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.

Autism is characterised by three types of impairment, all of which are present in some way:

1. Rigidity of thought and behaviour, and limited imagination or imaginative play, where the individual may carry out ritualistic actions, or focus upon minor details (such as an item of clothing rather than the person, or part of a toy rather than the whole thing).
2. Limited verbal and non-verbal communication with a lack of true two-way conversational skills, a failure to understand the emotions, gestures, or ideas of others, and an over-literalness in interpreting what is said.
3. Difficulty with social relationships, with an appearance of aloofness or indifference, and with inappropriate or repetitive styles of approach if contact is initiated.

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:

• marked and sustained impairment in social interaction.
• restrictive and repetitive patterns of behaviour and activities, and a strong preference for routines and avoidance of change.
• motor delays or clumsiness are also commonly associated with Asperger syndrome.

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.

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.

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.

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.

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;

and

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.

• the child's lack of generalisation of learning (every situation appears different to the child)
• the lack of incidental learning (everything needs to be directly taught)
• the literalness of understanding
• difficulties in becoming involved in group activities including play and games
• possible reactions to over-stimulation and the fact that this can easily occur in situations that other children cope well with
• observed behaviours which might be seen as simple naughtiness or non-compliance may in fact have a range of other meanings for the child with autism or Asperger syndrome (i.e. the observed 'naughty' or 'non-compliant' behaviour may in fact be the child's only way ... of indicating the need for help or attention, or the need to escape from stressful situations,... of obtaining desired objects, ... of demonstrating his/her lack of understanding, ... of protesting against unwanted events, ... of gaining stimulation).

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:

• Providing a very clear structure and a set daily routine (including for play). Ensuring the pupil knows the day's programme at the start of each day and can make frequent reference to this throughout the day, e.g. providing a 'picture board' with the day's activities 'laid out'. The child can move the activity 'picture' to the 'finished' section on the board before moving on to the next activity. Placing this board in a neutral ' area (i.e. area not linked with specific activities), creating a 'transition' area to enhance the understanding of finish and moving on to the next activity.
• Teaching what "finished" means and helping the pupil to identify when something has finished and something different has started.
• Providing warning of any impending change of routine, or switch of activity.
• Using clear and unambiguous language. Avoiding humour/irony, or phrases like "my feet are killing me or it's raining cats and dogs", which will cause bewilderment,
• Addressing the pupil individually at all times (for example, the pupil may not realise that an instruction given to the whole class also includes him/her. Calling the pupil's name and saying "I need you to listen to this as this is something for you to do" can sometimes work; other times the pupil will need to be addressed individually).
• Repeating instructions and checking understanding. Using short sentences to ensure clarity of instructions.
• Using various means of presentation - visual, physical guidance, peer modelling, etc.
• Ensuring consistency of expectation among all staff... and avoiding any 'backing-down' once a reasonable and manageable target has been set.
• Recognising that some change in manner or behaviour may reflect anxiety (which may be triggered by a [minor] change to routine).
• Not taking apparently rude or aggressive behaviour personally; and recognising that the target for the pupil's anger may be unrelated to the source of that anger.
• Specific teaching of social rules/skills, such as turn-taking and social distance.

• Minimising/removal of distractors, or providing access to an individual work area or booth, when a task involving concentration is set. Colourful wall displays can be distracting for some pupils, others may find noise very difficult to cope with.
• Seeking to link work to the pupil's particular interests.
• Exploring word-processing, and computer-based learning for literacy.
• Protecting the pupil from teasing at free times, and providing peers with some awareness of his/her particular needs.
• Allowing the pupil to avoid certain activities (such as sports and games) which s/he may not understand or like ; and supporting the pupil in open-ended and group tasks.
• Allowing some access to obsessive behaviour as a reward for positive efforts.

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.