Matt Bushell

The Autistic Spectrum

Conditions (ASC) Team

‘Overview of autism, neurodivergence and an

enabling

approaching in supporting people with autism

Autistic Spectrum Conditions (Wing/Gould 1979) –

Impairment of social instincts and rigid/repetitive behaviour

www.kent.gov.uk/socialcare8 * Autistic Spectrum Conditions Team

0845 8247100(

Social imagination

Social Communication

Social Interaction

Including difficulties with feelings and emotions, sensory stimuli, language,

sleep, food, mood, behaviour, movement, posture and attention levels

What causes autism No one really knows except that:

• The condition has genetic links

• Ongoing debates about environmental

impact but autism is not a new condition

• Different ‘brain wiring’

• MMR vaccine theory discounted but

perhaps health issues can ‘kickstart’ pre-

existing autism presence.

Prevalence Overview

National Figure 1.1% of Population

In Kent: 1.4 Million

ASC – Latest statistics suggest numbers in

the region of 14,000 all age across Kent

ADHD 5% children &YP 2.5% adults.

Suggests numbers in the region of 71,000

all age across Kent

Co-existing conditions

Attention Deficit Hyperactive

Disorder greatest co-existing

Condition – one third of people

ADHD has its own triad of impairment

1. Inattention

2. Impulsive

3. Hyperactivity

70% of people with autism have one co-existing condition

50% have two co-existing condition

These include learning disability, epilepsy, mental health, gastro-intestinal

Co-existing Health issue 70% of people with autism have a co-existing

condition; 50% have two conditions (NAS)

70% a Learning Difficulty, 50% a Learning Disability, 65% of people with Aspergers had a psychiatric disorder, 84% of those with PDD autism had an anxiety disorder, 30% have ADHD, 10% OCD and then physical disability a further percent ie epilepsy 25% (NAS)

• An associate Gastro-Intestinal issue (ie diarrhoea, abdominal pain, constipation) 9-91% - Virginia Bovell

• Some autistic behaviours could be pain behaviours

• sight (visual)

• sound (auditory)

• touch (tactile)

• taste (gustatory))

• smell (olfactory)

• balance ('vestibular')

• body awareness ('proprioception')

• The 8th sense (Interoception)

Our Senses – all can potentially be impaired with autism

What is Autism Spectrum Disorder?

• DSM-V: Social Communication & Restricted

Repetitive Behaviours.

• Must show deficits in socio-emotional reciprocity,

nonverbal communication, maintaining relationships

appropriate to developmental level.

• Must show at least 2 of stereotyped

speech/movements/use of objects, excessive

adherence to routines/rituals, abnormally intense

fixated/restricted interests, hypo/hyper sensitivity.

• From early childhood AND impairs everyday

functioning.

Historical view

A rare, neurodevelopmental disorder with a triad of symptoms, usually associated with intellectual disability, and categorically distinct from normal development and from other disorders.

Or is autism an extension of everyday human traits ?

Modern view

A relatively common, neurodevelopmental disorder with a dyad of symptoms, usually associated with normal-range IQ, and representing the extreme of trait distributions that extend throughout the general population.

• • sight (visual)

• sound (auditory)

• touch (tactile)

• taste (gustatory))

• smell (olfactory)

• balance ('vestibular')

• body awareness ('proprioception').

Our Senses – all can potentially be impaired with autism

Presentations of autistic people can vary

NAS video

But what is autism really?

We know the traits but we see those traits in us all, why is that? -

We believe its because we are all neurodevelopmental beings

and we all develop differently. Neurodevelopment relates to the

growth and development of the brain or central nervous system. A

narrower use of the term refers to brain function that affects

emotion, learning ability, self-control and memory and that unfolds

as an individual develops and grows

It is our view shared

by many others that

most difficulties in

autism occur because

of sensory issues, or

at least this is the

starting point.

Neurodoversity

Neurodiversity – ‘neurodivirgence’ such as autism,

ADHD and dsyslexia are inherent and valuable parts

of the spectrum of human variation. There is no right

and wrong way to develop. There is no normal brain.

The social model of disability, many of the negative

consequences of autism are caused by the societal

structures we live in rather than the condition itself.

We need to accept difference, break down barriers,

make reasonable adjustment and provide support

only to the people who are severely impacted in

areas specific to them:

Do we as a society make autism a disability?

Karen Williams – the Autism Fruit Salad

We are too keen to pathologize; but we should say is the child

presenting with neurodivergence. If so, is it a problem? If not then

why worry; where are the persons human rights in this?

If a diagnosis like autism causes an impact then in which areas might

the child need support in order for that person to learn and

development in their own individual way

Finnish Model – early on in childhood they identify individual ways of

learning etc, they get a plan before main stream and then everyone

is supported together.

The environments children access are generally very poor at

supporting sensory balance – supermarkets, hospital, classrooms,

dentists etc are full of excessive sensory information and bright light.

Diagnosing people late in adulthood is very harmful and traumatic.

Complete the right level of assessment at any early age and be

skilled at that because so many people misdiagnosed and that not

helpful either

Neurodiversity in Summary

We are all neurodevelopment beings and we all have strengths and weaknesses

Autism is not a disease to cure; people with autism should not have to feel psychologically affected by feeling of deficiency

Support and access should be provided for some most affected in some areas specific to them

Children with autism should not be subjected to attempts to normalise them

Most of all we should promote acceptance and value strengths

Mental Capacity

Belmonte (Cornell 2007) , autistic children begin to display

different social, communicative, and behavioural aspects of

development. When this occurs, these children adapt their

environmental responses to their social, communicative, and

behavioural reality. In so doing, they develop ways of existing

within a developmental world that is different in many ways

from non-autistic children but similar in a fundamental way—

responding in an appropriate manner that is adaptive to the

environments that they perceive.

