Autism in Children and Adolescents

Autism is a lifelong neurodevelopmental disorder often characterised by social and communication difficulties. Autism is a 'spectrum' disorder, which means that characteristics can vary significantly between individuals. It is incredibly complex, but the first step to learning to support your child is with a professional assessment.

What is autism?

As a parent, you may have growing suspicions that your child is processing information differently to other children and may wonder if they have autism. It can be helpful to get a formal diagnosis from an expert child and adolescent psychiatrist who will be able to identify whether your child has autism and what type of ongoing support they might need.

What is autism?

Autism is a neurodevelopmental disorder, characterised by difficulties with social communication, interacting with others and restrictive or repetitive behaviours or interests.

The term ‘spectrum’ means that the characteristics of autism will vary, often wildly, between individuals, which is why a detailed assessment which explores their strengths and challenges is needed.

Many people in the ‘neurotypical’ population will have autistic traits, but don’t meet the criteria for an autism diagnosis.

In recent years, the USA has moved to reduce the different classifications used to describe someone who is on the autism spectrum, which has previously included Asperger’s. It is likely that the UK will follow this revised system of classification and the ICD-10 (the manual Psychiatrists use when diagnosing conditions) is being revised. This understandably can make it confusing for families and individuals.

Signs of autism

In some children, the signs of autism are very obvious, and they may be diagnosed with ASD from an early age. But for other children, the symptoms of autism are more subtle and harder to pick up.

Some children have certain strengths that enable them to mask some of their difficulties with social communication and interaction – these can make it harder when you are thinking of seeking a formal diagnosis. An autism assessment should look at all areas of a child’s life, both at home and school, and will take into consideration the views of many of the adults in your child’s life. This feedback helps the clinicians to ensure they are looking holistically at your child’s difficulties and whether they meet the criteria of autism.

The importance of early diagnosis of autism

Early diagnosis of autism can make a real difference to the child and their family.

Adjustments can be put in place, which will help the child thrive in their environment
A diagnosis of autism can help both the child, their family and their school understand certain behavioural characteristics.

Autism is a lifelong developmental condition and having an autistic child can affect the whole family. Unmet needs can disrupt family life as certain things may be harder for your child – their behaviour may be unpredictable, and they may have specific needs which impact on the whole family.

Types of autism

There are two main classification systems used by practitioners in the UK, the (ICD-10), which is a medical classification list by the World Health Organisation and the DSM-5 - the fifth version of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. In recent years the DSM-5 has removed some of the previous ‘classifications’ of autism and it is likely the UK will follow.

What are the types of autism?

In recent year, the DSM 5 (the diagnostic manual used by psychiatrists in the USA) has changed the classification names for autism spectrum disorder, removing terms such as ‘Asperger’s’.

As the UK manual (the ICD-10) normally follows the DSM 5, it is likely that ‘autism spectrum disorder’ will become the commonly given diagnostic term.

Currently, as of 2018, the following are subtypes of autism are recognised within the UK

Autistic spectrum disorder
Asperger’s syndrome
Pathological demand avoidance (PDA)
Childhood disintegrative disorder
Pervasive developmental disorder (not otherwise specified)

Asperger’s Syndrome

In the previous classification, the diagnosis was given when there were the difficulties characteristic of autism, but without the delay in speech or cognitive development.

Asperger’s syndrome has been removed from the DSM 5 as a diagnostic category and is now included within the autism umbrella term. Whilst it still remains in the ICD-10 (the manual that UK psychiatrists use) there is general consensus that the term may be removed in the future.

The changing terminology is often confusing for autistic people and their families alike and can lead some to question what impact it will have on them, if any. The important thing to know is that autism is an umbrella term and considered to be a spectrum disorder (meaning severity of characteristics can vary between individuals).

Pathological demand avoidance

PDA is a behavioural profile within autism and although there is some contention as to how it falls within the autism umbrella, those with pathological demand avoidance share many of the same characteristics of autism – social communication, interaction, and repetitive and restricted behaviours.

