Signs & Symptoms of Autism, Aspergers & PDA
COMMUNICATION (VERBAL AND NON-VERBAL)
Between the age of 2 and 3 - no response to name and no pointing for showing or following your point to show them something; poor eye contact (Baird, 2005). Although I personally know some children with ASD who have amazing eye contact despite being considerably disabled in the other recognised impairments.
ABSOLUTE SIGNS FOR A REFERRAL FOR AN ASD ASSESSMENT:
1) No babble, pointing or gesture by 12 months
2) No single words by 18 months
3) No two word spontaneous (non-echoed) phrases by 24 months
4) any loss of any language or social skills at any age. (Baird, 2005).
SOCIAL IMPAIRMENT: limited or lack of imitation of another, such as clapping after you clap, not responding to a 'peek-a-boo' game; lack of showing toys and objects to another person; lack of interest in or limited response to others happiness or distress; limited variety of imaginative play or pretending with others in imaginary games; being in their "own little world" and failure to join in and initiate simple social play and preference for solitary play; odd relationship with adults such as being too friendly or too ignoring (Baird, 2005).
IMPAIRMENT OF INTERESTS, ACTIVITIES AND OTHER BEHAVIOURS: Over sensitivity to sound or touch; unusual motor mannerisms such as hand flapping or finger flickering in front of their eyes: 'biting hitting or aggression to peers; oppositional to adults; over-liking for sameness or inability to cope with change, especially in an unstructured setting; repetitive play with toys (such as lining things up and playing inappropriately with them (such as lining up toy cars or spinning the toy car wheels constantly); turning light switches on and off, despite being 'told off' and told to stop' (Baird, 2005).
FOR SCHOOL AGE CHILDREN:
The following signs should alert a teacher or parent to ask for a referral for an ASD assessment:
COMMUNICATION:
Abnormalities in language development, including mutism and odd pitch and intonation of spoken language; persistently repeating others spoken word (including sentences from favourite DVDs and videos exactly to the word (verbatim)); reference to them self as you, he or she beyond the age of 3; unusual vocabulary for child's age or peer social group (including very advanced language and even if there was no language delay in early years); tendency to talk about specific topics all the time despite them not being time or environment relevant and appropriate (Baird, 2005).
SOCIAL IMPAIRMENTS:
Difficulties or inappropriate attempts in joining in with other children's play (the child may display aggressive or disruptive behaviour because of this).
Lack of awareness of classroom appropriate behaviour and inappropriate behaviour towards the teacher or a teaching assistant (such as criticising them or speaking frankly with no tact or understanding of appropriate communication to an elder or 'respect for your elders,' teacher/pupil relationship).
Unwillingness to co-operate with whole classroom activities.
Inability to appreciate or follow the current trends, the 'in thing' for example, with regard to other children's style of dress, the latest and most popular toy or understanding the 'in way' to speak to be peer appropriate.
Being the class policeman (always' telling tales' or telling other children the rules).
Easily over whelmed by social and other stimulation (e.g. attending assembly, being in the playground; putting hands over ears and possibly screaming).
Failure to relate normally to familiar adults (either too intense or no relationship at all).
Showing extreme reactions to invasion of their personal space and extreme resistance or stress to being hurried (Baird, 2005).
PATHOLOGICAL DEMAND AVOIDANCE (PDA):
PDA is increasingly being recognised as part of the autism spectrum. I originally became aware of this condition when I attended one of Elizabeth Newson's conferences back in the early years of my daughter's infant education. I was lucky to have a very supportive 'Autism Specialist Teacher' from the Bristol Autism Outreach Team, as it is called now, who supported me beyond her remit (in my opinion) and attended conferences and anything we could hear or find out about to learn more to help us as a family. You can download a copy of the 'defining criteria for PDA' from the Autism East Midlands Elizabeth Newson Centre HERE.
However, here are the main features of PDA:
- Obsessively resisting ordinary demands
- Appearing sociable on the surface but lacking depth in their understanding (often recognised by parents early on)
- Excessive mood swings, often switching suddenly
- Comfortable (sometimes to an extreme extent) in role play and pretending
- Language delay, seemingly as a result of passivity, but often with a good degree of 'catch-up'
- Obsessive behaviour, often focused on people rather than things (PDA Society, 2017).
