AUTISM

DRG.YUNITA DYAH PUSPITA SANTIK.,M.KES(EPID)

INTRODUCTION

• Autism covers a wide range of abilities and difficulties.

• It is very rare that two people with Autism will have exactly the same signs and
symptoms.
• Autism rarely occurs in isolation from Learning Difficulties or Mental Health
Problems.
• Although there are differences between people with Autism there are also similarities,
especially surrounding the triggers that can cause them stress and anxiety.
• Social Skills: usually delayed. Difficulty in
reading social situations and acting
appropriately.
• Communication Skills: includes both verbal
and non-verbal skills. Language delay –
usually late talkers. Find it difficult to
verbally express emotions.
• Ritualistic Behaviours: repetitive
behaviours similar to OCD (often
manifested through counting or sorting
objects). Restrict everyday life and
experiences.
• Recent changes to the criteria for the diagnosis of
Autism. This can be found in the DSM V (Diagnostic &
Statistical Manual of Mental Health Disorders V).
• The terms Asperger’s Syndrome, Pervasive
Development Disorder and Autism are now replaced by
Autism I, Autism II and Autism III
Some concerns around Autism types are that:
• The diagnosis process has become too simplistic.
(Diagnosis is now made within the areas of Social
Communication and Ritualistic Behaviours).
• Asperger’s Syndrome as a term no longer exists.
• The categories do not go far enough to give
descriptors about an individuals sensitivity, resilience
or scope of symptoms.
• Autism: A spectrum of neuropsychiatric disorders
characterized by deficits in Social interaction and
Communication and unusual and repetitive
behaviour. Some but not all people with Autism are
non- verbal.
• Asperger’s Syndrome: Also known as Asperger’s
disorder, is one in a group of neurodevelopmental
disorders that have effects on a person’s behaviour,
use of language and communication and pattern of
social interactions.
• Research (2014) has indicated that current
incidences of Autism is 1 in 68 children (for every 5
children diagnosed 4 will be male and 1 female).
The increase cannot be completely explained by the
change in the DSM V criteria.
Symptoms of Autism often appear gradually so
theories about the build up of toxic metals and
pollutants in combination with other factors such as
genetics, heredity and neurology may offer the most
realistic explanation. Below are some of the possible
causes of Autism:
• PCB (Polychlorinated Biphenyls) found in old
electrical equipment and also found in fluorescent
lighting.
• Inability to detoxify metals such as mercury and
lead
• Lower than average presence of Vitamin E.
• Pesticides and other pollutants
• Myth] Tantrums.There is usually a trigger to a behaviour. Remember that inappropriate behaviour is
the result of a person being in a situation that is difficult to understand, they feel threatened or are
experiencing difficulty in communicating their needs (see Sensory Meltdowns).
• [Myth] Autistic people don’t want friendships. They do want friends, but they find it hard to crack the
social codes to join in with other people.
• [Myth] All people with Autism are good at Math. Some may be very good at math but they are just as
likely to be good at other subjects such as Art or Music.
• [Myth] People with Autism are not creative. People with high functioning autism can put a different
slant on a solution to a problem as they can think outside of the box.
• [Myth] People with Autism have no feelings. They have feelings and emotions the same as everyone
else, but they have difficulty in expressing and sharing them.Also refer to ADHD Myths and facts.
Below are some of the key signs of Autism :

