An Introduction

to Autism

Example heading

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 What is autism?
Autism is a complex lifelong neurodevelopmental
disability that affects the person in all areas of life,
throughout life. It is permanent and pervasive.
It is a dysregulation of the central nervous system that
affects how the individual learns, processes information
and interacts with his/her world.
What do Neuro Imaging and
Brain Studies show about
the development of autism in
individuals?
Advanced brain imaging techniques such as
electroencephalography (EEG) and Functional magnetic
resonance imaging (fMRI) have recently provided
evidence of some important, albeit subtle changes in the
brains of children and adults on the autism spectrum.
• Brain studies have shown differential activation
in areas related to the core domains of autistic
dysfunction (Verhoeven et al., 2010).
• Reduced connectivity between brain regions,
especially associated with language processing (Duffy
& Als, 2012).
• White matter alterations in communication pathways
and integration of the two brain hemispheres
(Anderson et al., 2011) and mechanisms that are
essential for higher cognitive function.
Areas of the Brain associated with
autism:
• Frontal lobes – Executive Functioning
• Temporal Lobe – Auditory centre, speech and
memory
• Cerebellum – Motor skills and shifting attention
• Amygdala – Primitive emotional centre
An Introduction to Autism
Autism Facts and Figures:
• Recent prevalence rate is around 1 in 100
• Equates to an estimated 115,400 Australians (0.5%)
on the autism spectrum
• Note: This was an 79% increase on the 64,400
people estimated to have the condition in 2009
Australian Bureau of Statistics survey of Disability,
Ageing & Carers, 2012
• Present at birth; evident usually by age 3.
• The male – female ratio is at around 4:1 (Whitely et
al., 2010).
• Presents in all ethnic and socioeconomic groups
• Often associated with other disorders, e.g. learning
disabilities, ADHD, epilepsy, Fragile-X, Tourette
Syndrome, Obsessive Compulsive Disorder,
chromosomal abnormalities.
Possible Causes:
• Genetic factors:
• higher incidence
in families with
history of autism
• higher concordance
in identical twins
genetic ‘vulnerability’ but no single ‘causal’ gene
• The Autism Genome Project (AGP) has identified
a number of autism susceptibility genes
• Some of these determine synaptic connections,
cell growth and communication between cells.
• Metabolic aetiology:
• Recent research from the Imperial College of
London and the University of South Australia
(Yap et al, 2010) has shown that it is possible
to distinguish between children on the autism
spectrum and neuro-typical children by looking
at by-products of gut bacteria and the body’s
metabolic processes in the children’s urine.
• Scientific research has NOT found evidence to
support a link between the MMR vaccination
and autism.
The DSM V: a tool for Diagnosis:
• Autism now consists of a single category i.e.
Autistic Disorder, Asperger’s Disorder and PDD-NOS
no longer exist as a diagnosis category. The only
diagnosis under DSM-V is autism.
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• The domains of impairment are reduced from three
areas of impairment (DSMIV) to 2 i.e. the Social and
Communication domains were conflated into one
domain (Social Communication) and Restricted and
Repetitive Patterns of Behaviour and Interests now
specifically includes unusual sensory behaviours.
Students with a diagnosis of Asperger’s Syndrome or
PDD-NOS under the DSM IV will retain their diagnosis until
reassessed under the DSM V.
Strengths of autism:
• Memory
• Factual learning strengths
• May have high level skills in IT, Maths, Music,
Drawing...
• Specialised interests - encyclopaedic knowledge
• Rules-based - order, routine, prediction
• Superior visual learning skills
• Refreshingly frank and logical
• Quirky sense of humour
The two Domains of autism:
1a. Social Communication:
Communication
Approximately 25% of children on the autism spectrum
remain nonverbal or minimally verbal (Koegel, Shirotova,
& Koegel, 2009).
Many children on the specrum develop high levels of
verbal capacity and are often able to use higher order
3 © Autism Spectrum Australia (Aspect) 2016
expression and linguistic construction. However, at the
other end of the Spectrum while many children with on
the spectrum develop speech and language skills, it may
not be to a normal level of ability, and their progress is
usually uneven. For example, they may develop a strong
vocabulary in a particular area of interest very quickly.
Difficulties may include:
• Vocabulary and the ability to say complex sentences
may differ from receptive language skills (Koning &
Magill-Evans, 2001) – they may sound much more able
than they are.
• Difficulties with comprehension of verbal information.
• Tendency for literal interpretation
• Language usage that can be overly formal and
pedantic
• Differences in prosody and rhythm, pitch, intonation,
rate and volume of speech (Attwood, 2007).
• Impairments in nonverbal communication – eye
contact, facial expression, use of body gesture.
Children on the spectrum often are unable to use
gestures—such as pointing to an object—to give meaning
to their speech. They often avoid eye contact when
listening and processing oral input, which can make them
seem rude, uninterested, or inattentive.
1b. Social Communication: Social
Relating:
Limited social interaction demonstrated by individuals
on the spectrum does not necessarily reflect a lack of
desire to interact (Saskatchewan Education,1999).
May include:
• Impairment in the ability to read social situations
and respond appropriately (Gray & Garand, 1993).
• Poor understanding of social conventions such how
to initiate, maintain and end a conversation.
• Difficulties with reciprocal conversations (Linblad,
2005).
• Frequent changing of topics and tangential
responses.
• Lack of appreciation of non-verbal social cues
• Differences in showing empathy
• Play often lacks the imaginative qualities of social
play
 2a Restrictive Patterns of Behaviour
and Interest:
May include:
• Restricted interest in a narrow area
• Repetitive speech, (echolalia), repetitive movements,
(rocking, flapping), repetitive use of an object or toy,
(spinning wheels of toy car).
• Preferring routines - doing things the same way each
time, difficulty with flexibility within these routines.
• May be due to difficulties in understanding language,
social situation, anxiety and sensory integration
difficulties.
2b. Sensory:
• Sensory Processing is the ability to organise and
interpret the information we receive through the
senses from our bodies and from the world.
• This enables us to produce an appropriate response
for the particular situation, task and environment.
• 95% of people on the autism spectrum have
Sensory Processing Difficulties (Tomcheck & Dunn
2000).
• Students on the spectrum are vulnerable to sensory
overload
Students on the spectrum may be Hypersensitive
or Hyposensitive to a range of stimuli and these
sensitivities may vary throughout the day.
The picture above is not representative of where
all students experience sensitivities but is simply
an example of where one student has sensitivities
at one particular time.
An Introduction to Autism
• Sensory processing dysfunction interferes with
language, motor planning, cognition and emotional
well being (Murray-Slutsky & Paris, 2005).
• The aim of sensory integration is to bring the
student to a calm-alert state where he/she can
function successfully within the environment (Ayers,
2000).
• There are also two Interoceptive (internal) Senses:
• a. The Vestibular system controls our sense of
movement and balance. It is the unifying system
in our brain that modifies and coordinates
information received from other systems. The
vestibular system functions like a traffic cop,
telling each sensation where and when it should
“go or stop.“
• b. The Proprioceptive System is part of the
vestibular system, where special receptors
in muscles and joints travel quickly from the
cerebellum to enhance tone and joint stability.
Frequent Proprioceptive activities such push-pull
and heavy work activities are calming,
safe input to use with a child who appears
disorganised. This input doesn’t reverberate in
the nervous system for hours like other sensory
input, so it is important to reintroduce the input
often, throughout the day.
• Other sensory issues may include:
• Limited “proximal” awareness
• Low muscle tone, low postural tone
• Gross and fine motor difficulties
The Three Theories of learning:
The above diagram depicts how the Learning Theories
impact on the two Domains of autism ie. Social Relations
and Repetitive and Restricted Patterns of Behaviour and
Interest. This is also illustrated in the following picture
where the two domains of autism are visible as “the tip of
the iceberg”, however, what underlies autism, and directly
impacts on the two domains, are the three Learning
Theories. i.e. Theory of Mind, Executive Functioning and
Central Coherence.
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1. Theory of Mind: • Difficulties initiating alternative strategies
• Anxiety due to all of the above:
“Because of my lack of confidence, I am terribly afraid
of upsetting others without realising it or meaning to, by
saying or doing the wrong thing. I wish I could read minds
then I would know what they wished for and I could do the
right thing. Socialising is harder than any Maths equation
for me” (Flesisher, 2003, cited in Attwood, 2007)

