What is Autism Spectrum Disorder?
Autism, or Autism Spectrum Disorder (ASD), is a type of developmental disability that affects an individual’s behaviour, communication and social skills.
The behaviour and thought patterns of people with autism develop in a different way to most of the population. Often, someone with autism may have some degree of communication difficulty affecting social interactions. This may be expressive – they may have problems with speaking, non-verbal communication, eye contact or making themselves understood; or receptive – finding it difficult to understand other people, in particular reading emotions, subtext, or indirect communication. Many people with autism have a particular love of routine and order, and some find it distressing when these routines are disturbed.
Autism is described as a spectrum disorder because there are multiple and varied traits of autism, and within each there is a range of severity. Individuals with autism usually share some common traits or signs, but the effects on different people vary widely. For some people, autism can be profoundly disabling and they may have to rely on others for many aspects of daily life. Others may function in a completely independent way and live an entirely ‘normal’ life, perhaps with some adjustments for some subtle autistic traits.
People with autism are sometimes described as neurodivergent, meaning that they experience the world in a different but equally valuable and acceptable way compared to a more ‘normal’ or neurotypical person’s experience.
Types of Autism
People used to talk about different types of autism. However, within each type, there was a wide range in how much individuals were affected by their condition. There was also a lot of crossover of symptoms across the different types, and so classifying autism in this way wasn’t always very useful.
Autism is now referred to as autism spectrum disorder (ASD) due to the wide range of effects it has on people. It’s important to remember that no two people have the same experience or expression of autism, and so when we talk about someone’s autism, it’s more helpful to talk about their individual traits and the person as an individual.
That said, some people do still refer to different types of autism and find that having broad classifications helps with some general understanding of the wide-ranging effects of the condition.
People may still talk about different types of autism, and could refer to:
Asperger’s syndrome is a type of autism in which the affected person may need some adjustments in their everyday life but does not necessarily need particular help to function. People with Asperger’s may be able to work and function well, but are likely to have social communication challenges. Asperger’s syndrome is associated with focused interests, and people with Asperger’s may be particularly knowledgeable about specific things, sometimes to the exclusion of other interests.
Pervasive Developmental Disorder
This describes autism in which the affected individual needs to have more significant adjustments to function in the world. People with pervasive development disorder (PDD) are slow to develop socialisation and communication skills, and may never meet expected childhood interactive development.
This would now be described as autism on the severe end of the spectrum, where the person needs substantial support. People described as having autistic disorder would likely have limited verbal and non-verbal communication skills and experience distress in situations which would not affect most people.
Now that the range of traits of autism are better understood and recognised, autism is more often categorised by the amount of support or adjustment needed for the individual to live a full and satisfying life within a world designed for neurotypical people.
Signs and Symptoms of Autism
There are lots of symptoms or traits associated with autism and everyone experiences autism differently. Some common signs among people with autism include issues with:
- Social communication and interaction such as finding it difficult to know what others are feeling without being directly told; behaving in a way that is not considered appropriate by most people; misunderstanding metaphors and taking figurative expressions literally.
- Anxiety about changes in routine or unpredictable social situations.
- Being excessively focused on single subjects, sometimes to the exclusion of other aspects of life.
- Sensitivity to specific triggers such as sound, light, or touch – people with autism may have intense reactions to stressors which seem innocuous to others, sometimes feeling actual pain at certain sounds or lights.
Sometimes, the traits of autism are summed up as a person having ‘restrictive, repetitive behaviours, activities, and interests’. The extent of these can be extremely varied – from having a particular interest in one thing to the exclusion of almost everything else, to compulsive hand or head movements. This may also include distress at being unable to continue these compulsive behaviours.
When individuals with autism experience something unexpected or out of their routine, they may become extremely distressed and inconsolable. Parents and/or caregivers of individuals with autism sometimes refer to these episodes as a meltdown. These kinds of experience aren’t restricted to childhood, though many people with autism develop good coping strategies over the years.
What Causes Autism?
While there is no clear single cause for autism, some factors – both genetic and environmental – are associated with a predisposition to autism.
Having a close relative who has autism makes a person more likely to have the condition, and being exposed to certain chemicals while in the womb is also thought to have an impact. If an identical twin has autism, there is a 36% chance that their twin sibling – who shares 100% of their DNA and the same conditions in the womb – have the condition as well. The rate of concordance for non-identical twins – sharing 50% of their DNA and the same conditions in the womb – is around 3%.
Do Vaccinations Cause Autism?
It’s important to note that vaccines do not cause autism, and in fact, save many lives every year. One small study suggested a link, leading to media and public attention over the potential risks of vaccination. The results of the study were repeatedly and conclusively overturned and the doctor behind the claims was struck off the medical register. Nonetheless, the study is still touted in opposition to vaccination programmes but there is absolutely no evidence that vaccines cause autism. In fact, there is extensive evidence that they do not cause autism. In addition, the suggestion that autism is worse than the deadly illnesses that vaccinations protect us against is offensive and harmful.
Autism is mainly diagnosed through assessment of the traits and symptoms of the individual. These traits can appear vastly different in different individuals. It may also be expressed differently at different stages of a person’s life.
Being diagnosed early in childhood means that people with autism can have early interventions and support, allowing them to reach their potential throughout the important early stages of education and beyond.
Behavioural evaluation including observation and conversation both with the person in question and with their close family is a major part of the assessment for autism spectrum disorder. Teachers and care workers’ reports may also be useful supporting evidence of autism traits and concerns.
Autism may be considered as a diagnosis when a child doesn’t meet some of the usual expected developmental milestones. All children are different, but there are some broad similarities in almost all children’s development. Most infants begin to make deliberate eye contact by the age of around six months, will begin to ‘babble’ and repeat sounds, then later to play with other children and generally develop their social and communication skills in line with what is usual for their age.
