About
Autism
Introduction
Autism is a developmental condition that affects the way a child socialises and communicates.
No two autistic children are the same and there are likely to be differences
Although their Autistic neurotype is always present; it can take time to become identifiable
Therefore an autistic individual may be diagnosed anytime during their lifespan.
Autism is not always easy to recognise particularly in girls and teenagers where they are able to mask a lot of symptoms.
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Autism has been known by many different names in the past. These include Autism Spectrum, Autism Spectrum Disorder, High Functioning Autism, Asperger's Syndrome and Autism Spectrum Condition etc.
Since May 2013, all forms of Autism have been recognised using the single term Autism Spectrum Disorder, according to the new classification system, the DSM-5. This is the term most commonly used by many clinicians in UK as well. However many associations such as the National Autistic Society and literature still reserve the term Asperger Syndrome.
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We recognise that the medical model of assessment is a deficit model however we strongly believe in the strengths and positive attributes that Neurodiversity brings.
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A lot of children and young people are misunderstood and parents are often blamed for the child's behaviours. Families have felt let down due to a poor understanding of their child, in various settings. Some children struggle with mental health issues such as anxiety and depression before they are even considered to have Autism.
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It is believed that there are more than 1 autistic individual per 100 individuals. However, data from the US suggests that it is even more common than that.
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How does Autism present as
Our experience suggests that there are many different autistic traits.
Most people are familiar with Autism where an individual presents very early on with severe speech delay and repetitive behaviour such as flapping and lining up of toys. They are happy in their own world.
With this trait of Autism a paediatrician assessment helps rule out other serious medical conditions that can also present in the same way.
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Some autistic children instead of having delayed speech, are often very advanced in the use of speech.
Closer inspection of their behaviours highlight some of the following characteristics as per the NICE guidelines:
Social interaction and reciprocal communication behaviours
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Spoken language:
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preference to not talking much to others despite good speech ability
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unusual style of speech for example mumbled, unclear, too fast or too low in volume
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may have a monotonous tone or robotic sounding voice with little variation in pitch
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may prefer to use learnt phrases
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Conversation may be dominated by excessive information on topics of their passionate interest
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talking 'at' others
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others may misinterpret their responses as seemingly rude or inappropriate without intentions to be hurtful
Interacting with others
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May prefer to keep their personal space to themselves
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May come close to other's personal space
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Prefer a fewer close friends or reciprocal relationships or their own company
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not seemingly keen on the concept of friendship although may find it easier with adults or younger children
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Preference for their own company over others
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May not enjoy exchanging greeting and farewell behaviours
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Have their own awareness and understanding of socially expected behaviours that may be different to other non autistic individuals
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Passionate about winning at games and keen at following the rules of the games
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May have different interests to those what other young people his or her age are interested in
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Have their own style of communication in social situations which is not variable depending on the social context or hierarchy.
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They be choose a very formal or very familiar style of social communication.
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​Like to know things as they are rather than reading in between lines, take things literally and not keen follow the hidden language of sarcasm or metaphor.
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Makes comments that are honest and truthful without the need to consider social hierarchies
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Occasionally some children and young people do not like the pressure of responding to the requests of others (demand avoidant behaviour)
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Eye contact, pointing and other gestures
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May prefer to look away either by eye contact or orientation of their body
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Not prefer to express all their feelings with gestures and or facial expressions choosing to have limited facial expressions and minimal gestures
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Ideas and imagination
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Flexibility in social imaginative play and creativity may not be their strength but they may be able to reenact scenes seen on visual media for example, television.
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Unusual or highly passionate interests and repetitive behaviours
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Enjoy or find pleasure in repetitive movements such as hand flapping, body rocking while standing, spinning, finger flicking.
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Preference for highly specific interests or hobbies often with intense interest.
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A strong adherence to rules or fairness
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Their like to spend time in highly passionate behaviours or rituals.
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Intense passion with routines may lead to emotional distress if things are changed without notice
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Their like for predictability may leads to anxiety or other forms of distress including aggression when things are changed without warning
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Over or under reaction to sensory stimuli, for example textures, sounds, smells is common.
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Excessive reaction to taste, smell, texture or appearance of food
Other Autistic Traits
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Unusual profile of skills and deficits (for example, social or motor coordination skills poorly developed, while particular areas of knowledge, reading or vocabulary skills are advanced for chronological or mental age).
