tag:theconversation.com,2011:/ca/topics/asd-8041/articlesASD – The Conversation2024-03-27T01:24:33Ztag:theconversation.com,2011:article/2251802024-03-27T01:24:33Z2024-03-27T01:24:33Z‘Noisy’ autistic brains seem better at certain tasks. Here’s why neuroaffirmative research matters<figure><img src="https://images.theconversation.com/files/582749/original/file-20240319-24-qstvmi.jpg?ixlib=rb-1.1.0&rect=135%2C81%2C5781%2C3854&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/brain-wave-on-electroencephalogram-eeg-epilepsy-562046677">Shutterstock</a></span></figcaption></figure><p>Autism is a <a href="https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(22)00166-7?fbclid=IwAR2plqjNc7PoPCl7S0xzWpK_dCLfzaov9rl7u5wBdt8DaOc6lNrCekYp1RY">neurodevelopmental difference</a> associated with specific experiences and characteristics. </p>
<p>For decades, autism research has focused on behavioural, cognitive, social and communication difficulties. These studies highlighted how autistic people face issues with everyday tasks that allistic (meaning non-autistic) people do not. Some difficulties may include recognising emotions or social cues. </p>
<p>But some research, including our own study, has explored specific advantages in autism. Studies have shown that in some cognitive tasks, autistic people <a href="https://academic.oup.com/brain/article/128/10/2430/274623?login=false">perform better</a> than allistic people. Autistic people may have greater success in identifying a simple shape <a href="https://pubmed.ncbi.nlm.nih.gov/15985068/">embedded within a more complex design</a>, arranging blocks of <a href="https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-7610.1993.tb02095.x">different shapes and colours</a>, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976471/">spotting an object within a cluttered visual environment</a> (similar to Where’s Wally?). Such enhanced performance has been recorded in <a href="https://www.sciencedirect.com/science/article/pii/S0960982215005552">babies as young as nine months</a> who show emerging signs of autism. </p>
<p>How and why do autistic individuals do so well on these tasks? The answer may be surprising: more “neural noise”.</p>
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Read more:
<a href="https://theconversation.com/from-deficits-to-a-spectrum-thinking-around-autism-has-changed-now-there-are-calls-for-a-profound-autism-diagnosis-194049">From deficits to a spectrum, thinking around autism has changed. Now there are calls for a 'profound autism' diagnosis</a>
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<h2>What is neural noise?</h2>
<p>Generally, when you think of noise, you probably think of auditory noise, the ups and downs in the amplitude of sound frequencies we hear. </p>
<p>A similar thing happens in the brain with random fluctuations in neural activity. This is called neural noise. </p>
<p>This noise is always present, and comes on top of any brain activity caused by things we see, hear, smell and touch. This means that in the brain, an identical stimulus that is presented multiple times won’t cause exactly the same activity. Sometimes the brain is more active, sometimes less. In fact, even the response to a single stimulus or event will fluctuate continuously.</p>
<h2>Neural noise in autism</h2>
<p>There are many <a href="https://www.nature.com/articles/nrn2258">sources of neural noise</a> in the brain. These include how the neurons become excited and calm again, changes in attention and arousal levels, and biochemical processes at the cellular level, among others. An allistic brain has mechanisms to <a href="https://www.nature.com/articles/nrn3061">manage and use this noise</a>. For instance, cells in the hippocampus (the brain’s memory system) can make use of neural noise to enhance memory encoding and recall.</p>
<p>Evidence for high neural noise in autism can be seen in <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2011.00051/full">electroencephalography (EEG) recordings</a>, where increased levels of neural fluctuations were observed in autistic children. This means their neural activity is less predictable, showing a wider range of activity (higher ups and downs) in response to the same stimulus. </p>
<p>In simple terms, if we imagine the EEG responses like a sound wave, we would expect to see small ups and downs (amplitude) in allistic brains each time they encounter a stimulus. But autistic brains seem to show bigger ups and downs, demonstrating greater amplitude of neural noise. </p>
<p>Many studies have linked this noisy autistic brain <a href="https://www.cell.com/trends/cognitive-sciences/abstract/S1364-6613(15)00091-1?rss=yes&mobileUi=0">with cognitive, social and behavioural difficulties</a>. </p>
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Read more:
<a href="https://theconversation.com/most-adults-with-autism-can-recognise-facial-emotions-almost-as-well-as-those-without-the-condition-187995">Most adults with autism can recognise facial emotions, almost as well as those without the condition</a>
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<h2>But could noise be a bonus?</h2>
<p>The <a href="https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(22)00166-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0166223622001667%3Fshowall%3Dtrue">diagnosis of autism has a long clinical history</a>. A shift from the medical to a more social model has also seen advocacy for it to be reframed as a difference, rather than a disorder or deficit. This change has also entered autism research. Neuroaffirming research can examine the uniqueness and strengths of neurodivergence. </p>
<p>Psychology and perception researcher <a href="https://www.sciencedirect.com/science/article/pii/S0042698909003563?via%3Dihub">David Simmons and colleagues</a> at the University of Glasgow were the first to suggest that while high neural noise is generally a disadvantage in autism, it can sometimes provide benefits due to a phenomenon called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1388245703003304?via%3Dihub">stochastic resonance</a>. This is where optimal amounts of noise can <a href="https://theconversation.com/like-to-work-with-background-noise-it-could-be-boosting-your-performance-119598">enhance performance</a>. In line with this theory, high neural noise in the autistic brain might enhance performance for some cognitive tasks.</p>
<p>Our 2023 research <a href="https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1110714/full?utm_source=F-NTF&utm_medium=EMLX&utm_campaign=PRD_FEOPS_20170000_ARTICLE">explores this idea</a>. We recruited participants from the general population and investigated their performance on letter-detection tasks. At the same time, we measured their level of autistic traits. </p>
<p>We performed two letter-detection experiments (one in a lab and one online) where participants had to identify a letter when displayed among background visual static of various intensities. </p>
<p>By using the static, we added additional visual noise to the neural noise already present in our participants’ brains. We hypothesised the visual noise would push participants with low internal brain noise (or low autistic traits) to perform better (as suggested by <a href="https://www.sciencedirect.com/science/article/abs/pii/S030101041000193X">previous research</a> on stochastic resonance). The more interesting prediction was that noise would not help individuals who already had a lot of brain noise (that is, those with high autistic traits), because their own neural noise already ensured optimal performance.</p>
<p>Indeed, one of our experiments showed people with high neural noise (high autistic traits) did not benefit from additional noise. Moreover, they showed superior performance (greater accuracy) relative to people with low neural noise when the added visual static was low. This suggests their own neural noise already caused a natural stochastic resonance effect, resulting in better performance. </p>
<p>It is important to note we did not include clinically diagnosed autistic participants, but overall, we showed the theory of enhanced performance due to stochastic resonance in autism has merits. </p>
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Read more:
<a href="https://theconversation.com/autism-is-still-underdiagnosed-in-girls-and-women-that-can-compound-the-challenges-they-face-176036">Autism is still underdiagnosed in girls and women. That can compound the challenges they face</a>
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<h2>Why this is important?</h2>
<p>Autistic people face ignorance, prejudice and discrimination that can <a href="https://www.liebertpub.com/doi/abs/10.1089/aut.2021.0005">harm wellbeing</a>. Poor mental and physical health, reduced social connections and <a href="https://theconversation.com/what-are-masking-and-camouflaging-in-the-context-of-autism-and-adhd-193446">increased “camouflaging” of autistic traits</a> are some of the negative impacts that autistic people face.</p>
<p>So, research underlining and investigating the strengths inherent in autism can help reduce stigma, allow autistic people to be themselves and acknowledge autistic people do not require “fixing”. </p>
<p>The autistic brain is different. It comes with limitations, but it also has its strengths.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621908349942906881"}"></div></p><img src="https://counter.theconversation.com/content/225180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeroen van Boxtel receives funding from Australian Government through an Australian Research Council Discovery Project (project number DP220100406), the ACT government.</span></em></p><p class="fine-print"><em><span>Jovana Acevska and Pratik Raul do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Neural noise’ isn’t the sounds you hear, but rather the variability of responses in your brain. Autistic people are thought to have greater variance that can be a disadvantage or a strength.Pratik Raul, PhD candidiate, University of CanberraJeroen van Boxtel, Associate professor, University of CanberraJovana Acevska, Honours Graduate Student, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940492022-11-08T19:40:36Z2022-11-08T19:40:36ZFrom deficits to a spectrum, thinking around autism has changed. Now there are calls for a ‘profound autism’ diagnosis<figure><img src="https://images.theconversation.com/files/493985/original/file-20221107-14-gmzv1x.jpg?ixlib=rb-1.1.0&rect=24%2C40%2C5439%2C3596&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hanleystokeontrent-staffordshireunited-kingdom-july-14-600w-2178385225.jpg">Shutterstock</a></span></figcaption></figure><p>A heated debate about autism was reignited after the recent publication of an <a href="https://www.spectrumnews.org/opinion/viewpoint/its-time-to-embrace-profound-autism/?utm_source=Spectrum+Newsletters&utm_campaign=410c2aae31-DAILY_20221027_THURSDAY_PROFOUND+AUTISM+VP&utm_medium=email&utm_term=0_529db1161f-410c2aae31-168616145">article</a> advocating for use of the term “profound autism”.</p>
<p>This term is not an official part of the autism diagnosis. But the 2021 <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01541-5/fulltext">Lancet Commission on autism</a> – part the journal’s program to gather expertise on pressing global health and science issues – argued the term should refer to people with a diagnosis of autism who have very high support needs, such as 24-hour care for basic needs and safety. The Lancet Commission estimated that around 20% of autistic people meet criteria for “profound autism”.</p>
<p>Now debate centres on whether this term is an appropriate way to highlight the high support needs of a subgroup of autistic people – or whether the term may be a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01541-5/fulltext">step backwards</a> for <a href="https://www.thenation.com/article/society/autism-division/">community understanding and acceptance</a>.</p>
<h2>The autism spectrum</h2>
<p>Our understanding of autism has changed dramatically over the past 30 years.</p>
<p>The term “autism” was <a href="https://link.springer.com/article/10.1007/s10803-021-04904-1">first introduced</a> into the diagnostic manual in 1980. To receive this diagnosis, children demonstrated significant development difficulties, such as “gross deficits in language development” and “a pervasive lack of responsiveness to other people”.</p>
<p>These difficulties meant people with a diagnosis of autism in the 1980s and 1990s tended to have high support needs – likely 24-hour care.</p>
<p>The 2000s and 2010s saw a major reconceptualisation of autism. Autistic behaviours became understood as present in people who do not have intellectual or significant language difficulties. </p>
<p>This new understanding of autism led to people with a much more diverse range of abilities receiving a diagnosis of autism. The “<a href="https://link.springer.com/chapter/10.1007/978-3-030-27275-3_7">autism spectrum</a>” was born.</p>
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<h2>Advocacy and representation</h2>
<p>The rethinking of autism to a “spectrum” emerged out of a large body of high-quality research.</p>
<p>Another important catalyst was the extraordinary work of autistic people themselves, who through important <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2021.635690/full">advocacy</a>, championed the rights and needs of all autistic people. This advocacy reshaped community views about autism, in particular, that not all autistic people have intellectual disability.</p>
<p>Media <a href="https://www.spectrumnews.org/opinion/viewpoint/portrayals-autism-television-dont-showcase-full-spectrum/">portrayals</a> of autism accelerated the shift in community views about autism. TV shows focused on stereotypes of men (it was almost always men) who were intellectually gifted, but had social difficulties. Shaun Murphy in The Good Doctor and Sheldon Cooper from The Big Bang Theory are two examples.</p>
<p>The greater community visibility of autism has been overwhelmingly positive. It has fostered greater acceptance of difference and increased support for a broader range of people. However, like all important societal changes, there have been challenges too.</p>
<p>A key source of debate has been whether broadening the diagnosis of autism has made the diagnostic label no longer entirely fit-for-purpose.</p>
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Read more:
<a href="https://theconversation.com/autism-is-still-underdiagnosed-in-girls-and-women-that-can-compound-the-challenges-they-face-176036">Autism is still underdiagnosed in girls and women. That can compound the challenges they face</a>
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<h2>Diagnosis and ‘profound autism’</h2>
<p>The purpose of a diagnosis is to help define and identify a health condition or disability. Diagnoses provide understanding about what a condition is, and what it may mean for the person diagnosed. In many cases, a diagnosis can also provide information about the most appropriate clinical management.</p>
<p>A current criticism of the autism diagnosis (officially, “<a href="https://www.cdc.gov/ncbddd/autism/hcp-dsm.html">autism spectrum disorder</a>”) is that it is too broadly defined. How can a single diagnostic label that incorporates television’s Dr Cooper as well as people who require around-the-clock care, serve all autistic people?</p>
<p>This was part of the argument the Lancet Commission made when proposing the term “profound autism”. The experts involved claimed that, because people with very high support needs are unable to advocate for themselves, they “are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01541-5/fulltext">at risk of being marginalised</a> by a focus on more able individuals”.</p>
<p>The term “profound autism”, they <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01541-5/fulltext">argued</a>, would </p>
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<p>spur both the clinical and research global communities to prioritise the needs of this vulnerable and underserved group of autistic people.</p>
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<p>Strong counter points have been made against the use of the term “profound autism”. These include advocating for alternative ways to describe the different needs of autistic people. For example, using brief descriptions such as “autistic person with intellectual disability”.</p>
<p>A <a href="https://www.thenation.com/article/society/autism-division/">key criticism</a> is that, after the significant gains of the past few decades in recognising the broad spectrum of autistic people, dividing autistic people into two groups using relatively arbitrary criteria would represent a retrograde step.</p>
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Read more:
<a href="https://theconversation.com/should-adhd-be-in-the-ndis-yes-but-eligibility-for-disability-supports-should-depend-on-the-person-not-their-diagnosis-191576">Should ADHD be in the NDIS? Yes, but eligibility for disability supports should depend on the person not their diagnosis</a>
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<h2>A discussion of great significance</h2>
<p>It is clear there is a large group of people who do not feel well served by the broad nature of the current autism diagnosis. There is a clinical and moral responsibility to acknowledge and value this perspective, and explore it further.</p>
<p>To do so would be entirely consistent with the history of our changing understanding of autism over time.</p>
<p>Whether or not “profound autism” is eventually seen as an appropriate diagnostic term, it is important to acknowledge that this debate touches on deeply personal issues of identity and understanding.</p>
<p>The voice of autistic people must be central in this discussion. The voices of families who care for autistic people must also be valued.</p>
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Read more:
<a href="https://theconversation.com/an-autism-minister-may-boost-support-and-coordination-but-governments-that-follow-south-australias-lead-should-be-cautious-188885">An autism minister may boost support and coordination. But governments that follow South Australia's lead should be cautious</a>
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<img src="https://counter.theconversation.com/content/194049/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the NHMRC, the ARC, the Autism CRC, and the Angela Wright Bennett Foundation. </span></em></p>A reignited debate centres around whether broadening the diagnosis of autism has made the diagnostic label no longer entirely fit-for-purpose.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1879952022-08-03T00:56:48Z2022-08-03T00:56:48ZMost adults with autism can recognise facial emotions, almost as well as those without the condition<figure><img src="https://images.theconversation.com/files/477075/original/file-20220802-12-wtizjt.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5599%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/two-friendly-male-mature-students-600w-160661273.jpg">Shutterstock</a></span></figcaption></figure><p>Difficulties with social communication and interaction are considered <a href="https://www.asha.org/practice-portal/clinical-topics/autism/#:%7E:text=Restricted%2C%20repetitive%20behaviors%2C%20interests%2C,hypo%2Dsensitivity%20to%20sensory%20input.">core features</a> of autism. There is a common perception autistic people are poor at recognising others’ emotions and have little insight into how effectively they do so. </p>
<p>We are used to seeing these challenges <a href="https://www.researchgate.net/publication/347366137_Popular_culture_and_the_misrepresentation_of_Asperger's_A_study_on_the_sitcoms_Community_and_The_Big_Bang_Theory">portrayed</a> in popular culture, such as television shows <a href="https://www.imdb.com/title/tt6470478/">The Good Doctor</a>, <a href="https://www.imdb.com/title/tt6315640/?ref_=fn_al_tt_1">Atypical</a> or <a href="https://www.imdb.com/title/tt11904786/?ref_=fn_al_tt_1">Love on the Spectrum</a>. And there are <a href="https://www.researchgate.net/profile/Jacqueline-Hill-4/publication/283921846_Systemizing_empathy_Teaching_adults_with_asperger_syndrome_and_high_functioning_autism_to_recognize_complex_emotions_using_interactive_multimedia/links/56c197d408ae2f498efaae60/Systemizing-empathy-Teaching-adults-with-asperger-syndrome-and-high-functioning-autism-to-recognize-complex-emotions-using-interactive-multimedia.pdf">exercises and therapies</a> autistic people might do with a psychologist or speech pathologist to try to help them <a href="https://journals.sagepub.com/doi/abs/10.1177/01626434221095031">improve</a> at this important social skill.</p>
<p>Yet, the research findings are <a href="https://onlinelibrary.wiley.com/doi/10.1002/aur.2713">messy</a>. Some studies have very small sample sizes, others do not control for cognitive ability. Some studies only show participants a limited range of emotions to respond to. Some rely heavily on static images of face expressions or only require multiple-choice responses. Studies designed this way don’t capture the dynamic demands of everyday social interactions.</p>
<p>Our new research sought to overcome these challenges and found little difference between the ability of adults with autism and those without to recognise emotions in others.</p>
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Read more:
<a href="https://theconversation.com/150-years-ago-charles-darwin-wrote-about-how-expressions-evolved-pre-empting-modern-psychology-by-a-century-170880">150 years ago, Charles Darwin wrote about how expressions evolved – pre-empting modern psychology by a century</a>
