Learning disabilities –usually begin early in life, unless the result of a brain injury. It is linked to an overall cognitive impairment. A child with a learning disability may have one or more learning
difficulties and related social and emotional issues. The characteristics of a learning disability are a significantly reduced ability to understand new or complex information, or to learn new skills,
reduced ability to function independently which affects development. IQ is one method of identifying a learning disability alongside social functioning and other factors such as social contexts.
Social functions include communication, assessing risks, taking care of self, and being safe.
3. Discuss the three causes of general learning difficulties 3 Marks
A learning difficulty is caused by the brain working differently to the norm. The three causes of general learning difficulties are
Heredity – Learning disabilities often run in the family. Genes are passed from the parents, e.g. Chromosome abnormalities such as
Down’s syndrome or Turner syndrome or fragile X
Problems during pregnancy and birth – it can result from anomalies in the developing brain, or a result of illness or injury. This can include Mother’s illness during pregnancy, foetal
exposure to alcohol or drugs, low birth weight, oxygen deprivation, or by premature or prolonged labour or a very premature birth
Something affecting the development of the brain after birth, or in early childhood.- this can be caused by head injuries, malnutrition, toxic exposure such as heavy metals, radiation or
pesticides, neglect, child abuse, lack of mental stimulation early in life or significant illness or injury affecting brain development.
The Definition of Autism 4. Outline three differences between autism and Asperger syndrome 6 Marks
People with Asperger’s suffer from less severe symptoms than those with autism. Three differences between autism and Asperger syndrome are
Learning ability - People with Asperger’s do not on the whole experience language delays.
Some people with Autism may never speak ever. However, children with Asperger’s speech patterns may be unusual, with lack inflection, or may be formal, monotone, they may not
understand the subtleties of language e.g. humour, or understand the give-and-take nature of a conversation.
Cognitive ability - Some diagnosed with autism also have learning difficulties, and may have
below than average IQ. Most people with Asperger’s possess average to above-average intelligence. a person with Asperger’s doesn’t have a significant cognitive delay
Those with ASD have characteristics that stop them from behaving according to socially
accepted norms. Autistic people are seen as aloof and uninterested in making friends and forming relationships. Those with Asperger’s may have social issues but appear to want to fit
in, but do not have the skills to achieve this, resulting in social awkwardness, lack of empathy and non-existent appropriate non-verbal communication skills .
5. Describe the three different conditions within the autistic spectrum 3 Marks
Asperger’s - the mildest form of autism, they are usually obsessively interested in a single
object or topic. They often learn all about their preferred subject, and discuss it nonstop. Social skills are impaired, and often awkward and uncoordinated physically.
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Autism - Those with autism have more severe impairments involving social and language
functioning, as well as repetitive behaviours. Often, they have learning difficulties and seizures.
Pervasive Developmental Disorder – Not Otherwise Specified PDD-NOS those diagnosed
with this condition share some traits of autism or Asperger’s. Most have milder symptoms than those with autism, but they do not share the language skills and above-average
intelligence associated with Asperger’s.
6. Explain five social interaction limitations of a young person with ASD 5 Marks
Difficulties with social interaction include
Non-verbal communication – Non-verbal communication takes up around 70-80 of overall communication. There are deficiencies in the use of non-verbal cues and behaviours, e.g. eye
contact, posture, personal body space, and gestures to control social interaction. This
manifests as both inability to use non-verbal communication or read it from others, which can result in miscommunication. Lack of eye contact means that they miss out on many
important meaning cues, but even with eye contact they may not understand the subtleties of communication such as humour, or read the true meaning from expressions or tonality of
voice. Miscommunication or lack of understanding could result in frustration, outbursts and other challenging behaviours
Peer relationships – they may find it difficult to develop and maintain appropriate relationships, resulting in them becoming loners. Some may enjoy this but for others this
may result in frustration and depression as they don’t have friends. It may also make them feel uncomfortable in the presence of peers, making school time difficult, and disengaging in
learning
Difficulties with social communication – delays in language development may mean that learning and communication with others is problematic.
Deficits in the ability to initiate or sustain a conversation – the ability to start a conversation is key to developing relationships. Because of this ASD children are disadvantaged socially
even if they want to make friends.
Repetitive use of language or idiosyncratic language - Some with ASD repeat words or phrases or repeat what someone else has just said or use inappropriate language. This can
be frustrating for the listener and impede social interaction, and shows lack of understanding.
Inflexibility - flexibility is useful in school and in the wider world. Although a school day is
structured in the form of lessons, there can be many changes throughout the day, and layout may change. For an ASD person this may be very unsettling and cause disruption.
