Autism (A complete guide)

Autism spectrum disorder is a developmental disorder with lifelong disability having a strong genetic component that affects the way a person communicates and relates to the people and world around them. 

The signs and symptoms of autism often develop gradually, though some children with autism experience worsening in their communication and social skills after they have reached developmental milestones at a normal pace.

Symptoms of Autism 

Autism is a disorder with high variability. Its symptoms first appear during infancy or childhood, and generally follow a steady course without remission.

People with autism experience severe impaired in some areas but may be superior, in others.

Observable symptoms gradually begin after the age of six months, and symptoms become more evident by the age of 2 to 3 years.

See also: Symptoms of autism 

1. Impairment of imagination  

• This is also known as inflexibility of thought and can affect people on the autism spectrum in a number of different ways. 
• –  Social imagination allows you to understand and predict other people’s behavior, make sense of abstract ideas and imagine situations outside your immediate daily routine
• –  Plan ahead and organize ourselves 
• –  Imagine the future
• –  Understand other’s thought and feelings
• Understand that others may have a different point of view 
• –  Understand the concept of danger 
• –  Prepare for change/ accept unexpected changes
• –  Cope with new and unfamiliar situations 
• –  Generalize concepts
• –  Problem solve 
• –  Make decisions/ choices 
• Transition from one setting/ task to another

• People with Autism are also involved in some special interests, routines or compulsions 
• –  Children on the spectrum may engage in these behaviors as they can act as a form of comfort. 
• –  The routine or ritual is a predictable situation in an unpredictable world 
• –  It is important not to confuse this impairment with a lack of imagination. For example, children on the spectrum may well be able to produce fantastical stories and can be very creative. 
•   In order to address these impairment, we: 

• –  Create a structured and predictive environment 
• –  Have daily routines 
• –  Visual timetables 
• –  Limit choices 
• –  Use visual cues to enhance understanding 
• –  Use first /next sequence

1. Impairment of Communication

It covers difficulties at both verbal and non-verbal level of communication

Difficulties with verbal communication may result in a child with autism having a very literal understanding of language and they may find turn taking in conversation difficult. 

 Conversation may be repetitive and based purely on a child’s own special interests and not adapted to the social context they are in. 

If you have autism then you find difficulty in understanding jokes and sarcasm. A person the spectrum can take up to 10 seconds to process an instruction or comment 

Some difficulties with non-verbal communication include difficulty reading or interpreting facial expressions, body language and using eye contact correctly.  

Managing communication problems

Here are the ways to manage communication problems in people with autism: 

• –  Use less language- keep it simple and specific 
• –  Say what we mean and mean what we say 
• –  Give time for processing instructions or comments i.e 10 seconds 
• –  Attract attention- begin with the child’s name then follow through with the request 
• –  Present information visually 
• –  Use PECS ( picture exchange communication system)

1. Impairment of social understanding 

• Look it may be difficult for a child on the autism spectrum to understand unwritten social rules, understand others feelings and emotions, initiate and maintain interactions and to form friendships.
• As a result, the interactions of a child with autism may seem over formal, egocentric or inappropriate. 
• Again there is wide ranging ability in terms of social understanding in children on the autism spectrum. 
• Some children may see interactions with others purely as a means of having their needs met and may lack motivation to interact, preferring to focus on a repetitive activity or obsession.  
• –   Children on the autism spectrum may also have difficulties in knowing how to respond appropriately to new or unfamiliar situation 
• –   Many children with autism may need help in developing an interest in, and understanding of social interaction 
• Here are the ways to improve social understanding in autism
• –  Develop social skills group 
• –  Use turn taking games and mutual help activities to encourage interdependency e.g cricket.
• –  Encourage recognition of a child’s own emotions 
• –  Use social stories 
• –  Use conversation cards  

Repetitive behavior

Example of a young boy with autism who has arranged his toys in a row.

Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows: 

• Stereotyped behaviors: Repetitive movements, such as hand flapping, head rolling, or body rocking.
• Compulsive behaviors: Time-consuming behaviors anticipated to reduce anxiety that an individual feels compelled to perform repeatedly or according to rigid rules, such as placing objects in a specific order, checking things, or hand washing.
• Sameness: Resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
• Ritualistic behavior: Unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.
• Restricted interests: Interests or fixations that are abnormal in theme or intensity of focus, such as preoccupation with a single television program, toy, or game.
• Self-injury: Behaviors such as eye-poking, skin-picking, hand-biting and head-banging.

No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors.

Sensory Processing

Processing sensory information gives you feedback about the environment and yourself. 

It allows us to make sense of the world around us and how to respond to it. 

We all know about the five senses( touch, taste, sight, smell and hearing) however there are another two sensory systems we need to be aware of: the proprioceptive system and the vestibular system 

 Proprioceptive system (Body awareness) 

• It informs you where your bodies are in space and how they are moving. 

 Vestibular system (Balance)

It provides information on where your body is in space, its speed, direction and movement. It is fundamental in helping us to keep our balance and posture.  

Sensory processing is the ability to take information through our senses and organize this information so that we can react, adapt and interact appropriately with the world around us 

We all have different sensory processing abilities and most of us have sensory intolerances and preferences 

 Sensory sensitivities can be broken down into two main areas: 

Hypersensitivity (High sensitivity) 

 This is where too much sensory stimulation occurs and the individual can become aversive to touch and noise etc.

What are Causes of Autism?

• i)   Proposed factors are genetic and environmental factors but theory of causation is still incomplete 
• II)  It is generally accepted that autism is caused by abnormalities in brain structure or function. There are numerous ongoing studies which try to determine the cause but reached no conclusion to date. 
• III)  Family Theories ( cold mother myth)
•   Child lack appropriate attachment from mother’s side that is, neglectful child  
• iv)  Genetic predisposition 

Most significant cause for autism spectrum disorder is genetic vulnerability. 

Autism has 90% heredity contribution. Researchers found that if one identical twin is autistic, the other often has learning or social disabilities.

• v)  Bio medical approach: 
• The latest scientific research that shows autism to have at least some biological causes like heavy metal poisoning for example, drinking contaminated water.
• Vi)  Yeast infection
• Gluton free diet is recommended to avoid infections in autism
• Vii) Food sensitivity 
• Stomach remains upset most of time thus, gluton free diet should be used
• Viii)  Nutritional deficiency 
• People with autism develop nutritional deficiencies as they have limited themselves to one diet for instance, child only eat bread.
• Ix)  Digestion
• Autistic people tend to have more digestive problems particularly to wheat and dairy products so more allergies 
• X)  Minerals
• Autistic people have certain deficient in minerals such as sulphur, zinc, magnesium, iodine, lithium etc.

Which tools are used to assess Autism? 

• Few psychological tests, which provide guidelines for diagnosis of autism are CARS (Childhood autism rating scale), GARS, CABS and Autism behavior checklist.

• Play Based assessment 
• Standardized assessment procedures which specifically define methods and steps to be taken in order to assess a person with ASD 

Here are the ways to Manage Autistic Child 

 Over the years, various types of traditional and non-traditional treatments have been used to reduce autistic behaviors and to increase appropriate behaviors.

Although there is no known cure to autism but there have been cases of children who recovered or improved. 

• The goal of treatment is to manage and improve symptoms and functioning 
• No single treatment is best nor is every treatment right for each person 
• Treatment is typically tailored to the child’s needs 
• Every treatment starts with a thorough assessment of the child’s deficits and assets in the context of a trans disciplinary evaluation   

Major Interventions for Autism

1. Applied Behaviour Analysis

Important Features:  It is one of the most frequently used intervention 

Basic Philosophy: we all respond to specific actions or instructions in our environment (antecedents) with the exception of certain rewards (Consequences) 

Guiding Principal: Behavior therapy is used to build the skills that the child lacks, such as language, play, self-help, social, academic and attention skills 

Important Steps: 

• Find out what they want-what’s reinforcing 
• Deliver it to them immediately when they exhibit the behaviors we are trying to teach 

Duration of Intervention: 40 hours a week for approximately two years 

Popularity: The parents of young children have reported significant improvements in their child’s ability to access the world 

Criticism: Inappropriate and narrow focus, robotic 

1. TEACCH ( treatment and education of autistic and related communication handicapped children)

• Treatment and Education of Autistic and related Communication Handicapped Children 
• It is a lifelong program for people with autism based on a recognition of characteristics strengths and typical impairments 

Structured teaching has four major Components:

• 1. physical organization 
• 2.Schedules 
• 3. work systems 
• 4. task organization 

It is a behavior based program which includes a focus on the person with autism and the development of a program around this person’s skills, interests and needs 

Autism has neuropsychological basis which must be addressed.

