month course for parents whose child
has been diagnosed with ASD, but hasn't started school yet.
The programme aims to inform and support parents, and offers
practical advice about looking after their child and helping them improve their
skills.
EarlyBird Plus is for parents of children who have received
a later diagnosis of ASD and are four to eight years of age. The programme aims
to address the child's needs at both home and school by training parents and
carers, together with a professional who regularly works with their child.
EarlyBird and EarlyBird Plus programmes are run by licensed
teams and are available in most parts of the UK. To find out if there's a team
in your area, call 01226 779218 or email earlybird@nas.org.uk.
Psychosocial
treatments
If your child's behaviour is causing problems, they'll be
assessed for possible triggers, such as a physical health condition, mental
health problem, or environmental factors.
A physical or mental cause will be addressed using
medication and/or psychological treatments.
In some cases, such as where a child with ASD also has an
anxiety problem, a psychosocial treatment may also be recommended. These are
supportive treatments that help people overcome challenges and maintain good
mental health.
The National Institute for Health and Care Excellence (NICE)
provides more information about interventions for challenging behaviour.
Medication
In some cases, medication may be prescribed to treat some of
the symptoms or conditions associated with ASD. For example:
•sleeping problems – this may be treated with a medication
such as melatonin
•depression – this may be treated with a type of medication
known as a selective serotonin reuptake inhibitor (SSRI)
•epilepsy–this may be treated with a type of medication
called an anticonvulsant
•attention deficit hyperactivity disorder (ADHD) – this may
be treated with a medication such as methylphenidate
•aggressive and challenging behaviour, such as tantrums or
self-harming – this may be treated with a type of education called an
antipsychotic if the behaviour is severe or psychological treatments haven't
helped
These medications can have significant side effects and are
usually only prescribed by a doctor who specialises in the condition being
treated. If medication is offered, your child will have regular check-ups to
assess whether it's working.
Treatments
not recommended
A number of alternative treatments have been suggested for
ASD. However, these should be avoided, because there's little or no evidence
that they're effective and some may even be potentially dangerous.
Treatments that aren't recommended for ASD include:
•special diets – such as gluten-free or casein-free diets
•neurofeedback – where brain activity is monitored (usually
by placing electrodes on the head) and the person being treated can see their
brain activity on a screen and is taught how to change it
•auditory integration training – a therapy that involves
listening to music that varies in tone, pitch and volume
•chelation therapy – which uses medication or other agents
to remove metal (in particular, mercury) from the body
•hyperbaric oxygen therapy – treatment with oxygen in a
pressurised chamber
•facilitated communication – where a therapist or another
person supports and guides a person's hand or arm while using a device such as
a computer keyboard or mouse
Funding
treatments
Some of the interventions for ASD take a lot of time and
labour, and can cost a significant amount of money if not available on the NHS.
Many local education authorities (LEAs) provide partial or
sometimes total funding towards specialist education and training, but this
varies widely between LEAs.
Adults
living with autism
Some people with autism spectrum disorder (ASD) grow up
without their condition being recognised, sometimes through choice.
However, a diagnosis can make it easier to access a range of
support services that may be available locally.
It's never too late to be diagnosed with ASD, although it's
not always easy because some local NHS authorities don't provide NHS funding
for diagnosing ASD in adults.
Read more about diagnosing ASD in adults, or see The
National Autistic Society website for further information about autism
diagnosis for adults.
Treatment
and support
With a proper diagnosis, adults with ASD may be able to
access local autism support services, if available in their area. You can
search for services for adults using the Autism Services Directory.
The healthcare professionals who diagnose you with ASD
should be able to provide more information and advice about the care and
support services available to you.
Read about assessing your care and support needs.
Examples of programmes that may be available in your local
area include:
•social learning programmes – to help you cope in social
situations
•leisure activity programmes – these involve taking part in
leisure activities, such as games, exercise, or going to the cinema or theatre
with a group of people
•skills for daily living programmes – to help you if you
have problems carrying out daily activities, such as eating and washing
Adults with ASD may also benefit from some of the treatments
offered to children with ASD, such as psychological therapy and medication.
Read more about the help and support available for people
with ASD.
Benefits
Adults diagnosed with ASD can also claim some benefits, such
as the Personal Independence Payment (PIP). This is the new benefit replacing
Disability Living Allowance (DLA) for people with a disability who are aged 16
to 64.
You can find out more about benefits for adults with autism
on The National Autistic Society website, or you can visit GOV.UK to read more
about benefits.
Accommodation
Adults with ASD can live in all types of housing. Some
people may be suited to a residential care home, while others may prefer to
live on their own and receive home support. Some people with ASD live
completely independently.
Supported living can work very well for some adults with
ASD, because it means they can choose a place to live in the community, either
alone or with other people, with the support they need. They may need 24-hour
care, or they my only need help with important tasks for a couple of hours each
week.
The level of support an adult with ASD needs will be decided
after your local authority's social services carry out an assessment, and it's
agreed with the person and their carer.
Read more about care assessments.
Employment
It can be difficult for people with ASD to find a job. For
example, they may find the work environment too noisy, or travelling to work
may be too stressful because of the crowds. Sudden changes in routine can also
be upsetting.
However, in the right job and with the right support, people
with ASD have much to offer. They're often accurate, reliable, and have a good
eye for detail. Being in a working environment can help the individual's
personal development tremendously.
Read about disability in the workplace and the Equality Act.
If you're having problems getting a job or staying in a job,
you may be able to access a supported employment programme in your local area.
These programmes can help you write your CV and job applications, and prepare
you for interviews. They can also help you choose which jobs would suit you and
provide training for that role.
Those providing the programme can also advise employers
about any changes that need to be made to the workplace to suit people with
ASD, as well as supporting you and the employer before and after you've started
work.
See The National Autistic Society website to find help with
getting a job.
Making
decisions
Someone with ASD may have the capacity to make some
decisions (for example, to decide what items to buy at the local shop), but
lack capacity to make other decisions (for example, making decisions about
complex financial issues).
Where someone is judged not to have the capacity to make a
specific decision after they've had a capacity assessment, that decision can be
taken for them – but it must be in their best interests.