Children with PDA have a deep anxiety about not being in control of a situation and having demands placed on them. Their anxiety will play out in their behaviours which can include:

Resisting every day demands of life
Deploying tactics to avoid having to do something
Lacking social understanding
Mood swings – anger, irritability
Procrastinating

The difference between girl’s vs boys

Over the years there has been a great deal of research about the prevalence of autism in girls versus boys – results ranging for boys being twice as likely to ten times as likely to have an autism diagnosis.

Part of this is due to historical reasons – initially it was only believed that boys could be autistic, but over time this belief has stopped and now it is understood that autism does not discriminate on gender.

That said, in general, girls are recognised as being naturally more able socially than boys and hence can mask their difficulties better. They also present more subtly and therefore can be more difficult to recognise. Below are some of the common areas that autistic girls and boys can differ on – but some symptoms are the same for both.

Autistic girls tend to be less aggressive than autistic boys, and get into trouble less, so can fly ‘under the radar’ which may mean them aren’t identified as readily as being autistic
Autistic girls tend to find it easier to follow nonverbal social clues
Autistic girls are more likely to have anxiety or depression
Autistic girls are more likely to adjust into social groups (often because girls take on a mentor role and may ‘sweep’ up an autistic girl into a friendship group)
Autistic girls may develop focused interests in more ‘socially acceptable’ or less stereotypically autistic interests; whereas boys may develop obsessional interest is ‘geeky’ topics like computer games or aeroplanes, girls may become very focused on TV programmes or pop groups.

We know that the autism symptoms change and develop over time and puberty can often be a very difficult time for autistic teenagers, as not only does a teenage brain develop at a fantastic rate, but a teenager’s body develops and changes, which can be hugely distressing for an autistic young person.

Finding a clinician who understands the complexities of autism and is aware that often symptoms can be different between the sexes is key to ensuring your daughter receives the right diagnosis.

Signs of autism in children

There are some characteristics of autism that are shared by all autistic children – however the way that these autism symptoms are presented will vary hugely between children.

Autism Spectrum Disorder Triad of Impairments

In 1978, the triad of impairments was introduced as a concept and has since formed the backbone of diagnostic criteria for autism. Whilst Autism Spectrum Disorder can very a great deal between individuals, they all share three common characteristics to a greater or lesser degree.

In recent years, the diagnostic criteria for autism have been reduced to two domains – social communication and restrictive patterns of behaviour, interests, and activities.

Social communication, interaction and imagination are key characteristics of autism

One characteristic of autism is finding it difficult to maintain friendships, to work with others and to manage social situations. You may notice your child does not have the same relationships as their peers – this is not unusual for an autistic child.

Social interaction is perhaps the most important of all the triad, particularly for those who are receiving a diagnosis later in childhood or as an adult. Social interaction tends to be pervasive and can have a heavy impact on day-to-day life for everyone involved.
Social communication – difficulty understanding and translating body language, metaphors, sarcasm, and social interactions are all signs of autism. Your child may have difficulty maintaining eye contact and may also find it hard to retain and process verbal communication.
Social imagination is the term used to describe our ability to manage change and our preferences for routine – often autistic people will find disturbances to routines deeply challenging and even upsetting.

Common social communication and interaction Autism symptoms include:

Difficulties interpreting body language
Lack of facial expressions
Delay or lack of speech
Difficulties with making eye contact
Abnormal tone of voice when speaking
Being detached in group settings
Lack of empathy for other’s emotions
Difficulty understanding their own emotions
Lack of awareness of personal space
Little interest in playing with other children
Being unable to successfully play with other children (which can cause huge distress)

Repetitive, restricted behaviours, interests, and activities

The world can be a terribly uncertain and even scary place for an autistic person. Engaging in repetitive and restricted behaviours or interests is a key characteristic of autism spectrum disorder.

