Family Therapy UK
Autism and Asperger's Syndrome
Autism is three to four times more prevalent in boys than girls. It is characterised by an emotional and intellectual detachment from people and the world around them.
There is some evidence to suggest that girls tend to be more seriously affected. It becomes apparent before the age of three years and it occurs in 2 to 5 children per 10,000. About three quarters of affected children have severe general learning disabilities. It is characterised by abnormal functioning in the areas of:
• Social interaction
• Difficulties with speech, language and non-verbal Communication
• Restricted, repetitive patterns of behaviours.
• Difficulties with imagination and inner language
It is thought to have a genetic component. Where a child has autism, their siblings are 50 times more likely to have the disorder than the general population. In identical twins, 65%-90% of the time, both twins will have the disorder. Although it is a brain disorder, it is unclear how it develops. It is thought there may be a link between autistic disorders and rubella, hydrocephalus, hyperthyroidism, encephalitis, infantile spasms and other diseases. About 25% of autistic children develop epilepsy. Some theories speculate that the emotional difficulties are due to heightened emotional awareness. The subsequent withdrawal and preoccupation of these children is an attempt to filter out the bombardment of their senses. Other theories argue that autistic children are incapable of building a construct (a complex and interacting picture) of the world. Because of this, they are incapable of understanding other people's experiences and sharing in them. As yet, although there is much research, the causes of autism are unclear and open to debate.
Asperger’s Syndrome
The degree of autism varies and the term "autistic spectrum disorders" describes a scale of these disorders from very severe to very mild. Along this scale lies 'Asperger's Syndrome'. Because Asperger's syndrome is not as marked a condition, it is sometimes not diagnosed until children are a little older - often when they start school and the child's difficulties become more apparent. Children with Asperger's Syndrome have normal to high verbal skills but do not grasp the emotional subtleties of ordinary communication. They often prefer their own company and share many of the social and emotional difficulties of children with autism.
Autism and Asperger's are not associated with poor parenting, child abuse or neglect. There is no correlation with schizophrenia. However, good parenting and handling of such children can affect their development in a positive way.
Difficulties in socialisation
Autistic children have very poor awareness of the normal rules of social interaction. They miss the subtleties of normal conversations and behaviour. They are not aware of other people's emotions and can act in a way that appears inappropriate and out of place in the situation they are in. They often ignore other people and pay little more attention to their own parents than they do to strangers. They often shy away from touch and do not respond in a warm and positive way to hugs. This can be very difficult for parents. They can appear unfeeling and cold because they lack the ability to appreciate the effect of their behaviour on others and do not recognise the emotional signals that other children of a similar age have learnt.
Communication difficulties
Because of these difficulties, their communication is poor, often lacking in emotional content, sounding flat and without colour. Many autistic children are mute or find it difficult to hold a conversation or understand simple questions. They give the impression of being somewhere else and not connected to what is going on around them. They find it hard to develop their imagination and do not develop the normal world of make-believe that other children do. Often what they say, and the way they react, does not match the situation they are in.
Restricted and repetitive behaviours of behaviour
These children have restricted and repetitive patterns of behaviour. They can become rigid in their behaviour and find changes of routine very difficult to cope with. They find change of any sort difficult to cope with. For instance, having to change clothes, dealing with a change in the position of furniture, or ornaments or a favourite toy can be very hard for them to accept. They can develop rituals and become over interested in dates, objects, smells, ordering and collecting things. They can throw huge tantrums when confronted with change or a demand to stop a repetitive behaviour such as characteristic hand flapping, finger snapping, rocking and swaying.
Autistic children often develop fears and phobias. They can develop problems with eating and sleeping. They can develop aggressive behaviour and are prone to throwing tantrums. Where there is severe learning difficulty, there may be associated self injury such as biting or head banging. They can be hypersensitive to noise, smells or pain.