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<h2>Two matched groups</h2>
<p>For our <a href="https://onlinelibrary.wiley.com/doi/10.1002/aur.2713">research</a>, conducted by then doctoral student Dr Marie Georgopoulos, myself, Professor Robyn Young and post-doctoral researcher Dr Carmen Lucas, we <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2781">studied</a> a relatively large sample of 67 IQ-matched autistic and 67 non-autistic adult participants. We presented them with multiple examples of 12 different face emotion types captured not only in still photographs but also videoed in the context of social interactions. Participants were then able to give open-ended reports of the emotions they saw. </p>
<p>Several key findings emerged. First, emotion type, the way in which the stimuli were presented and the format for providing responses all affected accuracy and speed of emotion recognition. But those variations didn’t affect the differences between autistic and non-autistic groups’ responses. </p>
<p>Second, although emotion recognition accuracy was a little lower for the autistic group, there was substantial overlap in ability between the two groups. Just a small subgroup of the autistic participants performed below the level of the non-autistic group.</p>
<p>Third, the autistic participants responded more <a href="https://onlinelibrary.wiley.com/doi/10.1002/aur.2713">slowly</a>, but again there was considerable overlap between the two groups. Although slower responses to others’ emotions might impede social interactions, our study suggests autistic people were probably just acting more cautiously in the <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2781">laboratory setting</a>. </p>
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<a href="https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two people talking at a table" src="https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477082/original/file-20220802-21-5zj3k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Further research could look at how autistic people respond after recognising emotion in others.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/upset-girlfriend-sitting-silence-boyfriend-600w-2028537980.jpg">Shutterstock</a></span>
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<p>We <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2781">found</a> there was no evidence that, as a group, autistic people were less aware of strengths and weaknesses in their emotion recognition skills than their non-autistic peers. But again, the awareness of people within in each group varied substantially.</p>
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<strong>
Read more:
<a href="https://theconversation.com/autism-is-still-underdiagnosed-in-girls-and-women-that-can-compound-the-challenges-they-face-176036">Autism is still underdiagnosed in girls and women. That can compound the challenges they face</a>
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<h2>Challenging beliefs</h2>
<p>These findings challenge some common perceptions about autistic adults’ ability to recognise others’ emotions and their insight into their processing of emotions. The findings also demonstrate previously unacknowledged capabilities of many autistic people and remind us that autistic adults are not all the same.</p>
<p>That said, there are many unanswered questions. A full understanding of emotion processing by autistic people will require the incorporation of many more elements in future research. </p>
<p>For example, it is possible our findings underestimate autistic individuals’ difficulties with processing emotions. These difficulties might only emerge in the hurly-burly of real-life interactions with others. </p>
<p>So, we will need to develop more sophisticated research methods that still allow us to conduct carefully controlled studies. These studies would seek to accommodate the complexities of everyday interpersonal interactions that not only require processing of faces, but also gestures and voice tone or emphasis at the same time. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pWghD2Gzpzk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In The Good Doctor, Freddie Highmore plays a doctor with autism.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-on-the-autism-spectrum-experience-more-bullying-schools-can-do-something-about-it-184385">Kids on the autism spectrum experience more bullying. Schools can do something about it</a>
</strong>
</em>
</p>
<hr>
<h2>The impact of autism</h2>
<p>Future research will also need a greater focus on how autistic people respond to others’ emotions. Perhaps they can recognise emotions but respond in ways that might compromise the effectiveness of their social exchanges? </p>
<p>We have conducted further research to explore autistic and non-autistic adults’ perceptions of the appropriate ways to respond to different emotions displayed by others. This is but one dimension of what is often referred to as “<a href="https://journals.sagepub.com/doi/full/10.1177/0956797621995202">empathic responding</a>” – knowing what might be considered an appropriate reaction when confronted with another person who is, for example, sad, angry, or frustrated. However, sensing what an appropriate response is then carrying out that action, or even being motivated to do so, don’t necessarily go hand-in-hand. </p>
<p>Answers to questions like these will be critical for refining interventions and therapies <a href="https://link.springer.com/article/10.1007/s10803-011-1328-4">designed to improve social interaction skills</a> in autistic people. Identifying the most important focus for intervention, the most effective procedures and the developmental stages at which such interventions should be implemented, are all important areas for ongoing research.</p><img src="https://counter.theconversation.com/content/187995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neil Brewer receives funding from Australian Research Council</span></em></p>Problems identifying and responding to emotions in others is thought of as a core feature of autism. But our research shows there may be minimal differences in this aspect of social interaction.Neil Brewer, Matthew Flinders Distinguished Emeritus Professor of Psychology, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1843852022-06-09T02:13:13Z2022-06-09T02:13:13ZKids on the autism spectrum experience more bullying. Schools can do something about it<figure><img src="https://images.theconversation.com/files/467378/original/file-20220607-15990-f1fiay.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5964%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Children diagnosed with neurodevelopmental disorders, such as autism, experience various types of challenges at school. This might be due to communication, and also relationships with other children. </p>
<p>Accumulating evidence indicates autistic children are more likely to be bullied.</p>
<p>We’ve just published a study which observed <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2792743">autism is the top risk factor</a> for bullying exposure among all neurodevelopmental disorders.</p>
<p>And in a <a href="https://pubmed.ncbi.nlm.nih.gov/21499672/">Canadian survey</a>, 77% of children on the autism spectrum reported being bullied. </p>
<p>The risk is also substantially higher for children with other types of neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD), Tourette syndrome, and intellectual disability, when compared with non-neurodiverse children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-more-children-have-autism-now-than-before-4497">Do more children have autism now than before? </a>
</strong>
</em>
</p>
<hr>
<h2>The risk factors and harms of bullying</h2>
<p>While the reasons for a higher risk of being bullied among children with neurodevelopmental disorders are complex, one potential reason is impaired communication skills. <a href="https://www.tandfonline.com/doi/full/10.1080/00220671.2014.958812">These can cause</a> peer rejection and difficulties in establishing friendships. </p>
<p>Impulsive behaviours often associated with neurodevelopmental disorders can also result in difficulties fitting in, thereby <a href="https://journals.sagepub.com/doi/10.1177/1362361313477920">increasing the risk</a> of social exclusion and consequent bullying encounters, either as a victim or a perpetrator.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cartoon showing bullies pointing at a boy" src="https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467384/original/file-20220607-24949-yun4pk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bullying can lead to long-term psychological and physiological symptoms.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Bullying exposure can lead to not only longtime psychological symptoms such as depression and anxiety, but also <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1323641111">physiological symptoms</a>. </p>
<p>Data from the <a href="https://journals.sagepub.com/doi/full/10.1177/0004867417700275">Longitudinal Study of Australian Children</a> indicate the experience of being bullied can be associated with a four-fold increased risk of self-harm or suicidal thoughts among adolescents aged 14-15 years.</p>
<h2>What our study found</h2>
<p>Our new study found children on the autism spectrum are more likely to be bullied at high schools than primary schools (an opposite trend from non-autistic children). It’s possible that in high schools the differences due to autism are more pronounced and noticeable. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">What causes autism? What we know, don’t know and suspect</a>
</strong>
</em>
</p>
<hr>
<p>Our findings also suggest children on the autism spectrum who do <em>not</em> need special health care experience greater risk of being bullied than children on the autism spectrum with special health-care needs. This implies the need for supports for children with higher functioning autism might be underestimated. </p>
<p>Children on the autism spectrum living in areas with low socioeconomic resources were also more likely to be bullied than other children on the autism spectrum. This highlights the importance of more mental health supports and attention to social care needs for children from disadvantaged backgrounds.</p>
<h2>What can schools do?</h2>
<p>Currently, most evidence-based anti-bullying programs are delivered through the school’s universal behaviour management system. This means everyone receives the same standard information about bullying and no individual features related to victims or bullies are discussed.</p>
<p>In Australia, the <a href="https://www.bullyzero.org.au">Bully Zero</a> bullying education program is delivered through a mix of online and face-to-face workshops. It aims to provide information about bullying including the different types, its impact, and resilience (or emotional intelligence). <a href="https://bullyingnoway.gov.au/">Bullying No Way</a> provides professional resources for bullying prevention by educating students, families, and school staff. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Blackboard that says 'Stop bullying'" src="https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467386/original/file-20220607-15946-939qjf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bullying programs don’t address underlying risk factors.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Although these programs provide useful advice on management strategies, few of these programs address the underlying risk factors for being bullied.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-25-years-since-we-redefined-autism-heres-what-weve-learnt-125053">It's 25 years since we redefined autism – here's what we've learnt</a>
</strong>
</em>
</p>
<hr>
<p>In light of our new findings, we think neurodiversity and inclusiveness should be integrated into school-based anti-bullying programs. Additionally, there are other things schools should be doing to decrease the risk children on the autism spectrum will be bullied: </p>
<ul>
<li><p>kids in schools should be taught neurodiversity is a difference, not an impairment</p></li>
<li><p>kids should be encouraged to use proper language that aligns with neurodiversity. For example, use respectful language such as “person on the autism spectrum” instead of “autistic person”</p></li>
<li><p>teach students about empathy in the context of neurodiversity. This includes understanding how a child on the autism spectrum may react to stress differently from other children, and avoiding describing the interests of a person on the autism spectrum as “restricted”</p></li>
<li><p>organise bullying prevention workshops at high schools, since older children on the autism spectrum are more likely to suffer from bullying than younger children on the autism spectrum</p></li>
<li><p>schools in socioeconomically disadvantaged areas need to ensure they have anti-bullying programs with a particular focus on neurodiversity. </p></li>
</ul>
<p>Understanding of neurodevelopmental disorders can enhance inclusiveness and reduce stigma, which is essential to building anti-bullying environments.</p>
<p>And the risk modifiers identified can inform us of which groups (children on the autism spectrum who are older, with better functions, and living in disadvantaged neighborhoods) may need to be prioritised for specific supports.</p><img src="https://counter.theconversation.com/content/184385/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study has found autism is the top risk factor for bullying among all neurodiversities.P. Daniel Lin, Senior Lecturer (UNSW) and Conjoint Associate Professor (Western Sydney University), UNSW SydneyValsamma Eapen, Professor and Chair of Infant, Child and Adolescent Psychiatry, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1820102022-04-30T12:01:54Z2022-04-30T12:01:54ZAutism, ADHD and school absence are risk factors for self-harm: new research<p><a href="https://theconversation.com/mental-health-one-in-three-young-people-in-england-are-struggling-new-report-130149">Self-harm</a> – physically hurting yourself – is common in young people, affecting about <a href="https://capmh.biomedcentral.com/articles/10.1186/1753-2000-6-10">one in five</a> teens by the age of 18. </p>
<p>Only about <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/attendance-at-the-accident-and-emergency-department-in-the-year-before-suicide-retrospective-study/373A148B712A0A45061F0AE574ACAD98">one in eight</a> self-harm episodes in teenagers are seen at hospital emergency departments. However, attending hospital for self-harm is one of the <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/suicide-following-deliberate-selfharm-longterm-followup-of-patients-who-presented-to-a-general-hospital/2A40FE4860E86668306A98F07F21D6FC">strongest risk factors</a> for future suicide. </p>
<p>In our <a href="https://doi.org/10.1186/s12916-022-02329-w">newly published study</a>, we identified some of the risk factors for self-harm by combining information from hospital assessments with other sources of information, such as school attendance, special educational needs and free school meal status. Bringing sources of information which relate to the same individual together in this way is is called data linkage. It is a powerful tool to maximise the value of public health data.</p>
<h2>Girls are at higher risk</h2>
<p>Self-harm refers to any act of self-injury carried out by a person, regardless of their motivation. This commonly involves self-poisoning with medication or self-wounding by cutting.</p>
<p>Our findings show that the risk for self-harm was nearly three times higher for boys with autism spectrum disorder (ASD) compared to those without. ASD was not a significant risk for self-harm in girls, though this may be due to an <a href="https://childmind.org/article/autistic-girls-overlooked-undiagnosed-autism/">underdiagnosis of ASD</a> in <a href="https://theconversation.com/why-many-women-with-autism-and-adhd-arent-diagnosed-until-adulthood-and-what-to-do-if-you-think-youre-one-of-them-179970">girls</a>. In general, though, the risk of self-harm was higher in girls (1.5%) than in boys (0.3%), which chimes with what previous research <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-328">has shown</a>.</p>
<p>Although evidence suggests that ASD is a risk factor for <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70248-2/fulltext">self-harm in adults</a>, much less research has been conducted on risk among teenagers. The research that does exist has often included small, selective studies, using clinical samples rather than whole population samples. </p>
<p>By contrast, data linkage allowed us to study a huge amount of information. We assessed data from over 113,000 young people aged 11-17 years from four boroughs in south London, collected between 2009-2013. Our findings of increased risk for self-harm in boys with ASD are therefore important in addressing this research gap. </p>
<p>We also found that attention deficit hyperactivity disorder (ADHD) was a strong predictor of self-harm for both boys and girls. Young people with ADHD were approximately four times more likely to self-harm than those without the condition. Adolescents who had previously attended mental health services for ADHD were at four times the risk of self-harm than those who had not attended services for ADHD. These are important findings due to a gap in evidence: there have been <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-133">very few UK studies</a> exploring the association between ADHD and self-harm, particularly in girls.</p>
<figure class="align-center ">
<img alt="A teenage boy in a green t-shirt and jeans sits on the ground holding a book over his head." src="https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460521/original/file-20220429-15-narlv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Boys on the autism spectrum are at greater risk of self-harming that girls.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-high-school-student-using-book-102482045">michaeljung | Shutterstock</a></span>
</figcaption>
</figure>
<h2>Socio-economic risk factors</h2>
<p>We also discovered that young people who spend time away from school, either through exclusion or absence, were at greater risk of self-harm. For those with less than 80 per cent attendance, the risk of hurting themselves was three times greater than those with more than 80 per cent attendance. These findings do not show that school absence causes self-harm. They do, however, suggest that this is an important group of young people at whom to target preventive interventions. </p>
<p>Previous research examining socio-economic risk factors for self-harm has shown that girls who receive <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/abs/ethnicity-socioeconomic-status-and-selfharm-in-swedish-youth-a-national-cohort-study/07AFBBB6EB0BCB48E687BB0AB9ECE130">free school meal status</a> are also significantly more likely to engage in self-harm. Similarly, <a href="https://pubmed.ncbi.nlm.nih.gov/15819745/">looked-after children</a> have been shown to be at heightened risk. </p>
<p>Our research also led to some unexpected findings. Having English as a second language seemed to act as a protective factor for self-harm. However, this may be due to adolescents with English as a second language perhaps not presenting to mental health services. <a href="https://link.springer.com/article/10.1007/s10903-013-9971-9">Previous research</a> has found language barriers to be an important contributor to disparities in access to services. </p>
<figure class="align-center ">
<img alt="Three teenagers in school uniform walk away from the camera, outside." src="https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460524/original/file-20220429-20-kiaipt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adverse community experiences with the mental health system mean that not all children at risk of self-harm will be identified.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/three-black-teenagers-walking-backpacks-park-691135204">Katarzyna Golembowska | Shutterstock</a></span>
</figcaption>
</figure>
<p>Additionally, although we found associations between free-school-meal status and self-harm, we did not find a connection between neighbourhood deprivation and self-harm. While this is at odds with <a href="https://linkinghub.elsevier.com/retrieve/pii/S0277-9536(17)30568-3">previous research</a>, our findings do support <a href="https://link.springer.com/article/10.1007/s00127-018-1601-3">recent research showing</a> that some deprived inner-city areas, such as parts of London, have lower rates of self-harm. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750675/">Factors</a> that might explain this include, on the one hand, community solidarity and what researchers have termed a culture of self-reliance and, on the other hand, a collective sense that being identified as being mentally ill is risky – that mental health services are intrusive and coercive.</p>
<p>Data linkage allows whole populations to be studied. It is less intrusive than asking people to complete surveys. And it allows research to include people who may not proactively take part in traditional studies. We have also been able to take a lens to the risk factors behind self-harm in young people and identify those groups who may be most vulnerable. These findings are an important step in the development of strategies to prevent self-harm and demonstrate the power of data linkage to tackle public health issues.</p><img src="https://counter.theconversation.com/content/182010/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Widnall receives funding from the NIHR School for Public Health Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Johnny Downs receives funding from National Institute for Health Research (NIHR) Biomedical Research Centre
