Autism Andrew Carpenter London Brokerage Network
First Reactions What do you think you know about autism? What experience do you have? What words or phrases come into your mind when thinking about autism?
A little bit of history - First identified by Leo Kanner (1943) & Hans Asperger (1944) - 1960’s – First person in UK diagnosed with autism - Lorna Wing and Judith Gould (1979) – Triad of Impairments - Asperger’s Syndrome (1980’s) - Ongoing research, leading to new & increased understanding – DSM 5, etc.
Terminology What do the following stand for in terms of autism? ASC – ASD – AS – HFA – PDA – PDDNOS What terms should we use? A person with autism? An autistic person? Someone who has autism?
True or False? • Autism is classed as a type of learning disability • Autism is caused by the MMR vaccine • The majority of people with ASC find socialising very important • Women cannot be autistic • Autism is a ‘spiky’ condition, affecting people differently at different times • All autistic people have remarkable ‘special skills’ • Autistic people are emotionally ‘cold’
Terminology (2) High and Low Functioning Mild and Severe What does that mean to you, when you hear those terms? What criteria are you using to make those judgements? “I’m a little bit autistic” / “Everyone’s somewhere on the spectrum” ???
Triad of impairments
However… really a ‘dyad’ Social communication and interaction. Restricted, repetitive patterns of behaviour, interests or activities. And… More emphasis on sensory issues
What does that really mean? (1) Social and Emotional Difficulties with: - Friendships - Managing unstructured parts of the day - Working co-operatively
What does that really mean? (2) Language and Communication Difficulties with: - Processing and retaining verbal information - Understanding jokes, sarcasm, social use of language, reading between the lines (literal interpretations) - Body language and facial gestures
What does that really mean? (3) Imagination (Flexibility of Thought) Difficulties with: - Coping with change - Generalisation - Empathy (but… the double -empathy problem)
But also… • Sensory issues (hyper or hypo) • Anxiety and depression • Knock-on physical effects • Sense of identity • Poor balance / bad at sports / clumsy • Food intolerances / bad tummies • Memory…? (‘selective’) • Alexithymia • Strong sense of right and wrong and sticking to the rules • Conventional presentation for unconventional reasons • THERE IS A DISTINCT LACK OF RESEARCH!
Alexithymia May or may not be good at ‘cognitive empathy’ and reading other people, but very poor at noticing own emotions, unless obvious Need extra time to process information or answer questions anyway, especially about feelings. May need help to work it out.
Autism and Mental Health Particularly vulnerable to mental health problems 65% individuals have a psychiatric disorder (Ghaziuddin et al 1998) Often regarded as having ‘treatment resistant’ mental illnesses (Dossetor, 2007) Difficulties in communication mean anxiety and depression goes undiagnosed and untreated (Howlin 1997)
Autism and Mental Health (2) Anxiety – Almost universal ! Depression – Awareness of difference, social exclusion, bullying, maintaining relationships and jobs, sensory differences, etc) PTSD – more common than we think, experiencing events in a more stressful and threatening way due to differences in understanding the world, visual memories more prone to intrusive flashbacks Drug/Alcohol – self-medicate to reduce inhibitions
Autism and Mental Health (3) Phobias – for unconventional reasons? OCD – ordering, hoarding, routine, repeated questioning, overlapping with Tourette’s/tic -like disorders and need to differentiate from coping mechanisms & special interests ADHD – 31% meet criteria for ADHD (Leyfer et al 2006) 65% inattentive, 12% hyperactive, 23% combined Eating disorders – 20% of anorexia cases could be diagnosed as ASD (Gillberg et al 1994-5)
Autism and Mental Health (4) Catatonic-like symptoms – increased passivity, slowness, initiating and completing actions. Also, increase in repetitive behaviour, reversal of day and night. Psychosis/delusional beliefs – paranoid ideation (being treated unfairly), grandiosity are prevalent. Often linked to everyday worries and anxieties, acute and stress-related, attempts to interpret a confusing world and other people. Schizophrenia – common misdiagnosis, but no evidence of increased incidence with autism. Borderline PD – common misdiagnosis for autism
Autism and Mental Health (5) What is autism and what is a mental health issue? BE CAREFUL!
