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Aims & Objectives Welcome to this brief e-learning lesson about Autism. The lesson will only take between 20 to 30 minutes to work through and is followed by a small test. It is intended to provide a introduction to the topic of Autism Spectrum Disorder, and covers the topic overview, at the end of the lesson are a list of websites that will provide you with further information.

Introduction The Autism Act 2009 was brought about by a cross party campaign within Parliament in support of a private members bill brought by Cheryl Gillian Member of Parliament for Chesham and Amersham. This was also supported by a wide range of organisations including The National Autistic Society The Act made two key provisions: • That the Government produce an adult autism strategy by 1 April 2010 • That the Secretary of State for Health issue statutory guidance for local authorities and local health bodies on supporting the needs of adults with autism by 31 December 2010. Statutory guidance is guidance that local authorities and local health bodies have a legal obligation to follow.

In 2010 the strategy Fulfilling and Rewarding Lives was published. One of the outcomes identified the need to increase awareness and understanding of autism across the public sector. It lays out that the Local Authorities and the NHS should: Ø Should provide autism awareness training for all staff Ø Should provide specialist autism training for key staff Ø Can not refuse community care assessment for adults with autism, solely based on IQ Ø Must appoint a local autism lead Ø Have to develop a pathway for diagnosis and assessment of adults with autism Ø Need to commission services based on adequate population data.

What is Autism? Leo Kanner an American psychiatrist and Hans Asperger an Austrian paediatrician published papers in 1943 & 1944 on their findings regarding groups of children that they had studied. Leo Kanner used the word autism (which is from the Greek word selfism) to describe the withdrawn behaviour of several children he studied. Asperger published his article which was translated into English in the 1980's and the term Asperger Syndrome was used for the first time. The Department of Health notes that there a number of terms that different individuals/groups prefer to use, including Autistic Spectrum Disorder (ASD) or Condition(ASC) In England, it is estimated that 1 in every 100 children has an ASD. It is estimated there is similar number in adults although there are limited statistics to confirm this estimate.

So what are we talking about? There are many terms you may hear autism referred to as, but it is recognised that we use the word “autism” as an umbrella term for people who have an Autism Spectrum Condition (ASC) who have received a diagnosis of: • Autism / High Functioning Autism • Asperger’s Syndrome • Atypical Autism It should also be noted that people who do NOT have autism are increasingly being referred to as neurotypical. The International Classification of Diseases (ICD) team are reviewing some of the terminology and classifications used to describe the condition; the Diagnostic & Statistical Manual of Mental Disorders team has already completed this review so you may hear other terminology used. Atypical Autism

Myths and Truths Myth Truth Autism is relatively common 1 in every 100 have autism, that’s over half a million people in the UK Autism is a ‘hidden disability’ You can’t always tell if someone has autism At present many adults with autism do 2/3 adults are not receiving the not receive the support they need Many adults with autism have spent time with no job or access to benefits True for 51% adults - 10% of these for over a decade Autism is a mental health condition False - Autism is a developmental condition. However some individuals experience anxiety or depression, also some do have other co-existing psychiatric conditions.

Myths and Truths Myth Truth Only males have Autism. Affects 1: 4 , females : males. Ration in Asperger’s/High Functioning is 1: 9, there is also an argument that more women DO have autism but diagnosis gets missed You can cure ASC’s Lifelong condition. It is a neurobiological condition It’s caused by the MMR inoculation. No link has been established It’s caused by bad parenting Absolutely not! Asperger’s is a mild form of Autism Not true ! But the outward symptoms can be less obvious.

Question? Which of the following statements is FALSE? Autism is a mental health condition Autism is a ‘hidden disability’ Autism is relatively common Continue

What are the impairments? A person with autism may have impairments including: Ø Social Communication Ø Social Interaction Ø Social Imagination This is referred to as the 'Triad of Impairments'. Social Imagination and Rigid Thinking Difficulty with understanding people's intentions, thoughts & behaviour, envisaging situations outside their own routine. Social Communication Difficulty in recognising & understanding other people's feelings and managing their own; difficulty “fitting in” with others Social Interaction Difficulty with both verbal and non-verbal communication, for example not understanding the meaning of gestures, facial expressions or tone of voice.

Social Communication How we may notice signs of social communication impairment? : Language development with little or exaggerated use of gestures: -For some their vocabulary might be limited or unusual and may not be supported by hand gestures or body language or the person may over-use hand gestures when communicating or will find difficulty to stop talking Lack of communicative intent: - People with autism prefer to do something themselves rather than asking other people, they may be comfortable with long silences or pauses with little desire to initiate a conversation other than to fulfil a need. Processing information: - The person with autism may take things literally and not understand common phrases for example they may take “it's raining cats and dogs” literally or pay no attention to sarcasm. Therefore it is important for you to consider how you are speaking when communicating. Often the person with autism takes longer to think and answer you Some people may point to symbols, use sign language or use a hi-tech communication aids such as an i. Pad to help them to communicate.

