Autism spectrum disorder in children

Social interaction and communication

Social differences revolve around the give-and-take of normal social interactions, non-verbal social communication, and skills in developing, maintaining and understanding relationships.

Communication skills can vary greatly between children with ASD; some children may have little if any speech, while others may have well-developed language skills. However, those that do have language skills often find it difficult to communicate effectively. They may say odd or inappropriate things, make blunt or impolite comments, talk about a specific topic for long periods of time with no awareness that others have lost interest, or say things that are not relevant to the current conversation.

Differences with non-verbal communication include difficulty in making and maintaining eye contact, and understanding non-verbal communication of others such as facial expressions and hand gestures such as pointing.

Some people with ASD seem quite aloof or detached from others, but this is not the case for all people with ASD, with some being quite affectionate and fond of company. People with ASD do often tune out when others are talking to them, or appear not to listen, especially when the conversation does not involve their favourite topic of interest.

Behaviour and interests

People with ASD can have a very narrow or unusual set of interests, or they may play in a repetitive way. They may know everything about a certain topic and talk about it constantly, want to watch the same television show over and over, or focus their play on a single toy.

They often show limited imaginative play, but may use toys and other objects in unusual ways, such as lining up objects, focusing on the spin on the wheel of a toy car, or watching the light shine off various things. Some children with ASD engage in unusual behaviours, such as hand-flapping or rocking, which is usually a sign of excitement or agitation. Many experience difficulties coping with change, but do better when they are prepared ahead of time for changes in routine.

There is unlikely to be a single cause of ASD, and it is likely that environmental, biological and genetic factors may play a role. ASD is more common in people with intellectual disability, Fragile X syndrome, Down’s syndrome and other developmental disorders.

Assessment of ASD is typically conducted by a multidisciplinary team of allied health professionals. This team usually includes a paediatrician or child psychiatrist, a psychologist, and a speech pathologist. Sometimes other professionals, such as an occupational therapist or audiologist might also be involved.

Usually your GP would make the referral to a paediatrician or child psychiatrist. If the paediatrician or child psychiatrist believes your child may have ASD, they may then refer your child to a psychologist and any other health professionals for additional assessment, diagnosis, and intervention.

Parents, family, and other carers play an important role in the assessment and treatment of a child. As part of the assessment, the psychologist asks the parent about the child’s development, their strengths and difficulties, and their behaviour. The assessment often involves obtaining background information such as family history, as well as current information. The psychologist is likely to observe your child in different settings such as at home, at preschool or school, or in childcare to better understand their behaviour and how they interact with others.

The psychologist may also conduct assessments of your child’s learning, language and communication, and various day-to-day skills typical of children their age.

Research shows that treatments focusing on changing behaviour and improving skills produce the best results for children with ASD.

These approaches address multiple problems common to ASD such as delays and differences in language, social skills, communication, cognitive functioning and play. Most interventions focus on increasing desirable behaviours and decreasing undesirable behaviours, and improving social behaviours, communication, play skills, coping skills and connection with others.

In each of these approaches, parents and carers have a central role in intervention. If your child receives intervention, you would be involved in therapy sessions to learn ways of practising skills at home with your child. Psychologists and other health professionals in your team can also work with your child’s educators to develop consistent ways of supporting learning and behaviour at home, preschool or school.

As early intervention leads to better long-term outcomes, it is important to seek help early and follow up on recommendations made by the health professionals in your team.

Use your child’s strengths

Many children with ASD have a range of strengths. Some children with ASD may be particularly skilled at music, maths or another activity, or they may have a lot of knowledge around a particular area of interest. Try to harness these skills to motivate and stimulate your child’s learning and communication by showing interest in their activities and to foster interaction and communication.

Use your child’s special interests to increase motivation in other areas

Children with ASD can have a small number of intense interests and seem quite unmotivated to engage in other important activities. Rather than focusing on diverting your child’s attention from these specific areas of interest, see if they can be used as a springboard for strengthening your engagement with your child, for expanding your child’s interests and increasing your child’s motivation for other activities.

• Share their interests: Play alongside your child, following their lead in their play. Talk about your play and make observations about what your child is doing, and what you are doing. Your observations will help your child make connections over time between their perspective and yours. Playing alongside your child can also help them learn to take turns and to experience shared delight.
• Gradually include minor variations in the play to help expand your child’s imagination and tolerance for minor changes. Introduce changes that are not too far from your child’s original idea and which make sense around the theme of your child’s play. For example, your child may enjoy the sensory experience of throwing objects in the air and watching them fall back down. You might join this play by bringing a range of safe objects such as soft balls, feathers, and balloons and noting your child’s reaction to this expanding play.
• Incorporate their special interest, toy or game into other activities. For example, a child may have a particular interest in Thomas the Tank Engine. The characters from these stories can be used to help your child engage in counting activities, learning colours, and even social stories where the characters are used to act out certain social interactions. Your child’s desire to engage in these activities may also help them finish off less enjoyable tasks, so as to move on to their preferred activity.

Use visual aids and reminders

Children with ASD are often helped to understand routines and activities with visual timetables and visual reminders of the steps to complete tasks. For example:

• Create activity boards or step-by-step reminders for activities or routines that your child needs help with, such as making lunch or packing their school bag.
• Create reminders and step-by-step guides using written words for children able to read, or using photos or pictures to describe steps.

Prepare your child for changes

Changes to daily routines can be difficult for children with ASD, so where possible, prepare your child for any changes. This might include changing teachers when teachers are away, or changes to daily routines that can happen from time to time.

Involve your child in social activities

Being involved in social activities can help your child learn social and play skills from other children and adults. There are a range of programs you can consider, from social skills groups specifically developed for children with ASD, to social- and activity-based groups such as Scouts and Guides. Your council may have information about group activities in your local area.

If you are concerned about your child’s development a psychologist may be able to help. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of developmental issues, including ASD. A psychologist can help you as a parent to develop your child’s social and communication skills.

Psychologists sometimes offer group programs for children with developmental disorders to help them socialise and develop skills together.

If your child is referred to a psychologist by your GP, you might be able to get a Medicare rebate. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details. There are number of ways to access a psychologist. You can:

• use the Australia-wide Find A Psychologist directory or call 1800 333 497
• ask your GP or another health professional to refer you.

Getting a medical check-up

A medical check-up is also important to assess other aspects of your child’s development. First talk to your GP and speak with them about whether a referral to a paediatrician might be a useful next step.