Introduction Certificate in Understanding Autism Welcome to this Level 2 Certificate in Understanding Autism. We hope you find all of the information contained in this resource pack interesting and informative. This learning resource and the assessment questions have been approved by NCFE as a great way to meet the learning outcomes for this qualification. (A complete list of the learning outcomes can be found on the last page of this resource.) The course is made up of three parts (A, B and C). This is Part A which contains two units: UNIT 1: Introduction to autism UNIT 2: Using a person-centred approach to support individuals with autism As you start to read through each page you will be able to make notes and comments on things you have learnt or may want to revisit at a later stage. At the end of each section you will be asked to answer the relevant assessment questions. Once you have answered the questions, go to the next section and continue studying until all of the assessment questions have been completed. Please make sure that you set aside enough time to read each section carefully, making notes and completing all of the activities. This will allow you to gain a better understanding of the subject content, and will help you to answer all of the assessment questions accurately. Good luck with your study. Now let s begin! 1
Unit 1: Introduction to autism Welcome to unit one. This unit is split into six sections. These are: Section 1: What is meant by autism Section 2: Theories that relate to autism Section 3: How autism is diagnosed Section 4: Characteristics that may be present in individuals with autism Section 5: Conditions that commonly co-occur with autism Section 6: Common misconceptions surrounding autism Section 1: What is meant by autism Within this section you will learn about: Different social and communication disorders How autism can be considered as a spectrum condition Why it is important to recognise that autism is a lifelong condition. 2
Different social and communication disorders Q. What is autism? A. Autism is an umbrella term that describes a range of conditions characterised by a difficulty in forming relationships, communicating and managing repetitive and obsessive behaviour. Some examples of autism include: Autistic Spectrum Condition (ASC) Asperger syndrome High-functioning autism (HFA). Autism spectrum condition Autism Spectrum Condition (ASC) or simply autism is widely understood to be social disorder or disability. Its features include limited social, emotional and communication skills, and a tendency to engage in obsessive and repetitive behaviour. Other features may include cognitive delays, rigid behaviour and Sensory Processing Disorder, which will be discussed later. Individuals differ widely in terms of how the symptoms of ASC are presented. The origins of ASC are disputed, and theorists differ according to the primacy of genetic factors things that may affect the child at conception due to the genes passed on by mother or father and environmental factors, including things that may happen in the womb, during birth, or in early infancy and childhood. Key Fact The siblings of children with Autism Spectrum Condition are 18% more likely to have autism than other children. Source: http://www.bbc.co.uk/news/health-14507532 3
Understanding Autism Asperger syndrome M P LE This is a considerably milder type of autism spectrum condition, although it is still relatively challenging to diagnose. In terms of their everyday responses and behaviour, people with Asperger syndrome are generally as similar to people in the mainstream of society as they are to those with autism. Partly as a consequence of this, there are likely to be many individuals with Asperger syndrome who may have the condition but are unlikely to ever be medically diagnosed. Asperger syndrome is generally seen as lacking the language and developmental delays of other autism disorders, although individuals differ widely in the extent to which the condition is disabling in practical terms. High-functioning autism (HFA) S A High-functioning autism is difficult to distinguish from Asperger syndrome, and is more difficult still for medical professionals to practically diagnose. Individuals with HFA may exhibit some of the features of Autism Spectrum Condition, such as limited social skills, obsessive interests and emotional responses which may in some cases seem inappropriate. However, they are likely to be significantly more intelligent than average, and are much more likely to occupy professional positions such as those in education, ICT and industry. High-functioning autism is often seen as a positive benefit in terms of career progression, as those with the condition display a greater tendency and ability to take a key interest in one or more activities, which encourages study, progress and excellence. Key Fact The human brain is still regarded as a relatively mysterious bodily organ in comparison to what we know about the heart, lungs, liver and kidneys. This is why autism can, in many ways, be considered a complex series of conditions about which there is still a great deal to be learned. 4
Understanding Autism How autism can be considered as a spectrum condition What is a spectrum? LE A spectrum is a group or category of behaviour with certain key features, but with important differences within it, ranging from mild to severe. In the case of autism, the term spectrum describes the range of people with symptoms affecting their communication, social interaction and social imagination, and recognises that these symptoms differ significantly in how individuals experience them. Autism has a practical impact on the individual in terms of how they are perceived, their experience of the environment and of other people, their ability to function and access benefits from services and activities in the wider community and in society as a whole. The presentation and experience of ASC differs greatly from individual to individual, but most theorists recognise that all people with the condition experience difficulties or delays in three major areas, known as the triad of impairments. M P These three areas are: Communication Social development Repetitive or obsessive behaviour. S A 5
