World Autism Awareness Day

What is autism spectrum disorder (ASD)?

ASD refers to a group of complex disorders of brain development.  ASD is a developmental disability and people with ASD may communicate, interact, behave, and learn in ways that are different from other people.  Each person with ASD has his own strengths and weaknesses, just like normal people.  ASD is characterized in varying degrees by difficulties in social interaction, impaired verbal and nonverbal communication, repetitive behaviours, and differences in sensory perception.

The spectrum consists of many different ways in which the brain processes information such as language, executive functioning, perception, motor skills and sensory processing. Some traits create difficulties in everyday life – which usually leads to assessment and diagnosis of ASD.

Some of these characteristics may include:

• Little awareness of others.
• Poor imaginative play.
• The development of speech and language may be atypical, absent, or delayed.
• Minimal reaction to verbal input, might sometimes acts as though he/she cannot hear.
• Changes in routine or environment may cause distress.
• Pursues activities repetitively.
• Displays extreme distress/tantrums with no apparent reason.
• Difficulty in interacting with others and little or no eye contact.
• Prefers to play alone.
• Unusual habits such as rocking, hand flapping, spinning of objects.
• Sense of touch, taste, sight, hearing and/or smell might be heightened or lowered.
• Sudden laughing or crying for no apparent reason.
• Uneven gross/fine motor skills.
• Abnormal sleeping patterns.

Each person with ASD will have a set of traits that may be different in all areas of the spectrum, for example one person may be able to make good conversation, but when there are a lot of background noise or people talking, there might be sensory overload causing difficulties making conversations, where as another person with ASD might be happy in loud noisy places but might have difficulty with communication.  It is important to realize that not every autistic person behaves in the same way, but they are all capable of varying strengths and weaknesses.

Team Approach

As children and adults with autism has their own set of traits a team-approach to intervention is required to assist children and adults with ASD.  The team consists of the paediatrician, general practitioner, psychologist, neurologist, occupational therapist, speech therapist, audiologist, and the teacher or employer.  As each person with ASD is different, different members of the team will be involved.

Your paediatrician assists during every developmental follow up – especially ages 18 months and 24 months to look for any signs suggesting ASD.

Paediatricians with more training in developmental problems of children will help with the assessment and diagnosis of ASD by using the DSM 5 criteria. Severity of impairment is also assessed and if needed application for a care dependency grant (SASSA).  Referral to the multi-disciplinary team will follow after diagnosis.

Even though medication is not always needed and will not improve ASD as such, it might be helpful in children with concentration problems, disruptive or irritable mood, depression or seizures. Developmental paediatricians also assess children for other associative syndromes, seizures or hormone deficiencies that might be present.

 The role of the audiologist is to conduct hearing tests to determine if the individual has normal hearing, or if a hearing loss is present.  A hearing loss also result in difficulties with communication, sensory processing and difficulties coping in an educational setting.  If a hearing loss is present the appropriate referrals will be made, such as referring to an ear-throat and nose specialist, or the fitting of hearing aids.

The speech therapist’s role is to assist the person with autism with communication difficulties.  Communication can be verbal where you use words and your voice, or it can be non-verbal where you use body language, facial expressions, and gestures.

If you can’t communicate you cannot convey your needs and wants or tell stories.  You can’t show people what you know which might lead to feeling frustrated and isolated.

Learning is also affected, as well as relationships and independence.

The speech therapist works on language development such as vocabulary, sentence construction, grammar, syntax, semantics, and pragmatics.

Language learning therapy address literacy skills such as reading and writing.  Articulation (pronunciation of speech sounds), and auditory processing skills are also addressed.

The speech therapist will determine if a different mode of communication is required, especially for people who are non-verbal, such as augmentative alternative communication (AAC) by the use of an assistive device such as an iPad/tablet.

Psychologists play an important role in diagnosing ASD.

They provide psychotherapy to help children and adults with ASD manage specific challenges e.g., ADHD, anxiety, depression, and social skills training. The goal of psychotherapy is not to cure ASD, but to help people function at their best and cope with challenges.

Play therapy, cognitive behavioural therapy (CBT), addressing learning challenges and study methods are also provided.

Psychologists play an important role in assessment accommodations evaluations for school exams.  They assist in challenges that might arise between parents and children, by addressing behaviour and discipline challenges and providing parental guidance.

Psychoeducation is provided to the child, adult, parent, teacher and employer.

The role of the occupational therapist: We combine our senses sight, sound, smell, touch, balance, and the sense of our body in space in order to make sense of our environment. However, some autistic children and young people may have difficulty filtering sensory information, and it becomes overwhelming, uncomfortable and/or painful.

On the flip side some autistic people actively seek sensory sensations to calm themselves, relieve anxiety and often just for pleasure and relaxation. Experiencing sensory stimuli differently from the neurotypical population is known as sensory processing differences.

When we lack the “filters” to screen out irrelevant information, this can cause sensory overload and lead to a meltdown. Each sensory input builds and builds without being filtered out appropriately.

When a person is experiencing sensory overload, it can be incorrectly perceived as distressed behaviour. Sensory overload may also result in a withdrawal or complete shutdown.  Making sure a student with sensory processing differences has the right sensory opportunities and environmental adaptations throughout their day, will remove barriers to learning and go some way to improve their wellbeing.

Occupational therapy can provide advice and interventions to target each sense, helps the child’s nervous system to become more organised and regulated. This can reduce the child’s anxiety and exhaustion and improve their attention and performance.

Occupational therapist work to promote, maintain and develop the skills needed by students to be functional in a school setting and beyond. One way is by introducing and individualised sensory diet.

A sensory diet is a specifically designed daily activity plan. It aims to include sensory activities throughout the child’s waking day to improve focus, attention and insure the child is feeling “just right” throughout the day.

Just as the body needs the correct food spaced throughout the day, so does the body need activities to keep its arousal level optimal.

The effect of a sensory diet helps to restructure a student’s nervous system over time so that they are better equipped to tolerate situations and have the skills to take control of their over regulation requirements.

Teaching self-regulations strategies helps everyone recognise behaviours and emotions and successfully adapt and use strategies to meet the demands of any situation.

This can prevent meltdowns and decrease stress, anxiety, and fatigue. – (Laurie, C. 2022).

Conclusion

Some of the most famous people in the world are autistic, such as Bill Gates, Elon Musk, Steven Spielberg, and Steve Jobs.  As parents, friends, and medical professionals we need to take hands and assist people with autism to reach their full potential, you never know you might just know the next Nikola Tesla or Thomas Edison.

(Written by Dr Riekert Swart)