Autistic Spectrum Is Not New To Us

1. The term Autistic Spectrum Disorder covers a range of conditions, including autism and Asperger syndrome, that are characterized by impaired social interaction, communication difficulties and restricted, stereotypical, and repetitive activities and interests. Autistic spectrum disorder (ASD) is a developmental disorder that is usually diagnosed in childhood. Children and adults with this condition have a wide range of intelligence. Some have learning difficulties (up to 75%), while others have normal, or above, intelligence and intellectual capacity. Those in the latter groups are often described as having Asperger syndrome.

2. Most people with Asperger syndrome are within the normal range of intelligence but may have difficulties with social interaction and a restricted range of activities and interests. Their speech can be well developed and fluent but language may be used in unusual ways.

3. The causes of autistic spectrum disorder are not clearly understood but include genetic factors, chromosomal abnormalities, complications of pregnancy and child birth leading to organic brain damage. The condition is associated with epilepsy in up to 30% of cases.

4. Autistic spectrum disorders are four times more common in males than females. An increased incidence of autism has been noted over recent decades. It is however a relatively uncommon condition.

Clinical features
5. Autistic spectrum disorder is usually diagnosed in childhood; but some people with high functioning autism (Asperger syndrome) may not receive a formal diagnosis until adulthood.

6. Cognitive function is normal in 30% of people, 30% have mild to moderate impairment and 40% have severe intellectual impairment. In effect 70% have an IQ of 70 or below. Evaluation of IQ in isolation does not predict how an individual will function on a day to day basis.

7. The following types of features and functional limitations may be seen in adults with autism. The severity of the disabling effects is linked to the degree of co-existing learning difficulties/disabilities:-
• No speech or very limited vocabulary, echo speech of others
• Do not understand language, use of emphasis or tone variation to convey meaning
Corporate Medical Group - August 2005 1
• Great difficulty in using or understanding non verbal means of communication e.g. eye contact, body language, gestures
• Do not understand similes, metaphors, humorous, ironic or sarcastic remarks
• Difficulties in planning and organizing activities
• Cannot predict outcomes and the consequences of actions
• Have little or no imagination
• Confuse reality with fantasy
• Unable to appreciate thoughts, feelings, and emotional distress in others
• Have limited or no insight into their condition
• Indulge in repetitive and stereotypical behavior e.g. tapping objects, watching objects spin, rocking, teeth grinding
• Maintain rigid and inflexible routines e.g. eating the same food every day, watching the same videos
• Difficult, bizarre or challenging behavior if routine is changed, or sometimes unpredictably.
• Repeat the same comments or ask the same question many times
• May be uncooperative in carrying out personal care or allowing another to help.

8. However adults with Asperger Syndrome usually have normal cognitive function with minimal intellectual impairment, and may be educated to a high degree. Many of the features detailed above will not be present, but they do have difficulties with social interaction and a tendency to engage in restrictive interests and rituals. For example they may speak at length using unusual and sophisticated vocabulary, but in a monotonous tone or unconventional way. They may make socially inappropriate comments or find it difficult to maintain a conversation with other people or interact with a group of people. They have difficulty in understanding other peoples’ perspective or feelings. Their intense interest in something else may hamper their ability to talk to others or to engage in other activities.

9. Adults with autistic spectrum disorder may develop mental health condition such as depression, anxiety, compulsive behaviors, tics etc. Diagnosis and treatment of conditions such as depression/anxiety can be difficult in those with communication problems. Adolescents and young adults with Asperger syndrome have a higher suicide rate than those of the same age group in the general population Care and mobility considerations Autistic spectrum disorder with severe learning difficulty

10. Many adults with this degree of impairment will live in supported or residential accommodation with a high degree of help and support from care workers. Some will live at home with family. They will need help with most aspects of personal care to maintain nutrition and prevent self neglect. Attention will be required to discourage repetitive or aimless behaviors and encouragement to partake in appropriate activities. They may need watching over to prevent potentially dangerous behaviors or activities such as running off, or to deal with disruptive or challenging behavior Associated problems like epilepsy or other physical disabilities will increase the requirement for help and supervision including the administration of medication.
11. The ability to walk is likely to be unimpeded in the absence of neuromuscular problems affecting the lower limbs. But they will be unable to find their way out of doors without help from some one else.
Autistic spectrum disorder with mild to moderate learning disability

12. Within this grouping there will be a wide spectrum of disabling effects that may require help from others. Some will live in supported accommodation and some will live at home, usually with careers. They are likely to need help or encouragement to wash, dress, prepare food etc. They may need to be advised to wear clothes appropriate to the season and to eat a varied and nutritious diet. It may be necessary to discourage aimless and repetitive behaviors and to encourage participation in appropriate activities. Some may be vulnerable to financial and sexual exploitation. Medication may need to be given and supervised. They will often need help to communicate with others e.g. unfamiliar people, to avoid social isolation and to deal with correspondence and financial matters. Some may need to be watched over to prevent damage to surroundings or maintain a safe environment, and to discourage challenging behavior The care provided allows them to live within a structured environment and routine, whereby they are able to maximize their abilities to carry out tasks of daily living.

13. They are often likely to need guidance in both familiar and unfamiliar places, even if they are able to manage short trips on known routes e.g. to a local shop. Some may be vulnerable to exploitation or exhibit disturbed or anti social behavior when out. Communication with strangers may pose great difficulty, and they would be unable to ask for help or directions, or to respond to directions in a meaningful fashion. Autistic spectrum disorder and normal or above average intelligence.

14. Many people with higher functioning autism are likely to be able to deal with self care and bodily functions, and to be able to prepare a simple meal. Some will live independently, some will need a more structured environment within a family or with support from careers. A structured routine organized by another person may also be important in maximizing function. Some people would be unable to cope with a domestic emergency or have difficulty in communicating with strangers in this type of situation.

15. In some cases there may have difficulty communicating with others when out of doors. They may show unusual or unacceptable behavior such as shouting, if routine journeys are disrupted or altered.
Prognosis

16. Children diagnosed with autism can show much variation in their subsequent educational, social and employment achievements. Research has shown that 75% have a poor outcome, while 25% have a more favorable prognosis. Good prognostic features in children include language acquisition before age six, IQ above 50 and having a particular skill such as computer expertise. It is thought that early diagnosis and intervention improve outcome.

17. Adolescents with these conditions progress in their education and are able to acquire a variety of daily living skills as they mature. It is unlikely however that there will be much substantial change in their abilities in adulthood. Adults with moderate/ severe autism are unlikely to be able to live independently or be employed. Those with high functioning autism, including Asperger syndrome, acquire jobs, but their condition impedes their ability to secure or retain employment without support. Jobs secured may be of a lower level than their educational ability, and people may be unable to remain in a job for prolonged periods of time.
Further evidence

18. It may be difficult to obtain recent medical evidence for adults with autistic spectrum disorder, when they have limited contact with their general practitioners or hospital services, since their general health is satisfactory. However for older teenagers and young adults some reports and previous assessment, including those made by educational psychologists, may be available in their medical records. Copies of assessments made by occupational therapist, and by other specialist services for those living in the community with learning disabilities, may be obtained from social services or local authorities. This applies to those living at home and in residential accommodation. Customers or their careers. may also have copies of these assessments or care plans. Adults with autistic spectrum disorder who have associated mental health disorders may have been referred to community mental health teams and psychiatric clinics, from whom reports can be requested.