Individuals with autism are part of a distinctive group with common characteristics that are different, but not necessarily inferior 

The person is the priority. 

Guiding Principle: A teacher must provide structure, set up the classroom so that students understand where to be, what to do, and how to do it all as independently as possible 

Important steps 

• Centering on the individual 
• Understanding autism 
• Adopting appropriate adaptions 
• A broadly based intervention strategy building on existing skills and interests  

Duration of Intervention: Ongoing throughout education 

Used at: School as well as home based programs 

Who can deliver?  Parents and teachers

1. Son-Rise program

An educational treatment modality, which included joining children instead of going against them with the idea of giving an intensive stimulation based on an attitude of unconditional love and acceptance 

Autism is a rational, interactional disorder we should focus extensively on socialization and rapport building. 

• Aims at empowering the parents
• Nothing equals the power of the unparalleled love, deep dedication 
• Important steps: the trainer joins, rather than stopping a child’s repetitive, exclusive and ritualistic behaviors  

1. Floortime (DIR) approach 

• Developmental, individual difference, relationship based approach 
• Focuses on helping children master the building blocks of relating, communicating and thinking, rather than on symptoms alone 
• Floor time does not treat the child with autism in separate pieces for speech development or motor development but rather addresses the emotional development, in contrast to other approaches, which tend to focus on cognitive development 
• It is much like play therapy. The goals of floor time are encouraging attention and intimacy, two way communication, expression and the use of feelings and ideas, and logical thoughts. 

It assesses the child in three ways:

• D: understanding where the child is at his developmental level 
• I: finding out any biological challenges 
• R: building relationships with primary caregivers is a critical element 
• Other supplementary Methods 
• Pharmacotherapy 

There is no primary drug, which has been shown to be consistently effective in treating symptoms of autism 

However, specific medication might be indicated if autism is accompanied by hyperactivity, severe OCD, depressive symptoms or thought disorder 

• Sensory Integration therapy

Form of therapy consisting of motor and sensory activities

• Popular with both parents and teachers 
• Play therapy 
• Is to children what counseling is to adults 
• Expression of feelings through toys instead of words
• Hypo and hyper- sensitivity to sensory needs 
• Occupational therapy (OT)

This helps a person with autism to develop the skills for everyday living and learn to become independence.

These skills include dressing without assistance, grooming and hygiene, and fine motor skills.

People with ASD practice these skills outside of the therapy sessions, which are usually between 30 and 60 minutes.

• Speech therapy

Speech therapy helps to address the challenges in communication that people with autism experience.

Assistance might include matching emotions with facial expressions, learning how to interpret body language, and responding to questions.

A speech therapist might also try to teach the nuances of vocal tone and help the individual strengthen their speech and clarity.

• Music therapy 

Music is used to accomplish therapeutic goals 

      It is believed that music works on several levels, including cognitive, emotional, and neurological.

It also helps to explore a wider range of emotions. 

• PECS ( picture exchange communication system) 

Picture exchange communication system is an alternative system of communication that intends to help the child to communicate through pictures and express what they want. 

Conclusion 

Autism disorder is wide range of disorder with severe impairments in imagination, communication, social interaction and understanding. Researches have found strong genetic basis for this disorder.

Various intervention techniques have been developed to manage people with autism and they have proved to be effective in improving their level to functional.

Gadgets such as fidget spinners can also be used to help people with autism in order to stay calm and focused.

Related link:   https://raisingchildren.net.au/guides/a-z-health-reference/types-of-interventions-for-asd 

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