at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. </span></em></p>Data linkage, assessing information from over 113,000 teenagers in South London, addresses important gaps in research on the mental health and socio-economic risk factors for self-harm.Emily Widnall, Senior Research Associate, Population Health Sciences, University of BristolJohnny Downs, Senior Clinical Lecturer, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1803212022-03-30T06:06:56Z2022-03-30T06:06:56ZBudget 2022: $9.9 billion towards cyber security aims to make Australia a key ‘offensive’ cyber player<figure><img src="https://images.theconversation.com/files/455177/original/file-20220330-5678-1asypig.jpeg?ixlib=rb-1.1.0&rect=166%2C137%2C4670%2C3082&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">MICK TSIKAS/AAP</span></span></figcaption></figure><p>In the 2022 federal budget, Treasurer Josh Frydenberg launched a range of vote-winning initiatives – one of which included a breathtaking A$9.9 billion for cyber security over ten years.</p>
<p>Bundled under the acronym REDSPICE (which stands for resilience, effects, defence, space, intelligence, cyber and enablers), the program is expected to help build Australia’s intelligence and defensive (and offensive) capabilities. </p>
<p>But what does this mean, where is the money coming from and just how <em>offensive</em> are we planning to be?</p>
<h2>What’s REDSPICE?</h2>
<p><a href="https://www.asd.gov.au/about/redspice">REDSPICE</a> is a program to grow and enhance the intelligence and cyber capabilities of the <a href="https://www.asd.gov.au/">Australian Signals Directorate</a> (ASD) — the chief agency responsible for foreign signals intelligence, cyber warfare and information security.</p>
<p>Headline figures include 1,900 new recruits and delivering three times more offensive capability within the ASD.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455135/original/file-20220330-15-f5gtaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The REDSPICE program aims to bolster cyber capabilities across a range of areas.</span>
<span class="attribution"><span class="source">ASD website</span></span>
</figcaption>
</figure>
<p>A key <a href="https://www.minister.defence.gov.au/minister/peter-dutton/media-releases/budget-2022-23-delivers-record-investment-defence-and">justification given for the program</a> is, according to Defence Minister Peter Dutton, the “deteriorating strategic circumstances in our region” and “rapid military expansion, growing coercive behaviour and increased cyber attacks” from Australia’s adversaries.</p>
<p>This was also reinforced in a <a href="https://www.abc.net.au/news/2022-03-29/multi-billion-dollar-cybersecurity-federal-budget-package/100947938">pre-budget comment</a> from Dutton, who warned of China’s cyber warfare capability to launch “an unprecedented digital onslaught” against Australia.</p>
<h2>Potential outcomes</h2>
<p>The plans for the program will have effects beyond Canberra. They could see more <a href="https://www.zdnet.com/article/australian-budget-2022-delivers-au9-9-billion-for-spicy-cyber/">Australian technologies</a> being made available to our intelligence and defence partners overseas, as well as opportunities for increased data sharing (which is key to fighting against cyber threats).</p>
<p>Further investment in advanced artificial intelligence and machine learning will likely be used to detect attacks earlier than currently possible – potentially allowing <a href="https://www.threatintelligence.com/blog/automated-incident-response">automated responses</a> to cyber incidents.</p>
<p>Identifying previously “unseen” attacks is another significant challenge, and using advanced technologies to detect such incidents is essential for a strong defence.</p>
<p>Similarly, a doubling of “cyber-hunt activities” will see an increase in the analysts and automated systems actively looking for vulnerabilities in critical infrastructure. This is essential in protecting the services we depend on day-to-day.</p>
<p>A <a href="https://www.agcs.allianz.com/news-and-insights/expert-risk-articles/cyber-attacks-on-critical-infrastructure.html">major attack</a> against our water, electricity, communications, health care or finance services could have devastating consequences – first for the most vulnerable among us, and subsequently for everyone. </p>
<p>All of these technologies will be of value in reducing the large number of threats and incidents seen on a daily basis, and prioritising certain threats so they may be better handled by limited human resources in agencies.</p>
<p>The program will reportedly ensure a distribution of key functions both nationally and internationally, with a focus on building resilience in the “critical capabilities” of the ASD’s operations.</p>
<h2>Some new money, but mostly old money</h2>
<p>A$10 billion sounds like a significant windfall for our defence and intelligence agencies. However, a closer look indicates the “new” money is perhaps only worth around A$589 million in the first four years.</p>
<p>The majority of the balance comes from <a href="https://www.canberratimes.com.au/story/7677022/khaki-cyber-budget-pledge-boosts-australias-ability-to-strike-back/">redirecting existing defence funding to the ASD</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1508732811377020932"}"></div></p>
<p>Also, since the funding is spread over a ten-year period, it will only realise a proportion of the intended outcomes in the next government’s term. In fact, only A$4.2 billion falls within the next four years. </p>
<p>Future governments can always revisit these funding commitments and decide to make changes.</p>
<h2>Is Australia ready to be an offensive cyber player?</h2>
<p>Offensive cyber is perhaps the inevitable consequence of the increasing levels of <a href="https://cybersecurityventures.com/hackerpocalypse-cybercrime-report-2016/">cyber threats around the globe</a>.</p>
<p>Not only have we seen global cyber crime increasing, but there is growing evidence of nations being willing to engage in <a href="https://www.rand.org/topics/cyber-warfare.html">cyber warfare</a>. Recently this has been illustrated through Russia’s cyber attacks against Ukraine.</p>
<p>Australia has had a publicly acknowledged cyber offensive capability for some time. This was even outlined in the government’s April 2016 <a href="https://www.homeaffairs.gov.au/cyber-security-subsite/files/PMC-Cyber-Strategy.pdf">cyber security strategy</a> (and this was just the first official <a href="https://theconversation.com/the-cyber-security-strategy-is-only-a-small-step-in-the-right-direction-58208">acknowledgement</a>). It’s likely Australia has had this capability for even longer.</p>
<p>Offensive cyber represents a significantly different approach to a purely defensive or reactive approach. Initiating an attack (or retaliating) is a dangerous endeavour which can have unpredictable consequences.</p>
<p>Launching a highly targeted attack from Australia is certainly possible, but with such attacks we often see <a href="https://www.nyulawglobal.org/globalex/Cyberwarfare_Collateral_Damages.html">consequential damage</a> that affects individuals and systems beyond the target. For example, the NotPetya malware, first identified in 2017, <a href="https://www.wired.com/story/notpetya-cyberattack-ukraine-russia-code-crashed-the-world/">rapidly moved outside of the target country</a> (Ukraine) and had significant financial impact around the world. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-russia-wages-cyber-war-against-ukraine-heres-how-australia-and-the-rest-of-the-world-could-suffer-collateral-damage-177909">As Russia wages cyber war against Ukraine, here's how Australia (and the rest of the world) could suffer collateral damage</a>
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</p>
<hr>
<p>In the 2016 strategy there was specific reference to the importance of legislative compliance: </p>
<blockquote>
<p>Any measure used by Australia in deterring and responding to malicious cyber activities would be consistent with our support for the international rules-based order and our obligations under international law.</p>
</blockquote>
<p>But this is largely absent in the (brief) REDSPICE blueprint. Also, due to the covert nature of operations conducted by the ASD, we are effectively being asked to accept Australia operates ethically in the absence of any recorded or published data on operations to date.</p>
<p>Although there have been limited reports of <a href="https://www.aspi.org.au/report/australias-offensive-cyber-capability">legitimate cyber engagements</a>, a <a href="https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22media/pressrel/4951827%22">2016 Address to Parliament</a> by then Prime Minister Malcolm Turnbull referred to offensive attacks conducted by Australia in relation to operations against Islamic State (in partnership with UK and US allies):</p>
<blockquote>
<p>While I won’t go into the details of these operations […] they are being used […] they are making a real difference in the military conflict […] all offensive cyber activities in support of the ADF and our allies are subject to the same Rules of Engagement which govern the use of our other military capabilities in Iraq and Syria […]</p>
</blockquote>
<h2>Will it make a difference?</h2>
<p>We all want Australia to be a safe place, so any investment in intelligence and cyber security will be welcomed by most people. That said, it’s worth remembering this battle can never really be won. </p>
<p>Cyber defence is a constant game of cat-and-mouse. One side builds a better weapon, the other builds a better defence, and so it goes. As long as our adversaries are prepared to invest in technologies to infiltrate and damage our critical infrastructure, we will have a continued need to invest in our defences.</p>
<p>The increased focus on offensive initiatives may give us (and our allies) the upper hand for a while, but the cyber world doesn’t stand still. And the pockets of some of our cyber adversaries are also very deep.</p><img src="https://counter.theconversation.com/content/180321/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Haskell-Dowland does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The funds are allocated across a ten-year period, with most of the money redirected from defence spending.Paul Haskell-Dowland, Professor of Cyber Security Practice, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760362022-02-09T04:14:12Z2022-02-09T04:14:12ZAutism is still underdiagnosed in girls and women. That can compound the challenges they face<figure><img src="https://images.theconversation.com/files/444982/original/file-20220208-19-nflynh.jpg?ixlib=rb-1.1.0&rect=77%2C44%2C7095%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/sad-young-woman-glasses-sitting-600w-582841696.jpg">Shutterstock</a></span></figcaption></figure><p>Being autistic, but not diagnosed, can lead to a lifetime of struggles and being misunderstood for women. </p>
<p>This issue has been highlighted in the last few years by celebrity women including <a href="https://www.abc.net.au/news/2020-05-27/hannah-gadsby-new-show-douglas-on-autism-and-life-after-nanette/12282772">Hannah Gadsby</a>, <a href="https://www.forbes.com/sites/emilywillingham/2013/09/29/wall-street-actress-daryl-hannah-also-autistic-woman/?sh=675bd17349fa">Daryl Hannah</a>, British reality star <a href="https://news.sky.com/story/christine-mcguinness-tv-star-trying-to-be-a-bit-more-myself-now-after-amazing-diagnosis-of-autism-12485953">Christine McGuinness</a> and former Australian of the year <a href="https://www.abc.net.au/news/2021-11-22/australian-of-theyear-takes-toll-on-grace-tame/100525768">Grace Tame</a>. By talking about their <a href="https://www.theguardian.com/society/2021/nov/19/diagnosis-women-autism-later-life">adult autism diagnosis</a>, they are helping to debunk the myth that autism is for boys and men. </p>
<p><a href="https://www.autismspectrum.org.au/about-autism/what-is-autism">Autism</a> affects thoughts, feelings, interactions and experiences in an estimated one in 70 people. In childhood, autism is now diagnosed in <a href="https://www.autismspeaks.org/autism-statistics-asd">three boys for every one girl</a> (a ratio that has greatly reduced over time). <a href="https://doi.org/10.1007/s10803-018-3609-7">Girls are often diagnosed later than boys</a>, so miss out on opportunities for early support. </p>
<p>Girls who have autism but not a diagnosis grow up not understanding why they are sometimes confused in social situations. They might not be able to make friends as easily as others and can sometimes be targets for bullies. This can lead to lifelong <a href="https://www.ingentaconnect.com/contentone/bild/gap/2021/00000022/00000002/art00009">feelings</a> of failure and thinking they have character defects – or being told they do. </p>
<p>These experiences growing up can lead to or interact with <a href="https://www.spectrumnews.org/features/deep-dive/intersection-autism-trauma/">post-traumatic stress symptoms</a> in adulthood.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-make-up-half-the-disability-population-but-just-over-a-third-of-ndis-recipients-173747">Women make up half the disability population but just over a third of NDIS recipients</a>
</strong>
</em>
</p>
<hr>
<h2>Girls get diagnosed (and misdiagnosed) with other things</h2>
<p>Girls who don’t get diagnosed tend not to have readily <a href="https://www.clinical-partners.co.uk/insights-and-news/item/openhouse-on-autism-autistic-girls-traits">observable</a> co-occurring difficulties, such as hyperactivity. But many girls and women receive other (sometimes incorrect) diagnoses instead of, or before, an autism diagnosis. </p>
<p>Our recent <a href="https://www.ingentaconnect.com/contentone/bild/gap/2021/00000022/00000002/art00009">case study</a> provides reflections from our perspectives as a psychologist (Tamara) and a late-diagnosed autistic woman (Carol). In the discussion, Carol describes her confusion and challenges growing up, and how they resurfaced following traumatic experiences as an adult.</p>
<p>There is a long-standing bias in the world of mental health to view some symptoms as the domain of males, such as aggressive and externalising symptoms, while internalising symptoms like anxiety are seen as the <a href="https://link.springer.com/chapter/10.1007/978-1-4419-1467-5_5">domain of females</a>.</p>
<p>Clinical observations reveal many women who receive their autism diagnosis in adulthood have had various other diagnoses including anxiety disorders, depression and mood disorders, borderline personality disorder, obsessive compulsive disorder and eating disorders. Where the underlying cause is likely autism, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040731/">treatments and support need to be tailored</a> to be effective. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1486671744605700096"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hannah-gadsbys-follow-up-to-nanette-is-an-act-of-considered-self-care-114502">Hannah Gadsby's follow-up to Nanette is an act of considered self-care</a>
</strong>
</em>
</p>
<hr>
<h2>Undercover autism</h2>
<p>Research suggests girls quickly learn to copy others, which has the effect of “<a href="https://link.springer.com/article/10.1007/s40489-020-00197-9">masking</a>” or “camouflaging” their difficulties. They might practise making facial expressions in the mirror so they can be ready to make their expressions match upcoming social situations; they may copy other girls to learn how to position their bodies. </p>
<p>They might have an array of scripts to say in different situations, especially when there is a risk of having to engage in “small talk”. They use rule-based approaches rather than intuitively responding in the moment. </p>
<p>Their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543385/">special interests</a> might be more “acceptable” than those of autistic boys. Think <a href="https://www.autismawareness.com.au/understanding-autism/women-girls#:%7E:text=Although%20every%20child%20with%20autism,to%20arrange%20and%20organise%20objects">animals, music, books, or just learning and researching</a>, compared to <a href="https://www.spectrumnews.org/features/deep-dive/the-benefits-of-special-interests-in-autism/">videogames or trains</a>. </p>
<p>Trying to be perfect, or <a href="https://journals.sagepub.com/doi/abs/10.1177/1365480220973112">achieve in other areas</a>, can be another response to one’s social difficulties. These strategies can result in autism not even being considered by parents, teachers and clinicians. Compared to boys, girls <a href="https://pubmed.ncbi.nlm.nih.gov/31815760/">are observed to have fewer repetitive behaviours</a> such as movements, narrow interests, or ritualised behaviour.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/NwEH9Ui4HV8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘People say to me: you don’t look autistic. Here’s what women with autism want you to know. (Iris)’</span></figcaption>
</figure>
<h2>Getting a diagnosis matters</h2>
<p>Not picking up on social situations quickly enough can put women and girls at greater risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901292/">traumatic experiences</a>.</p>
<p>Parents and <a href="https://www.teachwire.net/news/why-autism-goes-unseen-in-girls-and-how-you-can-spot-it">teachers</a> need better support to identify and understand autism in girls. They may spot girls not picking up social cues or appearing a little behind their peers in some areas. These can be carefully explored. A conversation with a young person about how they navigate social situations can be revealing. Confusion or a rule-based approach may be quickly apparent. </p>
<p>Autistic girls grow into women who may have a very direct style of communication and not pick up on the subtleties of office politics. This can result in them receiving negative professional feedback and reinforce self doubts. </p>
<p>Clinicians too need to be better at understanding how <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.539835/full">girls and women with autism might get missed</a>. Thinking beyond binary notions of gender is also important – there is more <a href="https://www.tandfonline.com/doi/full/10.3109/09540261.2015.1111199">gender diversity</a> in autistic people. Exploring the presentation of non-binary and gender fluid people with autism is an emerging field that could shed further light on autistic presentations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="girl covers face. blurred effect." src="https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444983/original/file-20220208-27-19pw8w9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Girls with autism may be working hard to copy social cues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-sad-blond-little-girl-sitting-1146759368">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/autism-screening-tool-may-not-detect-the-condition-in-some-women-96488">Autism screening tool may not detect the condition in some women</a>
</strong>
</em>
</p>
<hr>
<h2>4 ways testing should change</h2>
<p>From an autistic woman’s perspective, the diagnostic assessments need rethinking: </p>
<ul>
<li><p>they should consider <a href="https://theconversation.com/neurodiversity-at-work-benefits-everyone-why-companies-are-hiring-autistic-people-146788">autistic strengths</a> and not focus solely on deficits and impairments. Sometimes autism isn’t considered because of the presence of strengths </p></li>
<li><p>they should incorporate the common lived experiences of autistic women. These have now been well-documented by autistic women, many with successful careers and yet areas of difficulty</p></li>
<li><p>the differences between the presentation of autism in females and males should be reflected in the diagnostic criteria</p></li>
<li><p>autistic people should be included in the design and content of diagnostic tests.</p></li>
</ul><img src="https://counter.theconversation.com/content/176036/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Without a diagnosis, girls might experience social difficulties and traumatic situations – and grow into women who blame themselves.Tamara May, Senior Research Fellow, Monash UniversityCarol A Adams, Professor of Accounting, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638642021-07-13T15:17:40Z2021-07-13T15:17:40ZTreating specific symptoms of autism or ADHD can help children, even without a diagnosis<figure><img src="https://images.theconversation.com/files/410713/original/file-20210712-21-1bzbgkp.jpg?ixlib=rb-1.1.0&rect=232%2C29%2C4760%2C3450&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Treating children's mental health symptoms, even without a diagnosis, can be beneficial.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>For individuals experiencing mental health difficulties, early access to support services and effective intervention <a href="https://doi.org/10.2147/PRBM.S117499">can be life-altering</a>. To access these services through the health-care system, however, most institutions require an official diagnosis. </p>
