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
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Four times as many boys as girls are diagnosed with ASD. Females diagnosed with autism tend to be more severely affected than males. Girls with autism show more irritability and externalizing
behaviours than boys.
Evidence suggests that females have a degree of protection against autism; it takes more autism risk genes to tip girls’ brain development onto the autism spectrum than it does for boys. The female
protect effect may result from sex chromosomes. Girls have two matched Xs, but, a mutation on a boy’s X or Y chromosome may prove more harmful because he lacks that matched copy. More
mutations are required to produce autism in females. Researchers suggest autistic characteristics in girls depend on intelligence. Girls with an IQ less than
70 have greater social communication impairments than boys. But those with IQs above 70 tend to have fewer restricted interests. These differences may make it difficult to recognize the signs of
autism in girls. But restricted interests among girls may just be more socially appropriate e.g. a girl with autism might give facts about a pop star whereas a boy might talk about a train timetables, or
girls may collect makeup rather than coins, so less noticeable.
In relation to understanding of friendship and the quality of social relationships, boy’s score lower than girls, consistent with the general sense that girls have better social skills. This is consistent with
those with and without ASD. Some research has shown that females with autism were similar to the typically developing males. This may mean this maybe the result of why more boys are diagnosed
than girls. Instead of evaluating on an absolute scale, we need sex-specific assessment tools or compare girls scores with those of unaffected girls of the same age
. Other differences include
Girls with Asperger’s are better at masking and coping with symptoms.
Boys are more susceptible to organic damage
Autistic girls have different brain activity in responses to social cues
Girls carry more mutations.
Girls with more mild forms of autism maintain eye contact for longer than girls severely impaired. This is the opposite for boys.
Explaining Autistic Behaviour 10. Explain what constitutes as challenging behaviour 6 Marks
Cultural norms define acceptable and unacceptable behaviours and can change depending on the social context. Challenging behaviour is socially constructed, so can be situationally or contextually
specific. But in general terms challenging behaviour describes behaviours that challenge others, potentially putting them or those around them at risk, or leads to a poorer quality of life. It can also
impact on their ability to join in everyday activities or to be rejected or excluded from activities. It is a sign that something is not working or a need being unfulfilled, or a problem with communication.
Communication is the main way we interact and express our needs, likes and dislikes. If communication is a problem, it can be frustrating and result in challenging behaviour. If this
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behaviour leads to a desired outcome, it may be repeated again and again, as it is a way they see they can control things around them. It can be manifested in the following ways
Self-injury e.g. head-banging, scratching, pulling, picking, grinding teeth and eating things that arent food.
Aggressive e.g. biting and scratching, hitting, pinching, grabbing, throwing, verbal abuse.
Stereotyped e.g. repetitive movements speech manipulation of objects and rocking.
Non-person directed e.g. damage to property, stealing, incontinence, lack of awareness of danger and withdrawal.
Disruptive e.g. screaming and spitting and inappropriate sexual behaviour
Other behaviours e.g., smearing, stripping off and running away
11. Define the characteristics of autism through childrens behaviour 10 Marks
