What we know about Autism now
We used to think of autism as an extremely rare condition, now we recognise that it's a spectrum of conditions, of differing severity and differing manifestations but affecting between one and one and a half percent of the population.
Key Characteristics of Autism
Autism is characterised by areas of difference or impairment, and one is what we call in social communication, people's interest and understanding of other people's motives. A desire to share things and communicate with others socially.
Restricted & repetitive behaviours
When we talk about the second domain, which we call restricted and repetitive behaviours, we're often talking about, behaviours that have to be undertaken in quite a rigid or restricted way. So:
- eating the same set of foods,
- walking the same way to school,
- having the same schedule, such as eating lunch at 12 o'clock
- and having a very strong sense of needing to abide to rules.
Hyper and hypo-sensitivity
And finally, the third component that's been more recently recognised in autism, is what we call sensory atypicalities. And by that I mean either hyper, that's oversensitive or hypo sensitive, under sensitive, to a range of different sensations. So it may be things that you see or hear or touch. And those are the three components of autism.
Autism & co-existing conditions
One of the things that we, as a research group, have been really interested in understanding, is what happens to autistic children with mental health, coexisting or co-occurring mental health problems over time. We now know that some of the genes that increase the risk of having autism, Risk factors with Autism also increase the risk of having adhd and other related neurodevelopmental disorders.
We followed children now from late childhood into early adulthood and one of the really striking findings is, how consistent or persistent the difficulties are, and how they state the same sorts of difficulties.
Why early intervention is critical
What we know is that if we identify and treat conditions, such as anxiety or adhd earlier on, we can make a difference to that child or young person's trajectory.
Better Understanding of the Autism
People used to think, and these were clinicians, parents, teachers, used to think, that autism and the way in which a child presented, was all just due to their autism. And what we found is, by pulling out separate bits that aren't necessarily part of those core characteristics, we can find areas that are impairing the person's quality of life and well-being and find ways of intervening or managing those additional difficulties.
Children with ADHD & Autism
So, if we think about children with adhd, which is a common neurodevelopmental condition, is frequently seen alongside autism and on the other hand, we see conditions like anxiety, across the lifespan, is a common mental health problem and in older adolescents and adults, depression, sadly becomes a common coexisting or co-occurring condition.
Identifying co-existing or co-occurring conditions
Sometimes it's a challenge for clinicians,to distinguish autism from some of the other mental health problems and neurodevelopmental conditions like adhd. And clinicians, when they're uncertain, need to spend sufficient time to try to disentangle the differences.
Is it anxiety or repetitive Autism behaviours?
Children may ask questions over and over again and trying to distinguish between whether a child is asking questions like:
- when are we going home,
- when will we get there,
- what's going to happen at school today.
Whether that's a very repetitive pattern of behaviour, that's related to autism, or whether it's being driven by anxious reassurance seeking, because it's something that's making them anxious, so that they're asking for reassurance say from a parent or another adult. Those are the kinds of things that clinicians need to try to disentangle.
Why it isn't always easy to identify Autism or ADHD
Both autistic children and children with adhd may fail to pay attention to things but the underpinning reasons for that are quite different. What we try to do, is look for what's the overall or most common pattern of behaviour. Is the child generally paying attention to things that interest them, and not focusing or concentrating for sustained periods when something is boring or they say I don't like that, or is the overall pattern one of, it's really hard to pay attention, unless I'm super interested in what I'm doing.
And we make that sort of judgment.
Disturbed behaviours vs a frustration of communication
One of the things that's become really important in the last few years is, to try to identify autism as early as possible. So when we think about teachers, and how they might help autistic children in their class, one of the very first things to say is that because of the difficulties that many autistic people have, recognising their feelings and then communicating them to others, they may express that with disturbed behaviour.
But typically autistic children may find it more difficult than non-autistic children to say this is what I'm feeling or experiencing and can you help me with it.
Teachers and strategies for children with Autism
So teachers need to do a bit of detective work when they're working with children, and think:
- what's going on here?
- what's the timing of this behaviour?
- what are the possible triggers?
And write down when the behaviour is occurring, what was happening beforehand. And think about whether different strategies for management, are actually making the behaviour better or worse. They need a classroom assistant to help them keep on track. The difficulty they have may be magnified by underpinning language problems, or by underpinning lack of motivation to please the teacher in the same sort of way that most children do, so they may need more tangible rewards or reinforcers to complete tasks.
Understanding triggers with co-existing conditions
I was working with one girl who went on to a top university and explained to me that, until she was 16, she didn't realise that it wasn't her school shoes that were causing her tummy to ache. It was the fact that she was going to school that was making her anxious, that was causing her tummy to ache.
So it's those very direct relationships that sometimes we have to work on when we're going to start therapy for conditions like anxiety and depression. Some of the interventions are very practical, but finding the triggers which are different is really important.