Question? Which of the following statements is FALSE? People with autism have difficulty with communication, relationships and making sense of the world around them Autism is a permanent, life-long development disability People with autism may also experience over or undersensitivity to sounds, touch, smell, light or colours Autism is a temporary condition affecting children Continue

How may we recognise the signs of … social imagination impairment? Fixed routines and rituals: - People with autism will often develop habits which enable them to cope with the complex environment in which they live. These habits/routines create a safe world for them. Changes to these routines can be achieved but it is best to avoid any sudden changes as this will be stressful for the individual involved. Fixated with, or having a 'special interest' in a particular topic: - Having a special interest is a common trait for people with autism, they can also develop an intense interest or enthrallment in an object or activity. Lack of social understanding including understanding the emotions of others and the thoughts of others, here are some examples: - Remarks that others find blunt or rude, such as : “I'm sure you've put on weight" or '‘ Your deodorant is making my eyes water”: these are personal topics which most of us would not openly say in this direct way but a autistic person may not understand that telling the truth is sometimes hurtful to other people’s feelings. Not knowing how to behave appropriately at unfamiliar social events might feel uncomfortable. The people at the event may all be very welcoming and friendly but the individual feels very uncomfortable, as they are unsure of the “rules” or conventions e. g. How should I eat? How should I sit? What is it OK to say?

What are the signs of a social interaction impairment? Eye contact : - Some may find it very difficult to judge or maintain the appropriate amount of eye contact. If too little is used it may appear to others that they are not interested or not listening, but this may not be the case, it is just it does not come naturally. Where eye contact is used to the other extreme – too much - others may find this uncomfortable, even threatening. Many people with Autism do not instinctively understand social rules of what is “too much or not enough”. Empathy for others: - People with Autism find it difficult to understand or predict what others are thinking and feeling which makes it all too easy to upset or offend them. This results in some people with Autism appearing insensitive. Interactions: - A person with autism can be friendly and wish to establish social relationships. However, because they may lack some subtle social skills, they may lack confidence and avoid social situations or interactions and can appear socially inappropriate or “clumsy”, or aloof.

Sensory Processing People with autism sometimes have differing reactions to sensations (sensory stimuli), showing under- or over-sensitivity to some or all of the following: Ø Noises Ø Lighting Ø Colour Ø Tastes or smells Ø Touch To deal with this they may have developed coping tactics. Examples can include: Ø Seeking visual stimulation by viewing objects from unusual angles Ø Seek physical stimulation by rocking Ø They may also refuse to wear certain clothing. Ø May avoid going out to avoid sensory stimuli Ø May do things in a certain way – sensory issues can be reasons for “unusual” behaviours and agitation. It is key to recognise these coping tactics to help them with their anxiety. Please also be aware of particular triggers that can cause stress for the person e. g. bright flashing lights and loud noises, which may result in anxiety, or extreme distress.

Understanding Language People with ASC often have difficulty understanding spoken language. Difficulty will increase as levels of anxiety or stress rise, or if there are distractions in the environment such as noise. To help with this we should use language that is clear, direct and literal. Here are some examples of good and bad use of language which ones would you use? “I want you to stay until you have completed the form” “I’ll be back in a minute” “We will go upstairs, after you have filled in the form and collected your things” “Make sure everyone has a copy please”. or or “Please complete the form today” “I’ll be back soon” “Fill in the form, get your things and then we will go upstairs” “Photocopy this 3 times and give one copy to Neera, Jo and Dave. ” How we can help. . . Speak slowly and clearly, Use simple, clear, direct language. Use visuals – writing or pictures can be used to help understanding and memory Allow time for processing. Don’t offer too many choices. Give information in a logical order. Check if they’ve understood you – and if you’ve understood them correctly!

Strengths and Talents There are many positive characteristics associated with ASC. People may display talents in music, maths, art, accountancy, photography, IT or other areas. You may be familiar with famous autistic adults but it is important to remember that the majority of productive people on the spectrum lead their lives in comfortable obscurity. Consider some of the well-known people with autism. Satoshi Tajiri This Japanese video game designer, who suffers from Asperger’s Syndrome, is most famous as the creator of Pokemon – the ubiquitous video game, card game, entertainment, and merchandising juggernaut. His success at Nintendo was inspired from a young age by his love of collecting insects. When he got older, he developed a passion for arcade games. Stephen Wiltshire Stephen is an amazing architectural artist who is able to reproduce real life buildings in a drawing from his own memory. He can recreate the smallest detail from memory after only seeing the subject once. In his early years Stephen was mute, but when he started school he managed to convey an enthusiasm for art, and with the support and encouragement of his teachers began to flourish, demonstrating the uncanny talent for which he is now known.

Applying this learning and ideas to work environments Check your own service/workplace – is it Autism Aware? Plan how to make your own service more ‘autism friendly’ with simple, realistic improvements to - the physical environment - information available - the personal communication skills of the staff Offer realistic ‘Flexibility’ within your service Offer appointments at start / end of the day, to avoid waiting time & crowded waiting areas Choose / create a quiet, visually uncluttered meeting environment Avoid the unexpected – e. g. offer to phone at a pre-arranged time, or for the individual to phone you, to allow preparation for the call Consider the sensory stimulation in your environment

Question? Which of the following statements is FALSE? People with autism can find the world very confusing and this causes them anxiety Autism is more common in males than females People with autism will never get qualifications or get a job One in a hundred people (1%) has autism Continue

Further information can be found from the following websites: www. autism. org. uk/ www. nhs. uk/Conditions/Autistic-spectrum-disorder www. treatingautism. co. uk www. peach. org. uk/

PL EC OU AM Remember to click the ‘Home’ icon when you finish the Test to save your results EX Please click the ‘Test’ icon in the left column, and then click for Questions. RS E You have now finished the lesson, now please take the test.