<p>But what about those who have symptoms, but don’t quite meet the criteria for a mental health diagnosis? These individuals may be overlooked by the health-care system, despite symptoms that may be treatable.</p>
<p>In most cases, a diagnosis must meet the criteria in the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions">Diagnostic and Statistical Manual of Mental Health Disorders</a> (DSM-5). For example, a child suspected to have attention deficit hyperactivity disorder (ADHD) must have <a href="https://www.cdc.gov/ncbddd/adhd/diagnosis.html">six or more symptoms</a> that affect their quality of functioning. Some examples of these symptoms include:</p>
<ul>
<li>Often fidgets with or taps hands or feet, or squirms in seat.</li>
<li>Often has trouble organizing tasks or activities.</li>
<li>Often interrupts or intrudes on others.</li>
</ul>
<p>This checklist serves as a line in the sand. If six boxes are checked, a diagnosis can be given but if any fewer are checked, no diagnosis can be given. Individuals in the latter category are often unable to access services, even though they would likely benefit from them.</p>
<p>On top of this, mental health conditions are not always clear cut and easy to identify. Two children with the same diagnosis could experience very different symptoms, and their daily lives may be affected in very different ways. To complicate things further, factors like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101894/">gender, age</a> or <a href="https://www.intechopen.com/books/adhd-new-directions-in-diagnosis-and-treatment/the-comorbidity-of-adhd-and-autism-spectrum-disorders-asds-in-community-preschoolers">having more than one diagnosis</a> can impact how symptoms present as well as whether (and how quickly) a diagnosis can be made.</p>
<p>Since symptoms can vary from person to person, there is no one-size-fits-all treatment plan. For example, some children with ADHD may benefit from programs aimed at improving language, while others may benefit from those focusing on attention. This variability isn’t restricted to ADHD and is present in most if not all mental health conditions.</p>
<h2>Symptoms and functioning vs. diagnoses</h2>
<p>These factors have led some researchers to think of mental health difficulties in terms of specific symptoms as opposed to diagnostic categories. For example, one could focus on attention difficulties regardless of whether an individual had ADHD, a different diagnosis or even no diagnosis. The most widely used framework to do this is the <a href="https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc">research domain criteria</a> or RDoC approach, where symptoms rather than diagnostic labels are used to understand an individual’s mental health difficulties.</p>
<p>As developmental researchers, we use the RDoC approach to look at how symptoms of ADHD and autism spectrum disorder (ASD) in the general population can impact functioning. In two recent studies, we found that those with increased ADHD and ASD symptoms (but no official diagnosis) had more <a href="https://doi.org/10.1038/s41598-020-61047-6">learning</a>, <a href="https://doi.org/10.1016/j.jcomdis.2020.106036">language and social communication</a> difficulties. </p>
<p>These findings tell us that we do not need someone to be functioning at the lowest level in order to benefit from treatment. Those with varying levels of these disorders who are not yet diagnosed can also benefit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man and a little boy sitting at a table working on number and shape exercises." src="https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410716/original/file-20210712-17-pcc7ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The research domain criteria approach addresses symptoms rather than diagnostic labels to understand mental health difficulties.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Fully adopting an RDoC approach for mental health care would require a complete overhaul to the diagnostic system, and in reality, is not likely to happen any time soon. However, taking this approach in terms of research and support systems could lead to an immediate improvement for those presenting with symptoms. </p>
<p>This would include individuals who either fall short of a diagnosis, don’t fall squarely into a specific diagnosis, or are waiting for an evaluation. And in Canada, the time from referral to evaluation of diagnosis can take <a href="https://www.cps.ca/en/documents/position/asd-diagnostic-assessment">up to a year</a>. The good news is that there are resources available and actions parents can take to provide support that may help with specific difficulties.</p>
<ol>
<li><p>Gather information: You know your child best. A doctor is only able to pick up on the behaviours observed during the visit. Advocate for your child and let doctors and specialists know how they interact at home, school and within the community.</p></li>
<li><p>Learning programs: There may be programs within your community that support <a href="https://www2.gov.bc.ca/gov/content/family-social-supports/caring-for-young-children/how-parents-can-support-young-children">early learning</a> and help children develop important <a href="https://www.tyketalk.com/">language and social skills</a> regardless of diagnostic status. These programs may also be useful in helping your child <a href="https://childsfirststeps.com/">transition into the school system</a>. Many of these programs include <a href="https://www.cihi.ca/en/speech-language-pathologists">speech language</a> or <a href="https://www.cihi.ca/en/occupational-therapists">occupational</a> therapists who can help address specific difficulties.</p></li>
<li><p>Participate in research: As <a href="https://sensorylab.ca/">developmental</a> and <a href="https://lrcn.uwo.ca/">language</a> researchers, we administer a broad range of assessments. By participating in research, you may gain a better understanding of your child’s mental health and how their difficulties might be impacting their functioning. Participants are often compensated for taking part in our research</p></li>
</ol>
<p>We believe the best way to understand mental health difficulties is to move beyond the simple binary choice of having a diagnosis or not, and towards focusing on the varying degrees of symptoms across the broader population. Taking this approach in terms of research and support systems could lead to improvements in individualized, targeted care and to better quality of life for anyone experiencing mental health difficulties.</p><img src="https://counter.theconversation.com/content/163864/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaitlyn Parks receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Ryan Stevenson receives funding from the Natural Sciences and Engineering Research Council of Canada, the Social Sciences and Humanities Research Council of Canada the University of Western Ontario Faculty Development Research Fund, the province of Ontario Early Researcher Award, the Canadian Foundation for Innovation, and the US National Institutes of Health.</span></em></p>Not every child with mental health difficulties has a diagnosis. An approach that focuses on symptoms rather than diagnostic labels can help support children who could benefit from treatment.Kaitlyn Parks, PhD Candidate in Psychology, Western UniversityRyan Stevenson, Associate professor, Department of Psychology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1314242020-02-14T09:52:50Z2020-02-14T09:52:50ZAnxiety in autistic children – why rates are so high<figure><img src="https://images.theconversation.com/files/315278/original/file-20200213-10995-1mleov2.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4988%2C3030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-girl-over-isolated-background-1178042443">Krakenimages/Shutterstock</a></span></figcaption></figure><p>Many aspects of the world can be overwhelming for autistic children, so it is unsurprising that dealing with the challenging impact of anxiety has become a daily struggle for many autistic children and their families. In fact, autistic children are twice as likely to develop anxiety than non-autistic children. Not only this, but <a href="https://link.springer.com/article/10.1007%2Fs10567-011-0097-0">around 40%</a> are diagnosed with at least one anxiety disorder, with the most common being specific phobia, which is an extreme fear of a particular place, object, animal, person or situation. </p>
<p>Many autistic people carry this disabling anxiety into adulthood, which can negatively affect their future prospects and quality of life. Because of this, autism researchers have made it a priority to understand why autistic children are much more at risk of developing anxiety and what can be done to prevent it.</p>
<p>Sensory hyper-reactivity, such as being over-responsive to loud noises, bright lights and clothing fabrics, has been suggested as a reason autistic children develop anxiety. It is commonly experienced by autistic children and has recently become one of the criteria for an <a href="https://www.autismeurope.org/wp-content/uploads/2017/08/Diagnostic-criteria-for-autism-under-the-DSM-5.pdf">autism diagnosis</a>.</p>
<p>Autistic children can struggle to filter out and ignore things they hear, see, touch, smell and taste. This can lead to them feeling exhausted, stressed and overwhelmed, which in turn, can increase sensory hyper-reactivity, creating a vicious cycle of anxiety due to sensory difficulties and sensory difficulties due to anxiety. </p>
<p><a href="https://link.springer.com/article/10.1007%2Fs10803-011-1361-3">Existing research indicates</a> that sensory difficulties are one of the reasons autistic children are more anxious in a general sense. But when considering targeted therapies, we really need to know if sensory hyper-reactivity is more strongly linked to particular anxiety disorders, such as generalised anxiety disorder (feeling anxious about a wide range of situations) or social anxiety disorder (overwhelming fear of social situations).</p>
<p>This is important for understanding how to create strategies that prevent different anxiety disorders. That is why our <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2259">recent study</a> investigated the relationship between sensory hyper-reactivity and anxiety in more detail.</p>
<h2>Finding the link</h2>
<p>At the University of Reading’s Centre for Autism, we assessed sensory hyper-reactivity and anxiety in 41 autistic children, aged three to 14 years. All of the children had a formal diagnosis of autism and had average to above-average IQs. Parents completed questionnaires that told us the extent of their children’s sensory hyper-reactivity and anxiety. We also gave a questionnaire to children aged six years and over so they could rate their anxiety. </p>
<p>We found that autistic children who were more sensory hyper-reactive also had greater overall anxiety, as well as more symptoms relating to phobia and separation anxiety disorder. This tells us that sensory hyper-reactivity is related to anxiety in a general sense, but it may be more strongly linked to some anxiety disorders, and less so to others.</p>
<p>Yet we know that other autism traits, such as repetitive behaviours, have also been linked to anxiety, so we repeated the analysis controlling for broader autism traits. We could then see if our results changed when taking these into account. </p>
<p>We found that autistic children who were more sensory hyper-reactive also had more symptoms associated with phobia. But we no longer found sensory hyper-reactivity to be related to overall anxiety or separation anxiety. This tells us that other autism traits, together with sensory hyper-reactivity, may be why autistic children are more likely to be anxious. But sensory hyper-reactivity could be more specifically linked to symptoms of phobia.</p>
<h2>Early intervention</h2>
<p>There are existing therapies to help autistic children deal with their anxiety. But it would be better to combat any risk factors before these anxiety disorders have a chance to develop. For example, if an autistic child struggles with sudden loud noises at an early age, this may evolve into them developing a fear of things that produce these sounds, such as dogs because of their barking, or balloons, due to them popping.</p>
<p>If we can address sensory hyper-reactivity early on in autistic children, this might prevent them from developing phobias later in life. But how do we do this?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314805/original/file-20200211-146704-3ku7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The bark can be worse than the bite for some children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-scared-by-dog-1023402898">Inna Ska/Shutterstock</a></span>
</figcaption>
</figure>
<p>Sensory difficulties are often addressed using a <a href="https://link.springer.com/content/pdf/10.1023/A:1020541906063.pdf">range of approaches</a> through occupational therapy. But it is not clear how effective these approaches are in tackling anxiety.</p>
<p>As there is much individual difference in autism, with a range of strengths and difficulties, taking a personalised approach to helping autistic children may be the most effective method to prevent anxiety. So this may be key to developing effective, evidence-based therapies to improve the lives and future prospects of these autistic children.</p><img src="https://counter.theconversation.com/content/131424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keren MacLennan receives funding from MQ and Autistica. </span></em></p>Early interventions might help protect autistic children from anxiety disorders in adulthood.Keren MacLennan, Doctoral Researcher, Autism, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1296572020-01-21T13:46:44Z2020-01-21T13:46:44ZAutism: stem cell clinics are offering treatments despite lack of evidence it works<figure><img src="https://images.theconversation.com/files/310307/original/file-20200115-134842-1bizdsk.jpg?ixlib=rb-1.1.0&rect=0%2C547%2C4230%2C2274&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/photo-young-boy-sitting-on-grass-80888779">ZouZou</a></span></figcaption></figure><p>The outlook for autistic people today is <a href="https://www.thelancet.com/clinical/diseases/autism">brighter than it was 50 years ago</a> with many people now living in the community, rather than in institutions. But most low-functioning autistic people are not able to live independently in adulthood, putting them and their families under considerable social and financial pressure. So it’s hardly surprising that some parents of autistic children are keen to find a treatment for the condition. According to a recent <a href="https://www.bbc.co.uk/programmes/m000cz1l">BBC Radio 4 report</a>, stem cell clinics in the UK are now offering one.</p>
<p>Before we look at the viability of such a “treatment”, it is worth knowing a bit about stem cells. Stem cells are special cells that can develop into many types of cell, such as liver cells, blood cells or nerve cells. In the early developing embryo, stem cells can develop into any cell type, but stem cells in adults have a much more limited capability. </p>
<p>Adult stem cells can only develop into cell types of the organ they originate from. For example, stem cells originating from the bone marrow can only give rise to closely related cell types, such as fat, cartilage and bone cells, while stem cells in the brain can only differentiate into brain cells.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/understanding-autism-new-research-dispels-common-assumptions-126550">Understanding autism: new research dispels common assumptions</a>
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</em>
</p>
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<p>Stem cell therapies aim at regenerating or replacing cells that are affected by disorders and diseases. This can be achieved by isolating stem cells from the patient or a donor and turning them into the desired cells in a laboratory before transplanting them in the patient. </p>
<p>In an alternative approach, stem cells can be transplanted without differentiating them outside of the patient’s body in the hope that the tissue will dictate their fate. This idea is based on the assumption that every tissue contains specific signal molecules telling the stem cells what to become. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=303&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=303&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=303&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=381&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=381&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310985/original/file-20200120-69563-1iorvnf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=381&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Embryonic stem cells.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/embryonic-stem-cells-cellular-therapy-3d-768933475">Giovanni Cancemi/Shutterstock</a></span>
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</figure>
<p>A successful stem cell therapy relies on at least two things. First, the tissue and cell type affected by disease or disorder must be known. Second, the right stem adult cell type or early so-called <a href="https://www.nature.com/articles/nrm.2016.10">pluripotent cells</a> must be applied. If a disease is caused by degeneration of brain tissue, a cell type able to replace the nerve cells lost due to the condition needs to be used. If the target is bone tissue, a stem cell type that can replace bone cells should be applied. So a one-size-fits-all approach is unlikely to work. </p>
<h2>Under-regulated stem cell clinics</h2>
<p>The promise of stem cell therapies to tackle disorders with limited conventional treatment options has led to the development of a considerable industry offering stem cell therapies. </p>
<p>Initially limited to developing countries, the number of under-regulated stem cell clinics is growing in developed countries, <a href="https://www.sciencedirect.com/science/article/pii/S1934590916302107?via%3Dihub">including the US, Germany, Switzerland and the UK</a>. Most of these businesses are using a <a href="https://stemcellres.biomedcentral.com/articles/10.1186/s13287-017-0735-7">loophole in the law</a> which allows the use of stem cells isolated from the patient’s own body (so-called autologous transplantation) for debilitating conditions that cannot be treated with existing drugs. In contrast, all other stem cell therapies must undergo thorough assessments for <a href="https://stemcellres.biomedcentral.com/articles/10.1186/s13287-017-0735-7">quality, safety and efficacy</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/not-all-autistic-people-are-good-at-maths-and-science-despite-the-stereotypes-114128">Not all autistic people are good at maths and science – despite the stereotypes</a>
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<p>With an autologous approach, most stem cell clinics use cells isolated from the patient’s bone marrow or fat tissue. Although these cells are unable to generate any cell types apart from fat, bone cells or cartilage, many of the stem cell clinics offer treatments for a range of conditions, including dementia, cerebral palsy and autism. These therapies aren’t supported by scientific evidence and they are expensive – around £10,000. </p>
<p>The procedure usually involves isolating cells from the bone marrow or fat tissue of the patient and injecting the cells back into the bloodstream with the hope that the transplanted cells migrate to the organ affected by the disease. Once in the target tissue, stem cells could contribute to regeneration by replacing the faulty cells or by boosting the internal repair capability of the body. </p>
<p>Although some common genetic and environmental factors have been identified in autism, little is known about the exact type of nerve cells affected. Indeed, recent research published in the journal <a href="https://science.sciencemag.org/content/364/6441/685">Science</a> suggests that, in addition to nerve cells, microglia (a cell type that fulfils an immune function in the brain) could be affected in people with autism. </p>
<p>This cellular complexity in autism makes designing a stem cell treatment more than challenging. What cell types need to be replaced? Is it enough to boost the patient’s own repair capability? Even if these open questions would be addressed in the future, what stem cell type needs to be used? Is it viable to use adult stem cells or are more potent pluripotent cells needed? So, at least today, autism cannot be treated with stem cells. </p>
<p>An even more fundamental question has been discussed by <a href="http://autisticuk.org/neurodiversity/">autism activist groups</a>: does autism need to be cured at all or is it just a form of neurodiversity that society should embrace?</p><img src="https://counter.theconversation.com/content/129657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darius Widera does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To successfully treat people with stem cells, you first need to know which cells are faulty.Darius Widera, Associate Professor, Stem Cell Biology and Regenerative Medicine, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1206532019-09-05T20:47:24Z2019-09-05T20:47:24ZHow parents and caregivers can help keep children with autism safe<figure><img src="https://images.theconversation.com/files/291010/original/file-20190904-175700-1gljy0m.jpg?ixlib=rb-1.1.0&rect=16%2C2%2C982%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children with ASD are particularly prone to poisoning, suffocation and wandering that can lead to death by drowning or vehicular accident.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Preventable injuries are the <a href="https://www.parachutecanada.org/injury-topics">leading cause of death for Canadians under the age of 45</a>. Unfortunately, individuals with autism spectrum disorder (ASD) are <a href="https://doi.org/10.1016/j.ridd.2007.05.002">two to three times more likely to experience a preventable injury</a> than those without. </p>