A need for specialist approaches and attitudes to commissioning - Recovery model / throughput are not helpful - Kingwood Trust and ASPiration service - Personal experience and Coventry research
Communication Differences may include: - Non-verbal, or limited speech - Highly articulate (but… what is actually being processed?) - Understanding language - Literal interpretation - Non-verbal communication (reading and showing) - Andrew speaks Portuguese, but…
Strategies - Say less (My TEFL experience) - Wait for an answer (6-second rule) - Check understanding (Echolalia / The paradox of choice) - Watch your language and don’t make promises you can’t keep (“I’ll be back in 5 minutes”). Avoid the world of ‘ -ish ’ and build trust - Patience (50 Shades Safe Words!) - Teach, not cure - RESPECT THE AUTISM!
Social Interaction Differences may include: - Preference for being alone and avoiding interaction - Initiation of / response to social contact - Eye-contact
Social Imagination Differences may include: - Focused interests (and not knowing when focus needs to stop) - Imaginative thought - Reading between the lines / taking things at face value / not spotting ulterior motives - Desire for routine and sameness (but… ) - Adaptation to change - Organisation and planning (lists, pre-knowledge)
Sensory processing How many senses are there? - Visual - Auditory - Olfactory - Gustatory - Tactile - Proprioceptive - Vestibular
Sensory processing (2) Differences may include: - Hyper and Hypo - Mono-processing (one thing at a time) - Filtering And may lead to: - Poor balance/co-ordination, unusual walk, dizziness - Rocking, flapping, jumping, ‘tics’ - Unusual reaction to pain - Dislike of touching, hearing/light/patterns sensitivity - Dislike of certain clothing - Impact on diet and eating
Sensory processing (3) “I have a constant sensory fidgeting, making it hard to concentrate.” “It’s overwhelming” “I’m constantly thinking about what others are thinking of me” “ Sensory sensitivity in any form can make it difficult to concentrate, to trust, at attending to things other than the source of hypersensitivity to join in or to relax. If the discomfort or distraction is extreme enough, they can distract from the abilities to learn .” (Donna Williams) “I have no idea what ‘relaxed’ means or would feel like”
And don’t forget… • Anxiety, depression & PTSD • Knock-on physical effects • Sense of identity • Alexithymia
Anxiety “Imagine how you felt when you did something really anxiety provoking, such as your first public speaking engagement… Now just imagine if you felt that way most of the time for no reason” (Temple Grandin) Possible Causes of increased anxiety • Communication • Emotional responses (inc ‘Am I getting it right?’) • Environment • Sensory differences • Interaction • Planning and preparation and choice • Unfamiliar experiences and changes to familiar environments
What kind of things / areas do you need to think about?
Adapting Practice Issues include: - Environment - Session structures - Visual rather than reading - ‘Internal vocabulary’ may be different - Processing information - Sometimes doing the opposite of ‘best practice’ for non-autistic people
Adapting Practice: Environment What should we consider?
Environment Lighting Noise People Waiting room Clear signs Partitions Clutter First and last appts
Adaptations: Session Structure What should we consider?
Session Structure Duration Tel or face-to-face Intervals between sessions Importance of agenda- setting Reminders for appts (e.g. by text)
Keep it Visual!
Keep it Visual! Use of pictures/photos Use of diagrams/Body or emotion maps Having handouts that back up what you have said Use of session summaries Use of multi-media / apps Make it appropriate to the person (e.g. use any special interest)
Watch your language!
Language Avoid metaphors / abstracts Clear / simple Pacing and processing time Backed up with visuals Find out how they talk about their emotions and inner world More ‘Dos’ than ‘ Donts ’ Always check, check and check again! Don’t overload!
Self Awareness: Laying the Foundations Spend time checking out awareness of thoughts, feelings, cognitions, behaviours Explore/explain the links between thoughts and feelings, etc. Remember to keep this visual and accessible Use their language, not yours
Recommend
More recommend
