image3

What is Autism...**DISCLAIMER**

Autism is a term 'neurotypical' people have given to those who brains are wired and work differently. 


At Every Mind, we believe completely that this brain difference is to be celebrated rather than labelled as a 'disorder'.  Autistic people hold a wealth of strengths and abilities that have enabled the world to develop in unique and marvellous ways. The current terminology that autistic people have a 'disorder' is, in our opinion, completely inaccurate. 


The current diagnostic manual that we use in the UK is largely 'deficits based' meaning we currently diagnose people based on what they cannot do or how they are 'impaired'. Although at Every Mind, in order to make a diagnosis of ASD we have to follow this 'deficits' model, we entirely do not agree with its ethos. 


What follows is a description of the traits of ASD according to the DSM-V. We have included this to help parents/teachers/individuals consider if someone is autistic. We have also included some screening measures that can help also in considering ASD. Do give us a call or drop us an email to discuss further if you are identifying a number of traits.

What is Autism?

Autism is a 'neurodevelopmental disorder' characterised by difference in how a person communicates, understands and interacts with the social world. Autism is highly variable in its presentation meaning how the differences manifest from person to person differs hugely. Furthermore, how autism presents can look different at different times in life and development, and be highly related to the stresses and pressures of the world and environment around them. How the traits of autism present can also vary enormously between girls and boys which will be outlined further below.



What is the diagnostic framework for an autism diagnosis?

The current diagnostic manual that we use in the UK, DSM-V, defines autism as the following:

 

A. Persistent deficits in social communication and social interaction  across multiple contexts, as manifested by the following, currently or  by history (examples are illustrative, not exhaustive; see text): 

  1. Deficits in social-emotional reciprocity, ranging, for example, from  abnormal social approach and failure of normal back-and-forth  conversation; to reduced sharing of interests, emotions, or affect; to  failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social  interaction, ranging, for example, from poorly integrated verbal and  nonverbal communication; to abnormalities in eye contact and body  language or deficits in understanding and use of gestures; to a total  lack of facial expressions and nonverbal communication.
  3. Deficits in developing, maintaining, and understand relationships,  ranging, for example, from difficulties adjusting behavior to suit  various social contexts; to difficulties in sharing imaginative play or  in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or  activities, as manifested by at least two of the following, currently or  by history (examples are illustrative, not exhaustive; see text): 

  1. Stereotyped or repetitive motor movements, use of objects, or speech  (e.g., simple motor stereotypes, lining up toys or flipping objects,  echolalia, idiosyncratic phrases).
  2. Insistence on sameness, inflexible adherence to routines, or  ritualized patterns of verbal or nonverbal behavior (e.g., extreme  distress at small changes, difficulties with transitions, rigid thinking  patterns, greeting rituals, need to take same route or eat same food  every day).
  3. Highly restricted, fixated interests that are abnormal in intensity  or focus (e.g., strong attachment to or preoccupation with unusual  objects, excessively circumscribed or perseverative interests).
  4. Hyper- or hyporeactivity to sensory input or unusual interest in  sensory aspects of the environment (e.g. apparent indifference to  pain/temperature, adverse response to specific sounds or textures,  excessive smelling or touching of objects, visual fascination with  lights or movement).

=

  1. Symptoms must be present in the early developmental period (but may  not become fully manifest until social demands exceed limited  capacities, or may be masked by learned strategies in later life).
  2. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  3. These disturbances are not better explained by intellectual  disability (intellectual developmental disorder) or global developmental  delay. Intellectual disability and autism spectrum disorder frequently  co-occur; to make comorbid diagnoses of autism spectrum disorder and  intellectual disability, social communication should be below that  expected for general developmental level.





What traits might I actually see in my child?

Below is a summary of some of the traits that you may see in your child: 

     

Possible indicators of ASD in 0-5 year olds

 

Spoken Language 

- Language delay in babble or words

- Reduced use of language for communication

- Regression in speech and language skills

- Repetition   of the speech of others which may be immediate, delayed or mitigated   (‘echolalia')

 

Responding  to others

- Absent  or delayed response to name being called (assuming adequate hearing)

- Reduced responsiveness to social smiling


Interacting  with others

- Reduced  social interest in others

- Reduced  imitation of others’ actions

 - Reduced initiation of social play with others

 - Reduced enjoyment of situations that most children like (e.g. birthday parties)

- Reduced shared enjoyment with others

 - Reduced eye contact, pointing and other gestures

 - Reduced use of facial expressions to communicate with others

- Reduced social eye contact 

- Reduced pointing or showing objects to share interest

 

Play and Imagination

- Reduced use of pretend play

- Reduced use of shared imaginative play

 

Restricted interests and/or rigid and repetitive behaviours 

- Repetitive movements such as hand flapping or finger flicking

- Repetitive play

 - Over-focussed or unusual interests

 - Excessive insistence on own agenda

 

Over or under reactive to sensory stimuli such as textures, taste, smells


 

Possible indicators in 5-18 year olds

Spoken language 

‒very limited use

‒excessive use

‒monotonous in tone

‒repetitive language, with frequent use of certain phrases or with content dominated by excessive information on topics of interest

‒talking ‘at’ others rather than a two-way conversation


Responding to others

‒Reduced response to others’facial expressions

‒Reduced response to name being called (assuming adequate hearing)

‒Reduced repertoire of social responses

‒Reduced ability to interpret non-verbal cues

‒Difficulty with ‘small talk’Interacting with others

‒Reduced social interest in others

‒Reduced awareness of socially expected behaviour

‒Reduced ability to share in the social play of others

‒Reduced enjoyment of situations that most children like

‒Reduced or poorly integrated use of gestures, facial expressions and eye contact during social communication with others (assuming adequate vision)

‒Reduced pointing or showing objects to share interest


Play

‒Reduced variety and flexibility in imaginative play


Restricted interests and/or rigid and repetitive behaviours 

‒Repetitive movements, such as hand flapping, spinning and finger flicking

‒Repetitive play and focused on objects rather than people

‒Over-focused or unusual interests

‒Excessive insistence on following own agenda

‒Strong preference for familiar routines




What about Autism in girls?

Much of what we know about autism and how we diagnose has been largely defined by boys. For years, it was believed that autism was a largely 'boy difference' and much of our research, understanding and intervention has been based on this knowledge. We now know that autism is just as prevalent in girls but that it can manifest in more subtle and different ways. 


Social and communication 

- An awareness of the need for social interaction

- A desire to interact with others

- Passivity (a ‘loner’), often perceived as ‘just being shy’

- A tendency to imitate others (copy, mimic or mask) in social interactions, which may be exhausting

- A tendency to ‘camouflage’difficulties by masking and/or developing compensatory strategies

- One or few close friendships

- Intense andpossessive within friendships

- A tendency to be ‘mothered’in a peer group in primary school but often bullied in secondary school

- Developmentally appropriate language skills 

- A good range and frequency of non-verbal (gestural) communication

- Clear demonstrations of good imagination (e.g. fantasises and escapes into fiction and pretend play) but prone to being non-reciprocal, scripted and overly controlled


Restrictive and repetitive behaviours and interests(RRBIs)

- Less severe and frequent RRBIs

- Restricted interests may be less focused on objects or things and more focused on movement, people or animals (e.g. hair twirling, soap operas, celebrities, pop music, fashion, horses, pets, and literature)