• Limited or inappropriate social interactions (finding it difficult to break the social code or act inappropriately in
formal settings).
• ‘Robotic’ or repetitive speech (sometimes they may even have an accent that is not indigenous to where they
Difficulties with nonverbal communication (gestures, expressions, etc.) but have average to above average verbal
skills
• Tendency to discuss self. They will monopolise conversations which will be about self or their current favourite
topic and generally appear aloof.
• Inability to understand social/emotional issues or nonliteral phrases. They will find it hard to appreciate jokes.
• Lack of eye contact or reciprocal conversation. Lack of eye contact may be because they are concentrating.
• Obsession with specific, often unusual, topics. They will be able to share information about their favourite topic
which could be weather, time tables or dinosaurs.
• Awkward movements and/or mannerisms. Could be mistaken for dyspraxia.
• The proportion of Males with Autism outnumbers Females by roughly 4 to 1. The initial
question why are there more males than females with Autism? Is it a Male dominated
problem or there another reason?
• Some of the symptoms are so subtle that parents and teachers may not be able to pick up
on the clues. Previously Autism signs and symptoms in girls have also been incorrectly
diagnosed as personality disorders.
Autism in Girls Vs Autism in Boys:
• Girls with autism tend to be withdrawn rather than aggressive when they are frustrated. In
the classroom or during social occasions this behaviour is not immediately obvious as
being a problem.
• Females tend to have the ability to express their emotions in a calmer way.
• Females are generally more supported by their neurotypical friends who help them cope
with difficult social situations. Peer support masks some of the issues that parents and
teachers would have generally recognised.
Personality Traits of a Female with Autism:
• Obsessive tendencies (animals, dolls and other female orientated interests).
Neurotypical girls will play with dolls and re-enact social situations, the Asperger girl may
collect dolls but not re-enact social situation or play dolls with their peers.
• Fascination with particular subjects which will result in them age related behaviours. A
preteen with Asperger’s may still be fascinated with stuffed animals or cartoons.
• They have a tendency to mimic neurotypical children, but will use phrases and gestures
inappropriately.
• They get bored with people of their own age and will show little empathy with their
friends and their worries.
• Generally girls are more passive than boys who have Autism.
• Most kids with Classical or Borderline
Autism symptoms have this affirmative
qualities. Please note, that Not all of these
positive attributes apply to every person
with Autism or Aspergers.
• Also, children with
ADHD /ADD or oppositional defiant
disorder (ODD) tend to not to display such
personality traits.
• Stimming should not be confused with Tourette’s Syndrome or Tics.
• Stimming is a defined as a repetitive body movement that is self-stimulatory and can be
as simple as a sideways gaze or as obvious as running in circles or jumping and clapping.
• Stimming can affect any part of the body.
• Some Stims may involve repetitive throat clearing, hand flapping, repeating the same word
or sound because of the tickling sensation that it gives in the mouth. Echolalia in autism is
also another form of stimming.
• Stimming can also involve chewing on clothes or rocking back and forth repeatedly.
• The difference between stimming and mimicking an action or behaviour is the amount of
times that it is repeated.
• Treatment of Stims will depend on the cause of a Stim.
People with Autism are Visual Learners. There are three main strategies that we learn new information:
• Visual – what we see and how we interpret it
• Auditory – what we hear and how we interpret it
• Tactile – what we feel and how we interpret it