These behaviours are thought to help in the following ways:

Create order and reliability in a chaotic world
Help the child relax
Increase or decrease amount of sensory input
Help copes with uncertainty

A child might display repetitive movements, difficulty with changes to routine and have very focused interests. These are all key characteristics of autism.

Repetitive movements can include:

Repetitive movement with objects
Repetitive movement of body parts such as arm or hand flapping
Rocking
Spinning
Head banging
Stimming (repetitive activities involving the senses such as feeling certain textures)
Lining up toys or shoes in certain way

Routine and an ‘insistence on sameness’ are common areas of difficulty with an autistic person. Distress may be experienced if there are changes to:

Physical environment
Appearance of someone (for instance a haircut or wearing makeup)
Eating certain foods
Wearing certain clothes
Transitions to school holidays
Conversations having to follow a certain pattern

Fixated interests

Many autistic people will develop intense and highly focused interests – often to the exclusion of all else. They may develop a very in-depth amount of knowledge, carry objects around related to their interest and find it hard to have a conversation about anything else

Sensory sensitivities

Many autistic people will have difficulties processing sensory information – they may be overly or under sensitive to certain textures, smells, sounds or tastes. Being ‘hyper’ or ‘hypo’ sensitive can be difficult for other people to understand – it is like a complete overload of the system and can be almost physically painful to bear.

Common sensory sensitivities include:

So sensitive to light it’s difficult to get to sleep
Preferring close views of objects
Poor depth perception (might struggle to throw and catch)
Unable to pick up smells
Overly sensitive to smells – new washing detergent etc
Has a restricted diet because of texture or taste of foods
Tastes and eat inedible food group due to liking texture and taste
Likes chewing objects because of texture
Finds certain fabrics physically painful

Getting an autism diagnosis for your child

Getting a diagnosis for your child or teenager can be key to understanding what their challenges and ensuring they get the best possible support in place.

Why get a diagnosis?

As parents, we are often loathed to ‘label’ our children, worried that doing so may somehow define them unfairly. However, an autism diagnosis has many benefits, including:

Creating an understanding of why your child finds certain things challenging
Ensuring your child has the correct support around them to enable them to thrive
Enabling other conditions, such as depression, or ADHD to be detected.
Giving your child a way to understand why they find some things difficult compared to other children

What happen in an autism assessment?

It's important to get an assessment with a psychiatrist who is trained and experienced in diagnosing autism to ensure they consider all aspects of your child’s life and other conditions that may be present.

The ‘gold-standard’ approach to diagnosing autism in children is to have several clinicians involved – this is known as a multi-disciplinary approach and ensures a comprehensive and objective assessment.

Our autism assessments use evidence-approved recommendations with input from some of the most senior psychiatrists in the UK.

Autism assessments are extremely thorough, and parents are often amazed at the level of detail our clinicians go into to ensure they have the right information to inform important diagnostic decisions.

Pre-assessment questionnaires – we will ask you and your child’s school to complete some forms that are important in understanding how your child behaves in different environments and what challenges they experience.
Appointment for your child – your child will meet with a Clinical Psychologist, who will spend a few hours with them, using toys, games and conversation to understand how your child sees the world. Whilst it should be a fun experience for your child, the psychologist will be using evidence-based and approved screening tools to assess your child against the criteria relevant to autism.
Appointment for you – a key part of the diagnosis is understanding your child’s development, which is why you will meet with a Child and Adolescent Psychiatrist to go into some depth about your child’s developmental history.
Diagnostic report – following your appointments the clinicians will need to write everything up, using all the information that has been gathered. A full and comprehensive report is written, with a diagnosis (where one can be made) and further recommendations.
Feedback appointment – all too often parents receive the diagnosis for their child and then are left feeling ‘What is next?’. It’s natural to have a lot of questions, so as part of our assessment you will meet with the Psychiatrist again to have time to go through the report and ask any questions you have.

How can I support my autistic child?

Autism is a lifelong condition. There is no ‘cure’, but there are lots of things you can do to help an autistic child overcome their challenges.

