How to tackle eating problems in children with autism
How should we support children with autism?
Around 700,000 people in the UK - more than 1 in 100 - are autistic. We consult a pair of experts to find out how children with autism communicate and interact with the world, and how, with the right emotional and educational support, parents can help them fulfil their social and academic potential.
UK charity the National Autistic Society (NAS) defines autism as a lifelong developmental disability that affects how people perceive the world and interact with others.
"Children on the autism spectrum see, hear, feel and experience the world in a different way from other people, particularly in terms of how they communicate, and experience and interact with the sensory world around them," says Carol Povey, director of the NAS Centre for Autism.
The fact that most parents know - or know of - someone with an autistic child is testament not only to the prevalence of the condition (around 700,000 people in the UK, more than 1 in 100, are on the autism spectrum) but also to increased awareness around characteristics, diagnosis and treatment.
The autism spectrum
All autistic people share certain difficulties, but being autistic affects people in different ways. Some may have accompanying learning disabilities, mental health issues or related conditions such as attention deficit hyperactivity disorder (ADHD).
The autism spectrum also encompasses Asperger's syndrome, which affects people of average or above average intelligence, who may still have specific learning difficulties such as understanding and processing language.
"Asperger's syndrome isn't separate from autism - it's all part of the same condition," explains Povey. "The term is often used to describe the more able end of the autistic spectrum."
How is an autistic child diagnosed?
Until a child reaches 7 years of age, the behavioural indicators that denote autism and other autistic spectrum disorders (ASDs), such as ADHD, tend to overlap. For this reason, a diagnosis is sometimes not made until then.
However, most children on the autism spectrum display characteristics from the age of 3 years.
"We would expect to see some signs in those very early years, when children are developing their social and interactive skills, and their language is developing," says Povey.
"Doctors look at how the child interacts with other people - whether they are playing with other children and are able to take part in give-and-take games, whether they seek comfort from others, and whether they are able to make reciprocal friendships.
"They also look at the child's linguistic ability and reciprocal social communication (ability to respond appropriately to social cues from others), including broader facial expressions, tone of voice, receptive and expressive language, and eye contact.
"There may also be issues around repetitive behaviour and routine. Autistic children are often highly focused on certain activities and become distressed when things change.
"Finally, and this is a relatively new understanding, children on the autism spectrum may have very different sensory sensitivities to their peers. They may be over- or under-sensitive to light and touch, become distressed by everyday noises, or even find the texture of certain clothes and foods challenging."
Impact on academic performance
Within the school curriculum, children on the autism spectrum can struggle with comprehension, due to literal thinking and missing the subtleties that different situations provide. In the playground, a pupil may not understand the rules of a game, or require time on their own to 'de-stress' before returning to the classroom. A designated quiet area that they know they can retreat to is often useful.
However, with structured, informed support from classroom teachers, teaching assistants (TAs) and special educational needs (SEN) practitioners, large numbers of children on the autism spectrum learn to successfully navigate the school environment - and even excel academically.
"SEN support ranges from adaptations and targets being put into place up to roughly the equivalent of 13 hours of 1:1 support from a TA," explains Amy O'Donovan, assistant headteacher and SEN leader at a primary school in Surrey.
"Other children may have an Education Health and Care Plan that legally states the specific level of support required to meet their identified needs.
"It is important that all staff receive ASD training and know what strategies they can put in place.
"These include visual aids such as timetables to support understanding and the use of technology to support recording of work, as many ASD children struggle with the physical task of handwriting. Support to understand and teach social skills through comic strip conversations and social stories can also be hugely beneficial."
What is Ritalin® used for?
Povey is quick to correct a common misconception that drugs such as Ritalin® can be used to treat autism.
"National Institute for Health and Care Excellence (NICE) guidelines state that drugs such as Ritalin® should not be used to 'treat' the core features of autism," she says. "There are no pharmaceutical interventions supported by research evidence that have been shown to change autism. If a child is receiving something like Ritalin®, then it is usually to treat associated conditions such as ADHD.
"Clinicians have to be very careful in their use of medication because it may affect autistic children differently."
Home strategies and support
What strategies can parents with autistic children put in place at home?
"Allowing children time to unwind with a favourite activity after school can help," says O’Donovan. "Other tips include visual timetables and schedules outlining routines at home, and warnings when these change; social stories to help children manage situations such as going out for dinner; and the use of visual aids such as photos of the clothes they need to put on in the order in which they should put them on.
"It is also worth parents taking part in support groups or Cygnet training to share tips and strategies with each other and provide each other with support."
"Parents often feel isolated, but knowing other families in the same situation can be immensely supportive," agrees Povey. "NAS has branches across the UK where families get help, support and information.
"The families who are the most successful at raising children on the autistic spectrum are the ones where family bonds are really strong and the autistic child is a valued member of the family.
"So it is about getting to know your child and appreciating their strengths as well as their difficulties. We have moved away from seeing autism as a medical condition and much more as a different way of being - one that is just as valuable."