Definition

• social relationships
• social language and communication skills
• imagination

The triad is usually accompanied by repetitive patterns of behaviour and interests, and often by challenging behaviour. Around 75% of children with autistic spectrum disorders have general learning difficulties that fall in the moderate (IQ 35-50) range. The children usually have an uneven pattern of cognitive strengths and weaknesses, with reading decoding skills often being way ahead of comprehension - a condition known as hyperlexia. Around 10% of the children have a special skill in such areas as music, art or computational skills.

Children with Asperger Syndrome are amongst the most able of those within the autistic spectrum and will often be educated in mainstream schools. Diagnosis is sometimes difficult for these pupils, as they do not have such an obvious learning disability, but may have been considered 'odd' by their teachers and classmates. Obsessions are associated with special interests rather than behaviours. It is less usual for motor mannerisms or preoccupation with parts of objects to occur. Language skills may appear good, but they may fail to make adjustments to fit different social contexts or the status of different listeners. Non verbal aspects are impaired, such as tone of voice, facial expression, gesture, gaze and posture. Motor development may have been delayed with clumsiness or awkwardness evident later.

Children with Asperger Syndrome have a higher degree of self-awareness and interest in others. They are often more aware of the impediments to normal social relationships that they experience and this can lead to a painful degree of distress or anger towards others. Some young children with an early diagnosis of autism may later 'evolve' into a pattern more consistent with Asperger Syndrome.

Epidemiological studies suggest that 2-5 children in every 10,000 fall within the autistic spectrum.

The following section enlarges upon the triad of impairments that characterises autistic spectrum disorders, and is reprinted with the kind permission of the UK National Autistic Society from their booklet Could this be Autism? The address for NAS publications, together with the NAS weblink, is given below (see Resources).

The Triad of Impairments

Autism is a pattern of abnormal development that unfolds over time. In most cases, the triad of impairments emerges in the first 2-3 years of life. Sometimes indications are there even earlier. In infancy one of the most important indications that autism could be present is the absence, or very delayed development, of drawing the attention of parents and others to objects or events. In normal childhood development, by the time a child is 12-18 months, they are usually pointing at things and trying to engage the interest of the person they are with so as to invite them to look too. They also gain attention by bringing toys and make eye contact when doing this. If this behaviour does not occur, or begins very late and is limited to the child's own interests, an autistic disorder should be suspected.

Because autism is a complex condition it is easy to miss important clues. The triad can be shown in many different ways:

Impairment of Social Interaction

A child with autism will:

• often appear aloof and indifferent to other people, especially other children, although some will enjoy certain forms of active physical contact;
• passively accept social contact and even show some signs of pleasure in this, but rarely make spontaneous approaches;
• occasionally approach other people but in an odd, inappropriate, repetitive way, paying little or no attention to the responses of those they approach.

Impairment of Social Communication

A child with autism will:

• not appreciate the social uses and pleasure of communication. This is true even of those who have a lot of speech, which they use to talk 'at' others and not 'with' them;
• not understand that language is a tool for conveying information to others. They may be able to ask for their own needs, but find it hard to talk about feelings or thoughts and will not understand the emotions, ideas and beliefs of other people.

Impairments of Imagination

• A child with autism will:
• be unable to play imaginatively with objects or toys with other children or adults;
• tend to focus on minor or trivial things around them, for example an ear-ring rather than the person wearing it, or a wheel instead of the whole toy train;
• have a limited range of imaginative activities, possibly copied and pursued rigidly and repetitively;
• miss the point of pursuits that involve words, e.g. social conversation and literature especially fiction and subtle verbal humour.

Repetitive Behaviours

Alongside the triad of impairments, the child will usually show repetitive activity of behaviour. At a simple level, this might involve repeatedly flicking their fingers or an object like a piece of string. More complex signs might include an insistence on following an identical route to certain places, a lengthy bedtime ritual or the repetition of a sequence of odd bodily movements.

The child may also form an intense attachment to particular objects for no apparent purpose, arrange objects in lines or patterns, or collect things like pebbles or plastic bottles without apparent regard to their intended purpose. They may become fascinated by certain topics, such as electricity, astronomy, birds or train timetables, or even specific people, asking the same series of questions and demanding standard answers. While some of these patterns of behaviour are recognisable features of normal development, it is the intensity and frequency, combined with a disregard for the normal use of purpose of activities, that suggests they are part of a pervasive developmental disorder.

Challenging Behaviour

The child may also demonstrate challenging behaviour such as running away, screaming, biting or kicking other people, grabbing things off counters in shops, socially unacceptable habits or making naive and embarrassing remarks.

Special Skills

About 10% of children with autistic spectrum disorders have some special skill at a much higher level than the rest of their abilities, for example music, art, numerical calculations or jigsaw puzzles. Some have a remarkable memory for dates and things that particularly interest them.

Assessment

Interventions

The following extract is reprinted with the kind permission of East Sussex County Council (UK), and is taken from their booklet Understanding Autism and Asperger Syndrome. Details of how to obtain this publication are given below (see Resources).

