What is Autism?
Autism is a lifelong neuro-developmental difference. This means it is a condition that affects the development of the brain. Autism affects the way a person communicates and interacts with others, how information is processed and how the person makes sense of the world.
The human population is highly diverse. Neurodiversity is a term that describes this normal variation across all people. Within the autistic population there is also a great deal of diversity and autism manifests differently from person to person.
For children and young people, there is a reciprocal relationship between the autistic learner and the environment - this includes the physical environment and the people around them. With appropriate understanding and adjustments autistic people can flourish.
Autism often co-occurs with other neuro-developmental differences including;
- Attention Deficit Hyperactivity Disorder (ADHD)
- Developmental Co-ordination Disorder (DCD) also referred to as Dyspraxia
- Developmental Language Disorder (DLD)
- Foetal Alcohol Spectrum Disorder
- Intellectual Disability
- Tourettes and Tic disorders
- Specific Learning Disorder/ Differences e.g Dyslexia, Dyscalculia
Further information on Neurodiversity is available within the Toolbox - see Neurodiversity.
Autism is not a linear scale running from 'high functioning' to 'low functioning', which are unhelpful terms. Instead, autism varies in several different ways - sensory differences, levels of anxiety, social skills and executive functions all vary both from person to person and from time to time. This short comic strip provides one explanation.
How common is autism?
Autism affects around 1.03 % of the Scottish population (micro segmentation McKay et al 2018).
There are some groups where autism is under recognised for example:
- Black and minority ethnic children and young people
- Children living in poverty
Around 4% of children who are referred for autism assessments because they have similar presentations, do not receive a diagnosis of autism, however they are still entitled to and require their needs to be met.
Useful links about under-recognised groups
Rutherford, M., McKenzie, K., Johnson, T., Catchpole, C., O’Hare, A., McClure, I., ... & Murray, A. (2016). Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. Autism, 20(5), 628-634.
Baird, G., Douglas, H. R., & Murphy, M. S. (2011). Recognising and diagnosing autism in children and young people: summary of NICE guidance. BMJ, 343, d6360.
Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., & Charman, T. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). The lancet, 368(9531), 210-215.
What causes autism?
For most individuals the cause of autism is not identified. Autism is generally thought to have a genetic basis and research is ongoing.
An interesting Ted talk on causes of autism can be found in the professional learning section.
What is core to autism?
- Communication differences
- Sensory differences
- Thinking difference
- Impact of Environment
When the above four aspects are not supported appropriately this will lead to increased anxiety for the autistic person.
Autism: males and females
Autism is thought to be more common in boys than girls, however there is a growing consensus that girls are under diagnosed or misdiagnosed. A range of reasons are given for this, including different societal expectations; diagnostic tools being designed around boys; special interests are often gender determined due to social expectations and interests of girls might be perceived as less unusual (e.g. strong interest in lip balms compared with interest in trains).
The quiet, anxious presentation of autism occurs across genders but might be more prevalent in girls and these individuals are more likely to be missed.
Information from SIGN 145 guidance annex 2
- Abnormalities in language development, including muteness
- Odd or inappropriate prosody
- Persistent echolalia
- Reference to self as ‘you’, ‘she’ or ‘he’ beyond three years
- Unusual vocabulary for child’s age/social group
- Limited use of language for communication and/or tendency to talk freely only about specific topics.
- Inability to join in play of other children, or inappropriate attempts at joint play (may manifest as aggressive or disruptive behaviour)
- Lack of awareness of classroom ‘norms’ (criticising teachers, overt unwillingness to cooperate in classroom activities, inability to appreciate or follow current trends)
- Easily overwhelmed by social and other stimulation
- Failure to relate normally to adults (too intense / no relationship)
- Showing extreme reactions to invasion of personal space and resistance to being hurried.
Impairments of interests, activities and/or behaviours
- Lack of flexible cooperative imaginative play / creativity
- Difficulty in organising self in relation to unstructured space (e.g. hugging the perimeter of playgrounds, halls)
- Inability to cope with change or unstructured situations, even ones that other children enjoy (school trips, teachers being away, etc).
- Unusual profile of skills / deficits
- Any other evidence of odd behaviours, including unusual responses to sensory stimuli.
Information from SIGN 145 guidance
Language and communication
- Problems with communication, even if wide vocabulary and normal use of grammar
- May be unduly quiet, may talk at others rather than hold a ‘to and fro’ conversation, or may provide excessive information on topics of own interest
- Unable to adapt style of communication to social situations, e.g. may sound like ‘a little professor’ (overly formal), or be inappropriately familiar
- May have speech peculiarities, including ‘flat’ un-modulated speech, repetitiveness, use of stereotyped phrases
- May take things literally and fail to understand sarcasm or metaphor
- Unusual use and timing of non-verbal interaction (e.g. eye contact, gesture and facial expression).
- Difficulty making and maintaining peer friendships, though may find it easier with adults or younger children
- Can appear unaware or uninterested in peer group ‘norms’, may alienate by behaviours which transgress ‘unwritten rules’
- May lack awareness of personal space, or be intolerant of intrusions on own space
- Long-standing difficulties in social behaviours, communication and coping with change, which are more obvious at times of transition (e.g. change of school, leaving school)
- Significant discrepancy between academic ability and ‘social’ intelligence; most difficulties in unstructured social situations, e.g. in school or work breaks.
Rigidity in thinking and behaviour
- Preference for highly specific, narrow interests or hobbies, or may enjoy collecting, numbering or listing
- Strong preferences for familiar routines; may have repetitive behaviours or intrusive rituals
- Problems using imagination, e.g. in writing, future planning
- May have unusual reactions to sensory stimuli, e.g. sounds, tastes, smell, touch, hot or cold.