Children with autism often don’t follow the same pattern of social development as children without autism, and may never meet certain milestones; for example, some people with autism never become comfortable with eye contact, and some never communicate verbally.
Diagnosis of autism is more common than ever before; probably because there is increased awareness and understanding of the condition. Boys are more commonly diagnosed with autism than girls are, by a ratio of around 4 to 1. This is probably in part because of the genetic element of autism, but may also be because autism is expressed and recognised differently in boys and girls.
Some signs which could indicate autism in children could also be the result of another condition, so an assessment for autism might include investigations to rule out other conditions – for example, a young child who does not respond to their parent’s voice or who does not make eye contact should be assessed for hearing loss or problems with their eyesight.
Treatment for Autism
There is no ‘cure’ for autism, and in fact, campaigners dispute the idea that neurodivergence is something that should be cured, but rather suggest that it is a natural diversity that should be embraced. However, for people with any degree of autism to live in a society created by, and for, neurotypical people, there are challenges to overcome and adaptations to be made. Occupational therapy may be able to help individuals with autism improve everyday skills and become more independent in day-to-day life, while speech therapy can help improve verbal, nonverbal and social communication.
The social skills which most people learn throughout their lives may never come naturally to people with autism, but recognition and assessment of needs and differences on an individual basis can help create management strategies.
For children and young people with autism, behavioural strategies can be incorporated into their learning and play to help them interact or provide situational coping strategies. A team which includes a partnership between healthcare professionals, families, educators and – most importantly – the person in question are the best people to create an individualised learning and development plan.
There are a range of techniques developed to help people with autism learn to live independently in a world which they may not always understand:
- Behaviour and communication approaches: People with autism can benefit from some forms of cognitive behavioural therapy. These are programmes that teach individuals with autism techniques to manage certain traits of autism which may cause challenges in their everyday lives. These kinds of approaches can include interventions designed to teach life skills, social and communication skills, and prepare for work or education. Speech and language therapists, occupational therapists, and specialist educators may be involved with these kinds of interventions.
- Medication: Autism itself cannot be cured or treated with medication, but medication can be helpful in managing some of the symptoms of ASD. Some people – both children and adults – with severe expressions of autism may show frustration and distress through aggressive or self-harming behaviour. This can cause intense stress for themselves and the people around them. Specialists are an essential resource for individuals whose expressions of autism cause harm or are difficult to manage. Specialists can use behavioural therapy techniques or prescribe medications to help with this kind of particularly challenging behaviour. Medication can also help with anxiety or certain compulsive behaviours which have been difficult to manage, alongside other forms of therapy.
As autism is a lifelong condition, any good treatment plan should include long-term goals and ways of monitoring progress and ongoing need.
Resources Available for Individuals with Autism in Singapore
Autism is fairly common, affecting around 1% of the population of Singapore, and this is reflected in the availability of resources and support.
The growing awareness and understanding of autism have resulted in more and earlier diagnoses, better support, and a greater number of professional interventions available. Peer support groups are available and specialist healthcare professionals are working hard to destigmatise and clarify autism information for everyone. Besides real-life programmes and support centres, there is a huge amount of information and support available online as well.
Many children with autism go through the mainstream school system with no problems or only reasonable adjustments, but for those with more significant special educational needs, there are schools dedicated to children with autism who need extra care and support. Every child diagnosed with ASD in Singapore should have an individualised intervention plan to enable parents and carers to access support and help the child reach their full potential.
The Autism Association (Singapore) was set up to support people with autism and enable them to live full and meaningful lives. They offer schools and centres for children and adults to access both professional and peer support, as well as programmes to enhance and encourage life skills. The Enabling Guide also has a useful page of further resources for people living with autism in Singapore.
Living with Autism Spectrum Disorder
Conditions that affect the way people interact and communicate are historically poorly understood and often stigmatised. People whose behaviour seems unusual or difficult for most people to understand may find it harder to socialise and interact. Autism also means having a unique way of experiencing the world, and sometimes our world just isn’t designed for people who aren’t neurotypical. However, there is great worth in diversity, and some autistic traits are valuable and admirable; people with autism are often deeply focused, analytical, methodical, with distinctive imaginations and less preconceived judgement of others.
Medical language has changed over recent years to try to be more inclusive and less objectifying. This change can be quite subtle, but for autism, it has meant a change from talking about ‘an autistic person’ (i.e. a person defined by their condition) to ‘a person with autism’ (i.e. someone who has a condition but is not primarily defined by it).
Education and media have also begun to recognise a need to represent the diversity within a population, including people with disabilities, communication disorders, and neurodiversity. Recognising the spectrum of autistic traits has meant that people with autism are now – hopefully – being accepted simply as people who have a different way of experiencing and interacting with the world.
Some people with autism may find social interactions difficult. Certain types of social setting can cause anxiety, particularly being in noisy places, around unpredictable people, or simply out of a routine or ‘comfort zone’. This doesn’t mean that people with autism don’t want to socialise or have friends, and loneliness in autism is very common. Socialising may take some extra planning or adjustments, but just because someone gets anxious over meeting people doesn’t mean they don’t want or need human interaction.
The huge variety in the effect that autism may have on a person means there’s no one right way to be or live when you have autism. Some people may struggle with certain activities or interactions and may need assistance from formal or informal carers. The ‘spectrum’ part of autism spectrum disorder; the sheer range of traits and extent of effects, means that there is no broad answer to the challenges of autism. However, there is support out there, and there are many aids and techniques to help people with autism overcome any challenge.
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