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A General Introduction

What is Autism?
Autism is a complex lifelong neurodevelopmental disability that affects the person in all areas of
life, throughout life. It is permanent and pervasive.
It is a dysregulation of the central nervous system that affects how the individual learns, processes
information and interacts with his/her world.

What do Neuro imaging and Brain Studies show

about the development of Autism in individuals?
Advanced brain imaging techniques such as electroencephalography (EEG) and Functional magnetic
resonance imaging (fMRI) have recently provided evidence of some important, albeit subtle
changes in the brains of children and adults with an ASD.

Brain studies have shown differential activation in areas related to the core domains of autistic
dysfunction (Verhoeven et al., 2010).

Reduced connectivity between brain regions, especially associated with language processing
(Duffy & Als, 2012).

White matter alterations in communication pathways and integration of the two brain
hemispheres (Anderson et al., 2011) and mechanisms that are essential for higher cognitive


Areas of the Brain associated with Autism:

Frontal lobes- Executive Functioning
Temporal Lobe- auditory centre, speech and memory
Cerebellum- Motor skills and shifting attention
Amygdala Primitive emotional centre

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Autism Facts and Figures:

Recent prevalence rate is around 1 in 100

Equates to an estimated 64,600 Australians (double since 2003 Survey) Australian Bureau of
Statistics survey of Disability, Ageing & Carers, 2009
Present at birth; evident usually by age 3.
The male female ratio is at around 4:1 (Whitely et al., 2010).
Presents in all ethnic and socioeconomic groups
Often associated with other disorders, e.g. learning disabilities, ADHD, epilepsy, Fragile-X,
Tourette Syndrome, Obsessive Compulsive Disorder, chromosomal abnormalities.

Possible Causes:

Genetic factors:
- higher incidence in families with history of Autism
- higher concordance in identical twins
- genetic vulnerability but no single causal gene
- The Autism Genome Project (AGP) has identified a number of autism susceptibility
- Some of these determine synaptic connections, cell growth and communication
between cells.
- Metabolic aetiology:
Recent research from the Imperial College of London and the University of South Australia (Yap et
al, 2010) has shown that it is possible to distinguish between children with and without autism by
looking at by-products of gut bacteria and the bodys metabolic processes in the childrens urine.

- Scientific research has NOT found evidence to support a link between the MMR vaccination and

The DSM V: a tool for Diagnosis:

ASD now consists of a single category i.e. Autistic Disorder, Aspergers Disorder and PDD-NOS
no longer exist as a diagnosis category. The only diagnosis under DSM-V is Autism Spectrum

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The domains of impairment are reduced from 3 areas of impairment (DSMIV) to 2 i.e. the
Social and Communication domains are collapsed into 1 domain (Social Communication) and
Restricted and Repetitive Patterns of Behaviour and Interests now specifically includes unusual
sensory behaviours.

Students with a diagnosis of Aspergers Syndrome or PDD-NOS under the DSM IV will retain
their diagnosis until reassessed under the DSM V.

Strengths of Autism:

The two Domains of Autism:
1. Social Communication: Communication

Approximately 25% of children with autism remain nonverbal or minimally verbal (Koegel,
Shirotova, & Koegel, 2009).
Many children with ASD develop some speech and language skills, but not to a normal level of
ability, and their progress is usually uneven. For example, they may develop a strong vocabulary
in a particular area of interest very quickly.
Difficulties may include:
Vocabulary and the ability to say complex sentences may differ from receptive language
skills (Koning & Magill-Evans, 2001) they may sound much more able than they are.
Difficulties with comprehension of verbal information.
Tendency for literal interpretation
Language usage that can be overly formal and pedantic
Differences in prosody and rhythm, pitch, intonation, rate and volume of speech (Attwood,
Impairments in nonverbal communication eye contact, facial expression, use of body
Children with ASD often are unable to use gesturessuch as pointing to an objectto give
meaning to their speech. They often avoid eye contact, which can make them seem rude,
uninterested, or inattentive

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1. Social Communication: Social Relating:

Limited social interaction demonstrated by individuals with autism does not necessarily reflect a
lack of desire to interact (Saskatchewan Education,1999).
May include:
Impairment in the ability to read social situations and respond appropriately (Gray &
Garand, 1993).
Poor understanding of social conventions such how to initiate, maintain and end a
Difficulties with reciprocal conversations (Linblad, 2005).
Frequent changing of topics and tangential responses.
Lack of appreciation of non-verbal social cues
Differences in showing empathy
Play often lacks the imaginative qualities of social play

2. Restrictive and Repetitive Patterns of Behaviour and


May Include-
Restricted interest in a narrow area
Repetitive speech, (echolalia), repetitive movements, (rocking, flapping), repetitive use of an
object or toy, (spinning wheels of toy car).
Preferring routines - doing things the same way each time, difficulty with flexibility within
these routines.
May be due to difficulties in understanding language, social situation, anxiety and sensory
integration difficulties.

