what is autism?

by Claire Laurent

what is autism? | help and info

Talking to people and making friends are things we take for granted and it's these social skills that parents relish seeing develop in their children. From the first smile at six weeks, through to recognising family and learning to play with others.

© Getty

But children with autism may find it hard even to look others in the eyes or alternatively may stare, find making friends difficult and are often unable to understand other's feelings.

what is it?

Autism is a lifelong developmental disability affecting the way a person communicates and relates to others. It affects an estimated 535,000 people in the UK, about 1 in 110 people.

Children and adults with autism have difficulties with everyday social interaction. Their ability to develop friendships is generally limited as is their capacity to understand other people's emotional expression. People with autism can often have accompanying learning disabilities but everyone with the condition shares a difficulty in making sense of the world.

Asperger's syndrome Asperger syndrome is a form of autism. People with Asperger syndrome may have normal or even above average levels of intellect. They have the common traits with autism but usually have fewer problems with language than those with autism, often speaking fluently, though their words can sometimes sound formal or stilted. Children with Asperger's syndrome often attend mainstream school and, with the right support and encouragement to help them communicate appropriately and cope with the social demands, they can make good progress and go on to further education and employment.

People can be affected to a hugely varying extent, which is why it is sometimes called a 'spectrum disorder'. Autism is at the severe end of the autistic spectrum and is often associated with learning difficulties. For more on this issue, see our feature when your child has special educational needs. Mild versions of autism, without significant language disorder or learning disability, are often referred to as Asperger's syndrome. For more on this issue see the boxes Asperger's syndrome and Josh has Asperger's syndrome.

key signs

Many people on the autistic spectrum have a mixture of features from these two syndromes but do not fit neatly into either. Typically, they all show great resistance to changes in routine and all of them will have what is known as the 'triad' of impairments, which appear within the first three years. These are:

• Impaired social interaction
  Difficulty with social relationships, perhaps appearing aloof and indifferent to other people. It has been suggested that the problem underlying social impairment is a lack of the in-built ability to recognise that other people have thoughts and feelings.
• Impaired social communication
  Difficulty with verbal and non-verbal communication, for example, not understanding the meaning of facial expressions and tone of voice. Those at the high end of the spectrum may talk at others and not with them while those at the extreme end of autism may have few linguistic skills or may be mute.
• Impaired imagination
  Difficulty in developing play and imagination, often pursuing the same activity repetitively, possibly copied and pursued rigidly and repetitively. Children may focus on minor or trivial details while missing the imaginative understanding of the whole scene. For example, focussing on a wheel instead of the whole toy train.

In addition to this triad, repetitive behaviour patterns and resistance to change in routine are often characteristic.

what causes it?

It's not clear what causes autism, but it is thought to have a genetic link. It's likely that many genes are affected not just one and possible inheritance is complicated.

Medical conditions are thought to account for around 10% of cases of autism. Conditions that affect brain development and which occur before, during or after birth such as maternal rubella, tuberous sclerosis (an inherited disorder affecting the skin and nervous system), lack of oxygen at birth and encephalitis (inflammation of the brain usually caused by viral infection) have been associated. Complications of childhood illnesses, such as whooping cough and measles, may also be linked.

diagnosis

Children with autism look no different to other children, so their antisocial behaviour can be misunderstood by others and can make it hard for parents to get an accurate diagnosis. However, an early diagnosis is important so that parents can start to understand what they can do to help.

Angie Lee-Foster, Head of Policy & Campaigns at the National Autistic Society (NAS), says 'Asperger's syndrome typically doesn't get picked up until school age, although we often hear of people not picked up until secondary school and beyond. Autism is normally picked up by about two years old and there is work to show it can be earlier.'

Home videos can help here. An experienced doctor looking at a video of a child in his first year of life can look at the way a child interacts with his carer. For example, does the child look at an object, if the carer calls his attention and points at something, or does he disregard the pointing?

Health visitors and GPs will screen for overall developmental progress and if you and they continue to have concerns, will refer your child for a specialist assessment. The specialist will base his diagnosis on your child's developmental history and on observing the child. He may bring in other specialists such as a speech and language therapist or a psychologist to help with diagnosis.

older children and adults

People at the more able end of the spectrum are often aware that they are different to other people and they have difficulty in forming or keeping relationships. If undiagnosed their behaviour can appear odd, which can lead to bullying or teasing at school. Depression, therefore, can be a feature as the person gets older. It's also important to remember that a child's personality will affect their reaction to their disabilities. See the mind feature on depression.

getting help and treatment

Autism is a lifelong condition for which there is no cure. However, there is plenty parents can do and there are a range of therapies around, one of which may work well for your child. It is also crucial that you get a Statement of Educational Needs for your child. This will usually be through the specialist who diagnoses your child but you may have to enlist support from your GP and, if you child is at school, through the school's educational psychologist. For more information check out the feature on special educational needs

If your child has another condition alongside autism, such as epilepsy, ADHD or depression, these need to be treated too, perhaps with medication as well as help with managing their behaviour. See the feature on ADHD or go to the mind feature on depression.

It's important, too, to get support for yourself and the rest of your family. Your GP or health visitor may be able to put you in touch with a local support group or family with an autistic child, or you could contact the NAS (see help and info).

At home, the most common approaches you can take are mainly behavioural management but some people try dietary changes. Both are time consuming and draining for parents but the effort is worth it when your child responds. You can find out more about these therapies from your specialist or by contacting the NAS (see help and info) but it's important to consult your doctor or dietician before embarking on them so that you receive the best advice and support. The NAS runs Earlybird Centres in several different areas around the country which aim at early intervention and run programmes to teach parents the skills they need to help their child.

behavioural therapies

These behavioural methods aim to help people with autism and their families manage the condition while encouraging the child to achieve as much as he can. Children with autism often do better in a structured environment and with lots of one to one contact and this is the basis for all of these therapies.

TEACCH: The aim of the TEACCH programme, which was developed in the 1960s in the US, is to help prepare people with autism to live or work more effectively at home, school and in the community. There is an emphasis put on reducing the child's 'autistic behaviours' and parents are shown how to do this so they can continue the work of the professionals.

LOVAAS: An early intensive behaviour therapy approach, also developed in the US more than 30 years ago. It's a home-based programme consisting of one-to-one work with your child for six to eight hours a day everyday. It helps develop basic self-help, language and play skills and each achievement is rewarded. Parental involvement is a strong element of LOVAAS with parents being taught the necessary skills to continue therapy at home.

SPELL: This approach is still currently being developed. It stands for Structure, Positive, Empathetic, Low arousal, Links. It is an educational approach which tries to see the world from the child's viewpoint and designs a programme that is structured, calm and positive and works at developing links with parent's local networks.

Dietary: Treatments involving Vitamin B6 with magnesium, or giving Vitamin C, have been around since the 1960s and have been shown to be beneficial in some people with autism.

Some parents in the States report favourably on giving their children a gluten and casein-free diet, although no research appears to have been done on it. Gluten is found in wheat and casein comes from human or cow's milk. A reduction in the amount of yeast in a child's diet may also be helpful. Some research shows that most children with autism have excessive amounts of intestinal yeast, known as candida, which can lead to particular enzymes with an opiate effect leaking from the intestine and into the bloodstream and affecting the parts of the brain controlling speech and behaviour. It's important to get professional dietary advice before dramatically changing your child's diet.

(April 2002, resources updated May 2005)

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