Distilled from workshop presentations for the New South Wales Autism Society, 3-4 April 2004, Sydney.
Autistic spectrum disorders (ASD)
The spectrum of autistic disorders includes not just classical autism (Kanner, 1943) and Asperger Syndrome (Asperger, 1944, trans. 1991), but also a range of less well-defined conditions that all share a pattern of developmental differences referred to as the 'triad of impairments' (Wing, 1996). These are difficulties in social and emotional understanding, all aspects of communication regardless of language level, and a lack of flexibility in thinking and behaviour. There is nothing that protects these children from other disorders and many will have additional problems, such as language difficulties and/or general intellectual impairment. ASD are biological disorders but as yet there are no clear biological markers, so they have to be recognised from the pattern of development within the triad.
Parents and early years professionals need to know that a child has an ASD because this enables them to suspend their normal intuitive understanding of behaviour and try to work out what that behaviour means for this particular child. For example, a child may not be making eye contact with others but this, by itself, has different implications according to the cause. The child may have an ASD but alternatively may have a severe visual problem, or may have profound learning difficulties, or another neurological disorder such as Fragile X, or may have been severely abused. Nor does the presence, rather than the absence, of a particular behaviour of itself signify an ASD, as when the child has severe temper tantrums and appears non-compliant. Those behaviours may result from neglect or mismanagement at home, from a conduct disorder, from developmental delay or ADHD as well as from an ASD.
Behaviour may be the only level we can see; but the ASD does not lie in that behaviour itself, rather in what underlies it. There are no behaviours that are of themselves 'autistic', which is why it makes no sense to talk of 'autistic features' or 'traits' (and still less of 'autistic tendencies'). All behaviours are human responses to states and situations, and that is no different in ASD. Behaviours can be a clue to what the child is thinking, feeling, understanding and so on, but they cannot by themselves tell us what to do or help us understand the child. Knowing the child has an ASD means we can interpret those behaviours in the light of our understanding of the key difficulties in ASD, and thus we are more likely to reach a sensible notion of what is happening at the psychological level--the level at which we need to try to work. However, each child with an ASD will be different from every other--in spite of the common triad of difficulties--so we also need to understand that particular child and how the ASD interacts in that child with other skills, abilities, attitudes, difficulties, personality, and past and present experiences.
ASD are developmental disorders, which means that the disorder arises during development. This often confuses parents, because the main social problems may not appear until the child has to engage in more complex social interactions with peers, or the language problems until the child has to use language in social and communicative ways (instead of isolated words or single, echoed phrases). As with any developmental disorder, when we see a child we do not see a list of symptoms, but the results of how that child has adapted to those difficulties. The blind child is not the same as a sighted child who wears a blindfold: the former has developed a different way of perceiving and interpreting the world. So, children with ASD also develop compensations for their difficulties. They may learn to listen by looking away at a blank space but, if the adult makes them look at a confusing and overwhelming face when being addressed, they may lose that capacity to attend to what is said and, moreover, may experience sensory overload and even pain. …