<p>Children with ASD are <a href="https://doi.org/10.1542/peds.2012-0762">particularly prone to poisoning, suffocation and wandering</a> that can lead to death by drowning or vehicular accident.</p>
<p>They often <a href="https://doi.org/10.1016/j.rasd.2010.07.008">need systematic training to learn safety skills</a>. And they need explicit instruction — to increase the likelihood of using these skills effectively <a href="https://doi.org/10.1901/jaba.1987.20-89">in different settings and with different people</a>. </p>
<p>Teaching safety skills to children with ASD at a young age is of utmost importance. However, preliminary research suggests that caregivers of children with ASD may not be comfortable teaching these safety skills themselves due to a <a href="https://doi.org/10.1007/s10803-016-2809-2">lack of knowledge or experience</a>. </p>
<p>As an associate professor at Brock University and <a href="https://www.bacb.com/bcba-d/">Board Certified Behaviour Analyst-Doctoral</a> (BCBA-D), I have been working with a community clinician and graduate students to empower caregivers to teach safety skills to their children. </p>
<h2>A model for teaching children with autism</h2>
<p>Behavioural skills training (BST) is a strategy commonly used to teach a variety of skills to people with disabilities. This can include safety skills such as <a href="https://doi.org/10.1353/etc.0.0063">learning how to solicit help</a>, <a href="https://doi.org/10.1007/s10864-016-9248-1">what to do upon finding a firearm</a> and <a href="https://doi.org/10.1901/jaba.2005.26-04">reducing the risks of abduction</a>.</p>
<p>Research suggests that the BST model ensures that the person being trained <a href="https://doi.org/10.1002/jaba.113">not only understands the new skill, but is able to perform it accurately</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=599&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=599&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291011/original/file-20190904-175691-yfa43o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=599&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">All young children are at risk around household chemicals, but those with autism may need extra training to keep themselves safe.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The model involves: (1) instructions, (2) modelling, (3) rehearsal and (4) feedback. First, the trainer provides verbal and/or written instruction on how to complete the skill, and a brief rationale. Next, the trainer models the skill by provides an accurate demonstration. </p>
<p>The trainer then provides the learner with the opportunity to practice the skill and offers feedback in the form of descriptive praise if the learner completes the skill accurately. If the learner does not complete the skill accurately, the trainer offers corrective feedback.</p>
<p>These <a href="https://doi.org/10.1007/BF03391819">rehearsal and feedback steps are repeated until the learner is able to accurately execute the skill</a>. </p>
<h2>Instructions must be clear and concise</h2>
<p>The first step to teaching safety skills is to select the behaviour you would like to teach (for example, what to do when lost). The next step involves outlining the instructions to use when implementing BST. </p>
<p>It is important that instructions are clear and concise. We recommend breaking the skill down into three or fewer steps. For example, when we teach children what to do if they become lost or separated from their caregiver, we teach them to: (1) call out for caregiver, (2) find a worker, (3) tell the worker they are lost. </p>
<p>Once you have determined the instructions, ensure that you have all of the materials required — for example, props. Also, ensure the environment adequately facilitates learning for your child by eliminating any distractions.</p>
<h2>Follow these five steps</h2>
<p>The following training steps can be applied to teaching a variety of safety skills. </p>
<ol>
<li><p>Provide instructions relevant to the skill to your child. For example: “Sometimes when we are at the grocery store, we can get separated, which can be scary. If this happens, I want you to do three things. First, call out for me in a loud voice. Next, if I do not respond, find a worker. Then, tell the worker, ‘I’m lost.’”</p></li>
<li><p>Model the skill for your child, by first getting their attention, and then demonstrating all three steps in a mock scenario: “Let’s pretend we are in the store and I get separated from you.” </p></li>
<li><p>Ask your child to practice the three steps.</p></li>
<li><p>Provide feedback based on their performance, for example if your child calls out for you but in a quiet voice, you can say: “I like how you called out for me, but remember to use a loud voice.”</p></li>
<li><p>Continue rehearsal and feedback until you are confident that your child can perform the skill. </p></li>
</ol>
<h2>Practise in a natural environment</h2>
<p>It is also important to eventually practice the skill in the environment where the skill will be needed, such as in public settings.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291012/original/file-20190904-175678-1qf2oko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teaching safety skills in public settings could safe a child’s life.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For example, can the child perform the skill if separated in a grocery store? As a safety precaution have someone “under-cover” to also watch the child and to see if they engage in the appropriate steps. </p>
<p>If the child does not engage in the appropriate steps, provide feedback and repeat until everyone is confident. </p>
<p>If caregivers practice teaching basic safety skills using the steps of BST at home with their child, it may help to keep them safe if dangerous situations arise. </p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/120653/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kendra Thomson receives funding from Brock University. She is affiliated with Ontario Association for Behaviour Analysis. </span></em></p>This simple strategy could help your child safely negotiate dangerous situations such as getting lost in a public place or discovering a firearm.Kendra Thomson, Associate Professor in the Department of Applied Disability Studies, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1208202019-07-30T22:53:08Z2019-07-30T22:53:08ZNew autism early detection technique analyzes how children scan faces<figure><img src="https://images.theconversation.com/files/285857/original/file-20190726-43122-1yp4045.jpg?ixlib=rb-1.1.0&rect=26%2C22%2C970%2C643&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A child with autism spectrum disorder scans faces differently.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Imagine that your son Tommy is about to turn two. He is a shy and sweet little boy, but his behaviours can be unpredictable. He throws the worst temper tantrums, sometimes crying and screaming inconsolably for an hour. The smallest changes in routines can throw him off. </p>
<p>Is this a bad case of the so-called “terrible twos”? Should you give Tommy some time to grow out of this phase? Or, are these signs of autism spectrum disorder (ASD) — the <a href="https://www.cdc.gov/ncbddd/autism/data.html">neurodevelopmental disorder that affects around two per cent of the population</a>, the equivalent of
about one or two children on a full school bus? And how will you find out? </p>
<p>Our research group at the Applied Mathematics Department at University of Waterloo has developed a <a href="https://doi.org/10.1016/j.compbiomed.2019.103332">new ASD detection technique that distinguishes different eye-gaze patterns</a> to help doctors more quickly and accurately detect ASD in children. </p>
<p>We did this because there are so many benefits of early ASD diagnosis and intervention. Studies have found that <a href="https://doi.org/10.1542/peds.2009-0958">interventions implemented before age four are associated with significant gains in cognition, language and adaptive behaviour</a>. Similarly, researchers have linked the implementation of early interventions in ASD <a href="https://doi.org/10.1352/0895-8017(2007)112%5B418:EIBIOF%5D2.0.CO;2">with improvements in daily living skills and social behaviour</a>. Conversely, late diagnosis is <a href="https://doi.org/10.1542/peds.2014-3667C">associated with increased parental stress and delays early intervention, which is critical to positive outcomes over time</a>.</p>
<h2>Current ASD interventions</h2>
<p>Symptoms of ASD typically appear in the first two years of life and affect the child’s ability to function socially. Although current treatments vary, <a href="https://doi.org/10.1007/s10803-006-0320-x">most interventions focus on managing behaviour and improving social and communication skills</a>. Because the capacity for change is greater the younger the child is, one can <a href="https://doi.org/10.1007/BF02172020">expect the best outcomes if diagnosis and intervention are made early in life</a>. </p>
<p>Assessment of ASD includes a <a href="https://doi.org/10.1007/s00787-013-0375-0">medical and neurological examination, an in-depth questionnaire about the child’s family history, behaviour and development or an evaluation from a psychologist</a>. </p>
<p>Unfortunately, these diagnostic approaches are not really toddler-friendly and can be expensive. One can imagine that it is much easier for children to just look at something, like the animated face of a dog, than to answer questions in a questionnaire or be evaluated by a psychologist.</p>
<h2>Mathematics as new microscope</h2>
<p>You might wonder: What do mathematicians have to do with autism detection? </p>
<p>This is indeed an example of interdisciplinary research our group is involved in. We use <a href="https://doi.org/10.1016/j.compbiomed.2018.11.002">mathematics as a microscope to understand biology and medicine</a>. We build <a href="https://dx.doi.org/10.1152%2Fajprenal.00551.2017">computer models to simulate the effects of various drugs</a> and we apply mathematical techniques to analyze clinical data.</p>
<p>We believe that mathematics can objectively distinguish between behaviours of children with ASD from their neurotypical counterparts. </p>
<p>We know that <a href="https://doi.org/10.1016/j.neubiorev.2014.03.013">individuals with ASD visually explore and scan a person’s face differently from neurotypical individuals</a>. In developing the new technique for detecting eye-gaze patterns, we evaluated 40 children, mostly four- or five-year-olds. About half of these children are neurotypical, whereas others have ASD. Each participant was shown 44 photographs of faces on a screen, integrated into an eye-tracking system. </p>
<p>The infrared device interpreted and identified the locations on the stimuli at which each child was looking via emission and reflection of wave from the iris.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285862/original/file-20190726-43145-1mjcdci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When looking at a person’s face, a neurotypical child focuses more on the eyes whereas a child with ASD focuses more on the mouth.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Patterns of eye movement</h2>
<p>The images were separated into seven key areas — which we named features — in which participants focused their gaze: under the right eye, right eye, under the left eye, left eye, nose, mouth and other parts of the screen. We used four different concepts from network analysis to evaluate the varying degree of importance children placed on these features.</p>
<p>Not only did we want to know how much time the participants spent looking at each feature, we also wanted to know how they moved their eyes and scanned the faces.</p>
<p>For instance, researchers have known that when looking at a person’s face, a <a href="https://doi.org/10.1007/s10803-009-0803-7">neurotypical child focuses more on the eyes</a> <a href="https://doi.org/10.1023/A:1016374617369">whereas a child with ASD focuses more on the mouth</a>. Furthermore, a child with ASD also scans faces differently. When moving their focus from someone’s eyes to their chin, for example, a neurotypical child <a href="https://doi.org/10.1016/j.neubiorev.2014.03.013">likely moves their eyes more quickly, and via a different path than would a child with ASD</a>. </p>
<h2>Child-friendly diagnostic process</h2>
<p>While it is not yet possible to enter a doctor’s office and request this test, our hope is that this research may eventually make the diagnostic process less stressful for children.</p>
<p>To use this technology would require an infrared eye-tracker, which is commercially available, plus our network analysis technique. We have explained the algorithms so any software developers who wanted to could, theoretically, implement them. </p>
<p>By removing some of the barriers to early diagnosis, we hope that more children with ASD can receive early intervention, resulting in improved quality of life and more independence in the long term.</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/120820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anita Layton receives funding from the Canada 150 Research Chair program and the National Institutes of Health (U.S.).
</span></em></p><p class="fine-print"><em><span>Mehrshad Sadria does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mathematics researchers have developed a technique for detecting autism that could eventually make a diagnostic process faster and less stressful for children and families.Anita Layton, Canada 150 Research Chair in Mathematical Biology and Medicine; Professor of Applied Mathematics, Pharmacy, and Biology, University of WaterlooMehrshad Sadria, M. Math Candidate, Applied Mathematics Department, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1190782019-06-20T07:21:35Z2019-06-20T07:21:35ZWhy we should be wary of expanding powers of the Australian Signals Directorate<p>Last week, Home Affairs Minister Peter Dutton <a href="https://www.abc.net.au/insiders/peter-dutton-joins-insiders/11214610">reignited</a> the debate about new spying powers for Australian authorities during an interview on the ABC Insiders program. </p>
<p>His comments followed a police raid on <a href="https://www.bbc.com/news/world-australia-48511217">a journalist’s home</a> earlier this month related to the leaking of sensitive documents detailed in a <a href="https://www.dailytelegraph.com.au/news/nsw/spying-shock-shades-of-big-brother-as-cybersecurity-vision-comes-to-light/news-story/bc02f35f23fa104b139160906f2ae709">story</a> published in 2018. The documents outlined discussions and proposals for new powers for the <a href="https://www.asd.gov.au/about/index.htm">Australian Signals Directorate</a> (ASD) to monitor Australian citizens. </p>
<p>Dutton was at pains to deny this on Sunday’s ABC Insiders interview, stating:</p>
<blockquote>
<p>Well if you look back to what I said at the time, we don’t support spying on Australians, that was a complete nonsense.</p>
</blockquote>
<p>But he went on to say:</p>
<blockquote>
<p>I think there needs to be a sensible discussion about whether or not we’ve got the ability to deal with threats that we face.</p>
</blockquote>
<p>So let’s take a look at the powers the ASD currently has, and whether new powers are really needed.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/r9xNIKH4ZZI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">ABC Insiders interview with Home Affairs Minister Peter Dutton.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-raids-on-australian-media-present-a-clear-threat-to-democracy-118334">Why the raids on Australian media present a clear threat to democracy</a>
</strong>
</em>
</p>
<hr>
<h2>What is the role of the ASD?</h2>
<p>The ASD became a statutory agency in 2018 following the <a href="https://www.pmc.gov.au/national-security/2017-independent-intelligence-review">recommendations of an intelligence review</a> in 2017. </p>
<p>It sits within the Defence portfolio and is <a href="https://www.asd.gov.au/about/introduction.htm">responsible for</a>:</p>
<ul>
<li>cyber security </li>
<li>collection and communication of foreign signals intelligence</li>
<li>prevention and disruption of offshore cyber-enabled crime</li>
<li>support for military operations</li>
<li>assisting the national security community in Australia. </li>
</ul>
<p>Its focus is on activity that takes place outside Australia.</p>
<h2>What new powers are we talking about?</h2>
<p>The government hasn’t revealed any official plans to increase the powers of the ASD, but the original 2018 <a href="https://www.dailytelegraph.com.au/news/nsw/spying-shock-shades-of-big-brother-as-cybersecurity-vision-comes-to-light/news-story/bc02f35f23fa104b139160906f2ae709">story</a> written by Daily Telegraph journalist Annika Smethurst cited leaked documents suggesting the ASD would gain powers to secretly spy on Australian citizens. </p>
<p>The powers proposed in the documents reportedly included the ability to access emails, bank records and text messages of Australian citizens without their knowledge. (Currently, under the <a href="https://www.legislation.gov.au/Details/C2019C00018">Federal Intelligence Services Act</a>, the ASD is restricted to gathering intelligence and fighting cyber crime offshore.)</p>
<p>Under current laws, the Australian Federal Police (<a href="https://www.afp.gov.au/what-we-do">AFP</a>) and the Australian Security Intelligence Organisation (<a href="https://www.asio.gov.au/what-we-do.html">ASIO</a>) are the primary federal organisations with the power to undertake actions against individuals or organisations within Australia. The Intelligence Services Act does allow for requests of assistance to be made of the ASD, but these must be at the direction of the responsible minister. </p>
<p>In the case of <a href="https://www.asio.gov.au/special-powers.html">ASIO</a>, the Attorney-General can issue a warrant for the use of special powers, such as entering a premises to insert listening devices. A warrant to question or detain a person can only be obtained by applying to a judge appointed by the Attorney-General.</p>
<p>The AFP primarily obtains its search warrants and powers under the <a href="http://www5.austlii.edu.au/au/legis/cth/consol_act/ca191482/s3e.html">Commonwealth Crimes Act</a>. It needs to convince a judge that there is reasonable grounds for issuing the warrant.</p>
<p>By contrast, Smethurst’s story alleged that the expanded powers would allow the ministers for defence and home affairs to authorise a warrant sought by the ASD to undertake onshore actions, without judicial oversight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=481&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=481&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=481&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280166/original/file-20190619-171196-o7lnv9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">National Inteligence Community.</span>
<span class="attribution"><a class="source" href="https://www.oni.gov.au/national-intelligence-community">Screengrab, Office of National Intelligence</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-the-australian-intelligence-community-works-94422">Explainer: how the Australian intelligence community works</a>
</strong>
</em>
</p>
<hr>
<h2>Are the new powers needed?</h2>
<p>On Sunday’s Insiders program, Dutton attempted to frame the argument for new powers in terms of criminal activity. He used the examples of online paedophilia and cyber attacks on institutions such as banks and universities. </p>
<p>For that argument to work, we would have to see <a href="https://www.abc.net.au/news/2019-02-20/is-australia-cyber-hacking/10825642">cyber attacks on our institutions</a> originating from within Australia. That is simply not a current threat, and this has <a href="https://www.csis.org/programs/cybersecurity-and-governance/technology-policy-program/other-projects-cybersecurity">certainly not been the case</a> generally.</p>
<p>The <a href="https://www.oaic.gov.au/privacy-law/privacy-act/notifiable-data-breaches-scheme/quarterly-statistics-reports/notifiable-data-breaches-scheme-12-month-insights-report">Office of the Information Commissioner</a> reported that in the 12 months to March 31, 2019, there were 964 data breach notifications under the National Data Breach scheme, 60% of these were criminal or malicious. But no specific details are provided as to where the threat originated from.</p>
<p>The reality is that law enforcement agencies already have powers that allow them to access emails, bank records and text messages of Australian citizens – usually after satisfying a judge there is a reasonable need to do so. </p>
<p>The AFP currently targets online child abuse and paedophilia with the <a href="https://www.afp.gov.au/what-we-do/crime-types/child-protection/virtual-global-taskforce">Virtual Global Taskforce</a>, which cooperates with INTERPOL, EUROPOL and other law enforcement agencies. The AFP Child Protection Operations (<a href="https://www.afp.gov.au/what-we-do/services/child-protection/online-child-sex-exploitation">CPO</a>) team “performs an investigative and coordination role within Australia for multijurisdictional and international online child sex exploitation matters. It deals with cases in the online, and travel and tourism environments”.</p>
