Autistic spectrum disorders (ASDs)

About autistic spectrum disorders

According to the National Autistic Society, around one in 100 people in the UK have an ASD. ASDs include conditions such as autism and Asperger syndrome. The word 'spectrum' is used because the symptoms of ASDs vary widely in nature and severity between people who are affected.

Generally, children who have an ASD don’t develop the social and language skills that other children of the same age do. As a result, they find relating to other people difficult. Children with an ASD may also have unusual behaviours and learning disabilities.

Autism

Children with autism have difficulty communicating and interacting with others. This is often first noticed by the age of two. Some children with autism may have a learning disability, such as dyslexia (a condition that hinders the development of language-based skills, including reading, spelling and writing). Autism is more common in boys than girls.

Asperger syndrome

Asperger syndrome is similar to autism, but is usually less severe. Children with Asperger syndrome generally communicate better than those with autism and have average or above average intelligence. They don't usually have the learning disabilities that children with autism have.

Symptoms of autistic spectrum disorders

Children with an ASD have three main sets of symptoms that affect their communication, social skills, interests and behaviour. These characteristics can vary widely.

Communication

Children with an ASD don’t develop the usual speech or non-verbal skills that other children of the same age do. They also have trouble understanding the meaning of spoken or written language.

You may first notice that your child has communication difficulties if he or she:

  • can’t babble (say or make some meaningless words and sounds) or point by the age of one
  • doesn’t respond to his or her name
  • hasn’t learned any words by the age of 18 months

Your child may take words exactly as they mean – that is, he or she will have a very literal sense of language and won’t be able to understand jokes or sarcasm. He or she may also find it difficult to read body language and facial expressions.

Older children may have an unusual use of language, and have difficulty starting or keeping up conversations.

Children with severe autism may not speak at all, but can be helped to communicate in other ways, such as through signing or using pictures.

Social skills

Children with an ASD have difficulty engaging with other people, making friends and getting on well with their peers. They may be unable to cope with new situations. For example, if your child has an ASD he or she may:

  • not seek affection and resist being cuddled or kissed
  • prefer to spend time on his or her own
  • not understand other people's thoughts and emotions
  • find it difficult to accept simple social rules, which can cause problems at school
  • find it difficult to manage his or her emotions, which may be expressed as outbursts of anger or aggression

Behaviour and interests

Children with an ASD may show very little or no interest in play that involves pretending or imagination. Instead, they may be more interested in repetitive behaviours, activities and interests.

Your child may take up a special interest at a young age, such as collecting or music and art.

Other symptoms

Apart from problems that affect your child’s communication, social skills, interests and behaviour, he or she may also:

  • like sticking to the same routines, and may get very upset if these are disturbed
  • be over or under-sensitive to sight, sound, smell, touch and taste

Many children with an ASD also have other conditions such as attention deficit hyperactivity disorder (ADHD), dyspraxia (difficulty co-ordinating and organising thoughts and movements) or epilepsy (a condition that causes seizures).

Causes of autistic spectrum disorders

The exact causes of ASDs aren't fully understood at present. It’s thought that they are caused by a combination of factors, including the genes we inherit from our parents.

There is no scientific evidence to support the theory that there is a possible link between autism and the measles, mumps and rubella (MMR) vaccine.

Diagnosis of autistic spectrum disorders

If you notice your child might be showing signs of an ASD, contact your GP or health visitor.

Your GP will ask about your child’s behaviour and may also carry out a screening interview known as a Checklist for Autism in Toddlers (CHAT) if he or she hasn't started school yet.

If your GP thinks your child may have an ASD, he or she may be assessed at a child development centre to identify any specific needs. You and your child may need to see a range of professionals including a paediatrician, a child psychiatrist, a speech therapist, an occupational therapist, a psychologist and an educational expert such as a specialist teacher or educational psychologist.

A tool commonly used by specialists to diagnose ASDs is the Autism Diagnostic Observation Schedule (ADOS). This is a group of structured tests that can be tailored to different age groups.

If your child is diagnosed with an ASD, he or she may be assigned a key worker, such as a developmental paediatrician (a doctor who specialises in child development), a health visitor or school nurse who can provide you with information and support.

Treatment of autistic spectrum disorders

There isn’t a cure for ASDs, but children who are affected can be helped to manage their symptoms in a number of different ways. The following have some supporting scientific evidence to justify their use.

Behavioural therapies

Therapies such as Applied Behaviour Analysis (ABA) may help to improve your child's social and communication skills. This involves your child seeing a clinical psychologist or trained therapist who uses a technique that involves rewarding good behaviour. Your child’s psychologist or therapist will also set out a consistent and structured way of dealing with challenging or harmful behaviour.

Other therapies

Other therapies aim to help your child with communication and learning. These include the following.

  • A Picture Exchange Communication System (PECS) is where your child is taught to exchange a picture card for something he or she wants. This helps your child to express themselves.
  • EarlyBird is a three-month programme that helps you to manage your child and predict inappropriate behaviours at a pre-school age.
  • Occupational therapy helps your child adapt to his or her living environment.
  • Cognitive behavioural therapy (CBT) can help your child to challenge negative thoughts and behaviour.
  • Speech and language therapy helps your child to communicate better.

