Autism is a lifelong disability which affects a child’s ability to communicate and interact with people around them. It is a ‘spectrum’ condition, meaning that while all children with autism share certain areas of difficulty, their condition will affect them in different ways and to varying degrees.
Every child is unique, so any description needs to be taken as a general guide. However, all children diagnosed as having an autistic spectrum disorder will show difficulties in three main areas referred to as the ‘triad of impairment’. These are:
Children with autism can have difficulty understanding why they need to communicate. They may not be able to identify their own needs or communicate them to others. Some children with autism never develop spoken language or speech may develop much later than expected. Some children develop echolalia – repeating words they have heard that have little meaning. Other children may have good spoken language skills, but may still find it difficult to understand the two-way nature of conversation.
Non-verbal communication is also impaired, causing difficulty in understanding simple gestures such as nodding and shaking the head. Many children have a very literal understanding of language and think that people always mean exactly what they say. For example, the verbal prompt; Wash your hands in the toilet’ may lead the child to attempt to wash her hands in the toilet bowl. Open ended questions can also be challenging, as there are endless possible answers.
Children with autism have difficulty understanding how to interact with other people, including recognising and understanding other people’s feelings and expressing their own. They may not understand the unwritten social rules that other children naturally develop, for example, they may stand too close to other children, touch inappropriately or disrupt other children’s play. Some children play alone, rarely seeking the company of others.
Difficulties with social interaction mean that children with autism often find it hard to form friendships. Some may want to interact with others and make friends, but not know how to do so.
Children with autism will often have difficulty playing imaginatively with toys or with other children and adults. They have a limited range of imaginative play and sometimes copy actions and words from something they have seen eg on the television. They may tend to focus on the parts of an object rather than the whole thing, for example, spinning the wheels of a car rather than pushing it.
Difficulties in this area also mean that children cannot predict what will happen next, for example remembering that when a parent goes out, they come back again.
The characteristics of autism vary from one child to another, but as well as the three main areas of difficulty, children may also show:
Many children with autism find it difficult to cope with and understand change. They often need much encouragement to do something new or try a familiar task in a new way.
The world can seem a very unpredictable and confusing place to a child with autism. A fixed daily routine is preferred and rituals may develop, for example, wanting to enter nursery in the same way each day. This preference can be used positively in planning programmes to develop the child’s skills, from understanding of language to dressing and toileting.
Play provides children with opportunities to practice many skills including language and understanding of people and objects. A child with autism is unlikely to practice skills through pretend play activities and will need to be taught skills in other ways.
Children between two and three years old start to develop sequences in their play which gradually evolves into planning and organising what they want to do. Children with autism have difficulties in this area which can lead to them getting stuck in repetitive activities.
Children with autism may experience some form of sensory processing difficulty. This may occur in one or more of the five senses, which can be either hypersensitive (intensified) or hyposensitive (under sensitive).
Everyday experiences involve many sensations: the taste, texture and smell of food, the touch of clothes, and everyday sounds. A child with autism may become overwhelmed, anxious and distressed by these sensations and try to block them out with a repetitive noise or action that they can control, for example, rocking, spinning or hand flapping. Conversely, children who are hyposensitive may not feel pain at all, even when they are injured or ill.
Children with sensory sensitivity may also find it much harder to link body awareness and movement, (proprioceptive and vestibular system), leading to difficulties with body awareness, balance and motor control. They may have poor coordination or find it more difficult to avoid obstacles, get in and out of play equipment or carry out tasks involving fine motor skills, such as fastening clothing.