As PDA is not recognised as a specific, stand alone diagnosis and is not listed in the diagnositic manuals, it is not helpful from an intervention, therapy or treatment point of view because the same type of interventions, therapies and treatments that are useful for people with autism do not work for people with PDA. Therefore, it is highly preferable to seek an assessment for ASD with PDA as part of that diagnosis. This will enable professionals such as teachers and therapists who are not aware of this to find more appropriate training for understanding how to support a person or family with this very challenging addition to their circumstances.
Women and Girls are becoming increasingly more recognised and diagnosed with autism but this is a 'new concept' because until recent years, the assessment and diagnosis of autism spectrum conditions (ASC) are biased towards the many years of understanding of how autistic behaviours are recognised in boys. My daughter was diagnosed by a multi-disciplinary NHS team at the age of two under these 'male-related' behaviours. She was non-verbally communicative and ticked all the boxes for 'classic or Kanners autism' in the diagnostic manuals, the ICD-10 and DSM-IV, and it is only through her receiving a multi-faceted, holistic intervention and therapy regime over many years that she is now able to function at university level with support. She also received a diagnosis of Dyslexia at age 18 but this was only because her educational and social communication needs were such at this point, that she was reassessed by a highly qualified and experienced Educational Psychologist who was able to define her complex development and learning profile and prepare a comprehensive and in-depth assessment report to enable her to further progress in education with the specialist support recommended, to support her.
At the time of writing this, there is very limited resources to offer you on the signs and symptoms of autism in women and girls. However, I did attend the very first conference hosted by Lorna Wing and there, researchers were discussing how girls are more able to 'mimick' other children and have increased perceived ability to carry out pretend play due their developmental profile being 'more sociable' amongst other abilities compared to boys. In my opinion, this could possibly be because of the hormonal differences and general understanding that girls use more of their right brain than left and therefore the 'autism' behaviours are more obscured. Additionally, there was mention of a connection with eating disorders which in my opinion again, relates to a skewed perception of 'self,' both physically, emotionally and spiritually and the need to 'fit in' or be 'accepted' as part of a group. Girls still have the same underlying challenges but they are experienced slightly differently to boys because of the sex differences but this again is complex because there is evidence that the endocrine system (the system of the hormone functions and balances) can also differ in autistic people to those who are considered neurotypical.
It is my opinion as well that women and girls on the autism spectrum who are diagnosed later, some not until they are in their 40s and 50s, relate more to the Asperger syndrome end of the spectrum because otherwise they would be noticed earlier in childhood and fall under the 'male criteria' end of the spectrum, as my daughter was, where language is delayed before the age of three and verbal IQ is often considered lower, most often due to an underlying undiagnosed learning difficulty at that time due to the autism primarily presenting; again as happened with Farrah who was diagnosed with Dyslexia at age 18.
A good download on women and girls on the spectrum is Girls & Autism: Flying Under the Radar written by the National Association of Special Educational Needs (NASEN) which discusses the differences in autism behaviour presentations between boys and girls to enable you to recognise the signs and symptoms you may see in women and girls as well as other useful information to consider and implement. You can down load this from the NASEN website HERE.
REFERENCES:
I have referenced Gillian Baird because some of what I have written here is from her' Clinical Review' on the 'Diagnosis of Autism' (2005); published in the British Medical Journal (Volume 327, pages 490-493) and it was the most informative and easiest to translate from some clinical jargon.
PLEASE REMEMBER THESE ARE SIGNS TO LOOK OUT FOR AND IF YOU HAVE CONCERNS YOU SHOULD MENTION THIS TO YOUR GP, HEALTH VISITOR or PAEDIATRIC CLINICIAN AND ASK THEM TO REFER THE CHILD FOR A CLINICAL ASSESSMENT.
These signs on their own will not necessarily mean the child has autism. They are warning signs for a referral for an assessment.
EARLY ASSESSMENT AND INTERVENTION IS THE BEST ACTION YOU CAN TAKE TO GIVE THE CHILD THE BEST POSSIBLE PROGNOSIS BUT THIS DOES NOT MEAN THAT A CHILD RECEIVING A LATER DIAGNOSIS AND INTERVENTION WILL NOT MAKE POSITIVE GAINS WHICH WILL POSITIVELY IMPACT THEIR QUALITY OF LIFE AND INDEPENDENCE .