<p>In addition, the AFP’s Cybercrime Investigation teams within the <a href="https://www.cyber.gov.au/">Australian Cyber Security Centre</a> can undertake targeted intelligence to investigate cybercrimes of national significance. In any event, either ASIO or the AFP can make requests for assistance from the ASD under the Act as required. </p>
<p>The key difference is that under the new proposals is that some of these activities could being done in secret. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Th6EKCwhGrs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Mike Burgess, Director-General on the Australian Signals Directorate, delivers an address on offensive cyber security.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-state-actor-has-targeted-australian-political-parties-but-that-shouldnt-surprise-us-111997">A state actor has targeted Australian political parties – but that shouldn't surprise us</a>
</strong>
</em>
</p>
<hr>
<h2>We should be concerned</h2>
<p>The leaked proposal effectively suggests a blurring of the line between an externally focused defence organisation and internally focused law enforcement agencies. If the new powers are in line with those reported last year, they could potentially sideline the Attorney-General, and give the home affairs and defence ministers power in the approval process for use of the ASD’s functions. </p>
<p>It would take powers primarily designed to defend Australia against external threats and use them for internal investigations against Australian citizens. </p>
<p>Australians should rightly be concerned about any shift to an intelligence or investigative model that is based on the introduction of greater powers on the one hand, and less oversight and governance on the other.</p>
<p>The case needs be made that current laws and powers are ineffective and that there is a real need for any additional powers. Only then should serious consideration be given to the proposals outlined above. Issues of governance and transparency should be paramount in any realistic discussion of increasing the role and power of the ASD.</p><img src="https://counter.theconversation.com/content/119078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terry Goldsworthy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australians should be concerned about any shift to an intelligence model that is based on the introduction of greater powers on the one hand, and less oversight and governance on the other.Terry Goldsworthy, Associate Professor in Criminology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188412019-06-17T08:35:47Z2019-06-17T08:35:47ZExplainer: what is ‘hybrid warfare’ and what is meant by the ‘grey zone’?<figure><img src="https://images.theconversation.com/files/279751/original/file-20190617-118501-nrdczb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is an ongoing, low intensity cyber conflict between nation states that involves attacks and counter-attacks on critical infrastructure like power grids.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cyber-attack-written-newspaper-shallow-dof-208077409?src=NVocoXO6mtcudM-V8T3-5A-1-9">Shutterstock</a></span></figcaption></figure><p>At a conference last week, Australia’s defence minister Linda Reynolds and Defence Force chief Angus Campbell referred to national security risks using two terms that may not be familiar to many. In her speech, Senator Reynolds <a href="https://www.minister.defence.gov.au/minister/lreynolds/speeches/aspi-international-conference-war-2025">said</a>: </p>
<blockquote>
<p>What is clear now, is that the character of warfare is changing, with more options for pursuing strategic ends just below the threshold of traditional armed conflict – what some experts like to call grey-zone tactics or hybrid warfare. </p>
</blockquote>
<p>The concepts of “hybrid warfare” and the “grey zone” arguably build on longstanding military strategies. What is relatively new is adversaries exploiting information technology vulnerabilities to achieve an outcome. </p>
<p>As Senator Reynolds and <a href="https://www.aspistrategist.org.au/adf-chief-west-faces-a-new-threat-from-political-warfare/">General Campbell</a> highlight, activities in the information domain are a serious threat to our national interests. They demand the development of strategies to counter them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-internet-is-now-an-arena-for-conflict-and-were-all-caught-up-in-it-101736">The internet is now an arena for conflict, and we're all caught up in it</a>
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</em>
</p>
<hr>
<h2>What is hybrid warfare?</h2>
<p><a href="https://www.oxfordresearchgroup.org.uk/blog/interview-sascha-dov-bachmann">Hybrid warfare</a> is an emerging, but ill-defined notion in conflict studies. It refers to the use of unconventional methods as part of a multi-domain warfighting approach. These methods aim to disrupt and disable an opponent’s actions without engaging in open hostilities. </p>
<p>While the concept is fairly new, its effects and outcomes are often in the headlines today. Russia’s approach to Ukraine is an <a href="https://academic.oup.com/ia/article/92/1/175/2199942">example</a> of this form of warfare. It has involved a combination of activities, including disinformation, economic manipulation, use of proxies and insurgencies, diplomatic pressure and military actions. </p>
<p>The term hybrid warfare originally referred to irregular non-state actors with advanced military capabilities. For example, in the 2006 Israel-Lebanon War, Hezbollah employed a host of different tactics against Israel. They included guerilla warfare, <a href="https://apps.dtic.mil/dtic/tr/fulltext/u2/a516871.pdf">innovative use of technology</a> and effective information campaigning.</p>
<p>Following that war, in 2007, American defence researcher <a href="http://www.potomacinstitute.org/images/stories/publications/potomac_hybridwar_0108.pdf">Frank Hoffman</a> expanded on the terms “hybrid threat” and “hybrid warfare” to describe employing multiple, diverse tactics simultaneously against an opponent. </p>
<h2>What do is meant by the ‘grey zone’?</h2>
<p>Related to hybrid warfare, the term <a href="https://www.clingendael.org/publication/return-political-warfare">political warfare</a> commonly refers to power being employed to achieve national objectives in a way that falls short of physical conflict. </p>
<p>Such warfare is conducted in the “grey zone” of conflict, meaning operations may not clearly cross the threshold of war. That might be due to the ambiguity of international law, ambiguity of actions and attribution, or because the impact of the activities does not justify a response. </p>
<p>Recent discussions, including last week’s speeches, focus on the newer aspects of these concepts – specifically activities in the information domain. </p>
<p>Our increasing connectivity and reliance on information technology is a vulnerability that is being targeted by two key threats: cyber attacks, and the subversion of our democratic institutions and social cohesion. Both are <a href="https://www.themandarin.com.au/105494-michael-pezzullos-seven-gathering-storms-national-security-in-the-2020s/">recognised challenges</a> to our national security. </p>
<p>These are “hybrid threats” as they may be employed as part of a broader campaign – including political, criminal and economic activities. And because they feature the ambiguity associated with the grey zone, they are well suited to achieve political outcomes without resorting to traditional conflict.</p>
<p>While cyber attacks are carried out by a variety of actors, there is an ongoing low intensity cyber conflict between nation states. This includes attacks and counter-attacks on critical infrastructure, such as power grids, <a href="https://www.nytimes.com/2019/06/15/us/politics/trump-cyber-russia-grid.html">reported</a> between the US and Russia.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/russian-trolls-targeted-australian-voters-on-twitter-via-auspol-and-mh17-101386">Russian trolls targeted Australian voters on Twitter via #auspol and #MH17</a>
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</p>
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<h2>How do you defend against cyber attacks?</h2>
<p>Cyber attacks are of particular concern to the Australian government. What makes them quite different from traditional warfare is that the targets of cyber attacks are not just the military (although the Australian Defence Force (ADF) has <a href="https://www.abc.net.au/news/2019-02-19/australian-army-under-cyber-attack-major-general-marcus-thompson/10822966">recognised</a> the significant risks it faces in operating highly information-dependent systems). </p>
<p>A hybrid warfare approach would likely target all elements of national power including critical infrastructure, business systems and individuals. </p>
<p>Australia has taken great steps to protect against cyber attacks. Led by the Australian Signals Directorate (ASD), public and private sector organisations are being encouraged to improve their cyber security through the “<a href="https://www.cyber.gov.au/publications/essential-eight-explained">essential 8</a>” mitigations. These mitigations are focused on improving the security of systems via controls, such as patching vulnerabilities and multi-factor authentication, but they should be complemented with programs to increase user awareness of cyber threats. </p>
<p>ASD also has an <a href="https://www.aspi.org.au/report/australias-offensive-cyber-capability">acknowledged</a> ability to undertake active defence to respond to attacks. This effectively makes ASD the only authorised entity in Australia who can hack back. </p>
<p>Despite efforts to <a href="https://ccdcoe.org/research/tallinn-manual/">characterise the cyber grey zone</a>, it is surrounded by gaps in international law. The government’s <a href="https://dfat.gov.au/international-relations/themes/cyber-affairs/aices/pdf/DFAT%20AICES_AccPDF.pdf">international cyber engagement strategy</a> is helping to address these gaps. The strategy establishes priorities to work with other nations on security, standards of behaviour and cooperative mechanisms to fight cyber crime. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/view-from-the-hill-dutton-suffers-reflux-after-tasty-chinese-meal-115150">View from The Hill: Dutton suffers reflux after tasty Chinese meal</a>
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<h2>How do you defend against political warfare?</h2>
<p>Disinformation and deception are not new concepts in warfare, but we have seen a significant change in how information is being manipulated by nation states, especially through social media.</p>
<p>Authoritarian governments have demonstrated the ability and intent to <a href="https://www.belfercenter.org/publication/geopolitics-information">control information</a> domestically. For example, information in China is controlled by the state through a censorship system commonly known as <a href="https://www.washingtonpost.com/business/the-great-firewall-of-china/2018/11/05/5dc0f85a-e16d-11e8-ba30-a7ded04d8fac_story.html?noredirect=on&utm_term=.40c25dd0e724">the Great Firewall of China</a>. </p>
<p>There also is growing evidence such authoritarian governments may seek to <a href="https://www.belfercenter.org/index.php/publication/can-democracy-survive-information-age">interfere</a> with other nations’ affairs through manipulation of information. The 2016 US election and UK Brexit vote are suspected to have been influenced through such interference by Russia.</p>
<p>Democratic nations have a level of transparency and adherence to international law that precludes their involvement in disinformation campaigns. For similar reasons, they also typically aren’t prepared to defend against such campaigns.</p>
<p>But, as suggested by <a href="https://www.smh.com.au/politics/federal/grey-zone-tactics-australia-vulnerable-to-political-warfare-defence-chief-warns-20190613-p51xj6.html">General Campbell</a>, this needs to change. More needs to be done to develop our national ability to coordinate efforts to counter a hybrid campaign.</p>
<p>The hybrid warfare term may be in vogue, and its continuing use is uncertain. But hybrid warfare, with its various forms, is here to stay due to its obvious benefits to the actor employing it: deniability and exploiting the legal grey zone.</p>
<p>While the term might be interpreted by some as a matter for the military, there are many aspects that require a coordinated national effort if we are to preserve our freedoms and interests. In that regard, Senator Reynolds made a very important point in her speech last week: </p>
<blockquote>
<p>It is vital that we bring all of our sources of national power to bear on this problem, not just those of Defence.</p>
</blockquote><img src="https://counter.theconversation.com/content/118841/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our increasing connectivity and reliance on information technology is a vulnerability being targeted by two key threats: cyber attacks and the subversion of our democratic institutions.Andrew Dowse, Director, Defence Research and Engagement, Edith Cowan UniversitySascha-Dominik (Dov) Bachmann, Associate Professor in International Law (BU) and (extraordinary) Reader in War Studies (SEDU), Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/936572018-03-21T00:09:09Z2018-03-21T00:09:09ZAnimal study hints at link between vitamin D and autism, but don’t start supplementing yet<figure><img src="https://images.theconversation.com/files/211187/original/file-20180320-31624-1iucm5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Multiple studies have found links between vitamin D and autism, but nothing is conclusive yet. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/5iYJoPXTd4o">Unsplash</a></span></figcaption></figure><p>In the last few decades scientists have been discovering the many uses of vitamin D and the possible effects of not getting enough of it. An animal study published <a href="http://joe.endocrinology-journals.org/content/237/2/73.abstract">today</a> has found a possible link between the amount of the vitamin in the mother’s diet and her offspring’s behaviour. </p>
<p>Little was known about the role of vitamin D in humans until the 1990s, when it was discovered most tissues and cells in the body had a receptor specifically designed to attach to molecules of vitamin D. Our knowledge of evolution – and that most aspects of our body have evolved for a very good reason – twigged scientists to the possibility vitamin D may be important to bodily function.</p>
<p>Since this time, considerable research has found an important role for vitamin D in the development of bones, the brain and a number of other organs. A 2014 <a href="http://www.bmj.com/content/348/bmj.g2035">report</a> found a lack of vitamin D has been linked to 137 different conditions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">What causes autism? What we know, don’t know and suspect</a>
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<h2>What did the study find?</h2>
<p>Female rats were fed one of two diets just prior to becoming pregnant. The first diet contained adequate amounts of vitamin D (a vitamin D “replete” diet). The second diet contained minimal amounts (a vitamin D “deficient” diet). We then studied the offspring that resulted from these pregnancies.</p>
<p>In both humans and rats, a baby developing in the womb is completely reliant on the mother’s vitamin D stores. This means a mother’s level of exposure to vitamin D during pregnancy is highly correlated with the levels of vitamin D in the baby.</p>
<p>The data indicated there were several behavioural differences between the offspring from the two different groups. The offspring of females that had a vitamin D “deficient” diet during pregnancy showed differences in their social behaviour as well as in tasks of learning and memory compared to offspring of females fed a vitamin D “replete” diet. </p>
<h2>What does this mean?</h2>
<p>The data collected during the study indicated vitamin D deficiencies during pregnancy may lead to differences in the brain and behavioural development of offspring. </p>
<p>Of critical importance is the acknowledgement it is a long way up the evolutionary tree from rat to human. What research demonstrates is true for rats may not be for humans.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/of-mice-and-men-why-animal-trial-results-dont-always-translate-to-humans-73354">Of mice and men: why animal trial results don’t always translate to humans</a>
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<p>Nevertheless, this study sits in a broader context of a large body of research linking maternal vitamin D during pregnancy and child development. Many of the previous <a href="https://molecularautism.biomedcentral.com/articles/10.1186/s13229-017-0125-0">studies</a> have examined mice or rats. Therefore, these are subject to the same caveats as this most recent study. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211188/original/file-20180320-31602-eik709.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Animal studies can tell us a lot, but the results won’t necessarily apply to humans.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>A growing number of human studies have also been conducted, particularly in the area of autism. Autism is a neurodevelopmental condition in which children develop differently and show difficulties with social and communication skills as well as repetitive behaviours. </p>
<p>Numerous human <a href="https://www.ncbi.nlm.nih.gov/pubmed/27663117">studies</a> have provided an inkling of a link between vitamin D deficiency during pregnancy and the chance of having a child with autism. While the increase in chance is very small, the finding has been replicated in a different <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/339D73DC98FF9C2672A9A099D4F0F4F6/S2056472400002064a.pdf/gestational_vitamin_d_deficiency_and_autism_spectrum_disorder.pdf">country</a>.</p>
<p>Another key <a href="https://molecularautism.biomedcentral.com/articles/10.1186/2040-2392-6-3">study</a> found lower levels of vitamin D in the blood of newborn babies who later developed autism compared to siblings who did not develop autism.</p>
<p>No study that examines the behaviour of rats could ever claim to provide an accurate investigation of the study of human behaviours. What this study adds is another piece of evidence that vitamin D levels may be important to the development of brain and behaviour in mammals. </p>
<h2>Should expectant mothers supplement their vitamin D?</h2>
<p>The findings of the study don’t mean expectant mothers should rush out to buy vitamin D supplements. There have been <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2478893">studies</a> highlighting the health risks posed by “over-supplementation” of vitamins. Concerns have also been <a href="https://theconversation.com/the-sun-goes-down-on-vitamin-d-why-i-changed-my-mind-about-this-celebrated-supplement-52725">raised</a> about the marketing machines that push the “health effects” of vitamin supplements with very little evidence to corroborate the claims. </p>
<p>There is currently not enough evidence to recommend vitamin D supplementation for all pregnant women. Large-scale randomised controlled trials that comprehensively examine the safety of supplementation for humans, as well as the effect of this supplementation on the mother and the developing child, are critical to moving to this next step.</p>
<p>The best current guidance is to ignore the noise and the hype, and follow the clinical advice provided by the attending obstetrician, GP or midwife.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-more-children-have-autism-now-than-before-4497">Do more children have autism now than before? </a>
</strong>
</em>
</p>
<hr>
<h2>What causes autism?</h2>
<p>There is <a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">no one single cause of autism</a>. Various genetic factors are likely to be the ultimate cause of most cases of autism. These may work by themselves, or in combination with environmental factors, to lead a child’s brain to develop differently and result in the behaviours we diagnose as “autism”.</p>
<p>The more important question is how we can better help children and adults on the autism spectrum to reach their full potential. While this particular piece of research focuses on the earliest part of life, it’s critical to remember autism affects all ages. By focusing on the human behind the diagnosis, and how we can adapt to the unique strengths of each individual, our community will be enriched beyond measure.</p><img src="https://counter.theconversation.com/content/93657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the NHMRC, ARC and the Autism CRC.</span></em></p><p class="fine-print"><em><span>Caitlin Wyrwoll receives funding from the Ada Bartholomew Fund. </span></em></p>Autism and vitamin D: an in-depth look at what the new study actually found.Andrew Whitehouse, Winthrop Professor, Telethon Kids Institute, The University of Western AustraliaCaitlin Wyrwoll, Lecturer, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/898362018-03-08T22:08:37Z2018-03-08T22:08:37ZWhat happened to Asperger’s syndrome?<figure><img src="https://images.theconversation.com/files/208584/original/file-20180301-152559-ef4kzb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In 2013, the American Psychiatric Association stopped using the clinical term Asperger's syndrome, grouping the condition with other forms of autism under the term 'Autism Spectrum Disorder.'</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>I often get asked “Does my child have Asperger’s?” in my clinical work. Or, “Do I have Asperger’s?” </p>
