Autistic Spectrum Disorder and Asperger's Syndrome

What is Autism?

Autism is a life-long developmental disability affecting communication and social skills. People with autism can also have accompanying learning difficulties but, whatever their level of ability, everyone with the condition shares a difficulty in making sense of the world. Autism affects the way an individual communicates with and relates to people around them and makes sense of their environment.

People with autism are affected in a variety of ways and to differing degrees. However, they all have difficulties with using language and often have problems in processing and understanding language and using speech.

People with autism may also have sensory difficulties such as aversion to touch, sound or smell. The results of this combination of difficulties may be expressed as anxiety, frustration and challenging behaviour.

The exact causes of autism are not known but research shows that genetic factors are important. Autism affects about 91 in every 10,000 people - i.e. about 500,000 in the UK. Boys are more often affected than girls. Autism usually shows itself in the first three years of life but Asperger's syndrome is more difficult to identify and may not be recognised until after the child starts school.

As autism occurs in differing levels of severity and a variety of forms, the term Autism Spectrum Disorder (ASD) is often used to describe the whole range.

What are the signs?

Children with ASD or Asperger's syndrome have difficulties in three main areas: communication, socialising and behaviour. This may not always be apparent in the very early stages of development All children are different and show these difficulties to varying degrees but these areas form the 'triad' that leads to a diagnosis of ASD.

  • Communication - difficulties in this area are often the first to cause concern. Almost all children with ASD have some language delay - both in understanding language and expressing themselves. They may show little interest when people speak to them and if they speak themselves, may simply echo what they have just heard. What they say may have little relevance or meaning. Some speak in an odd or stereotyped way showing difficulties with rhythm, intonation and stress - all things which carry messages and social meaning in conversation. There may be difficulty in beginning conversations and in following them. However, children with Asperger's Syndrome (see below) may be early talkers although their language is often described as formal or very adult.
  • Socialising - children with ASD may ignore other people or appear insensitive and unaware of their needs, feelings and thoughts. They may not make eye contact or use and respond to facial expression and simple gestures. They tend to find it difficult to share, turn take and co-operate with others, preferring to play alone. Frequently, they lack imaginative play. For these reasons, they tend to form better relationships with adults than other children. They often lack understanding of the rules of social interaction and cannot 'read' social situations. They have difficulty in forming relationships and may feel lonely and excluded.
  • Behaviour and rigidity of thinking - children with ASD tend to crave routine and resist change as they find change difficult and unpleasant. They often have preoccupations with certain objects or routines - insisting on doing the same things repeatedly in exactly the same way each time. They may exhibit repetitive body movements such as hand flapping and any attempt to stop these causes distress. Children with Asperger's usually have more mild behavioural patterns but may still be easily upset by relatively minor situations.

Asperger's Syndrome

ASD includes the condition Asperger's Syndrome which describes people at the higher functioning end of the spectrum. People with Asperger's Syndrome are of average or above average intelligence and usually have fewer obvious problems with language. However, they may have difficulties understanding the subtleties of language and interaction. They interpret language very literally, have problems in understanding metaphors and figures of speech and find it difficult to see and understand another's point of view.

Tantum (1988) suggests that Asperger's Syndrome describes those people who:-

  • Use language freely but fail to make adjustments to fit different social situations or the needs of their listeners
  • Want to be sociable even though their peer group tend to avoid them because of their apparently eccentric behaviour
  • Are conspicuously clumsy
  • Develop unusual interests in which they become deeply engrossed
  • Have problems expressing themselves in ways such as their facial expression, gestures or posture.

These difficulties persist into adult life and can present particular problems in adolescence because of social isolation and awareness of being different from their peer group.

How can we help?

Education with appropriate levels of therapy support offers the most effective way of making sure that the child with ASD or Asperger's Syndrome reaches their full potential. A detailed assessment of their strengths, weaknesses and needs will help to determine the type of educational placement needed.

Criteria for Admission

The Percy Hedley Foundation offers specialist small group teaching with integrated therapy for the child with ASD who is able to work in a group with other children, albeit with high levels of support. Children who can benefit from the approach we offer do not usually have a diagnosis of 'core' or severe autism. They demonstrate some intention to communicate and interact and do not present with high levels of challenging or aggressive behaviour. They will usually have high levels of need for input from Speech and Language Therapy, Occupational Therapy and Physiotherapy services because of their language, sensory and co-ordination difficulties.

Our teaching approach

The presence of therapists as an integral part of the staff team is a key feature of our approach and ensures that the high level of therapy needed by the child with ASD is available to them.

Each small class group is staffed by a team including teacher, support assistants, speech and language therapist, occupational therapist and where appropriate, physiotherapist. The team also has access to an educational psychologist. This team works and plans together to produce an individualised programme to meet the needs of the child with ASD. Therapists offer individual and small group therapy where necessary but also work within the classroom, supporting children and helping them to generalise skills they have already learned.

Proven strategies are used such as high levels of visual support in the form of symbol based timelines and timetables. These allow the child to see the structure of the day and so understand the sequence of events. The TEACCH approach which similarly structures the environment for the child so that they understand what is expected of them is also used where appropriate. The staff team works together to ensure that the child who has difficulties with sensory integration has access to a range of strategies and approaches to minimise sensory stress and promote a readiness to learn. Consistency and a calm, highly structured environment are essential.

The child with ASD often needs explicit teaching to develop their language skills and their understanding of the social rules that most people learn easily. Percy Hedley offers specific social communication groups, usually lead by the speech and language therapists, which aim to teach the child how to form relationships, manage conflict and interact positively with others. Unstructured situations such as break and lunch times may be particularly difficult for the child and they will benefit from structured teaching of strategies to help them deal with these times.

If necessary, additional means of communication such as signing, symbols or voice output communication aids are used to develop language skills.

The class groups are determined by a child's age and ability and, although the group ethos is important, each child has their own goals and targets within the group. All children within school follow a broad and balanced curriculum, including the National Curriculum, which is modified according to their individual needs.

There is also an emphasis on working in partnership with parents to ensure a consistency of approach to learning across all environments. Parents are key members of the team.

 
References:

Tantum. D. (1988) Annotation: Asperger's Syndrome. Journal of Child Psychology and Psychiatry, 29(3), 245-255.