Autism spectrum disorder

Autism spectrum disorder (ASD) is a condition that children are born with, it affects their ability to relate with the world impacting their communication, their social interaction, their behaviour and interests as well as causing sensory difficulties. Autism is classed as a spectrum disorder and therefore the severity and diversity of difficulties may differ between children.

Autism spectrum disorder can affect a child’s speech, social communication skills, their ability to understand others and their ability to express what they are thinking or feeling appropriately.

Our speech and language therapists can help enhance your child’s communication, language and speech to the best of their ability by providing therapy, advice or in some circumstances additional or alternative forms of communication.

Autism spectrum disorder is a neurodevelopmental condition that affects a child’s day to day functioning. It affects the way a child interacts and interprets the world. There are two main areas children with autism have difficulties with, they are:

• Social communication and social interaction.
• Restricted, repetitive patterns of behaviour, interests or activities

Social communication and social interaction

Social communication refers to the social use of language, this is the ability to use and interpret language and behaviour with others, in order to have successful communication. Social communication can be divided further into:

• Verbal communication.
• Non-verbal communication.
• Social cognition.
• Receptive and expressive language skills.

Social interaction refers to the behaviour of individuals who are partaking in a joint activity. For there to be successful interaction, the child must have certain skills and knowledge. Social interaction is important as it creates a foundation for a child to communicate with others. Example of skills needed:

• Ability to approach others.
• Peer related social competence.
• Social reasoning skills.
• Awareness of required speech style and language for the conversational setting.
• Awareness of unwritten social norms, social rules for interaction and linguistic politeness including, cultural influences and gender differences that impact upon interaction.
• Ability to resolve conflict.

Restricted, repetitive patterns of behaviour, interests or activities

Children with ASD may demonstrate behaviours that are repetitive and appear to be redundant for example, they may carry out repetitive movements (self-stimulatory behaviour) with their body that appear to others as being non-functional. Repetitive behaviours may be used by the child as a way of calming down, dealing with stressful situations or used to stimulate their senses.

Play may appear to be repetitive and lack imagination. Children may play with toys in a manner that is unproductive rather than playing with them for their actual use, e.g. lining them up according to their features such as colour or texture.

The cause of autism spectrum disorder is still unknown, there is research to suggest that there are genetic, physical, psychological and neurological factors that affect brain development.

The National Health Service has estimated that within the United Kingdom 1 in 100 people have autism spectrum disorder.

The characteristics of ASD can vary in each child and therefore children may appear to have different symptoms and severities.

Communication:

• Delayed development of speech milestones or may be non-verbal.
• Use of repetitive learnt phrases and inappropriate language.
• Difficulties with correct use of tone of voice.
• May prefer not to use their speech.
• May appear to speak at people rather than partake in a two way conversation.
• Have a literal understanding of what’s said.
• May use a lack of facial expressions or gestures while communicating with others.
• Children may have poor eye contact or avoid eye contact when in conversation with others.
• May have difficulty with listening and attention unless it’s of particular interest to them.
• May demonstrate a lack of understanding of others thoughts, perspectives, behaviours and emotions.
• May struggle with emotional regulation and understanding of emotions.
• Difficulty with inference.
• Difficulty with presupposition.
• May use challenging behaviour as a form of communication.

Interaction with other people:

• May appear to have a lack of interest in interacting with others including children their own age.
• May struggle to understand and follow a normal pattern of interaction and can come across as inappropriate or rude.
• May be unaware or struggle to understand unwritten social rules and social norms regarding interaction with others.
• May prefer to play alone rather than with other children.
• May prefer not to engage in or reject physical contact such as hugging initiated by another person, but might initiate this themselves.
• Might appear to have a lack of awareness of others personal space.
• May be unaccepting of others entering their personal space.
• May react negatively when asked to do something by others.

Behaviours:

• Children may carry out repetitive self-stimulatory behaviours e.g. shaking their heads side to side, playing with their fingers, flapping their hands and rocking.
• Children can experience hypersensitivity or hyposensitivity to their five senses.
• Children may play with toys in a repetitive manner that appears to lack imagination.
• May prefer to play with objects rather than take part in a game that requires interaction with others.
• Children may develop an interest in a certain area or activity which can be developed to a very high level.
• May have a preferred routine and any changes or disruptions to routines may cause them to become very distressed.

Social communication disorder is a new diagnosis that is given to children who present with social communication difficulties and social interaction difficulties similar to those with autism. Children with social communication disorder do not present with repetitive or restricted behaviours and interest but may also share other symptoms associated with autism.

Autism spectrum disorder has many characteristics that affect a child’s day to day routines and interactions. Many activities and tasks during the day, at home and school, can become difficult. Some difficulties shared by many children with ASD are:

• Understanding spoken and written language.
• Understanding instructions given by others.
• Speech and spoken language.
• Using their volume and tone of voice to express their emotions.
• Expressing their thoughts, feelings, and emotions in an appropriate way.
• Recognising emotions and facial expressions in others.
• Acknowledging and repairing conversational breakdown.
• Difficulty making friends.
• Understanding social rules and norms in different social situations.

Speech, language and communication difficulties can make day to day life extremely difficult for children with autism spectrum disorder. Our speech and language therapists can help reduce the level of difficulty by providing children with a tailor made therapy programme after a detailed assessment. This can help improve your child’s activity and participation in day to day activities.

Our speech and language therapists can provide detailed assessments on your child’s speech, language and communication abilities. As each child’s ability is different, assessments and assessment procedure would be individualised to each child. Our speech and language therapists can provide both formal and informal assessments for the following difficulties:

• Attention and listening difficulties

• Receptive language difficulties
• Expressive language difficulties
• Speech sound disorders
• Social communication difficulties
• Eating, drinking and swallowing difficulties

Speech and language therapy can be extremely valuable for a child who has autism spectrum disorder, it can help enhance, maintain and develop their already existing skills further.

The main goal of speech and language therapy would be to improve your child’s speech, language and communication skills to the best of your child’s ability.

Using information from a detailed assessment our speech and language therapists will create an individualised treatment programme, which would work on developing your child’s areas of need, while utilising their areas of strength. To maximise your child’s potential, our speech and language therapists will adapt the programme, to include the child’s motivations, interests and take into account their learning styles.

Speech and language therapy will collaborate with the child, their parents and the school to create a programme that is not just based on the needs of the child, but also based on the child’s, schools and parents priorities.

In some cases the child’s speech, language and communication difficulties may be complex and therefore other means of communication may need to be introduced such as Augmentative and Alternative Communication. This is any other form of communication besides speech such as, British Sign Language, Makaton, PECS, pictures, symbols and technological aids.

Some therapy options we provide include:

• Speech sound intervention.
• Language development programmes.
• Social skills intervention.
• Eating, drinking and swallowing advice and management.
• Advice training and support for parents, carers and other professionals.
• Adapting the child’s environments.
• Individual therapy.
• Group therapy.
• Communication groups.
• TEACCH Autism Program - (Treatment and Education of Autistic and Communication related handicapped CHildren) is a therapeutic tool to help those with autism understand their surroundings through scheduling, routine and structure. It can be used alongside other approaches.
• Rapid Motor Imitation Antecedent (RMIA) - Training programme for non-verbal children with autism. Involves them imitating simple motor movements before earning to say words.

Speech and language therapy can help a child who has ASD to better understand the world around them, to make new friendships, to access the educational curriculum and enhance their activity and participation in daily life. A speech and language therapist will assess your child’s needs at home and in their school environment to create a tailor made therapy programme that aims to work on your child’s and your goals and priorities.