What is Autism?
Autism Spectrum Disorder (ASD) is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them. People with autism see, hear and feel the world differently than other people. Individuals do not outgrow their diagnosis, however; many therapies and interventions have a proven ability to improve outcomes.
Autism is a spectrum condition that presents differently in every individual with a diagnosis but there are similar behaviours and characteristics that those on the spectrum may express to varying degrees.
Please note, this section refers to children and your child but the information also refers to adults living on the autism spectrum
- Individuals with Autism have difficulties interpreting both verbal and non-verbal language, such as gestures and tone of voice.
- Some individuals have a very literal understanding of language, and think people always mean exactly what they say.
- Some may have limited speech, repetitive speech (echolalia) or not speak at all but may have fully functioning receptive language.
- Some people find alternate forms of communication helpful such as sign language, visual symbols or assistive technology.
- Others have more typical language skills, but struggle to understand expectations in a social context.
Tip: Speaking in a clear, consistent way and using literal language can be helpful. When speaking to an individual with autism, give them time to process what has been said.
Reading other people can often be difficult for individuals with autism; recognizing or understanding other peoples intentions and feelings can be challenging. Similarly, it may be difficult for these individuals to express their own emotions. These challenges related to social interaction can make it hard to form build relationships. Many want to interact with other people and make friends, but may be unsure how to go about it. All of this makes navigating the social world challenging and may mean individuals:
- appear to be insensitive
- seek out time alone when overloaded by other people
- not seek comfort from other people
- appear to behave ‘strangely’ or in a way thought to be socially inappropriate
Repetitive behaviour and routines
For individuals with autism, the world can seem a very unpredictable and confusing place. Like all of us, having a daily routine can help us know what to expect out of each day. Some individuals may have specific clothing they prefer to wear, travel the same way, or eat exactly the same thing each day for breakfast. Change can be hard for everyone, especially for people on the autism spectrum; being prepared for change in advance can really help.
Experiencing over or under sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain is common for individuals with autism. For example, background noise that some people may not even hear may be unbearably loud or distracting for individuals with autism and maybe even cause severe stress or even physical pain.
ASD is often described in terms of difficulties, deficits and challenges. It is just as important to acknowledge to many strengths and abilities of individuals on the spectrum. Once realized, these can be used to promote development and plan for the future.
Visual processing and attention to detail
Visual thinking can be a strength for individuals with ASD which is why many are visual learners. Visual information lasts longer and is more concrete than auditory information and using visuals may help a person on the spectrum process information more accurately and efficiently.
An exceptional attention to detail is a common strength for those who are visually-oriented and many individuals on the spectrum have jobs and/or hobbies which utilize this strength.
Rule-based and logical thinking
It is common for individuals on the spectrum to find comfort in rules and predictability which can be an advantage in developing new skills.
Considering the 5 W’s (and H) for new or challenging situations can be very helpful: Who, What, When, Where, Why, and How. For example:
- When someone comes to the door, say hello.
- When it’s bed time, I brush my teeth.
Presenting rules visually can really help. Some people find a rule book using pictures and words effective. Rules that use first, then statements can help your child understand social interactions, like how other people are feeling. For example, If Sam is laughing, he might be happy.
These statements also tie in with your childs ability to follow clear steps and sequences, so you can use them when you want your child to do something. For example, First you put your shoes on, then you can go outside. Or you can use a simpler version“ for example, Shoes first, then outside.
Special topics of interest and autism spectrum disorder
People with ASD can often focus intently and learn a lot about topics they are interested in. Linking goals and intervention programs to these special interests can be very effective.
Here are some ideas for promoting a childs learning and social and communication skills by making the most of their special interests:
- Share your child’s interests by playing alongside her. This can develop your child’s play skills if you comment on what you are both doing, swap toys, take turns and so on.
- Use your child’s interests to expand his numeracy skills. For example, you could use Thomas the Tank Engine and friends to talk about colours, numbers and size.
- Build your child’s interests into challenging activities. For example, if having a bath is challenging, you could give your child some special interest toys to play with in the bath, or stick pictures of her special topic around the bath as a talking point.
- Develop your child’s conversational skills by talking to your child about his special interest. This might give your child extra motivation to communicate and talk with you. Your child might start by giving a speech instead of having a conversation. You could gradually introduce questions, and get your child to ask you questions too.
Rote memory skills and autism spectrum disorder
People with ASD are often good at memorizing (rote memory). Many children with ASD can remember large chunks of information, like conversations from movies, words to a song, number plates and so on. You can encourage your child to use rote memory for learning useful information, like your phone number and address, the alphabet and multiplication tables.
Diagnosis for Children
Make an appointment to speak with your GP and bring with you a list of behaviours and characteristics that make you think your child may be on the autism spectrum. Once you meet with your GP they may advise that your child should be referred for a formal assessment (diagnosis).
It is recommended that your child have a multi-disciplinary assessment. That is, an assessment by a team of registered professionals. The team may include; a pediatrician, a speech language pathologist and a psychologist found at the Janeway Hospital in St. John’s, Gander Central Health, Corner Brook Western Health or the Rainbow Clinic in St. Anthony/ Labrador.
Diagnosis for Adults
Make an appointment to speak with your GP and bring with you a list of behaviours and characteristics that make you think you may be on the autism spectrum. Your GP may refer you to a registered practitioner who will be able to formally assess you for an autism diagnosis. For a list of registered Psychologists in the province, click here
Private diagnosis is an option, and can reduce the waiting time. The costs of private assessments can vary and the ADOS is available from some private practitioners. Health authorities and education authorities may not accept the results of all private diagnoses. They might insist upon a diagnosis from the ADOS team before they will provide services to you and your child. For this reason, we suggest that you stay on the waiting list for an assessment through your regional health authority regardless of whether you receive a private assessment or not.
What is ADOS?
This is the Autism Diagnostic Observation Schedule and is a semi-structured assessment of communication, social interaction and play (or imaginative use of materials). The ADOS consists of four modules, each of which is appropriate for children and adults of differing developmental and language levels, ranging from nonverbal to verbally-fluent. The ADOS consists of standardized activities that allow the examiner to observe the occurrence or non-occurrence of behaviors that have been identified as important to the diagnosis of autism and other pervasive developmental disorders across developmental levels and chronological ages. To learn more about ADOS click here
Development Team Contacts
Referrals can be faxed to (709) 777-4955
Child Development Nurse Coordinator Janeway(709) 777-4003
Child Development Intake (709) 777-4957
Speech & Audiology Department (709) 256-5458.
Child Development Team
Western Memorial Regional Hospital
(709) 637-5000, ext. 6655
Curtis Memorial Hospital
St. Anthony, NL
Phone #: (709) 454-3333 Â Ext. 7275
Fax #: (709) 454-3417
How do professionals determine if someone is on the autism spectrum?
In North America, medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (revised May 2013) to evaluate autism spectrum disorder (ASD).
Autism Spectrum Disorder 299.00 (F84.0)
- Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).
- Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).
- Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
- These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
TABLE 2 Severity Levels for Autism Spectrum Disorder
Level 3: Requiring very substantial support
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
Restricted, Repetitive Behaviours
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2: Requiring Substantial Support
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.
Restricted, Repetitive Behaviours
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1: Requiring Support
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
Restricted, Repetitive Behaviours
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.