Causes of Autism 7. List the genetic environmental causes of autism 6 Marks
The exact cause of autism is not known, but research has pointed to several possible factors, including genetics and environmental factors. These include
Certain genetic mutations may make a child more likely to develop ASD. Some people have a genetic predisposition to autism, meaning that a susceptibility to develop the condition may
be passed on from parents to children. Younger siblings of children with ASD have an increased risk of developing the condition themselves and it is common for identical twins to
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certain health conditions associated with higher rates of ASD these include: Fragile X syndrome, Tuberous sclerosis, Rett syndrome, Neurofibromatosis, Muscular dystrophy,
Down’s syndrome, Cerebral , Infantile spasms a type of epilepsy, intellectual disability
about half of those diagnosed with autism have an IQ below 70.
prenatal exposure to the chemicals thalidomide and valproic acid, pollution or pesticides, exposure to alcohol or medications such as sodium valproate
Specific problems with the development of the brain and nervous system. Studies have found abnormalities in several regions of the brain, which suggest that autism results from a
disruption of early pre-natal brain development. Later, when the brains of children without autism get bigger and better organised, autistic childrens brains grow more slowly.
Factors associated with the mother including advanced parental age at time of conception, obesity or diabetes, maternal nutrition, infection during pregnancy and prematurity.
Any birth difficulty leading to oxygen deprivation to the brain
8. Provide a brief overview of how autism is diagnosed in adults and children 8 Marks Diagnosis in children
Diagnosing autism spectrum disorder ASD can be difficult, since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behaviour and development to make
a diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.
However, many children do not receive a final diagnosis until much older. Early recognition, treatment and management is crucial to assisting a child develop,
so a child be seen and assessed within 3 months of an initial referral. They are assessed by each professional separately, by a multi-disciplinary team clinical psychologist, paediatrician and speech
and language therapist using diagnostic tools
The key people who will notice differences are parents, so professionals must respond appropriately to parental concern. There is a specific pathway to diagnosis prescribed by NICE National Institute of
Clinical Excellence. Diagnosis must rule out other possible causes for behaviour. Detection is through observing social interaction and reciprocal communication behaviour. They look at
spoken language
responding to others
interacting with others
eye contact, pointing and other gestures
ideas and imagination
unusual or restricted interests andor rigid and repetitive behaviours Assessments include structured assessment tools in the form of questions to both the child and
parents. These toolkits assess communication, social interaction, and attention. Alongside these toolkits observation, developmental history, medical history and other factors associated with
increased are assessed – to ensure a complete picture is achieved before diagnosis is made.
Diagnosis is achieved with a discussion with all those who have assessed the child. If this is confirmed then it is presented in a full a formal diagnostic report – which will then inform what support is
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required. Care plans can then be put into place with specifically individually tailored support required, including adaptations, treatment and management strategies.
Diagnosis in adults
Assessment in adulthood may be as a result of previous misdiagnosis or other reasons. As with children professionals will assess if there are any other causes for their behaviour apart from ASD.
NICE has a set of guidelines for assessing for autism, laying out the specific diagnosis pathway.
Assessment is recommended if an adult presents with one or more of the following
“persistent social interaction problems
persistent social communication problems
rigid and repetitive behaviours, resistance to change andor restricted interests
difficulties in obtaining or sustaining employment or education
problems with starting and sustaining social relationships
contact at any time in his or her life with mental health or learning disability services
a history of a neurodevelopmental condition such as learning disability or ADHD or mental disorder.”
If they do present with any of the above then an Autistic Spectrum Quotient – 10 AQ-10 is administered, unless they have a moderate to severe learning disability as it could give an inaccurate
result. If a person scores highly in the AQ-10 then the person can be referred for a specialist diagnostic assessment. This assessment focusses on the person’s attention to detail, attention
switching, communication, imagination and social. They should be fully involved in the assessment, and significant others asked to input into the assessment.
A comprehensive assessment covers: core characteristics of autism especially those present in childhood and continued into adulthood, developmental history, behavioural issues, how they
function in different environments, mental, neurodevelopmental or physical disorders, hypo- or hyper-sensory sensitivity and attention to detail. They will also observe the person in social
situations. Alongside this specific screening tools can be used, which are similar to the 1s used for children.
Once a person is diagnosed a care plan should be drawn up, based on their specific needs, this can include psychosocial interventions, supported employment programmes and medication. This
should include a risk management plan. Risk management is important as those with ASD can be vulnerable to harm caused by others or themselves, this includes neglect, exploitation and abuse and
self-harm. So where appropriate a risk management plan should be used. Alongside this a crisis management plan should be drawn up identifying triggers, reactions to the triggers, how their
condition effects them during crisis, and management techniques for this.
9. Explain the gender differences of ASDs 6 Marks
