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.
5. Autistic spectrum disorder is usually diagnosed in childhood; but some people
with high functioning autism (Asperger syndrome) may not receive a formal diagnosis
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
• No speech or very limited vocabulary, echo speech of others
• Do not understand language, use of emphasis or tone variation to convey
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
• Repeat the same comments or ask the same question many times
• May be uncooperative in carrying out personal care or allowing another
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
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
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
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.
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.
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.