Autism Spectrum Disorder
Autism Spectrum Disorder
When children are born, they have a huge number of brain cells that initially are not massively interconnected. As children grow and learn, the cells within the brain connect to each other in ways that facilitate the recall of information, storing of knowledge, and understanding of social cues and situations.
As part of this process of growth and restructure, periodically the brain undergoes a “pruning process”, whereby brain cells that do not appear to be connected in helpful ways, get pruned out, and reused for other things. There are a number of theories about how autism develops, but one of these that has had some influence, is the idea that for some individuals, the pruning process disconnects some useful connections, thus making some issues more difficult to deal with. There is also some support for there being a genetic link (it can be more common in some families), and/or a relationship to DNA damage.
In particular, parts of the brain that deal with emotions, may for example, become poorly connected to parts of the brain that do intellectual processing. This makes emotions feel much more overwhelming, as it is now harder to work out why you are having strong emotions. It also makes it harder to assess risk, as it becomes harder to “read” the emotional state of others, which in turn makes it impossible to tell if they may hurt you. It becomes safer to treat all other humans as a potential risk. This of course, can then lead to significant social anxiety, can trigger avoidance of social situations, and lead to difficulties being in noisy classrooms, or busy school yards for example. Autism is for all these reasons, therefore defined as a ”Neurodevelopmental disorder”, often first seen in childhood, but which continues to be present as the individual grows to adulthood.
Often, and possibly to compensate for a deficit in one area, individuals on the spectrum may develop severe sensory sensitivities, (sometimes known as “superpowers”). They may become acutely sensitive to smell, to sound, to light. Often touch is very overwhelming, and often these young people become extremely sensitive to the emotions of others (they may not be able to respond well, but they become distressed for example, by distress in others). They are often extremely literal, not always understanding metaphor well. They may also be very strong in their beliefs about what is “right” and what is “wrong”, and this can at times cause disruptions in relationships with peers.
Diagnostically, clinicians typically look for three main criteria, which are likely to be more restricted or limited in those on the spectrum:
Firstly, the young person may have difficulties in social interactions compared to same aged peers. They may have poor eye gaze, limited friendships, and poor or unusual use of gesture.
Secondly, verbal and non-verbal communication is often difficult for them, and there may be delay in language development, a lack of speech, or a lack of being able to easily engage in make-believe play.
Thirdly, activities and interests may be restricted, obsessive, or abnormally intense. There may be repetitive physical behaviours such as spinning or flapping hands, and again, interests may be more restricted than in same-aged peers.
There are a number of support organisations for parents and young people on the Autism Spectrum, listed below and under the “LINKS” button on this webpage.
Assessment is a specialist area, and typically is by a Clinical Psychologist who has been trained in the use of the ADOS-2 and the ADI-R, as well as having specialist skills and experience in dealing with autism-related issues. Use of screening questionnaires can be helpful, but at times these do not provide a truly accurate assessment, being suggestive or indicative, rather than diagnostic. There is often a considerable leeway for error on some screening questionnaires (they can be wrong!).
It is also worth noting that girls on the spectrum can present very differently to boys on the spectrum. Boys are more likely to be sufficiently different in behaviour from their peers, that they are identified and referred at a younger age. Girls will often compensate by closely observing “successful” female peers, and modelling their behaviours on them. They are often very good at “masking” their distress, which can be strongly internalised. Typically such girls are more likely to first be noticed for school avoidance or social avoidance (anxiety), oppositional behaviour/not doing as they are asked (anxiety), or depressed mood (due to longstanding anxiety!). It seems that girls more often present around the time of puberty, when it can become hard for them to cope with the changes that are happening to their body, and the increased attention from males that can occur.
Information on Autism can be obtained from the following sites and places:
http://seonline.tki.org.nz/ASD/Learning/tips-for-autism
http://www.tipsforautism.org.nz/
REFERENCES
Frith, U. (1989, 2003). Autism: Explaining the Enigma. Oxford, England: Blackwell Publishing.
Ministries of Health and Education. (2008). New Zealand Autism Spectrum Disorder Guideline. Wellington: Ministry of Health.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
All views expressed in this information sheet are those of the author, however based on broad research and clinical experience. Any feedback may be directed to the author: Steve Williams, Consultant Clinical Psychologist, Director: C&A Hub.
This version: © August 2023.