Autistic spectrum disorders

Published by Bupa’s Health Information Team, October 2011.

This factsheet is for parents of children with an autistic spectrum disorder (ASD), or people who would like information about it including the symptoms, causes and treatments.

ASDs are a group of lifelong conditions that affect how a person communicates with and relates to other people.

This factsheet is relevant for both parents of children with an ASD and adults who have the condition. However, for simplicity, we will refer to your child throughout.

About autistic spectrum disorders

According to the National Autistic Society, around one in 100 people in the UK have an ASD. ASDs include conditions such as autism and Asperger syndrome. The word 'spectrum' is used because the symptoms of ASDs vary widely in nature and severity between people who are affected.

Generally, children who have an ASD don’t develop the social and language skills that other children of the same age do. As a result, they find relating to other people difficult. Children with an ASD may also have unusual behaviours and learning disabilities.

Autism

Children with autism have difficulty communicating and interacting with others. This is often first noticed by the age of two. Some children with autism may have a learning disability, such as dyslexia (a condition that hinders the development of language-based skills, including reading, spelling and writing). Autism is more common in boys than girls.

Asperger syndrome

Asperger syndrome is similar to autism, but is usually less severe. Children with Asperger syndrome generally communicate better than those with autism and have average or above average intelligence. They don't usually have the learning disabilities that children with autism have.

Symptoms of autistic spectrum disorders

Children with an ASD have three main sets of symptoms that affect their communication, social skills, interests and behaviour. These characteristics can vary widely.

Communication

Children with an ASD don’t develop the usual speech or non-verbal skills that other children of the same age do. They also have trouble understanding the meaning of spoken or written language.

You may first notice that your child has communication difficulties if he or she:

• can’t babble (say or make some meaningless words and sounds) or point by the age of one
• doesn’t respond to his or her name
• hasn’t learned any words by the age of 18 months

Your child may take words exactly as they mean – that is, he or she will have a very literal sense of language and won’t be able to understand jokes or sarcasm. He or she may also find it difficult to read body language and facial expressions.

Older children may have an unusual use of language, and have difficulty starting or keeping up conversations.

Children with severe autism may not speak at all, but can be helped to communicate in other ways, such as through signing or using pictures.

Social skills

Children with an ASD have difficulty engaging with other people, making friends and getting on well with their peers. They may be unable to cope with new situations. For example, if your child has an ASD he or she may:

• not seek affection and resist being cuddled or kissed
• prefer to spend time on his or her own
• not understand other people's thoughts and emotions
• find it difficult to accept simple social rules, which can cause problems at school
• find it difficult to manage his or her emotions, which may be expressed as outbursts of anger or aggression

Behaviour and interests

Children with an ASD may show very little or no interest in play that involves pretending or imagination. Instead, they may be more interested in repetitive behaviours, activities and interests.

Your child may take up a special interest at a young age, such as collecting or music and art.

Other symptoms

Apart from problems that affect your child’s communication, social skills, interests and behaviour, he or she may also:

• like sticking to the same routines, and may get very upset if these are disturbed
• be over or under-sensitive to sight, sound, smell, touch and taste

Many children with an ASD also have other conditions such as attention deficit hyperactivity disorder (ADHD), dyspraxia (difficulty co-ordinating and organising thoughts and movements) or epilepsy (a condition that causes seizures).

Causes of autistic spectrum disorders

The exact causes of ASDs aren't fully understood at present. It’s thought that they are caused by a combination of factors, including the genes we inherit from our parents.

There is no scientific evidence to support the theory that there is a possible link between autism and the measles, mumps and rubella (MMR) vaccine.

Diagnosis of autistic spectrum disorders

If you notice your child might be showing signs of an ASD, contact your GP or health visitor.

Your GP will ask about your child’s behaviour and may also carry out a screening interview known as a Checklist for Autism in Toddlers (CHAT) if he or she hasn't started school yet.

If your GP thinks your child may have an ASD, he or she may be assessed at a child development centre to identify any specific needs. You and your child may need to see a range of professionals including a paediatrician, a child psychiatrist, a speech therapist, an occupational therapist, a psychologist and an educational expert such as a specialist teacher or educational psychologist.

A tool commonly used by specialists to diagnose ASDs is the Autism Diagnostic Observation Schedule (ADOS). This is a group of structured tests that can be tailored to different age groups.

If your child is diagnosed with an ASD, he or she may be assigned a key worker, such as a developmental paediatrician (a doctor who specialises in child development), a health visitor or school nurse who can provide you with information and support.

Treatment of autistic spectrum disorders

There isn’t a cure for ASDs, but children who are affected can be helped to manage their symptoms in a number of different ways. The following have some supporting scientific evidence to justify their use.

Behavioural therapies

Therapies such as Applied Behaviour Analysis (ABA) may help to improve your child's social and communication skills. This involves your child seeing a clinical psychologist or trained therapist who uses a technique that involves rewarding good behaviour. Your child’s psychologist or therapist will also set out a consistent and structured way of dealing with challenging or harmful behaviour.

Other therapies

Other therapies aim to help your child with communication and learning. These include the following.

• A Picture Exchange Communication System (PECS) is where your child is taught to exchange a picture card for something he or she wants. This helps your child to express themselves.
• EarlyBird is a three-month programme that helps you to manage your child and predict inappropriate behaviours at a pre-school age.
• Occupational therapy helps your child adapt to his or her living environment.
• Cognitive behavioural therapy (CBT) can help your child to challenge negative thoughts and behaviour.
• Speech and language therapy helps your child to communicate better.

It’s important to remember that one therapy may work for one child but not for another, as all children have different levels of needs and abilities.

Medicines

Sometimes, your child’s GP may prescribe a medicine for him or her to take in the short-term to reduce symptoms such as agitation, aggression or hyperactive behaviour. However, these medicines can have side-effects. Always ask your GP for advice and read the patient information leaflet that comes with your child’s medicine.

Help and support

Health professionals involved in your child's care can provide help and support for you and your child's carers. For example, respite breaks give you a chance to rest while somebody else looks after your child – these may be provided by social services. Some families are also entitled to benefits such as disability living allowance to help cover the extra expenses involved in caring for a child with an ASD.

School

Children with an ASD often need an educational assessment and special support. Your child may go to a special school or, if possible, attend a mainstream school with extra help.

In general, autistic children do better if classroom activities are very structured. Most schools use the Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) approach, which provide a very structured learning environment with mostly visual instructions. Parents can work closely with teachers, using the same techniques at home.

Further advice is available from charities such as the National Autistic Society.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.