This condition stays with a person throughout their life, though it may show itself in different ways as the person matures and develops and their social situation changes. The characteristics of poor socialisation, communication and restricted and repetitive behaviours continue. Sometimes, these obsessions and interests can develop into genuinely useful skills such as mathematics, music or drawing, but this only tends to happen in the less severely affected.
What can you do if you suspect your child may have Autism or Asperger's Syndrome?The first thing to do is to get a proper assessment. This can be arranged by your doctor. The assessment will be made by a psychiatrist or developmental paediatrician. Educational psychologists and other health professionals may be involved as part of the assessment and treatment process. This often includes speech and language therapists. Sometimes, social workers may become involved or other mental health staff such as learning difficulty specialists.
A diagnosis may come as a great relief to some and a great shock to others. It is important to consider your own needs as a parent, couple and family as well as the child with autism. If you need counselling and information, seek it.
A diagnosis makes it clearer what needs to be done to help the child. An assessment should be made of the child's particular needs and a programme set up to meet them. Speech and language therapy is important to help the children develop the resources they have. Education can be provided in local special schools, in mainstream schools with special units or mainstream schools with additional support. Some children will benefit from residential schooling. Whatever the school, a statement of special needs should be made by the education department. This is the responsibility of an educational psychologist. Some health authorities have special teams which assess for autistic spectrum disorders (ASD's) in children. They will advise you and the school.
Children with Asperger's tend to be educated in mainstream school, sometimes in a special unit or with some additional support. They will benefit from social skills training and very clear instructions about rules and changes of routine. Because they may have difficulty in relating to other children, they can be bullied or become socially isolated. It is important that someone in the school keeps an eye on these children and develops an interest in their progress. It is useful if such a mentor can stay with the child throughout their stay in a particular school.
These children can be very demanding emotionally and physically. They will benefit from your love and understanding, but will also need clear boundaries and rules, with constant gentle reminders to complete tasks. It is important to praise all children when they are doing well. If there are two of you parenting, try to share the load. If there are other children, be aware that they can become "helpers" or feel neglected. It is difficult for other children to complain about being neglected when they know how serious their siblings condition is. If you are struggling as a family, seek out help from your doctor and social services or a family therapist. Try to spend some separate time with your other children.
Some children with autism may be managed at home when they are young, but become too difficult for parents to cope with when they get older. In adolescence, sadly many symptoms become worse. Many young people lose the language skills they have developed and there can be more hyperactivity and aggression. About one in ten of these children can live independently, another 15% semi-independently whilst two thirds remain totally dependent. Most autistic adults live in institutions, but many remain at home in the care of their families. As parents age they may find it more difficult to cope, or some other problem or change takes place that makes management difficult. It is important to be honest with yourself. If you cannot cope, discuss your concerns with relevant family members and professionals.
If behavioural problems become out of hand, social services can help. They can provide respite care (accommodation away from the family), help at home through family support workers, and advice about any additional help and benefits you may be entitled to. The health services can offer a range of advice and help. You can access these services through your local doctor or through social services. Voluntary societies such as MENCAP and other organisations can also offer help and advice and support. See the article Finding Help for some ideas about getting additional help and support for you and your family.
Treatment for Autism
Medication is sometimes used for children who are violent to others or self harm Other drug treatments can help reduce obsessive-compulsive behaviour. You need to discuss this with your doctor.
The main treatment offered is behaviour therapy. This concentrates on structured learning, setting up routines and giving clear, often repeated instructions. Learning can be facilitated by using interesting visual aids which capture attention. Praise is given for appropriate responses with less attention offered for poor responses. This work is very demanding and often needs doing over and over again - that is why you may need support and help.
Web sites:
The National Autistic Society UK
Autism UK Frequently asked questions for University Students
http://www.users.dircon.co.uk/~cns/index.html
Contact A Family UK (support group for families)
Dennis Neill
Family Therapist
Family Therapy UK
1st May 2008
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