Autism: a difficulty with communication

This relatively rare but disrupting disorder has only been recognised for just over 50 years. It is not a single disorder but is now seen as a group of related conditions, often referred to as the autistic spectrum. Children seem to have difficulty making sense of the world and communicating with others. They therefore tend to withdraw from contact and into their own world. Many autistics show surprising normality in some areas and may even seem to be talented in specific areas where communication and interpretation of information are not as necessary. Unfortunately such skills are usually very limited in range and adaptability. This can often leave a feeling of disappointment for families who hope for more general developments.

Apart from classic autism, also known as Kanner's syndrome, the most widely recognised conditions are Asperger's syndrome and Semantic-Pragmatic disorder. These are both seen as more moderate examples of this spectrum of difficulty. They differ from each other in that Asperger's syndrome tends to be identified in terms of an individual's difficulty in relating to others, whereas Semantic-Pragmatic disorder tends to be identified in terms of an individual's difficulties with language and communication. Someone whose language is reasonably normal but who has difficulty relating to others would probably be described as having Asperger's syndrome. Someone whose difficulties linked with language would probably be described as having a Semantic-Pragmatic disorder. Someone who has difficulties of both sorts, especially in a severe form with accompanying learning difficulties, would probably be described as Autistic.

The categories overlap and are, to some extent, a matter of interpretation. A cynic might say that cases of mild autism are described as Asperger's syndrome if they are identified by a doctor or psychiatrist. Identification as a semantic-pragmatic disorder may be said to be more likely if identified by a speech and language therapist.

Classic Autism

Autistic children are aloof and uninterested in other people, and frequently develop obsessive routines and rituals that interfere with social interaction. They have difficulty with all forms of communication and tend to use actions rather than speech to convey meaning. For example, instead of asking they will take an adult by the hand and lead them to do what they want. Autistic children are slow to develop language and those with severe learning difficulties may never learn to speak. If they do establish spoken language they may be able to speak clearly and grammatically, but make little purposeful use of language.

There are a number of specialist schools and units for more able autistic children, usually provided by educational charities rather than LEAs. The majority of children tend to be educated in schools for children with moderate or severe learning difficulties, but few teachers in these schools have had training in working with children in the autistic spectrum. Specialist training is only just beginning to be provided.

Asperger's syndrome and semantic-pragmatic disorder

Children with Asperger's syndrome tend to show no significant delay in language development but will use language oddly. They have poor conversational skills and may have difficulty understanding implicit or non-literal meanings. Their language is often stilted and pedantic.

Children with semantic-pragmatic disorder are able to relate to each other but have poor social skills and are often seen as odd by their peers. They are usually slow to develop speech but eventually establish good vocabulary and grammar. Their ability to initiate and maintain conversation also develops slowly but remains poor. They may be able to talk at considerable length on particular topics. At the same time they lack elementary conversational skills such as making eye-contact, maintaining an appropriate space from others, keeping to the topic or monitoring what others have said. This is perhaps the only group of children who develop extended language but not conversation. They may also have continuing comprehension difficulties.

Most of these children are educated in mainstream schools, though some may be placed in language units. They tend to be socially isolated but some make reasonable educational progress. Their difficulties become more apparent as they move through junior education into secondary school. Their poor ability to speak to their peers becomes an increasing problem as they reach adolescence. Their rigid and concrete style of thinking makes the increasing abstraction of the curriculum difficult for them to follow.

Similarities with other conditions

There are many overlaps with dyslexia, dyspraxia, dysphasia, attention deficit, hyperactivity disorder and pathological demand syndrome. These conditions also have features that affect the communication, organisation, and control skills of the child.

Causes

There are few clues to the origins of autistic spectrum conditions but it is suggested that something has affected the development of the brain. Recent research has pointed to a possible link between the MMR vaccination against measles, mumps and rubella and severe learning difficulties. Further research is now looking at the possibility that MMR may have caused less obvious damage leading to autism.

Other avenues of research focus on the preponderance of boys with autism ( a ratio of 4:1) and the possibility of an hereditary link. research into other causes includes investigation of the third of autistics who develop epilepsy and of the similarities of the behaviours seen in autism and following meningitis or encephalitis.

What is very clear is that autism is not caused by a lack of emotional care or stimulation!

Cures

There are no cures available at present. Autism is a life long condition. However, there are ways in which people with autism can be helped to develop their skills and be better able to cope with the condition.