It’s important to remember that one therapy may work for one child but not for another, as all children have different levels of needs and abilities.

Medicines

Sometimes, your child’s GP may prescribe a medicine for him or her to take in the short-term to reduce symptoms such as agitation, aggression or hyperactive behaviour. However, these medicines can have side-effects. Always ask your GP for advice and read the patient information leaflet that comes with your child’s medicine.

Help and support

Health professionals involved in your child's care can provide help and support for you and your child's carers. For example, respite breaks give you a chance to rest while somebody else looks after your child – these may be provided by social services. Some families are also entitled to benefits such as disability living allowance to help cover the extra expenses involved in caring for a child with an ASD.

School

Children with an ASD often need an educational assessment and special support. Your child may go to a special school or, if possible, attend a mainstream school with extra help.

In general, autistic children do better if classroom activities are very structured. Most schools use the Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) approach, which provide a very structured learning environment with mostly visual instructions. Parents can work closely with teachers, using the same techniques at home.

Further advice is available from charities such as the National Autistic Society.

Is everyone with an autistic spectrum disorder diagnosed as a child?

Answer

Not everyone with an ASD is diagnosed as a child. If you're an adult and think you have the behaviours associated with an ASD, contact your GP.

Explanation

It’s possible that adults can have an ASD and not have been diagnosed as a child. If you think you have some of the behaviours associated with an ASD, contact your GP. He or she will usually refer you to a psychiatrist or a clinical psychologist, who will have experience of diagnosing ASDs.

If you're diagnosed with an ASD, you will be able to access special services for people with ASDs. Organisations such as the National Autistic Society provide information about strategies for coping with ASD symptoms, such as how to socialise and recognise your anxieties.

Will my child grow out of his or her autistic spectrum disorder?

Answer

No, ASDs aren't something that your child can grow out of – they continue to affect a person throughout his or her life. Treatment and support can help to minimise the impact an ASD has on your child's life.

Explanation

ASDs are lifelong conditions. They don't go away by themselves and there isn’t a cure. A child who has an ASD will still have the disorder when he or she is an adult.

A child with an ASD can change as he or she matures, and they may learn how to manage their condition by the time they reach adulthood.

Adults who have an ASD can live a full and satisfying life with the right support. They may have relationships, marry and raise children, just like anyone else. However, some adults require lifelong care. Many adults with an ASD rely on their families and continue to live in the family home.

What extra help will my child receive at school if he has an autistic spectrum disorder?

Answer

Your child's school should provide extra help and support if he has an ASD and has special educational needs. Check with your local authority to see what kind of help is available.

Explanation

If your child has an ASD, there are programmes in place at schools to provide him or her with extra support. These programmes are called Early Years Action and School Action. The type of help your child receives may include:

  • extra support from a learning support assistant or teaching assistant on an individual basis or in small groups
  • special learning materials and equipment
  • environmental adaptations
  • further specialist help from an educational psychologist, a specialist teacher and/or a speech and language therapist (a health professional who specialises in identifying and managing speech and communication problems)

There will be a Special Educational Needs Co-ordinator (SENCO) at your child’s school who will be able to give you further information and advice.

If the school is unable to meet your child's needs, you can request a statutory assessment from your local authority. This will show what specialist help your child needs and how this can be provided.

Children with an ASD may be taught at:

  • a mainstream school – your child is taught alongside other pupils, but the school may provide extra support for your child for a set number of hours a week
  • a base or unit within a mainstream school – pupils with an ASD are educated separately in the base, but are able to access the mainstream school when appropriate
  • special schools – these are schools specifically for children with special educational needs
  • residential schools – your child stays overnight and will be provided with support 24 hours a day
  • independent schools – these aren't maintained by the local authority, so you will need to pay for them

The schools suitable for your child may differ between areas, so it’s a good idea to check with your local authority first. They will be able to provide you with a list of schools available in your area.

What can I do if my child becomes distressed when visiting new places?

Answer

Try to identify what is triggering your child's anxiety and prepare him or her in advance when going to new places. Make sure that your child goes to new places with his or her usual carer, who can provide comfort, support and an explanation.

Explanation

Children with an ASD often prefer fixed routines and can react badly when this is disrupted. Some children with an ASD may be oversensitive to certain sensory information, such as smells, lights or sounds. Trips to new places, such as the shops, can often be a stressful experience.

It can be helpful to identify what triggers your child’s anxiety by keeping a diary. Also, try to prepare your child in advance. For example, show him or her a picture of the place where you are going (eg a shop) and explain what you will do when you get there. You may find it helps to use a timetable to explain what will happen during your trip, including how you will get there, when you will eat and when you will return home.

If your child still becomes distressed after you’ve tried to prepare him or her for your visit, you could try the following.

  • Use earmuffs, earplugs, headphones or sunglasses if noise or bright/flickering lights cause your child to feel anxious.
  • Build up your child's tolerance to new events. For example for shopping, begin by taking your child to a local shop for a couple of minutes, gradually building up to a longer trip to a supermarket.
  • Give your child a familiar toy or comforter to take with him or her – this may help to focus his or her attention on something else while in a stressful situation.

After the visit, allow your child to have some calm time, such as winding down in the car or at home.