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Social and emotional development more be different to others, they are often not manipulative but excessive trusting (naivety)
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Due to liking of sameness there may be resistance to everyday simple demands
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Prefer no time constraints
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like their own ideas that are often thoughtful and detailed may be considered by others as not being flexible
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Find easier to adjust if the changes are not sudden or unexpected
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May express feelings at times as a panic response such as running away, aggression, shutdown, self-harm etc
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May be good at copying social behaviours to some extent
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Experiencing excessive mood swings and impulsivity
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May show extreme fondness towards another individual or things
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May be experts in role play to an unusually intense severity example living as another person, animal or character
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May have a very different presentation at home and at school
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Find happiness in their own company at the end of a social episode such as after coming back from school or a party
​There are many ways to identify Autistic traits
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A detailed history of the child’s or young person's development and presentation
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Medical examination
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Observation/ information from more than one setting such as educational setting if applicable or information from other professionals involved is helpful
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Blood tests and investigations are not routinely indicated but may be necessary depending on individual presentation
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Use of Autism specific tools as necessary​
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​​There are a number of Autism specific tools that can be used for an assessment. These include but are not limited to:
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ADOS-2
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ADI-R
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BOSA
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3Di
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Assessment for Autism can be complicated and very lengthy; we are here to make this process simple and easy and tailored to your child.
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Using standardised assessment tools, we assess your child and provide you with comprehensive reports and suggest strategies, that meet the needs of your child. Additionally when requested, we are able to provide a profile of your child such as demand avoidant.
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We are trained in all these Autism assessment tools including tele-consultation methods.
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During the assessment if any other needs become apparent, we would recommend further condition specific assessment. We feel this is important as for all diagnostic assessments, one should look out for any possible co occuring conditions.
Medical Conditions associated with Autism
There are a number of conditions that can co-exist with Autism. The presence of other conditions can sometimes mask the presentation of Autism. Therefore, experienced clinicians are required to uncover the complex presentation of Autism.
The common medical conditions that coexist with Autism include:
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Global Developmental Delay or Learning Disability
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Dyspraxia or Developmental Coordination Disorder
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Epilepsy
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Chromosomal Disorders and syndromes etc.
Therefore assessment by a medically trained expert is required to identify them
Functional and Behavioural concerns associated with Autism
Children with Autism may also have functional and/or mental health and/or behavioural concerns:
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​Functional conditions may be
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Eating Disorders such as Avoidant and Restrictive Food Intake Disorder (ARFID)
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Urinary Incontinence
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Faecal Incontinence
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Sleep Disorders
Mental health and Behaviour concerns may be
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ADHD
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Anxiety and Phobias
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Mood Disorders
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Oppositional Defiant Disorder
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Tics or Tourette Syndrome
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Obsessive Compulsive Disorder
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Self-Injurious behaviours
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Pathological Demand Avoidant Profile is being increasingly recognised by expert clinicians
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Therefore an expert assessment is recommended to uncover the possibility of these conditions
What is the benefit of a diagnosis
Autism is a lifelong condition but the traits are identified at different stages of life
Early support and reasonable adjustment has been shown to have a positive impact on the child’s development and outcomes.
Education of those caring for children with Autism has an important role in improving lives of those affected by Autism.
The amount of support required varies from individual to individual and across the life span. The condition requires reasonable adjustments to be made by others.
Role of Health
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Identify Autism in a timely manner
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Identify of other conditions that may be associated with Autism
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Support for co-occurring conditions such as ADHD, Sleep Difficulties, Aggression, sensory and co-ordination issues
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Advise and support parents and other professionals
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Support the individual with Autism
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Contribute to Education Health and Care Plan assessment, Disability Living Allowance etc.
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Coordination with other agencies such as education and social care.
Role of Education
According to the Special Education Needs and Disability Code of Practice, education settings should make reasonable adjustments for children and young people with Autism.​
The Autism Education Trust provides a rich source of information advice and support for schools and educational authorities.
Role of Social Care
There are a range of benefits that may be available to families with children who have a diagnosis of Autism. These include
Disability Living Allowance, Carers Allowance etc. ​
Each local authority publishes their Local Offer that helps parents navigate through the services available locally for children and young people with Autism and other special education needs and disabilities.