<p>These are challenging questions to answer. They have stimulated much debate among clinicians, researchers, and those who have identify with the term over the past several years.</p>
<p>Asperger’s Disorder (more commonly referred to as Asperger’s syndrome) is linked to the work of Hans Asperger, an Austrian physician who published his initial work in German in 1944. </p>
<p>He described children who presented with strong vocabulary and language skills in conjunction with a range of symptoms: Odd social use of language and tone of voice, social isolation from peers, repetitive behaviours, strong interests in unusual topics, and a desire to maintain structure and routine in their lives. </p>
<p>Much of the English-speaking world remained unaware of Asperger’s work until 1991 when it was <a href="https://www.cambridge.org/core/books/autism-and-asperger-syndrome/2B02EA3FF2E15A53E4B905446C47A6E8">translated and brought to the attention of clinicians</a> by <a href="https://www.theguardian.com/lifeandstyle/2011/may/24/autistic-spectrum-disorder-lorna-wing">English psychiatrist Lorna Wing</a>. </p>
<p>Although this description is similar to that of autism, Asperger’s account differed in that speech was less commonly delayed, motor clumsiness was more common, onset of symptoms occurred later, and his initial cases were all male.</p>
<h2>A ‘pervasive developmental disorder’</h2>
<p>Asperger’s syndrome made its official appearance when the World Health Organization (WHO) published the initial version of the <a href="http://apps.who.int/classifications/icd10/browse/2010/en#/F84.5">International Classification of Diseases (ICD), 10th edition</a>. </p>
<p>Subsequently, the American Psychiatric Association (APA) included it in the newly defined category of Pervasive Developmental Disorders (PDDs) alongside Autistic Disorder and other similar diagnostic terms in 2000, which brought more widespread clinical attention and an appreciation that not only males can be affected.</p>
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<figcaption><span class="caption">Increasingly movies, such as ‘Mozart and The Whale,’ depict characters with Asperger’s syndrome.</span></figcaption>
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<p>Interestingly, the APA reportedly included Asperger’s in an effort to <a href="http://www.childpsych.theclinics.com/article/S1056-4993(02)00052-4/fulltext">prompt researchers to identify potentially distinct subgroups of autism</a> — so that assessment and treatment could be refined and targeted. </p>
<p>These efforts yielded variable results, and the general research consensus is that <a href="https://link.springer.com/article/10.1007/s10803-004-2001-y">clinicians applied diagnostic criteria inconsistently</a> and that <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107413">individuals with Asperger’s and autism are more similar than different</a>. </p>
<h2>Replaced by ‘Autism Spectrum Disorder’</h2>
<p>As a result of this inconsistent application and similarities among the PDDs, the APA removed the clinical term from use and replaced it with a broad Autism Spectrum Disorder (ASD) term — encompassing several previous distinct disorders — when they published their <a href="https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0ahUKEwih9ryd-aXZAhUrwVQKHbsnA9oQFghIMAI&url=https%3A%2F%2Fwww.psychiatry.org%2FFile%2520Library%2FPsychiatrists%2FPractice%2FDSM%2FAPA_DSM-5-Autism-Spectrum-Disorder.pdf&usg=AOvVaw3X2R_mnICR-j5rcKTNTZrm">most recent diagnostic manual</a> in 2013. </p>
<p>However, the WHO continues to use the term, at least until they release the <a href="http://apps.who.int/classifications/icd11/release/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f437815624">ICD 11th edition</a> in 2019, which is reported to also use ASD in place of previous diagnostic terms.</p>
<p>It is this recent transition in clinical terminology that has stimulated substantial debate. </p>
<p>Should Asperger’s syndrome have been removed from use and replaced by the broad ASD term? </p>
<p>Scientists, clinicians and those living with Asperger’s have disagreed, sometimes quite strongly, on this topic. There was initial evidence that the new APA framework would result in a substantial number of individuals with Asperger’s syndrome <a href="http://www.jaacap.com/article/s0890-8567(12)00042-1/abstract">no longer meeting criteria for a clinical diagnosis</a>. And there are concerns this could have a <a href="http://www.tandfonline.com/doi/abs/10.1080/1536710X.2014.912186">negative impact on their financial support and services</a>, which are dependent on a diagnosis. </p>
<p>However, the APA states that individuals who had a diagnosis under the previous framework should not lose their diagnosis. And research has supported the grouping of previous clinical labels under the broader ASD term. </p>
<h2>‘Aspies’ identify with clinical label</h2>
<p>Despite these views, Asperger’s syndrome has become societally popular, with characters in <a href="http://www.accountantmovie.com/#start">movies such as <em>The Accountant</em></a> and <a href="https://www.nbc.com/community?nbc=1">television shows such as <em>Community</em></a> being portrayed as either having the condition or displaying traits commonly associated with it. </p>
<p>An interesting social phenomenon also began to occur in the early 2010s, in which those with Asperger’s began to personally identify with their clinical label — referring to themselves as “Aspies” or other similar terms that represent their unique attributes and characteristics. </p>
<p>Indeed, it is this personal identification that has led to some of the more <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459313488006">personal or emotional responses to the changes in diagnostic terminology</a>, with Aspies often <a href="http://journals.sagepub.com/doi/abs/10.1177/1049731513495457">rejecting the term ASD</a>.</p>
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<figcaption><span class="caption">In ‘The Accountant,’ Christian Wolff (Ben Affleck) is a math savant who works as a freelance accountant for some of the world’s most dangerous criminal organizations.</span></figcaption>
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<p>In the end, it appears as though Asperger’s has faded from clinical use, while remaining a popular term to describe a certain type of individual. </p>
<p>Given that the term was initially introduced in an effort to determine if it truly differs from other clinical descriptions, it is interesting to observe and reflect upon society’s adoption and integration of it. </p>
<h2>Asperger’s unique characteristics</h2>
<p>Many clinicians will even admit (if only privately) that they understand the unique characteristics demonstrated by someone with Asperger’s. </p>
<p>As for how I respond to parents, I try to describe the current clinical framework and how it has evolved over time. </p>
<p>I tell them that I appreciate the unique attributes commonly associated with the Asperger’s term and I suggest that if their child’s behaviour seems to align with that description, then they or their child may feel more comfortable thinking about things in that way. </p>
<p>I also work with families to understand how people can often personally identify with clinical terms (for example “an autistic person” as opposed to “a person with autism”) as there is concerted effort from the ASD community to use such person-first language. </p>
<p>In the end, the term that clinicians, families or individuals use is a matter of personal preference. One thing is certain though, Asperger’s is here to stay, even if the diagnosis isn’t.</p><img src="https://counter.theconversation.com/content/89836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam McCrimmon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As awareness of Asperger’s syndrome has risen within popular consciousness and culture, it has faded from clinical use.Adam McCrimmon, Associate Professor of Educational Studies in School Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/912422018-02-21T23:59:06Z2018-02-21T23:59:06ZHow we can design the music of our emotions<figure><img src="https://images.theconversation.com/files/207053/original/file-20180220-116327-soa547.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Biomusic' technology collects autonomic nervous system signals, such as heart rate, through a wearable sensor and maps them to sound.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Humans have been attempting to teach computers to read their emotions since the 1990s, when MIT professor Rosalind W. Picard founded the field of <a href="http://affect.media.mit.edu/">affective computing</a>. </p>
<p>Almost 30 years later, affective computing technologies are starting to appear in the commercial mainstream. These include the <a href="https://azure.microsoft.com/en-us/services/cognitive-services/emotion/">Microsoft Emotion API</a>, which analyzes facial expressions to detect a range of feelings, and <a href="https://www.affectiva.com/product/emotion-api-speech/">Affectiva’s Emotion Speech API</a>, which identifies emotion in pre-recorded audio segments. </p>
<p>These technologies may have particular significance for individuals with autism spectrum disorder (ASD), who often struggle with social interaction and communication. </p>
<p>The potential is obvious: If smartphone apps could provide unobtrusive emotional cues in real time, they could be used by individuals with ASD to facilitate social interactions. </p>
<p>Facial expression analysis could provide real-time feedback to those with ASD on the emotional state of people they’re having conversations with.</p>
<p>And wearable physiological sensors — such as the biomusic technology I develop — could provide individuals with ASD moment-to-moment insights on other people’s emotional reactions.</p>
<h2>Music of the nervous system</h2>
<p>I lead <a href="http://www.moraeslab.com/biapt/people/">a team that is actively developing a technology called “biomusic”</a> that translates physiological signals into musical output. </p>
<p>The technology collects autonomic nervous system signals — such as the amount of sweat in the skin and heart rate — through a wearable sensor. It maps features of these signals to sounds, generated and synthesized in real time. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=222&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=222&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=222&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=278&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=278&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207170/original/file-20180220-116330-m5j8ca.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=278&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Collaborative design of biomusic technology for individuals with autism helps to avoid stigma and privacy violations.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Since autonomic nervous system signals change with emotional state, changes in biomusic can reflect <a href="https://www.ncbi.nlm.nih.gov/pubmed/27625593">increases in anxiety</a>. They can also reflect recognition of another person. </p>
<p>In one of our pilot studies, for example, we demonstrated that <a href="https://www.hindawi.com/journals/ecam/2011/732394/abs/">the autonomic nervous system signals of children in complex continuing care changed in the presence of therapeutic clowns</a>, even when there was no other evidence of recognition or responsiveness.</p>
<p><a href="http://www.tandfonline.com/doi/abs/10.3109/07434618.2012.760648">My initial research</a> demonstrated that playing the biomusic of a child with profound multiple disabilities improved their caregiver’s interactions with, and perceptions of, them. </p>
<h2>Risks of ‘designing for autism’</h2>
<p>When the autistic community began expressing an interest in using biomusic for individuals with ASD, I struggled to find a way to tailor the technology for their needs. And to do it without falling into the trap of “designing for autism.”</p>
<p>Those in the autistic community have pushed back against the generalizations of the autistic condition. Many are fond of the saying — “If you’ve met one person with autism, you’ve met one person with autism” — to ward off well-intentioned but ill-informed designs based on preconceived assumptions about ASD. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207054/original/file-20180220-116360-1davb4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows that playing the biomusic of a child with disabilities in real time improved their caregiver’s interactions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Other problems can arise in the practice of “designing for autism.” Technologies designed for a specific (dis)ability run the risk of becoming stigmatizing, even if they solve a real problem. </p>
<p>The ethical questions that accompany all affective technologies — for example questions about how to maintain privacy — become much bigger for autistic individuals, who often struggle with emotional expression and awareness.</p>
<h2>Stories of inclusion and exclusion</h2>
<p>In efforts co-led by medical anthropologist <a href="https://mcgill.ca/tcpsych/faculty/melissa-park">Melissa Park</a> and art historian <a href="http://media.mcgill.ca/en/content/tembeck-tamar">Tamar Tembeck</a>, we sought out individuals for guidance. This included persons on the spectrum, family members, educators and employers of people on the spectrum, academics and members of the tech industry. </p>
<p>Our group of 30 people came together for a three-day workshop in Montréal to discuss how to effectively <a href="http://www.connectednarratives.org">meld biomusic and autism</a>. During the workshop, we engaged with biomusic in various ways to explore its potential opportunities, uses and misuses. </p>
<p>We walked through a fine arts museum while broadcasting our real-time biomusic to gain an understanding of what it was like to have strangers aware of our internal reactions. </p>
<p>We observed a dancer, Erin Flynn, dancing to her own biomusic, which allowed us to see the connection between her movement and the music — and to juxtapose the stillness of her body with the effort revealed by the intensity of her biomusic. </p>
<p>We listened to stories of inclusion and exclusion of people with ASD from our community partners, and lectures on theoretical frameworks for biomusic technology from our academic partners. </p>
<p>Over the three days, our group struggled through ethical, aesthetic and practical issues in the interface of biomusic and autism, and debated ways to address these concerns in future iterations of the technology.</p>
<h2>Encoding sound for privacy</h2>
<p>The discussions have profoundly shaped my team’s approach to designing biomusic technology. The anecdotes and stories shared by community members sparked ideas on how to overcome some nagging technical challenges. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207316/original/file-20180221-132660-1ibh7qi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dancer, Erin Flynn, dances to her own biomusic.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For example, our approach to issues of privacy shifted when we heard an individual with ASD describe the 20 different sounds she heard in a train engine when neurotypical individuals —those who aren’t on the spectrum —were only hearing two. </p>
<p>As a result of this story, we started designing auditory displays to be used for bio-feedback in which critical information about emotional changes were encoded to be imperceptible to neurotypical people. </p>
<p>A set of critical academic talks also inspired my team to design ways in which neurotypical people and those with ASD could experience their biomusic together. </p>
<h2>A collaborative design process</h2>
<p>This avenue of thinking has not only allowed us to explore potential new forms of interpersonal interaction, it has allowed us to further our understanding of how to reduce the stigma associated with using our assistive technology. </p>
<p>Formal and informal workshop discussions about the nature of emotion, from the perspective of those with ASD, steered us to design biomusic’s user interface so that the process of labelling an emotion was both collaborative and contextual. </p>
<p>These design decisions not only improve the information that biomusic receives about a user’s emotional state, they address more broadly the challenge in affective computing of gathering reliable subjective report of an individual’s moment-to-moment emotional state.</p>
<p>Navigating the dangers of “designing for autism” becomes possible when designers create ways for individuals with autism, and those who work and live with them, to become deeply engaged in the design process. </p>
<p>This practice increases the acceptance of the final technology in the autism community. It also results in innovative design ideas and implementations that can benefit individuals across the spectrum of neurodiversity.</p><img src="https://counter.theconversation.com/content/91242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stefanie Blain-Moraes receives funding from the Natural Science and Engineering Research Council (NSERC), the Canadian Institute of Health Research (CIHR), the Social Science and Humanities Research Council (SSHRC) and the Fonds de Recherche Nature et technologies Quebec. </span></em></p>Imagine a collaboratively-designed smartphone app that could provide cues to an autistic individual – about the emotional state of people they are communicating with.Stefanie Blain-Moraes, Assistant Professor of Physical and Occupational Therapy, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/887782018-01-08T22:47:38Z2018-01-08T22:47:38ZDoes my child have autism or is this ‘normal’ behaviour?<figure><img src="https://images.theconversation.com/files/201070/original/file-20180107-26169-1jsyy8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For many parents, sorting the "normal" quirkiness of childhood behaviour from the symptoms of autism spectrum disorder (ASD) can be anxiety provoking. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Raising a child is often one of the most challenging and joyous events in a person’s life. Watching your child grow and develop is a source of delight. However, some parents become concerned when their child appears to develop differently than others. </p>
<p>At times, parents may worry about the possibility of autism spectrum disorder, or ASD.</p>
<p>As an associate professor and registered psychologist in the <a href="http://werklund.ucalgary.ca">Werklund School of Education</a> at the University of Calgary, I specialise in diagnostic assessment of ASD for individuals from toddlerhood to adulthood. </p>
<p>Many families speak to me of their concerns (or others’ concerns) for their child and wonder about the possibility of ASD. </p>
<p>I have found that informing parents of the symptoms of ASD can help them decide if their worries are warranted. As well, many parents are unaware of how the disorder is currently characterized and therefore struggle to understand if an assessment may benefit their child.</p>
<h2>Individual symptoms are unique</h2>
<p>ASD is, according to the description used by most clinicians in North America, a <a href="https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890425596.dsm01">“neurodevelopmental disorder”</a> — meaning it becomes apparent during a child’s early development and results in difficulties with their personal, social, academic or occupational functioning. </p>
<p>Those with ASD typically demonstrate symptoms by two to three years of age. However, many will display signs earlier in development and ASD can be reliably diagnosed around <a href="http://www.sciencedirect.com/science/article/pii/S0890856714006923">18 months of age</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201069/original/file-20180107-26160-1nvf0c5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some children with ASD are very sensitive to sensory stimuli and become overly distressed by household noises.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Individuals must demonstrate challenges in two domains of functioning: 1) social communication and 2) restricted and/or repetitive patterns of behaviour. </p>
<p>Importantly, individuals with ASD are seen to fall on a “spectrum,” meaning that they can experience a range of difficulties within each domain. This means that each individual’s specific symptoms will be unique.</p>
<h2>Social communication challenges</h2>
<p>Within the <a href="http://www.sciencedirect.com/science/article/pii/S0890856709000318">social communication domain</a>, children may demonstrate a delay in speech development — either by using no single words by 18 months or no two- to three-word phrases by 33 months of age. </p>
<p>They may fail to direct others’ attention (e.g., by pointing or eye contact), follow another’s point or respond to their name. Sometimes they lack, or have limited skill with, pretend play. </p>
