Is Autism the ultimate invisible disability?
Dr Ernest Gralton
Background
Autism is a complex neuro-developmental condition, the exact cause in many cases is unknown however factors such as exposure to psychological trauma and certain infections at a young age are thought to contribute. The condition displays itself through behaviour. Many individuals with autism have difficulty with communication, social interaction and imagination, often causing a feeling of isolation. The lack of these social skills and the subsequent ability to modify behaviour based on “reading people”, is an intangible yet broad disability which impacts every day. The variation of these impairments varies tremendously between individuals depending on the nature and level of impairments, the presence of associated co-morbid conditions and other environmental influences; particularly parenting and exposure to psychological trauma.
The two most common co-morbid problems in childhood are Attention Deficit Hyperactivity Disorder and Developmental Coordination Disorder. These disorders significantly increase the disability of a young person with autism even if all the disorders are relatively mild. When they occur together they are sometimes described as the DAMP syndrome or Disorder of Attention Motor and Perception.
Any mental illness can co-exist with autism including serious conditions like Schizophrenia and Bipolar Affective disorder but they will often present atypically, in the case of Bipolar disorder as mixed affective or rapid cycling variants. Exposure to developmental trauma like childhood abuse and neglect can additionally compromise a person with autism, increasing the risk of behavioural disturbance and offending behaviour.
Non-verbal difficulties
People with autism can have particular problems recognising subtleness in facial expression vocal intonation and other types of ‘body language’ that makes up a significant proportion of communication between people. Their ability to empathise or understand the thinking of other people is often impaired. This inability to communicate often results in Autistic individuals feeling isolated and noticeably different from others. As they are unable to assess the facial expression of someone who may be alarmed or frightened by their behaviour, they will be unable to process that non-verbal cue and modify their behaviour accordingly.
A variety of Sensory Sensitivities are not uncommon in people with autism. These can effect any sensory system and the person can be hypo (under) or hyper (over) sensitive. A common sensitivity is to sound, particularly loud noises like bells, alarms, whistles, vacuum cleaners can induce intense distress and raised levels of arousal in particular people with autism. It is also common to hear histories of young people who will not eat particular foods (taste), and have very restricted diets or young people who will not wear particular clothing or types of fabric (tactile) as it feels very uncomfortable on their skin. Some refuse to have showers as they dislike the sensation of water falling on their skin or cannot stand the smell (olfactory) of particular bathing products like shampoo or perfumed soap. If these sensory sensitivities are not recognised parents and carers may react punitively, believing the young person to be being difficult or disruptive for other reasons increasing the risk of disruptive behaviour.
People with autism often dislike change and prefer routine. They find making relationships with people very difficult. Having such rigid routines and lack of tolerance to uncontrollable factors such as noise can result in frustration building up with limited outlets due to difficulties with communication. As a result young people with this condition can engage in a variety of types of offending behaviour. Most systems within the Criminal Justice system and in care settings are not configured to meet the needs of people with autism. They can be particularly vulnerable to bullying and exploitation especially in prison. Even most secure health care settings do not meet their needs and they can often remain ‘stuck’ making little or no progress in many secure environments.
Essential Stability and Routine
Conventional mental health rehabilitation pathways that commonly involve multiple moves through different environments of decreasing security are often inappropriate and can worsen outcomes. It is appropriate to limit these transitions wherever possible with the goal to make a very well planned move into a highly structured residential placement specifically to meet the needs of people with autism with appropriately trained staff.
A comprehensive multidisciplinary assessment is vital for young people with these complex developmental disorders in order to understand their behaviour, improve their skills and allow them to make a safe transition back into the community. Therapies which take into account the difficulties with communication are needed so individuals can be armed with the tools they need to move back into the community with a significantly reduced risk of reoffending. Professionals from a variety of backgrounds including Medicine, Psychology, Nursing, Education, Occupational Therapy, Speech & Language therapy, Physiotherapy are all required to comprehensively assess and help this complex group of people.
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References
www.nas.org.uk/
Gillberg C 2003Deficits in attention, motor control, and perception: a brief review. Archives of Disease in Childhood; 88:904-910
Martin, N C.; Piek J P, Hay, D 2006. DCD and ADHD: A genetic study of their shared aetiology. Human Movement Science 25 (1): 110–124.