Or, in some cases, children with Autism may use a combination of strategies.
• In a classroom setting if students are listening to the teacher/tutor and there are no visual examples of what they
are saying then Visual Learners will only take on 20% of what is said. If the students are trying to take notes at the
same time then that rate drops even further.
• People who have dyslexia are best at learning new skills when they can see a demonstration. They may be able to
relate to written instructions later but as they are visual learners they need to see ‘things in action’ so to speak. This
is the same for people with Autism.
Social Skills for Autistic Children
• The majority of people learn social skills by watching other people. Some of the time we learn behaviours ‘by
accident’. For people with Autism they can learn social skills by observation but they will need some support that will
explain actions and reactions to situations. They need support to be able to understand and then apply that
information to other situations. They also need to know that not every situation is the same so there needs to be a
certain amount of adaptability which people with high functioning find difficult.
Below are a few types of identified Risks involved with Autism and Asperger’s Syndrome. Any of these
risks can result in a situation where an intervention is needed to prevent the person unintentionally
hurting themselves or someone else.
• They will get very upset with any changes to timetable or routines if they are not told about it
• Misread social situations. E.g. in relationships not understanding the subtle clues when they are being annoying.
• Lack common sense and has little or no understanding of personal safety . E.g. difficulty understanding
consequences of actions.
• Can be distracted by strong interests. E.g. to the point where they may not eat or sleep as they are so engrossed
with reading a book or playing a computer game.
• Dislike getting messy. They will tend to avoid tactile activities such as food preparation or painting. They can get
very distressed if they do get messy. And likewise if they have a strong preference to wearing particular clothes they
will get upset if those clothes get dirty and they need to wear something else. (parents usually buy several identical
sets clothes to avoid this anxiety)
• If they get anxious or annoyed, they find it difficult to express their feelings so will appear to be very irritable and
verbally abusive. If the situation escalates they can become physically destructive.
• These are generalised risks and may not apply to everyone with Asperger’s syndrome, the important thing is at this
stage to acknowledge the level of risk and understand that there are support tactics that can be applied.
• In response to the identified risks here are some support tactics that are commonly used. The important aspect to
remember is that with sensitive support they can re-focus. Being able to physically move themselves out of a
situation is also a positive way to re-focus.
• Changes – Advance warning of changes to schedules will reduce stress and help to plan alternative routes and
scenarios.
• Misread social situations – Respond well to boundaries when they know what they are. The boundaries need to be
explained in simple terms that do not speak down to them.
• Crystal Clear Instructions – so as there is no misinterpretation or confusion.
• Mentor – They will benefit from a mentor to talk to when they become upset or anxious.
• Safe Place – somewhere that has been agreed prior to experiencing any difficulty.
• Cards or a Scribe – They may also benefit from having someone to scribe for them to express their feelings or focus
their ideas. If the person you are dealing with is very anxious for whatever reason they are going to find it very
difficult to communicate verbally so ideally you should some form of cards that they can point to that helps them
express their feelings without getting more stressed and anxious.
Remember that what you say will have a literal interpretation. Phrases to avoid:

• ‘Walk on ahead’ could be interpreted as ‘Walk on your head’;

• Has the cat got your tongue?
• Keep your eye on the ball
• You’ll have to pull your socks up
• Looks can Kill
• You are pulling my leg
• And a common phrase that could really upset an autistic child is ‘Have you got a frog in your throat?”
Be prepared for a major melt down! Choose your words carefully.
• Remember that visualisation strategies are not really useful. Ideally you will know something about
the person, such what they feel comfortable with or how they prefer people to explain things to them.
• People with Autism also have a heightened sensitivity to sound, smell, light, taste, touch and
visual stimulus. There are three other senses that are less well known. A person with Autism
can be more (hyper) or less (Hypo) sensitive in each of these sensory areas.
Vestibular: The sense of balance, movement and being able to know where you are
within the space you occupy.
Proprioceptive: The sense of being aware of your posture and how to self-correct.
Interceptive: The sense of the internal body and regulation.
• An example of Hypo-sensitivity is when a child spins for ages and they walk away with no
apparent ill effects such as appearing dizzy. This could be regarded as thrill seeking behaviour.
• An example of Hyper-sensitivity is when a child will only drink out of a cup made of a particular
material, or a particular colour and sometimes the cup may have to be a particular temperature
otherwise they will not even attempt to drink out of it. For more details, please refer to Sensory
Integration Disorder symptoms.
Sensory Meltdown

• Autistic children often resort to sensory overload. This should not be mistaken for a
tantrum. A tantrum is when a child or person cannot get their own way or gets the toy,
object or attention that they crave. A sensory Meltdown is when there is far too much
sensory stimulus and no way to get out of the situation.
• The level and type of sensory stimulus for one person may be painful and uncomfortable
for another person. This situation can occur when out shopping, when they shop is
overcrowded or the music is too loud or there is an odour that the person finds horrible.
(One person’s expensive fragrance is another person’s cat litter tray!)
• An inability to cope or withdraw from any sensory discomfort can be disastrous. Ideally a
person (child or adult) needs a quiet safe place where they can go to take some time out
and compose themselves. They should not be punished for being unable to cope.
Learning Difficulties

