Specialist Teaching Service

Autism is a developmental disorder which affects the way that a person relates to others. People with autism are affected to differing degrees but all will have difficulties in the areas of social interaction, verbal and non-verbal social communication, and imagination. This means that they will have problems in understanding the world in the way others do. Their development is likely to be uneven, with some types of skills being stronger than others. Asperger Syndrome is considered as part of the more able end of the autistic spectrum.

The incidence of autism is low, with estimates ranging upwards from 5:10,000 for very severe cases, so called Kanner autism, to 58:10,000 if more able individuals, such as those with Asperger Syndrome, are included.

Boys are four times more likely to be affected than girls.

People with autism are more likely than the rest of the population to have additional learning difficulties and to suffer from epilepsy.

Autism was first described by clinicians in the forties and has been the subject of much research, particularly over the last twenty years. Early academics wrongly attributed the cause to poor bonding with parents, resulting in incalculable anguish for blameless mothers and fathers. The evidence does not support this view; rather it favours a pre-natal cause, which is likely to have a genetic component. Several biological factors may converge in causing a psychological problem which results in a range of characteristic behaviour. Viral infection, pollution or other trauma may act on a genetic predisposition to cause autism in an unborn baby. Consequently, autism must be seen to be the result of an organic problem, and not caused by the way a child is brought up. The physiological nature of this problem is still not clearly understood. While work in the field of human physiology continues, psychologists have wrestled with the problem of explaining the collection of disparate, though characteristic, behaviour shown by people with autism. Some of the behaviour is outlined below. It is important to bear in mind that not every person with autism will display all the behaviour and that the way different characteristics are expressed may vary enormously from person to person.

This may range from the severe case of David, who seldom seems aware that other people share his environment and who shows no interest in interacting with others, not responding to their faces, voices or actions, to the less extreme behaviour of Prakesh, who tolerates and even interacts with other children during certain activities in the classroom, but who spends playtimes wandering about alone and often needs reminding to come back into school when playtime is over.

Here we see behaviour ranging from that of Rachel, who will only travel in one particular car and who refuses to walk a different way to the shops, visiting only the same shops in the same order, to that of Colin, who is much more flexible but who feels that every time he enters a room he must walk around touching all the furniture before he can be comfortable.

Again we see a range of behaviour. Mary is interested only in pieces of fluff which she collects from the carpet and balances on the edge of the table. She will do this all day, seeking no further amusement. Chan presents another dimension altogether. After spending an hour with him a psychologist was heard to express the opinion that ‘ There’s nothing wrong with this boy. He’s just spoken to me for about an hour on the Norman

Conquest.’ It’s only when you consider that Chan never talks about anything else that you begin to realise that something is not quite right.

Things which pose no apparent threat can take on an horrific significance to people with autism. Jonathan loved playing in the ball pool, but after a couple of months refused to walk down the corridor that led to it. His teacher coaxed him with the reward of going to the ball pool, but he refused and became very anxious. His speech was not sufficiently well enough developed to express the reason for his fears, but a careful examination of the problem revealed that the only difference in the corridor since he used to walk down without complaint was a fluorescent strip light that had started to flicker. This was changed and after a while Jonathan was able to use the ball pool again.

Ironically, while imagined dangers abound in autism, real threats are often poorly understood. Children may reach for hot things, run out in front of cars or leap out of high windows without any anticipation of the consequences.

People with autism may display a wide range of odd behaviours and mannerisms. Many enjoy rocking and flapping their hands. Some behaviour can appear alarming. Harry has a tendency to suddenly cry out and swing his arms backwards and round, as if swimming with a butterfly stroke; disconcerting if you are in a busy supermarket. Robert, a more able young fellow, spends a lot of time in the back garden, running over an imaginary letter ‘R’. He has beaten such a track into the lawn that it is not really so imaginary any longer.

Again we see a wide range of behaviour. Some people with autism never develop speech. Others will repeat exactly what they have just heard while others will repeat something they heard some time ago. One girl was known to repeat the entire previous night’s episode of ‘Eastenders’, fine if you happened to miss that particular one. Sometimes this echolalic speech, as it is called, will have very limited communicative intent. Some children may use it as a real communication. Harry will use the words ‘Do you want a biscuit?’ when what he means is that he would very much like a biscuit himself.

Many people with autism show very uneven ability. In some areas, particularly those associated with language, they may be very weak. In others, particularly those involving visual skills, they may be very strong. The world of autism has artists, inventors and musicians who are very gifted in tightly circumscribed areas but people with profound gifts are as rare here than they are in any walk of life. Unfortunately, people with autism are much more likely to have accompanying learning difficulties than the rest of the population.

Autism may affect an individual more or less severely. Some children will need specialist provision while others will do well in mainstream education.

From these observations it is possible to imagine a continuum stretching from the most profoundly impaired individual with autism to the most able.

Autism can be more or less severe and many children are likely to progress along the continuum as they get older.

Environmental and genetic factors play a part in determining character. This goes some way to explain why people with autism are such a diverse group. There seem, at first glance, to be far more differences than similarities between such people.

For autism to be recognised as a true condition, psychologists needed to look at large sections of population, considering all those people who had difficulties with communication and socialisation in order to isolate characteristic symptoms which might define a syndrome.