Types of support available

Working with therapists, like psychologists, family therapists, speech and language therapists and occupational therapists, you and your child can learn key coping skills that can really help overcome some of the challenges those with autism face.

The following types of therapy can have a significant impact on your child’s quality of life:

CBT
Family Therapy
Social skills training
Communication skills training
Speech and Language therapy
Occupational therapy
Educational support

The benefits of seeking support

Engaging in therapy for you, your child or even your whole family can have considerable benefits to all. It can be stressful managing challenging behaviours but working with an expert family therapist can help alleviate stress and give you effective skills that can make family life much more settled.

Children’s brains have an amazing capacity to learn, so many families are amazed with the amount a child can learn through social and communication skills sessions (with a psychologist, psychotherapist or other therapist trained and experienced in ASD). The great thing is these skills can last a lifetime and are a real investment in their future.

Every child will struggle with different things and at different times – what works for one won’t necessarily work for another. Finding a therapist who can adopt a flexible approach to working with your child is key.

Support for parents and guardians

Being a parent can be challenging at the best of times. But if your child has additional complications such as an illness or unexpected diagnosis, things can become even more testing. Seeking advice from an experienced, qualified professional can make a huge difference, but knowing when to seek support and where to turn can be a challenge.

Every child and family is unique, which means there's no one-size-fits-all approach to providing support. The following guidance breaks things down so you know your options and can make the choice that's right for your family in confidence, but please call us if there's anything you're uncertain of - or would simply rather speak to a human - we'll always do our best to help.

When's the right time to seek support?

Every family has its ups and downs and knowing when to reach out can be difficult. Change can happen gradually over long periods, and this can make things easy to miss. Often, there isn’t a clear point when it becomes obvious that support is needed.

If there are more bad days than good, if you feel like you simply don’t know what to do, or if you feel out of control, it might be time to have a conversation with someone who can help.

Areas that parents commonly seek support for their children include:

Low self-esteem
Bullying or being a bully
Sleep issues and night-time routines
Depression
Self-harm
Eating concerns, picky eating, or comfort eating
Concerns about behaviour – angry outbursts and tantrums
Bedwetting
Disruptive behaviour in the home
Change. This can include family breakups, deaths, a change of school or a house move

Support at school

Ideally, teachers who spend a lot of time with a student who needs support should endeavour to equip themselves with adequate knowledge of the child's specific requirements. And it's important that any support given is at the right level to support the child's specific challenges. Some children may need one-to-one attention. If possible, we recommend using an experienced learning support assistant, who will often provide a higher level of one-to-one help.

Strategies at home

Every child will face their own challenges and many parents will look to books, friends, or the internet to find parenting solutions to help. This approach can help, but there may also be times when it will feel like nothing seems to work. If you would like additional support, we can arrange a consultation with a parenting expert who will work with your individual situation to advise you on the best techniques for your child. They will be able to help you implement these techniques and provide follow-up appointments if needed.

What to expect from a parenting session

You may feel nervous about seeking help from a parenting expert and this is completely normal. No one likes to feel under scrutiny or judged. Our approach is completely non-judgemental. Our specialists create a neutral space to look at what isn’t working in your family and how adjustments might help.

Depending on your child's age and specific requirements, you may meet as a whole family. This will help the therapist see how the family works as a whole and then have time with the parenting advisor separately. Teenagers might have individual time with the therapist, and this can be very helpful in allowing them to speak their minds without fear of upsetting other people.

Occasionally, one session is all it needs. However, it usually takes a few sessions to improve things dramatically - and many families we work with cannot believe the difference it makes.

Getting clinical advice from an expert

It's normal to have lots of questions when your child is diagnosed with a mental health condition. Sometimes all you need is a conversation with an expert about what's happening in your family. It can be hugely helpful to speak to an experienced specialist who will be able to help you see things more clearly and explain your options. Small changes can make a big difference and it could be that you or your child would benefit from further assistance.