Autistic spectrum disorders are a heterogeneous group of neuro-behavioural syndromes characterized by major impairments in basic social relationships, abnormal language development, limited or non-existent imagination and extremely rigid patterns of behaviour. This comes under the Pervasive developmental disorder.
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood. It is one of three recognized disorders in the Autism Spectrum (ASDs).
The National Autistic Society, UK defines Autism as "A lifelong developmental disability that affects the way a person communicates and relates to people around them. Children and adults with autism have difficulties with everyday social interaction. Their ability to develop friendships is generally limited as is their capacity to understand other people's emotional expression."
Signs and Symptoms
There are three key areas of cluster features, which provide the criteria for a diagnosis for autism, these are known as the 'triad of impairments' (Wing and Gould, 1979)
1. Social: Impaired, deviant and extremely delayed social development - especially interpersonal development. The variation may be from 'autistic aloofness' to 'active but odd' characteristics.
2. Language and Communication: Impaired and deviant language and communication development - verbal and non-verbal.
3. Thought and behaviour: Rigidity of thought and behaviour and poor social imagination, like ritualistic behaviour, reliance on routines, extreme delay or absence of pretend play.
1. Social: Difficulties with social engagement may appear in different ways.
This will include a person who is classically 'aloof', but also a person who respond to social interaction, but may not be able to initiate it, through to the 'active but odd' person who seeks social interaction but is socially naive and cannot quite 'get it right'
A person may withdraw from social contact, or may cause others to leave them alone through their apparently 'anti-social' behaviour. They may seem cut off and passive, content to be by themselves but not resisting when others approach (especially someone familiar) who insists they join in.
Others may appear at first to be very sociable, even socially indiscriminate. They may pester people (even strangers) with questions and monologues and approach people too closely, making no distinction for different levels of intimacy. Far from avoiding others, people on this level, especially as young adults, may be desperate for friends and may be vulnerable to abuse in their eagerness to have a 'friend' at any cost. These behaviours are clearly different,almost opposites in some cases, yet they all demonstrate a lack of social understanding.
2. Language and Communication: Difficulties in all aspects of communication.
The problem of autism concerns communication rather than language. At one end of the spectrum, a person may speak fluently, but their speech has odd intonation and may show echolalia (automatic reiteration of words or phrases which have been heard recently or in the past) and 'reversal' of pronouns - referring to themselves as 'you' and the person being spoken to as 'I' - (at least when very young). Their understanding is literal. To say you can do something 'standing on your head'; to tell someone 'Looks can kill' or describe a person as a 'bad apple' will cause confusion.
A person with autism will often have difficulty holding conversation and tends to speak 'at' rather than speaking 'to' or 'with' people. There will also be difficulties in understanding and using facial expressions, body posture and communicative gestures. At the other end of the spectrum, a person will have the same difficulties in understanding all forms of communication, but will have no speech and will not easily compensate with sign or communicative gesture. Communication, at all levels of ability, is directed at having needs met, rather than sharing information or interests.
3. Thought and behaviour: Difficulties in flexible thinking and behaviour
This is shown in repetitive, stereotyped behaviour and with some people, an extreme reactionto change in expected situations or routines. Play is not socially creative or symbolic (although symbolic play acts may be copied or developed) and tends to be isolated, sometimes involving spinning objects, lining objects up in a ritualistic way, or a fascination with light or angles. The more able show these difficulties in their development of obsessive interests or 'hobbies' that are pursued to the expense of everything else. Understanding of fiction is minimal, even in the more able. Learning is by rote.
A person with autism is dependant on cueing or prompting to start behaviour or trigger thoughts and feelings. It is not that the individual cannot be creative in an artistic sense but that their behaviour is almost entirely habitual. The person is likely to have poor development with their sense of self-autonomy or the planning and reviewing of their thoughts or actions.
