What are the effects and signs?
Social Interaction / Behaviour problems
Social Interaction / Behavioural problems
A key feature of the deficit apparent in people with Autism spectrum disorders (ASD) is their inability to understand the thoughts of other people and themselves. A typical child can recognize the thoughts of other people as being potentially different from his/her own thoughts and so imagine how other people are likely to respond. This lack of understanding in a child with ASD is termed a deficiency in the formation of a ‘Theory of Mind’.
The ‘Theory of Mind’ can be thought of as a form of insight in which young children learn that others are not necessarily interpreting events or perceiving situations in the same way as they do. Children usually begin to develop the skill capacity to imagine the world from another person’s point of view before they begin school. Some people with ASD appear never to develop a ‘Theory of Mind’.
Social reciprocity essentially refers tothe ability to interact with others responsively, paying attention to the state of mind of the other person/people and responding to social cues. It is considered normal and appropriate that people will moderate their responses to each other in kind e.g. responding more positively to favourable actions from others and responding more negatively to harmful actions. This is an area where children with ASD may have significant problems.
The inability to successfully interact with others has many negative consequences. Very early on, children respond to others by their gaze, they turn toward voices, grasp a finger and may smile. Most children with ASD seem to have significant difficulty engaging in everyday human interaction and may seem indifferent to others leading to isolation. Isolation can lead to depression and behavioural problems. The inability to interpret and respond appropriately to social cues can often result in socially inappropriate and possibly offensive behaviour.
Repetitive behaviour patterns are also frequently seen. This may take the form of repeatedly flapping the arms, but may also take the form of intense preoccupations. Children may exhibit unusual interests to the exclusion of other activities with these interests taking on an obsessive quality, worsening their social isolation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules or lighthouses. Often there is great interest in numbers, symbols or science topics.
Outdoor mobility
In relation to outdoor mobility, parents may advise that their child exhibits severe behavioural problems including a refusal or reluctance to walk or may even require physical restraint outdoors. In such cases, third party evidence from an independent source must be sought to corroborate these claimed needs.
Communication abnormalities
Non-verbal communication
Non-verbal communication is often impaired. Use of gestures is often limited and facial expressions may be absent or inappropriate. There may be awkward/ inappropriate body language and often non-verbal cues are missed or misinterpreted. These non-verbal prompts are important in communication and interaction as conversation usually involves much ‘give and take’ that can be difficult for children with ASD who may also inappropriately interrupt others since turn-taking during a conversation is not recognised. Because interaction is significantly reduced, it can be difficult for these children to convey to others their needs. This can lead to considerable frustration and may lead to or exacerbate behavioural problems.
Speech
A wide variety of speech difficulties are present within the autistic spectrum. Some children may remain mute throughout their lives. Some use very little language and may only ‘coo’ or ‘babble’. Those that are able to speak may use language in unusual ways that may make them unable to communicate in a meaningful way. For instance they may repeat a phrase multiple times or may speak in a very literal way and be unable to interpret speech in a social context. The tone of their speech may also be affected, and may be monotonous or have other abnormalities of pitch.
Sensory sensitivity
A variety of sensory sensitivities may be present. Children may be sensory seeking or sensory avoidant or commonly, a mixture of both. Sensory profiles are highly individual. Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes and smells. For example, a child may have a particularly acute sense of smell or extreme sensitivity to pain. Other autistic children have very high pain thresholds. Their sensitivity to particular textures may affect their ability to eat certain foods or wear particular clothes since the sensation may be unbearable. They may respond to a stimulus in an unexpected way. The confusion and discomfort that results from distortion of sensory perception can be very upsetting and lead to behavioural problems.
Reliance on routines
ASD children are often heavily reliant on routine. They require consistency in their environment. Even slight changes in mealtimes or the time they go to school can be extremely disruptive for them. Unstructured activities are also particularly challenging since such children tend to do well in ordered activities. More radical changes such as changing schools or separation from parents because of divorce may be particularly stressful and result in behavioural changes.
Sleep disturbance
Many children with autism suffer from sleep problems, such as insomnia. Sleep disorder however is not a feature of autism per se; for instance, children with learning disabilities also have an increased incidence of sleep disorders. As with most children regardless of diagnosis, with increasing age sleep problems tend to improve.
There is no definitive prognostic advice that can be given about how long sleep problems will last in autism or if indeed it is a significant problem that would lead to night needs.
Aspects to consider are -:
- Level of disruption - how difficult is it to settle the child and does the child also have a behavioural problem that would make a high level of disruption likely
- Frequency of sleep problem
- Any indication in medical evidence
- Any indication of current or previous evaluation/treatment for sleep problems
Unfortunately no single one of those mentioned will give an answer, but it gives a picture of the likelihood of a significant problem.
Functional overview
In terms of function, ASD can be considered in terms of low and high functioning. Included in high functioning ASD are those with Asperger’s syndrome. The separation between the two is primarily by their cognitive ability i.e. I.Q.
Low functioning ASD -:
- low IQ (some use <85 as cut off)
- often have very poor speech
- often have significant behavioural problems
- may not respond well to behavioural therapy, and may not show a great deal of improvement.
High functioning ASD -:
- average or above-average intelligence level
- adequate vocabulary but words may be used in unusual ways
- difficulties with social interaction and struggle to develop and maintain friendships
- behavioural problems may be present (although can be severe, less likely to be so than in the low functioning)