The broad spectrum of people with varying types of ASC, including Asperger syndrome and high-functioning autism, means that there is a richness and diversity in the autistic population that matches the richness and diversity found in mainstream society. Individuals can be high functioning in one aspect of their ability or behaviour, whilst being low functioning in others. Example of this complexity and diversity are given below: Communication and social skills: Some people with ASC do not speak at all and may vocalise (make sounds) instead. Some display echolalia the practice of echoing what others say. Others may use a limited vocabulary in a very structured way. Some may communicate in sentences but have a limited understanding of nuances, irony and implication. Others may appear to communicate more or less conventionally Obsessions and interests: Some people with ASC have the same obsessive interests throughout their lives, whilst others may change with age. Some may cycle between interests, favouring some obsessions one month and others the next. Some have a single, underlying obsession, whilst others have a broader range of obsessions which may be similar in terms of the levels of personal enjoyment they experience. There is also a great deal of difference in terms of the degree of flexibility and adaptability displayed by individuals. A tendency to engage in repetitive or ritualistic behaviour may also be present in people with ASC. Key Fact Autism is classed as a spectrum condition as individuals experience difficulties in the three areas of the Triad of impairments, but these difficulties differ greatly from individual to individual. 6
The key factor in Autism Spectrum Conditions is how well the individual can adapt to mainstream society. In other words, ASC will affect the care and support the individual requires, depending on the extent to which the condition is disabling, and the extent to which it affects the individual s ability to function in terms of communication, social skills and self-help skills. It is important to remember that in broad terms, ASC can be both a disadvantage and an advantage to particular individuals. Due to the wide variety of types of Autism Spectrum Condition, it may not be immediately obvious that some people are living with an ASC as their behaviour may not differ significantly from the behaviour of individuals without autism. Read the following case studies for examples of how ASC can affect individuals in very different ways: C C Case Study: Robert Robert s parents noticed some delays in his development when he was a baby. He began to speak words such as mama and dada but stopped doing this after several months. He was also slow to learn to crawl, walk and successfully use the toilet. As he grew up, Robert failed to speak using conventional words and made noises (vocalisations) instead. He developed an obsessive interest in sound-making books and loved water play, which still shows no sign of diminishing. He can sometimes become anxious and aggressive if he cannot indulge his interests. He also hates noise, and can become aggressive if placed in social situations that are too noisy and busy. Case Study: Ahmed Ahmed grew up in the care system and as a child his carers noticed that he rarely smiled or showed much interest in playing with his peers. He did not seem to react positively to affection. As a small child, he struggled to understand jokes and irony, but generally his self-help and communication skills developed as expected. As a teenager, he struggled to make friends and experienced some bullying, which led to him becoming depressed. However, he took a keen interest in computers, from which he gained great enjoyment. He studied every aspect of ICT and eventually founded his own company. He is now married and settled in a comfortable and happy life. 7
Understanding Autism C Case Study: Cherise S A M P LE Cherise s parents noticed that she seemed unusually tearful and anxious as a baby. She was unable to settle herself enough to breastfeed, and seemed to dislike the company of other people. She was slow to learn to walk and bottom-shuffled instead of crawling. As she grew up, she developed an interest in doors but seemed to grow out of this, becoming obsessed with dolls as a young girl, then with boy bands as a teenager. She communicated in simple sentences and was able to make a few friends in the special school she attended. When she left school, she gained a job in a local supermarket with the support of a local employment organisation. 8
A Activity 1: Case studies Referring to the case studies, answer the following questions. 1. How could you help Robert to avoid situations that make him anxious and aggressive? 2. What could you do to help to minimise the incidence and impact of bullying on Ahmed? 3. What could you do to help Cherise succeed in her job? 9
A Activity 2: Autism spectrum condition Using the information provided in this section, answer the following questions. 1. Explain what is meant by the triad of impairments. 2. Read the previous case studies and identify the areas of difficulty experienced by: a) Robert b) Ahmed c) Cherise 3. Where would you place Robert, Ahmed and Cherise on the autism spectrum? Are their symptoms mild, more severe or somewhere in the middle? 10