2. Sensory:

Sensory Processing is the ability to organise and interpret the information we

receive through the senses from our bodies and from the world.
This enables us to produce an appropriate response for the particular situation, task
and environment.
95% of people with Autism have Sensory Processing Difficulties (Tomcheck & Dunn
Students with Autism may

be Hypersensitive or

Hyposensitive to a range

of stimuli and these

sensitivities may vary
throughout the day.

The picture to the left is

not representative of

where all students
experience sensitivities

but is simply an example

of where one student has

sensitivities at one

particular time.
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Students with autism are vulnerable to sensory overload

Sensory processing dysfunction interferes with language, motor planning, cognition and
emotional well being (Murray-Slutsky & Paris, 2005).
The aim of sensory integration is to bring the student to a calm-alert state where he/she
can function successfully within the environment (Ayers, 2000).

There are also two Interoceptive (internal) Senses:
a. The Vestibular system controls our sense of movement and balance. It is the unifying
system in our brain that modifies and coordinates information received from other
systems. The vestibular system functions like a traffic cop, telling each sensation where
and when it should go or stop.
b. The Proprioceptive System is part of the vestibular system, where special receptors in
muscles and joints travel quickly from the cerebellum to enhance tone and joint stability.
Frequent Proprioceptive activities such push-pull and heavy work activities are calming,
safe input to use with a child who appears disorganised. This input doesnt reverberate
in the nervous system for hours like other sensory input, so it is important to reintroduce
the input often, throughout the day.

Other sensory issues may include:
Limited proximal awareness
Low muscle tone, low postural tone
Gross and fine motor difficulties

The Three Theories of learning:

The above diagram depicts how the Learning Theories impact on the two Domains of autism ie.
Social Relations and Repetitive and Restricted Patterns of Behaviour and Interest. This is also
illustrated in the following picture where the two domains of autism are visible as the tip of the
iceberg, however, what underlies autism, and directly impacts on the two domains, are the three
Learning Theories. i.e. Theory of Mind, Executive Functioning and Central Coherence.

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1. Theory of Mind:
Theory of Mind (ToM) is understanding that others have their own thoughts, feelings and
experiences that are different from our own. This naturally develops between the ages of 3 5
years and becomes more complex over time.
It involves:

Understanding emotions in ourselves as well as others.
Predicting the behaviour of other people
Honesty- students with autism find it hard to tell a white lie.
Difficulties in managing conflict (confrontational and may
vehemently defend their own point of view without being
able to consider that of others)
Strict adherence to their decisions
Being perceived as rude
A compulsion for completion
Difficulties initiating alternative strategies
Anxiety due to all of the above:

Because of my lack of confidence, I am terribly afraid of upsetting others without realising it or
meaning to, by saying or doing the wrong thing. I wish I could read minds then I would know what
they wished for and I could do the right thing. Socialising is harder than any Maths equation for me
(Flesisher, 2003, cited in Attwood, 2007)

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2. Executive Functioning:
Just as an air traffic control system at a busy airport manages the arrivals and departures of many
aircraft on multiple runways, executive function skills allow us to retain and work with information
in our brains, focus our attention, filter distractions, and switch mental gears.

There are three basic dimensions of these skills:

Working memory The able to hold information as well as apply it. Typically, students with autism
have a lowered capacity to hold information in this way.
Inhibitory control - The ability to master thoughts and impulses so as to resist temptations,
distractions, and habits, and to pause and think before acting.
Cognitive flexibility - The capacity to switch gears and adjust to changing demands, priorities, or

Executive Functioning skills also help us to:
remember the information we need to complete a task
filter distractions, resist inappropriate or non-productive impulses
sustain attention during a particular activity.
set goals and plan ways to meet them.

Managing all of these complex behaviours is always difficult for the student with ASD, and is
especially difficult when the student is presented with unfamiliar and/or unexpected new tasks,
environments and problems.

3. Central Coherence:

Central coherence is the ability to focus on details as well as wholes

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May include:
Difficulties with social coherence- Intense focus, or even hyper-focus, on the details within
the larger whole of a situation, conversation and difficulty recognising the main idea, topic
or general point.
Seeing connections and generalising skills.
Difficulty prioritising and choosing.
Preference for the known
Idiosyncratic focus of attention and inattentiveness to new tasks.
(Cumine, Leach & Stevenson, 1998)

A final considerationEmotional Regulation:

Behavioural challenges in autism may also be compounded by the disordered development

of emotional regulation (Laurent & Rubin, 2004).

We know that a part of the brain called the Amygdala can be structurally and functionally
abnormal for children and adults with an ASD. The Amygdala has many functions including
the perception and regulation of emotions. The Amygdala can be structurally and
functionally abnormal for individuals with an autism , (Adolphs, Sears, and Piven, 2001).

We therefore, need to be aware of the amount of assaults our students face throughout
the day. Lenore Gerould refers to this as the adding of drinking glasses to a tray. The glasses
may vary in size but the last glass, not necessarily the biggest, is the one which causes the
tray to fall over. This analogy depicts the notion that a behavior and its triggers may have
no connection with each other and that a student with autism may have a meltdown over a
seemingly small matter.

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