Autism and Asperger Syndrome
(Reproduced from EPS Focus by kind permission of the author).
It must be recognised that legitimately included under the heading of Autism or of Asperger Syndrome will be children whose difficulties may vary widely in their precise nature and their severity. This overview, therefore, cannot be anything but a brief introduction, to be followed up by consultations with the educational psychologist, paediatrician, or speech therapist, or by reference to wider reading.
What is Autism and Asperger Syndrome?
Autism is characterised by three types of impairment, all of which are present in some way:
Asperger Syndrome has been viewed either as a less severe form of autism, or as a separate condition in its own right, but is unarguably part of the autistic continuum. The characteristic signs and behaviours include:
However, compared to autism, individuals with Asperger syndrome have relatively good expressive language, may have cognitive scores which fall in the average or above-average ranges, and rarely experience additional learning difficulties. As a result diagnosis may be delayed until the difficulties in social relationships and interaction become evident. Diagnosis therefore commonly does not occur until after the age of five.
The 'autistic continuum / spectrum'. The concept of a 'continuum' of autistic disorders (or 'autistic spectrum') highlights the range in terms of number or severity of symptoms that individuals may experience. At one extreme, there are children who require very specialist care and provision which will necessarily continue into adulthood. At the other extreme, there are children who can successfully and meaningfully be included within a mainstream school. This highlights the importance of individual assessment and intervention planning, and the need to avoid making assumptions or generalisations about the behaviours, skills, and prognoses of individuals who share the autism or Asperger diagnosis.
How common is Autism and Asperger syndrome?
For 'classic' autism, the estimated prevalence rate is around 5 per 10,000. The estimated prevalence rate of autistic spectrum disorders, including Asperger syndrome, is over 90 per 10,000 in the United Kingdom.
It is possible that this is an underestimate, since Asperger syndrome is not easily recognised, or it may be confounded with other (neurological) disorders such as Attention Deficit Disorder, Obsessive-Compulsive Disorder, or Oppositional-Defiant Disorder. Approximately four times more boys than girls are affected by autistic spectrum disorders.
What are the causes of Autism and Asperger syndrome?
There is no certainty concerning the causes of Autism or Asperger Syndrome, but reviews of studies suggests there may be some organic basis of autism. The developing nervous system may be adversely influenced at a very early stage by the effects of a variety of conditions such as maternal rubella, tuberous sclerosis, lack of oxygen at birth, ~ cough, allergies, or measles. Genetic factors appear significant but the sites of the relevant genes have not been pinpointed. Metabolic abnormalities, or mineral and vitamin deficiencies, may also be implicated among contributory causal factors.
No significant evidence exists for psychogenic theories (i.e. some lack of attachment or bonding - "emotional refrigeration"). There has been considerable publicity afforded to the hypothesised link between autism and the MMR vaccination. However, there is no widely accepted evidence to support this hypothesis; the research appearing to support this link has been much criticised for methodological flaws.
Much of the behaviour characteristic of autism may reflect a deficit in Theory of Mind. The individual cannot readily appreciate the feelings, knowledge, or beliefs in other people (nor indeed fully recognise or interpret his or her own thought processes). Hence stilted language interaction, a lack of self-consciousness, and weakness in understanding social situations ... i.e. problems in social communication.
Stimulus over-selectivity refers to responding to only part of a stimulus, rather than to the whole thing or the whole social setting, with implications for an inability to maintain multiple attention, or stress resulting from over-stimulation.
A limitation in central coherence implies an inability to use context or to generalise from one task or setting to another. This further highlights the tendency to attend to single elements of a stimulus or to fail to see the whole from the sum of the parts.
Weaknesses in language (and social) interaction may be explained at least partially by a lack of gaze monitoring. Pragmatic language, vocabulary development, and shared attention all assume that the speaker and listener are focusing upon the same thing, and a significant strategy for the listener is that of checking what the speaker is looking at. Such a strategy appears to develop spontaneously in young infants, but an absence of joint attention by around 18 months is a strong diagnostic indicator for autism.
Literalness of language usage implies that nothing can be taken for granted in the autistic child's response to instructions. For example, if requesting the child to ask his mum if she wants a cup of tea, one would need to request him also to return with the answer.