Theories of autism

• Dr Peter Vermeulen@

• Mind blindness such as Theory of Mind is just part of the

difficulty. Thought to be the main reason in autism that people

struggle to relate to others.

• Recently for higher functioning people, people are found to

have higher social cognitive ability but they struggle with

context.

• There are differences in social cognitive ability and social

performance (reading minds) – some mask true problems as

learnt to read some contexts

Context Blindness

---------- ---------

Context Blindness

– Absolute Thinking in a Relative World (Dr Peter

Vermeulen)

Non ASC ASC

Stimulus Stimulus

Meaning Meaning Meaning Meaning

Mentalisation – weaker on understanding others affecting

thinking/decision making in the moment

stronger on post analysis and rumination

Social functioning – weaker on empathy

stronger on systemisation

Strengths and weaknesses in ASD/ASC

Big Bang Theory

The predictive mind

Central Coherence

Focused on a fixed aspect rather than the whole. Key

aspect of autism. Affects so many areas including face

blindness.

Lady with autism explained that she sees people like a

Picasso painting – focusing first on their standout

features which could be a chin, hem of skirt, then hair.

Has to concentrate to form face. Prefers round

symmetrical faces and this affects affiliation to people.

.

Theory of Mind/Mentalisation

• Theory of mind refers to the notion that many autistic

individuals struggle to understand that other people

have their own plans, thoughts, and points of view.

Furthermore, it appears that they have difficulty

understanding other people's beliefs, attitudes, and

emotions (Elelson). ToM has recently been linked by

Ute Frith to ASD problems with Implicit and Explicit

Mentalisation.

• What helps – social stories, ABC work, repeated

exposure, cartoon scripts, Brain in Hand.

Executive Functioning

• Individuals with autism have less activity in the

amygdala (shown in red), which plays a key role in

processing emotions

• Autism and Asperger syndrome are part of a range

of conditions known as autistic spectrum disorders

(ASD). They affect the way the brain processes

information.

Stimming Behaviour Stereotypic Behaviours Related to Senses, many ‘stimming’

behaviour – present outward vulnerability:

• Visual staring at lights, repetitive blinking, moving fingers in

front of the eyes, hand-flapping

• Auditory tapping ears, snapping fingers, making vocal

sounds

• Tactile rubbing the skin with one's hands or with another

object, scratching

• Vestibular rocking front to back, rocking side-to-side

• Taste placing body parts or objects in one's mouth, licking

objects

• Smell smelling objects, sniffing people

Researchers have suggested various reasons for why a

person may engage in stereotypic behaviours. One set of

theories suggests that these behaviours provide the person

with sensory stimulation. One specific theory states that

these behaviours release beta-endorphins in the body

(endogeneous opiate-like substances) and provides the

person with some form of internal pleasure. Another set of

theories states that these behaviors are exhibited to calm a

person (i.e., the person's sense is hypersensitive). That is,

the environment is too stimulating and the person is in a

state of sensory-overload.

Stimming Behaviour (2)

Sleep

Research is increasingly pointing to underlying medical issues as a significant factor in sleep disruption associated with ASD include

•Gastro oesophageal reflux

•Sleep apnoea

•Night terrors

•Seizures

•Anxiety/over rumination

•Insufficient physical activity

•Circadian rhythm (natural wake/sleep cycles) disturbances

•Abnormal melatonin regulation.

•Heightened sensory experiences sensitivity to light, touch or sound

Overload – cannot wind-down .

Anger Vs Rage Cycles

Anger Vs Rage Cycles (2)

Tips for engagement

• If someone presenting with ‘behaviour’ – seek to find out the

cause

• People with autism often delayed in processing so give time to

answer questions

• Ask direct questions - not ambiguous

• Check that the sensory environment is right for interviewing and

assessing

• Check seating and avoid direct eye stare

• Resist touch unless necessary for safety; explain before doing

• During a ‘rage cycle’ encourage them to a safe place to calm

• Check understanding; might have to write down

• Check or assess if there are other reasons why a person is

presenting a certain way i.e. drug use

Enablement

Spectrum Star

Levels of Sensory Development

AMPS

Assessment

of motor and

process skills

Acquisitional /

compensatory

GOALS

Occupational Therapy Approach

Self CareProductivity

Leisure

=

Some options to support

Pressure vest

Apps

Spectrum Star

11 Key Issues

1. Lack of information/awareness of services and support available

2. Lack of a social care assessment service for higher ability children with autism which is comparable to that provided for other disabled children and that provided for adults with ASC 18+

3. Transition

4. Ongoing support for adults with ASC and behaviour support

5. Specialist support services

6. Employment

7. Carer’s needs

8. Lack of robust data across the system

9. Diagnostic assessment, post diagnostic support, clinical interventions and complex needs assessment (Health related issues)

10. Lack of awareness and understanding of autism by mainstream services, including failure to ensure reasonable adjustments

11. Leadership, integration and partnership working

Advocacy for All

bigger voices – better lives

The project

• Group member lead

• Each group develop according to the

individuals needs

• Develop stand alone groups

• Peer support and Buddying

• Promote joint activity family

Contact Details:

Autistic Specialist Conditions Team,Kroner House,

Europa Business Park,

Ashford,

Kent

TN24 8XU

Telephone: (03000) 418100

Email: sensoryandautism@Kent.gov.uk

Questions

Final video

‘Fix You’ – You Tube