Autism spectrum disorder, Asperger's syndrome

Children and adults with an autism spectrum disorder look the same as other people, and because of the invisible nature of their disability it can be much harder to create awareness and understanding.

Autism and Asperger syndrome still remain relatively unknown disabilities among the general population. Yet it is estimated that autism spectrum disorders are approximately four times as common as cerebral palsy and 17 times as common as Down's syndrome – touching the lives of over 40,000 families throughout New Zealand.

What is an autism spectrum disorder?

Autism spectrum disorder is a life-long developmental disability affecting social and communication skills. People with the disability can also have accompanying learning disabilities; but, whatever their general level of intelligence, everyone with the condition shares a difficulty in making sense of the world.

Because of the differing degrees of severity and variety of manifestations, the term 'autism spectrum disorder' is often used to describe the whole range.

This term includes Asperger syndrome, which is a form of autism at the higher functioning end of the autism spectrum. People with Asperger syndrome are of average (or higher) intelligence and generally have fewer problems with language, often speaking fluently, though their words can sometimes sound formal or stilted.

What causes the condition?

The exact cause or causes have not yet been identified, but research has shown that genetic factors are important. In many (perhaps most) cases, autism spectrum disorder may also be associated with various conditions affecting the brain, such as maternal rubella, tuberous sclerosis and encephalitis.

Onset is almost always from birth or before age three, although people with the condition may go through life without being diagnosed – and without receiving help that could help them live more fulfilled lives.

Who is affected?

'Classic' autism affects four times as many boys as girls; Asperger syndrome affects nine times as many boys as girls. It is found among all races, nationalities, and social classes.

Can people with autism spectrum disorders be helped?

An autism spectrum disorder is a life-long disability, but there are ways of helping, especially if a child is diagnosed early and receives appropriate intervention early in life.

Specialised education and structured support can really make a difference to a child's life, helping to maximise skills and achieve full potential in adulthood. An early diagnosis of autism spectrum disorder is essential in order to ensure appropriate support is given.

How common are autism spectrum disorders?

One person in 100 has an autism spectrum disorder, this includes people who have Asperger syndrome. The estimated population of people with autism spectrum disorders in New Zealand is approximately 40,000.

These figures include people at the higher functioning end of the spectrum who may not need specialist services and support, but who will still benefit from early recognition and sympathetic understanding of their special needs and unusual pattern of skills.

Recognising the disorder

Features of the disorder can vary widely from one person to another; there is no single feature that defines either autism or Asperger syndrome.

For example, a child with an autism spectrum disorder may make eye contact, speak with perfect grammar or put an arm around another child who is crying. Occasional behaviour such as this doesn't exclude an autism spectrum disorder; it's the overall pattern that's relevant, not the intermittent flashes of 'normality'.

The degree to which people with an autism spectrum disorder are affected varies, but all those affected have difficulty with social interaction, social communication and the development of shared imaginative play. This is known as the 'triad of impairments'.

Social interaction

People with autism spectrum disorders have difficulties with social relationships. They may, for example, appear aloof and indifferent to other people or passively accept social contact, even showing some signs of pleasure in this, but rarely making spontaneous approaches.

Social communication

People with autism spectrum disorders also have difficulties with verbal and non-verbal communication, for example, not fully understanding the meaning of gestures, facial expressions or tones of voice.

They also find it hard to appreciate the social cues and pleasure of communication. They do not understand language is a tool for conveying information to others. When they do use language it is generally used very literally with an idiosyncratic, sometimes pompous, choice of words and phrases and limited speech.

Imagination

There are difficulties in the development of play and imagination, for example children do not develop creative 'let's pretend' play in the way other children do. They have a limited range of imaginative activities, possibly copied and pursued rigidly and repetitively.

Children and adults tend to focus on minor or trivial things around them – an earring rather than the person wearing it, the wheel of a toy rather than the car itself. They also tend to miss the point of pursuits involving words, such as social conversation, literature, especially fiction, and subtle verbal humour.

Repetitive behaviours

In addition to this triad, repetitive behaviour patterns are a notable feature, as is a resistance to changes in routine. People with autistic spectrum disorders often become obsessed with particular objects or behaviours, focusing on them to the exclusion of everything else.

Sensory issues

People with an autism spectrum disorder may have 'sensory issues' or a difference in sensory integration, where they can be either hyposensitive or hypersensitive to outside stimuli.

This means that a person can be very sensitive to particular sounds, lights, smells and touch, etc. Particular sensations may be very absorbing and pleasurable, others may be perceived as unbearably intense, stressful and even painful. The anticipation of such an experience can lead to extreme anxiety or panic. There may also be a lack of sensitivity and therefore response to pain. These type of experiences can often be very bewildering to parents, teachers and other 'neurotypicals'.

Special abilities

Some people with autism spectrum disorders, who may be severely disabled in most ways, will sometimes display talent for, say, music, mathematics or technology. Some have a remarkable memory for dates and things that particularly interest them.

What do I do if I suspect an autism spectrum disorder?

If you suspect an autism spectrum disorder is present, have the person referred (or suggest they ask) for a specialist diagnosis and assessment as early as possible through their GP, Child Development Unit, Child and Family Guidance Centre or paediatrician.

Original material provided by Autism New Zealand Inc. Reviewed by everybody, June 2005.