A small number of people were found to demonstrate weaknesses in three areas: they had difficulties forming relationships, tending not to make approaches to others, or approaching in odd ways; they had problems with communication, both at the level of language and gesture and they tended to limit their interests to the familiar and narrow. In other words they had problems with social interaction, social communication and social imagination.

The psychiatrist Lorna Wing coined the term ‘Triad of Impairments’ to describe this conjunction of problems. It is now recognised throughout the world that all three must be present before a person can be said to have autism.

This idea is central to the way we try to understand autism today.

Along the autistic continuum, people may be more or less severely affected in each of the triad of impairments. This, combined with the influence of environmental factors, explains:

Each area of the triad interacts with the rest so, to some degree, their development is mutually dependent. Below is a description of the nature of each impairment, followed by three contrasting fictional cases that illustrate the breadth of the spectrum.

People with autism have some degree of difficulty forming bonds. They do not readily seek out the company of others. If they do, their approaches may be odd and perhaps not made to the person but to an article of their clothing or other interesting attribute. Depending on the severity of their impairment, people with autism may be felt to be aloof, passive or active but odd.

Harriet is aloof. She walks into a room as if there were nobody else there. She does not respond at all to faces or voices, unlike normally developing children, for whom other people form the most interesting part of any new setting. Attempts to involve her in activities result either in her taking no part and wandering away or emphatic rejection. She is unable to share her attention or to realise that other people are agents who can fulfil her needs.

Carl is passive. He tolerates the presence of other people and allows himself to be dressed or manoeuvred into position without complaint.

Simon is active, but odd. He likes to be close to people, but insists on stroking their hair and touching them very lightly on the palms of their hands. He does this to the people he knows well and also to total strangers.

For communication to place there needs to be

All people with autism will have some problem with communication, both in terms of spoken language and their understanding of body language, facial expression and gesture.

There is a gap in their knowledge of what communication is for:

Harriet is indifferent or hostile to the people that she meets. If they are trying to influence her behaviour in any way, she will beat them off. She has no speech. When she is hungry she screams, but does not seem to relate this discomfort with her mother bringing her some food.

Carl understands that if he takes your hand to the door handle, you may open the door. He will manipulate people in this way to express his wishes. He has some speech in that he repeats phrases that he has heard, usually without any meaningful intention.

Simon has quite well developed language, but his ability to use it is very inflexible. His gestures are stiff and formal. He is a poor judge of how to address people, using the same speech to his friends as he would to his head teacher. He has difficulty understanding that the same word can have more than one meaning and is completely bewildered by such phrases as ‘it’s raining cats and dogs!’

People with autism have difficulty with

Harriet shows no tendency to play with toys, and is uninterested in anything unless it is glittery and spins. When she comes into school each morning she flops down in a corner with her favourite spinning toy.

Carl likes toy cars, but he is never seen to ‘drive’ them around. He enjoys lining them up, becoming quite disturbed if other children try to join in and move the cars away. He will snatch them back and put them back into the line.

Simon, confronted with a toy castle and knights was heard to ask ‘What do you do?’

His teacher showed him how to play, with some knights trying to defend the castle from the others. He now enjoys playing with the fort, but always in the same way. He doesn’t extend the play for himself, though he will integrate new ideas from others.

Although the consequences of an impairment in imagination are difficult to grasp, they are of great significance in coming to terms with an autistic perspective.

These are some of the difficulties resulting from an inability ‘mind read’ the intentions or state of mind of other people. Further difficulties emerge when consideration is given to the fact that many of our ideas about ourselves derive from our impressions of what other people think about us. Our self image and self esteem depend on the quality of this two way social trading. Some authorities think that, as people with autism have an impaired capability in making such evaluations, they may have a poorly developed sense of identity.

The triad of impairments accounts for some of the worldview of people with autism, but not all. When some able people with autism talk about their experience they frequently mention difficulties with sight, hearing, touch and taste. This is not because there is anything wrong with the way their senses work, but how the sensory information is interpreted by the brain. Words may make sense for a little while then dissolve into a meaningless whisper or swell into a deafening thunderclap. They might seem unconcerned by extremes of temperature. Some qualities of touch may be unbearable: a light caress may be excruciating but a firm grip perfectly tolerable. This unpredictability of their sensory experience would be baffling and disturbing at the best of time but, coupled with an unstable social awareness, could be extremely frightening.

Autism is a life long developmental disability which affects all aspects of a person’s social understanding. As yet there is no cure and, while there are many approaches which people have found to be beneficial, there is no one approach which matches the needs of all. Much can be achieved through education that is sympathetic to individual needs and well informed about the nature of the condition.

Howlin, P (1998) Children with autism and Asperger syndrome. Chichester: Wiley

Jones, G (2001) Educational provision for children with autism and Asperger syndrome. London: David Fulton

Jordan, R. and Powell, S. (1995) Understanding and Teaching Children with Autism. London: Wiley

Leicestershire County Council and Fosse Health Trust (1998) Autism: How to help your young child. London: National Autistic Society

Wing, L. (1996) The Autistic Spectrum. London : Constable

The National Autistic Society
393 City Road
London EC1V 1NG