For a teacher or teaching assistant approaching the education of pupil with autism, there are three basic rules to follow:

1. understand the nature and implications of autism
2. structure and order the learning environment as far as possible so that it guides the pupil towards meeting expectations
3. teach visually as far as possible

Poor Attention and Distractibility

• Remove distracters
• Make a very clear work space for the child, if necessary with the child's name or photograph on his/her table, chair, work try, etc.
• When concentration is needed, let his/her work space be apart from the group, facing the wall and with side screens if necessary. Children with autism find it very difficult to block out distracting stimuli and feel overwhelmed by all the information coming into their senses. As a result they can find it helpful, supportive and relaxing to have a calm, quiet and distraction-free area to work in.
• Keep tasks short, structured and clear.
• Make a 'work then play' rule. This means that a pupil knows his/her preferred activities will follow on from the completion of set tasks, e.g. 'once the work is finished you can use the computer'.

Problems with Recall of Instructions

• Try to give one-to-one instruction after group instructions.
• Ask the pupil to repeat instructions back to you in the one-to-one situation to check understanding and accuracy of recall.
• Check the pupil has access to visual reminders and prompts, e.g. cards with pictures of equipment needed, or a written series of steps to take in tackling a task.

Difficulty Organising and Sequencing Tasks

• Make sure your pupil has all the equipment needed before beginning a task.
• If s/he has to collect equipment, sort out picture symbols from a bank of cards as a reminder.
• Put the material for the task in a basket or 'in tray' to the pupil's left. Create a clear working area with a mat or a taped square on the table in front of him/her and then have a basket or 'out tray' for finished work on the right.
• Ensure s/he knows the first thing to do, the next thing and the last thing to be done in every task.
• Use a simple diagrammatic or picture sequence to show how a task should be structured (for older more able pupils, a sequence of simple written instructions will help).

Difficulty Following Group Instructions

• Be aware that children with autism often find it hard to realise that group instructions apply to them
• Catch their attention by using their name before giving instructions.
• Repeat instructions individually to the pupil afterwards and ask them to repeat back verbally to you what they have understood. If they cannot repeat back orally, ask them to sequence some simple pictures/diagrams to show they have understood, or help them to do this.

Difficulty Knowing How to Ask for Help

• Use a picture sequence or written prompt for this, e.g. picture of pupil looking at work, then putting hand up, then teacher at desk, then pupil working alone.
• Go over this sequence with the pupil and practise the behaviour as necessary.

Problems Selecting Relevant from Irrelevant Information

• Keep tasks simple and as short as possible. A small steps approach will work best.
• The use of a highlighter to mark relevant test in a book or a raised symbol, e.g. a clip or peg, to indicate what stage of the daily timetable has been reached will act as a visual aid.

Resistance to Change in Activity and Routine

• Ensure children are warned about impending changes of activity in advance.
• With younger children, counting down to the end of an activity can help. With older children, a verbal five minute warning, and drawing attention to the clock, will cue them into the impending change.
• Ensure that a simple timetable for each day, in symbols or written format, is clearly visible for the pupil's reference, and point to the current and subsequent activities to make the routine clearer.
• If the timetable is uncertain, a question mark symbol in the appropriate place can be a helpful signal to a child that there may be unscheduled change, e.g. the question mark can signal that if the weather is fine there may be a nature walk on that day instead of PE.

Differentiation

The main area for careful differentiation concerns 'understanding' in the widest sense. Pupils with autism may have reasonable and even excellent technical skills (e.g. reading, computation), but true understanding of the meaning and purpose underlying the curriculum is likely to be substantially impaired.

Resources

The following books are available from IPS Publications; prices are shown in £ sterling; an approximate exchange rate for US$ is £1 = US$1-50. Postage is £1 per book for UK domestic orders, and £2 per book for overseas surface postage. A secure publication ordering system is available at IPS OnLine Store; any queries on publications should be addressed by e-mail to: pubs@devdis.com

Asperger Syndrome - Cumine, Leach and Stevenson £14

Autism and Learning - Powell and Jordan £14

Autism: From Theoretical Understanding to Educational Intervention - Peeters £19-50

Children with Autism and Asperger's Syndrome, A Guide for Practitioners and Carers - Howlin £17

Diagnostic and Statistical Manual of Mental Disorders - DSM IV (4th edition) £35

Handbook of Autism and Pervasive Developmental Disorders - Cohen and Volkmar (2nd Edition) £80

Teaching Children with Autism to Mindread, A Practical Guide - Baron-Cohen, Hadwin, Swettenham and Howlin £17

Teaching Pupils with Autism and Asperger Syndrome: Guidelines for Schools East Sussex County Council

Understanding and Teaching Children with Autism - Jordan £20

Support

The UK National Autistic Society has a wide range of publications including information leaflets and books. In addition, NAS can provide details of courses and conferences, support groups, consultancy services and university courses, applicable to the UK.

National Autistic Society, 393 City Road, London, England EC1V 1NG

Telephone: +44 (0)20 7833 2299

Facsimile: +44 (0)20 7833 2299

Website: www.oneworld.org/autism_uk/asd.html

Weblinks

The National Autistic Society:www.oneworld.org/autism_uk/asd.html

©2000 IPS

Updated 26Dec00 2210gmt rl