Why it is important to recognise that autism is a lifelong condition There is no known cure for autism. The only appropriate treatment comes in the form of education and support to enable individuals to accept their autism, to recognise it and adapt appropriate techniques to enable them to adapt and thrive. The assumption that there may be a cure risks leading to undesirable outcomes, including: A delay in providing considered and beneficial care and support for the individual to prepare them for growing up with autism. This can risk increasing their anxiety and depression A view of people with autism as ill, different, deficient and in need of care that is primarily medical in nature, and further restricts their social development A view that is similar to the medical model of disability, in that it sees the individual with autism as needing to change, and restricts the view that society should make appropriate adjustments to enable people with differing needs to succeed It is important to recognise that autism is a lifelong condition, in order to ensure that their changing needs are met to support them at different stages throughout their lives. Key Fact The medical model of autism sees the condition as undesirable and in the same light as a physical disease, such as diabetes or multiple sclerosis. It automatically resists the notion that autism may be something to accept and celebrate, and ignores the richness and diversity of the population of individuals with the condition. 11
Let s Summarise! Take a few moments to answer the following questions to help you summarise what you have learnt in this section. This will help you answer the upcoming assessments. 1. Identify two of the key features of: a) Autism Spectrum Condition 1. 2. b) High Functioning Autism 1. 2. c) Asperger Syndrome 1. 2. 2. Identify two symptoms an individual may display if they have: a) Mild autism 1. 2. b) More severe autism 1. 2. 3. Suggest some possible consequences of professionals attempting to cure an individual of their autism. Check your answers by looking back over this section. CONGRATULATIONS, YOU HAVE NOW COMPLETED SECTION 1. PLEASE NOW GO TO YOUR ASSESSMENTS AND ANSWER QUESTIONS Q1 TO Q3. 12
Section 2: Theories that relate to autism Within this section you will learn about: Theoretical models that relate to autism How the terms neurodiverse and neurotypical are used in relation to autism. Theoretical models that relate to autism The condition or range of conditions commonly referred to as autism, began to be identified, recognised, documented and researched in the 1940s. The work of a number of theorists has underpinned the development of how autism came to be defined during the course of the following seventy years. Three prominent theorists who put forward theories related to autism include: Leo Kanner Hans Asperger Lorna Wing and Judith Gould. Read on to find out more about each theorist and their theories. Leo Kanner Kanner s theories were developed in the 1940s, and if they were shared today, they would be greeted with some controversy. Kanner suggested that children with autism had suffered delays in emotional and social development due to a lack of warmth and affection from their parents. He called his research paper Autistic Disturbances of Affective Contact and used the term refrigerator mother to describe emotional coldness. In stating that this was the primary cause of ASC, Kanner would have prompted significant guilt, distress and confusion on the part of parents. His theories were only disproven in the 1970s. 13
Hans Asperger LE Understanding Autism M P Hans Asperger had difficulty finding friends during his childhood and was considered lonely, remote and odd by his peers. Examples of his behaviour include quoting poetry and referring to himself in the third person. He conducted some limited research with a small number of similar boys during the 1940s. He coined the term little professors, largely due to their ability to talk about a particular interest in great detail. He observed the following patterns of behaviour: Lack of empathy Little ability to form friendships One-sided conversations Intense absorption in a special interest Clumsy movements. A His theory of autism was referred to as Asperger syndrome posthumously (after his death). S Lorna Wing and Judith Gould Lorna Wing coined the term Asperger syndrome and helped found the National Autistic Society. Her research with Judith Gould underpins most of the agreed and shared approaches to the study and support of people with ASC today. Wing and Gould coined the term triad of impairments to describe the three areas in which people with autism experience difficulties and delays: communication, social interaction and obsessive behaviour. 14
A Key Fact Theories of how autism is caused, experienced and understood have changed radically since the 1940s. What is clear is that it is not a medical disorder or a learning disability, but a complex and highly variable social condition, with no known cure. Our understanding of autism today places an emphasis on understanding and acceptance of the condition, and supporting individuals to achieve their full potential, whatever that may be. Activity 3: Theoretical models that relate to autism Use the information provided in this section to complete the following activities. 1a. The Theories of Leo Kanner continue to be used today. True 1b. Hans Asperger coined the term little professors. True 1c. The research of Wing and Gould has been discredited, and is rarely used today. True False False False 2. Identify some problems with Asperger s theories being used to analyse ALL individuals with autism. 15