2. Executive Functioning:
Just as an air traffic control system at a busy airport
manages the arrivals and departures of many aircraft
on multiple runways, executive
function skills allow us to retain
and work with information in our
Theory of Mind (ToM) is understanding that others have brains, focus our attention, filter
their own thoughts, feelings and experiences that are distractions, and switch mental
different from our own. This naturally develops between gears.
the ages of 3 – 5 years and becomes more complex over
time. There are three basic dimensions of
these skills:

1. Working memory – The able to

hold information as well as apply it. Typically, students on
the spectrum have a lowered capacity to hold information
in this way.
2. Inhibitory control - The ability to master thoughts and
impulses so as to resist temptations, distractions, and
habits, and to pause and think before acting.
3. Cognitive flexibility - The capacity to switch gears and
adjust to changing demands, priorities, or perspectives.

Executive Functioning skills also help us to:

• remember the information we need to complete a task
• filter distractions, resist inappropriate or
non-productive impulses
• sustain attention during a particular activity.
• set goals and plan ways to meet them.

It involves: Managing all of these complex behaviours is always difficult

for the student on the autism spectrum, and is especially
• Understanding emotions in ourselves as well as others. difficult when the student is presented with unfamiliar and/
• Predicting the behaviour of other people or unexpected new tasks, environments and problems.
• Honesty- students on the spectrum find it hard to tell
a white lie.
• Difficulties in managing conflict (confrontational
and may vehemently defend their own point of view
without being able to consider that of others)
• Strict adherence to their decisions
• Being perceived as rude
• A compulsion for completion

5 © Autism Spectrum Australia (Aspect) 2016

 3. Central Coherence: Function capacity especially their capacity for
inhibitory control.
• We know that a part of the brain called the Amygdala
Central coherence is the ability to focus on details as well
can be structurally and functionally abnormal for
as wholes.
children and adults on the spectrum. The Amygdala
has many functions including the perception and
May include difficulties with:
regulation of emotions. The Amygdala can be
structurally and functionally abnormal for individuals
• Social coherence- Intense focus, or even hyper-focus,
on the autism spectrum, (Adolphs, Sears, and Piven,
on the details within the larger whole of a situation,
2001).
conversation and difficulty recognising the main idea,
• We therefore, need to be aware of the amount of
topic or general point.
assaults our students face throughout the day.
• Seeing connections and generalising skills.
Lenore Gerould refers to this as the adding of
• Difficulty prioritising and choosing.
drinking glasses to a tray. The glasses may vary in
• Preference for the known
size but the last glass, not necessarily the biggest,
• Idiosyncratic focus of attention
is the one which causes the tray to fall over. This
and inattentiveness to new tasks.
analogy depicts the notion that a behaviour and its
(Cumine, Leach & Stevenson, 1998)
triggers may have no connection with each other and
that a student on the spectrum may have a meltdown
over a seemingly small matter.

A final consideration…Emotional
Regulation:
• Behavioural challenges in autism may also be
compounded by the disordered development of
emotional regulation (Laurent & Rubin, 2004).
This has implications for the individual’s Executive

An Introduction to Autism 6