• School can be a challenging environment at the best of times but if a child is having difficulties such as
anxiety, depression then any stressful event can cause the child to overthink the situation and react to a fight
or flight stimulus which can then result in emotional trauma that in turn causes problems with concentration.
• Most people, who have Autism, also have Learning difficulties, such as Dyslexia, Dyspraxia, ADHD, and/or
Tourette’s syndrome. For some people there may be more than one Learning difficulty to cope with. If this is
the case then it is usual to focus on the Disability that causes the most difficulty or most concern.
• In other cases the disability may not be apparent at first as they may have found ways to disguise their
difficulty. It is important to support the child rather than the label. In most schools there are support guidelines
that can be adapted to help all children who are struggling, not just children with Autism and/or Learning
Disabilities.
• Because a child has a Learning Disability does not mean that their social and emotional needs are any less the
children who surround them at school. Consider how difficult it is for the child with Dyslexia to decode some
of the words in written instructions especially when they see how the other children are helping each other,
• If the child is above average intelligence, having a learning disability can be doubly difficult. Most people with
Dyslexia are average or above average intelligence and the same is the case with Asperger’s syndrome. This is
further confounded if the child suffers with anxiety. This will result in poor self-esteem and low confidence levels.
• Learning difficulties can lead to low self-esteem, isolation and ultimately behavior problems. If a child has a good
support system that allows them to learn to express themselves, deal with their frustrations and see
disappointments as challenges rather than an accepted ending they will have the chance to taste success.
• Generally children with Learning Disabilities have difficulties with expressing their feelings, which will cause
frustration and in some cases anger. They also have difficulty taking on strategies to enable themselves to calm
down. Good social and emotional skills are a worthy indicator of success for both children and adults. If a child or
adult can develop socially and emotionally, it can compensate for a lack of academic skills
• Early interventions can help children with Autism become more independent, confident and self-reliant in many
social situations. This does not mean that the interventions can ‘cure’; it means that the child will have a template in
which they can expand their knowledge and apply their learning to many different situations.
Mental problems

• Anxiety and Depression may be the most common disorders that are associated with Autism. 38% of adults with
autism have depression. In general terms people with Autism are very vulnerable to mental health problems
especially in late adolescence and early adulthood.
• One of the main causes of mental health problems can be related the difficulty with communication difficulties
especially with expressing feelings, anxiety or distress. Most clinicians have little knowledge or understanding of
developmental disorders so talking therapies such as CBT to alleviate anxiety and depression are not successful.
• It is difficult to diagnose depression and anxiety as people with autism as they have impaired non-verbal
communication and expression that may not be visible.
• Sleep Difficulties: Many people with Autism, especially high functioning Autism, may experience problems with
sleep. This is because they find it hard to block out thoughts and calm themselves down ready to sleep. In cases like
this they are often prescribed the hormone Melatonin. It is not a sleeping tablet it is a hormone that occurs naturally
in the body to send signals to the neurotransmitters that relay messages to the brain that it is time to sleep. There
are no side effects to Melatonin. Use of special weighted blankets can also aid falling to sleep, staying asleep and
waking refreshed.
• Lack of sleep can cause stress in the body, which can heighten sensitivities to anxieties.
• Bipolar Disorder: This is more noticeable in adults than young children as the symptoms are rarely picked up in
babies and toddlers.
• Bipolar disorder is where a person has mood swings that can last for several days of extreme highs and extreme
lows. We all have a range of feelings that we experience throughout the day but people with Bipolar disorder can go
from barely sleeping and being extremely active for several days to being stuck in bed for several days with
depression. It can be very debilitating if not treated.
• General Anxiety Disorder (GAD): This is about excessively worrying about everyday things. We all worry about things
like health, money and family problems. People with GAD are extremely worriers about these things and many other
things as well even when there is little or no reason to worry.
• From the time that they open their eyes in the morning to the time they go to bed they worry. Throughout the day the
anxiety may increase to the point where it prevents them from completing everyday tasks.
Behavioral Problems