Concreteness highlights the likely problem in developing (imaginative) play in that objects are not used as representations of something else ... a cardboard tube is a cardboard tube, not a telescope. The purpose of games, such as playground football, may not be appreciated, and the use of coats for goalposts would be very puzzling.
|Always try to look at the observed behaviour in terms of the function or meaning this behaviour has for the pupil|
Intervention and Management
Among pre-school children, or in specialist schools and centres, the range of intervention approaches serves to demonstrate the range of needs, and levels of need, among children all legitimately described as having autism or Asperger syndrome.
Such approaches include behaviour modification (e.g. early intensive intervention as described by Lovaas and his associates); dietary treatment; auditory integration therapy (designed to reduce sensitivity to particular sound frequencies); music therapy; and scotopic sensitivity treatment.
|An essential element is that all staff are aware of the nature of autism and Asperger syndrome|
Specialist teaching approaches include TEACCH; SPELL; Higashi Daily Life Programme; Facilitated Communication; the Picture Exchange Communication System (PECS); and The Options Approach (Son Rise).
Increasingly significant are parental involvement approaches, such as The Early Bird Project, designed to enable parents to appreciate the needs of the autistic child, to understand the significance for the child of the observed behaviours, and, thus, modify the setting and demands on the child to maximise progress and development.
For details of these approaches, which are outside the scope of mainstream schools, reference may be made to the Surrey EPS).
A common theme is that of seeking early intervention, with implications for rapid recognition of autistic signs and symptoms. Major goals for research are:
(a) identifying particular characteristics in the child or context which will enable the selection of the programme most likely to be effective;
b) determining how to enable the child to generalise behavioural or social or educational gains from the 'treatment' setting to other settings.
It has to be accepted that there is no cure for autism or Asperger syndrome. However, individualised education programmes and structured support can maximise the child's progress, reduce pressure and stress upon the child and the family, and minimise the incidence of behavioural problems.
Children whose needs are not at the severe end of the spectrum have been and can be successfully included within mainstream schools. This has been most successful where schools have been given opportunities to understand the implications of Asperger syndrome or autism for the child and have had the opportunity to explore strategies and interventions. There will need to be flexibility and a recognition that the child may need some approaches different to those used for the other children. Close working with parents is also essential, to ensure consistency and mutual support.
Classroom practice for children with autism or Asperger syndrome in mainstream school will need to take into account the following issues:
The programme for an individual pupil will need to be based on the assessments of the pupil's individual needs and developed by close collaboration of all those involved with the pupil. However, Basic strategies would include:
It is probable that these children will not take any advantage from counselling or from activities such as Circle Time. Instead, adults will need to constantly monitor the context to identify possible sources of uncertainty, peer-interaction problems, or other sources which could lead to stress for the pupil and consequent difficult behaviour. Once such possible sources are identified adults may be able to create changes in the context that diverts the potential difficulties (such as establishing an enhanced tolerance of the observed behaviours and style), or act as a 'mediator' to help resolve any problems.
Close liaison with parents and with other professionals (Educational Psychologist, Speech and language Therapist, Paediatrician) will need to be maintained. This will enable close monitoring of the pupil's progress in social and communication skills, and scholastic performance. It will also be important for sharing the process of interpreting behaviours and identifying triggers for negative or anxious episodes. Other professionals may also be helpful in identifying particular resources such as the Social Use of Language Programme or Playscripts.
The recently established consultative groups for SENCO's and SNA's working with children with autism/Asperger syndrome have provided a means of sharing information and strategies for dealing with particular issues, and the Educational Psychology Service will continue to convene these local groups.
Attwood A. (1998) Asperger's Syndrome : A Guide for Parents and Professionals, London, Kingsley Publishers.
Frith U. (Editor) (1994) Autism and Asperger Syndrome, Cambridge University Press.
Gross J. (1994) Asperger Syndrome, Educational Psychology in Practice 10(2), 104-110
Howlin P. (1998) Practitioner Review: Psychological & Educational Treatments for Autism, Journal of Child Psychology and Psychiatry 39(3), 307-322
Osmond A. (1996) Broken Lines, Special Children (October)
Smith P. and Walker R. (1996) Failing to Connect, Special Children (October)
Wing L. (1996) The Autistic Spectrum : A Guide for Parents and Professionals, London, Constable.
Mike Connor Chartered Educational Psychologist.
© Mike Connor 1999.
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