• Obsessive Compulsive Disorder (OCD): Often the anxiety through worry is so intense that it has a major impact on
the ability to live a normal life. A person may need to perform repetitive actions (e.g. checking or cleaning) and if
they are unable to perform these actions they will experience a heightened sense of anxiety.
• OCD needs to be put into perspective. We all need to wash our hands. We should all tidy up after ourselves.
Sometimes when we are under pressure we all experience the inability to relax and put negative thought out of our
minds. But in general terms these actions or thoughts do not encompass our behaviour to the point where it is
obsessional.
• Sleep Difficulties: Many people with Autism, especially high functioning Autism, may experience problems with
sleep. This is because they find it hard to block out thoughts and calm themselves down ready to sleep. In cases like
this they are often prescribed the hormone Melatonin. It is not a sleeping tablet it is a hormone that occurs naturally
in the body to send signals to the neurotransmitters that relay messages to the brain that it is time to sleep. There
are no side effects to Melatonin. Use of special weighted blankets can also aid falling to sleep, staying asleep and
waking refreshed.
• Lack of sleep can cause stress in the body, which can heighten sensitivities to anxieties.
• Seizures: It is estimated that one third of people with Autism also have epilepsy which can result
in seizures. In a general population the incidence of Epilepsy is 2 in every 100 people.
• It is thought that the brain abnormalities that are associated with Autism are probably the major
contribution to Epilepsy. Consider the differences that influences changes in the way
information is transferred between neurons across the neural synapse in the Autistic brain, the
explanation for the high incidence of seizures in people with Autism sounds logical
• Seizures can occur at any age but those most at risk are children with Autism over the age of 13
who have a lower than average IQ (below 70). Not all children who have a seizure are diagnosed
with Epilepsy. Typically a diagnosis is made after at least two seizures.
Attention Deficit Hyperactivity Disorder (ADD/ADHD)

• ADHD is one of the most widespread difficulties that may start at an early age and continue on through childhood,
adolescence and adulthood. In the classroom children who have only the inattentive signs of ADHD or ADD, will get
overlooked. This is because they are usually not causing any disruption in the class.
• For the child with Autism it is difficult to assess where the symptoms of Autism and ADHD/ADD begin and end. There may be
aspects of Autism that lend itself to ADHD/ADD and vice versa.
• Hyperactivity: Most children are very active but children with symptoms of hyperactivity are always on the move. They find it
very difficult to sit still; they can be found constantly fiddling with objects and moving from project to project without actually
completing anything.
• Impulsivity: Children that are impulsive have difficulty in controlling their behavior; generally they seem to have little or no
regard for other people’s personal space. They tend to ask what appears to be irrelevant questions and make tactless
observations.
• Aspects of behaviour are only a real concern when they are not age or ability appropriate. Again the importance here is the
realization that everyone has some of these behaviours to an extent, but it becomes a real problem when it affects daily living.
The categories do not go far enough to give descriptors about an individuals sensitivity, resilience or scope of symptoms.
Communication Passports

• These provide information about individuals in a way that promotes them as a person and not
just a disability. The information includes details of the person’s likes and dislikes as well as
anxiety triggers. It supplies details of how best to communicate and support that person in
different contexts. It also illustrates that person’s unique qualities.
• It provides important information that promotes the person as an individual not a disability.
• Information should include details of the person’s likes and dislikes as well as anxiety triggers.
• These Communication passports are usually easy to read and provide information from the
individual as well as Carers and professionals that are working with them. They can be used to
support vulnerable children and adults. The downside to the communication passports are that
they take some time to complete, but their value is priceless.
• There is a similar document that is used in Healthcare. It is a commonplace tool that is used in
both Hospitals and Care Homes. It can be accessed by medical staff as well as Carers and
Social Workers. It provides information about who to contact, who co-ordinates care for the
patient, and other similar information that is found in the Communication Passport.
• From the point of view of someone (child or adult) who is Autistic the information in these
passports are invaluable as it will help staff become more confident with dealing with the
patient and at the same time provides information about Autism. For the child or vulnerable
adult this means that a hospital stay becomes less traumatic.
• Autism Alert card is designed for older children and adults as a mini-information pack to enable
them to communicate if they are in difficulty.