<p>Other signs could include reduced interest in playing with peers, not showing or bringing objects to others to share an interest, smiling infrequently at others or failing to gesture to express their needs — for example by nodding or raising their arms to be picked up. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201071/original/file-20180107-26157-x84hn8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some children display symptoms of ASD but then grow out of them naturally.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Many children who receive an ASD diagnosis do not imitate others’ behaviours. For example, they might not wave back to someone who waves at them. Or they struggle to understand others’ language or show a limited range of facial expressions. </p>
<p>Sometimes they use others’ hands as a tool — for example, using a parent’s hand to point at pictures in a book rather than pointing themselves. And they may echo others’ words rather than using their own language to express needs or wants.</p>
<h2>Repetitive patterns of behaviour</h2>
<p>Regarding <a href="http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12207/full">restricted/repetitive patterns of behaviour</a>, some children show a strong preference for, or aversion to, sensory stimuli. For example, a child may crave visual input by staring at a fan for a long periods of time. Or they may be overly distressed by typical household noises, haircuts or being touched. </p>
<p>Children often become attached to specific objects — such as a block or a notebook that they must carry around with them — yet show little interest in toys. They can become intensely interested in things like door knobs or toilet seats, or become obsessed with a familiar cartoon character or toy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201072/original/file-20180107-26154-6mpa8h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smiling infrequently at others can be a sign of ASD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>They may repetitively wave their arms or hands, rock or spin when excited. Some children repeat actions over and over, such as turning a light switch on and off. Some focus on small parts of an object (the wheel of a toy car) rather than the entire object (the car). </p>
<p>Others may insistently line objects up — such as toys or family members’ shoes — and become distressed if the objects are moved. They may be aggressive towards others or may injure themselves. They often crave predictability and struggle when their routines are disrupted.</p>
<h2>Early identification is key</h2>
<p>Importantly, no single symptom is necessary or sufficient for a diagnosis. However, more symptoms do increase the potential for a diagnosis. </p>
<p>As well, many children display symptoms consistent with ASD yet grow out of them naturally and do not receive a diagnosis. Experienced clinicians take typical child development into account when determining if a diagnosis is warranted.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201067/original/file-20180107-26151-18h2lh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early diagnosis can provide families with the financial support needed to access successful interventions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>If you are concerned that your child may have ASD, an important first step is to speak with your doctor or pediatrician. <a href="https://autismcanada.org">Autism Canada</a> is an excellent resource that provides information on assessment and intervention opportunities.</p>
<p>Assessment often involves teams of professionals working together to identify a child’s fit with the symptoms of ASD and typically includes observation of the child in different settings, interviews with parents and completion of assessment tasks to evaluate a child’s development. </p>
<p>Early identification is key. This recognition enables children and their families to access <a href="http://pediatrics.aappublications.org/content/136/Supplement_1/S60.full">interventions and supports that have their greatest impact during early childhood</a>.</p><img src="https://counter.theconversation.com/content/88778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam McCrimmon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early intervention is key to treating autism, but how is a family to know which quirky childhood behaviours might be symptoms? An educational psychologist explains.Adam McCrimmon, Associate Professor of Educational Studies in School Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759622017-04-28T01:52:59Z2017-04-28T01:52:59ZHow parents can help autistic children make sense of their world<figure><img src="https://images.theconversation.com/files/166695/original/file-20170425-13401-10bx60n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with autism sometimes struggle to tell stories, but there are ways parents can help.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teenage-daughter-checked-shirt-sitting-on-590742155?src=FhUyqPr2FE4tBrgLJbqgmg-1-24">Pressmaster / Shutterstock.com</a></span></figcaption></figure><p>Glenn, a high-functioning seventeen-year-old with Autism Spectrum Disorder (ASD), comes home from school and tells his mother at dinner, “Allen was mean today.” His mother debates what to do. Should she ask for more details or let the subject drop? She knows that Glenn is not much of a storyteller.</p>
<p>Personal narratives are commonplace, and many people don’t realize just how important they are. What really happened when we ran into that truck? How did we feel when it happened? Personal narratives are the memories we share about the experiences we’ve had, and <a href="https://books.google.com/books?id=RNCRDgAAQBAJ&pg=PT401">the primary way</a> we make sense of those experiences. </p>
<p>As a researcher, I’ve studied many aspects of <a href="https://books.google.com/books?id=RNCRDgAAQBAJ&pg=PT401">the way children develop narrative skills</a>, and have discovered that personal narrative is a <a href="http://dx.doi.org/10.1007/s10803-012-1585-x">common stumbling block</a> for people with Autism Spectrum Disorder. </p>
<p>Fortunately, parents of children with ASD can help them improve these skills, becoming better storytellers and helping them make sense of the world around them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167032/original/file-20170427-15105-tq31vl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children and adults alike use personal narrative to tell doctors what happened to them or how they’re feeling.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-pediatrician-examining-child-hospital-536017048?src=UdiwTC33yeBCudrXJ_TKFQ-1-5">Monkey Business Images / Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Personal narrative in education</h2>
<p>Personal narrative is a vital part of child development. A child’s ability to tell a story when entering kindergarten <a href="https://eric.ed.gov/?id=ED497278">predicts fourth-, seventh- and tenth-grade reading abilities</a>. When children interact with pediatricians who want to know how they hurt themselves, they tell a personal narrative. It’s also how children tell parents and other authority figures when something has upset them. </p>
<p>Previous research has found that children’s narratives are <a href="https://books.google.com/books?id=yrmQAgAAQBAJ&pg=PA27">shaped in conversations with parents</a>. For instance, if parents ask their preschoolers lots of questions about actions (what happened and when), their children typically wind up telling action-packed narratives. If parents are instead interested in who said what to whom, their children wind up telling narratives filled with dialogue.</p>
<p>While most children develop narrative without special attention to those skills, some children lag behind their peers and could benefit from assistance. Several years ago, I worked with psychology professor <a href="https://www.mun.ca/psychology/bio/peterson.php">Carole Peterson</a> to develop <a href="http://dx.doi.org/10.1017/S0305000998003651">an intervention</a> to improve the narration of preschoolers at risk for academic underachievement due to poverty. </p>
<p>We randomly assigned half the parents to a program where we told them how important narrative was and how to improve their children’s narrative abilities. The other parents were asked to talk with their children as they usually did. After one year, children whose parents were in the intervention had significantly higher vocabularies than children in the control condition. In two years, the intervention children told significantly better narratives than their control peers.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167027/original/file-20170427-15117-189krxt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Young children’s storytelling style is heavily influenced by the questions their parents ask.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-telling-story-mother-179321840?src=WE8Y20gBoaAPL2yboTWHKQ-1-67">didesign021 / Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Personal narrative and autism</h2>
<p>Individuals with typical development can tell a complete, lively, engaging personal narrative by the time they’re <a href="http://dx.doi.org/10.1007/978-1-4757-0608-6">six years old</a>. Autism, however, affects how people are able to tell narratives. </p>
<p>In my research with psychologist <a href="http://faculty.uml.edu/ahillier/">Ashleigh Hillier</a>, we found that individuals with ASD – even those who function at a high level – tell personal narratives <a href="http://dx.doi.org/10.1007/s10803-012-1585-x">significantly less well</a> than peers with typical development. In fact, the narrative skills of individuals with ASD are often years behind developmentally, even into their 20’s and beyond.</p>
<p>Some people with ASD tell very minimal narratives – like Glenn, above. Others with ASD tell rambling, almost incoherent narratives that mostly involve their own special interests and are off-putting to others.</p>
<p>Hillier and I developed an intervention <a href="http://dx.doi.org/10.1177/1525740116669114">to improve narration in young people with ASD</a>, adapting the work I did with parents of preschoolers for parents of young people with Autism Spectrum Disorder. </p>
<p>We invited 10 families with 15- to 25-year-old, high-functioning individuals with ASD to participate in our <a href="https://www.uml.edu/Research/autism/">pilot program</a>. Half were randomly selected for the intervention, half to a wait-list comparison group. We collected narratives from the young people in both groups, along with an assessment by the parents of their child’s narrative ability. During a three-hour training session, the intervention group received a set of instructions, including:</p>
<ol>
<li>Talk to your son/daughter frequently and consistently about past experiences.</li>
<li>Spend a lot of time talking about each topic. Give them plenty of time to respond, do not rush them.</li>
<li>Be sure to always ask your son/daughter to describe how he or she felt about an experience.</li>
<li>Ask plenty of wh-questions (who, which, how, why, etc.) and few “yes/no” questions. Ask questions about the context or setting of the events, especially where and when they took place.</li>
<li>Always ask your son/daughter how an experience wound up.</li>
<li>Listen carefully to what your son/daughter is saying, and encourage elaboration with simple responses or by repeating what your son/daughter has just said.</li>
<li>Follow your son/daughter’s lead, but avoid questions that derail narrative in favor of your son/daughter’s special interests.</li>
</ol>
<p>The parents made recordings of their conversations for one year and were then invited back to discuss their experiences. We also collected their post-intervention ratings of their sons’ and daughters’ narrative ability.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167076/original/file-20170427-15097-7bveji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The right strategy can help draw out young people with ASD, helping them become better storytellers.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/converse-all-star-fashion-foot-girl-1581/">SplitShire / Pexels</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<h2>Storytelling can be learned</h2>
<p>Our pilot research succeeded: Most parents in the intervention group substantially improved their way of talking about past experiences with their children. </p>
<p>A month later, the young people whose parents participated in the intervention produced more elaborate narratives, with some parents doubling the length of their conversations with their children. These parents reported a significant improvement in their child’s narration and were also surprised to see the difference it made in their ability to communicate with their sons and daughters with ASD.</p>
<p>Personal narratives are important for children, but they become even more important as children grow up. They are a key way people form relationships – or even testify in court against those who have wronged them.</p>
<p>There is no such thing as a born storyteller. But with the right strategies, individuals with ASD can be helped to tell better stories. We look forward to expanding our project to document how improvements in narration positively affect relationships between parents and children.</p>
<p><em>More resources for parents of children with autism can be found at the University of Massachusetts, Lowell <a href="https://www.uml.edu/Research/autism/">Center for Autism Research and Education</a> (CARE).</em></p><img src="https://counter.theconversation.com/content/75962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allyssa McCabe works for the Center for Autism Research & Education at the University of Massachusetts, Lowell. She is related to an employee of The Conversation US.</span></em></p>People tell each other stories every day about the things they’ve seen and done. For many children with autism, this kind of personal narrative doesn’t come easily. Here’s how parents can help.Allyssa McCabe, Professor of Psychology, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/754912017-03-31T10:50:24Z2017-03-31T10:50:24ZThe things every child with autism wishes you knew<figure><img src="https://images.theconversation.com/files/163313/original/image-20170330-4569-yjguv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>We are often quick to make judgements on what we perceive to be happening when children behave in a way that draws attention – but when a young person with autism is struggling to cope with the world, the last thing they need is our criticism. </p>
<p>These 10 tips reflect our combined experience of research and close engagement with children with autism. And as a proud parent of a boy with autism, I would like everyone to think more about how they respond to children. </p>
<p>Because if we take time to respect and understand people with autism our communities will become more enriching and inclusive for everyone. </p>
<h2>1. See me for who I am</h2>
<p>There is only one of me, just like there is only one of you in the world. Like you, I have lots of different skills and abilities as well as things I find difficult. Just because I have autism <a href="http://www.autism.org.uk/about/what-is/myths-facts-stats.aspx">doesn’t mean I am the same</a> as everyone else with autism. Love and acceptance from family, friends and everyone around me is the best way to help me to grow and thrive.</p>
<h2>2. I hear, see and feel the world differently to you</h2>
<p>I find some noises, smells, tastes or lights stressful, frightening or even physically painful. Touch can overwhelm me and I might not like hugs. But I can experience details that you might miss – that I can enjoy and find funny or exciting – so come and share these things with me. Read some of the <a href="http://www.autism.org.uk/shop/books.aspx">books written by people with autism</a> to learn more about how the world can feel.</p>
<h2>3. I want friends, just like everyone else</h2>
<p>But my social behaviour might seem different from other people’s. For me, communication and interaction isn’t just through words. Some children with autism don’t use spoken <a href="http://www.autism.org.uk/about/communication/communicating.aspx">language and communicate in non-verbal ways</a>. This can include taking your hand to the object I want, or looking at something of interest – so watch me and learn my language. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163345/original/image-20170330-4592-1i823uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Having friends is important to me too’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>4. My behaviour is my way of communicating</h2>
<p>If I can’t talk or express my thoughts and feelings I can become very frustrated, sad and angry. People see my behaviour as difficult, naughty or deliberately challenging – but it’s likely to be <a href="http://www.challengingbehaviour.org.uk/">my way of communicating</a>. Don’t exacerbate these outbursts, help me say what I want to.</p>
<h2>5. Interact with me in ways I can understand</h2>
<p>Slow down and give me time. Be clear about what you say, and give me the chance to react – it takes up to 10-15 seconds for me to process what you say. Get to know my <a href="http://www.autism.org.uk/earlybird">interests and my ways of communicating</a>. And let my interests inspire <a href="http://www.hanen.org/Programs/For-Parents/More-Than-Words.aspx">your communication with me</a>. Don’t try to take over or control our interaction. Give me space and time to respond. When you learn to listen with all your senses you’ll realise <a href="https://www.pavpub.com/listening-with-all-our-senses/">how much I have to say</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163314/original/image-20170330-4551-am09d9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Work with me, not against me.’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>6. I live in the here and now</h2>
<p>I don’t always understand the bigger picture so understanding things in context may be difficult for me. Show me pictures and let me know what to expect and I can join in so much more easily.</p>
<h2>7. I am anxious and worry a lot</h2>
<p>This is because I have difficulties understanding the world and communicating my thoughts and needs. The way I see, hear or feel the world can be painful, and the world can be a <a href="http://www.phoebecaldwell.co.uk/autism.asp">frightening and confusing place for me</a>. When something happens or changes suddenly, I may panic. People might think I’m being silly but I am really terrified. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163312/original/image-20170330-4551-w9e3yd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Sometimes it all gets too much’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>8. Routine is really important to me</h2>
<p>Because it makes me feel safe and helps me to cope. That doesn’t mean I don’t want to experience new things. I just need more support to join in with the world. If you help me, I can find activities and sports that I will enjoy and you can enjoy with me. Find out what helps to <a href="http://researchautism.net/autism-interventions/types/motor-sensory-interventions">calm me</a>. If I am less anxious I can cope with more.</p>
<h2>9. I need your help to access the world and learn</h2>
<p>Every child with autism can learn. You just need to take time to understand how I make sense of the world and make learning relevant to me. Everyone learns in different ways. I might need to move more and use <a href="http://www.autism.org.uk/about/strategies/visual-supports.aspx">visual resources</a> but I love to achieve and learn – it’s a great way to help me feel more confident.</p>
<h2>10. Think about what I can do, not what I can’t</h2>
<p>I am a clever, sociable, whole person. I may be more interested in certain specific subjects and pick up on the detail more, but this is my interest. My brother may spend hours watching and playing football, my friend might like aliens, and I like talking about my videos and finding out people’s names. Love me and work with me and enjoy what I bring to the world.</p><img src="https://counter.theconversation.com/content/75491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Because the world can look different to a child on the autism spectrum.Helen Driver, PhD Researcher in Autism, Family and Communication, Northumbria University, NewcastleJoanna Reynolds, Research Psychologist and Senior Lecturer in Child and Family Wellbeing, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/564812016-04-01T10:19:50Z2016-04-01T10:19:50ZHow can we help young adults with autism thrive in the workplace?<figure><img src="https://images.theconversation.com/files/117036/original/image-20160401-31093-ltpmkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Navigating work and stress can be hard for anyone, but especially so if you have ASD.</span> <span class="attribution"><span class="source">Woman at work via www.shutterstock.com</span></span></figcaption></figure><p>The outlook is often bleak for young adults with autism spectrum disorders (ASD). Even when they manage to graduate from high school or college, it’s very difficult for them to find a full-time job.</p>
<p>While there are many programs that help them interact with society when they’re young, those services are typically cut off by the time they graduate, leaving them with few options if they’re unable to navigate the work world on their own. </p>
<p>As a result, just 58 percent of young adults in their late teens and early 20’s with ASD worked for pay outside the home after high school, a far lower share than those with other types of disabilities, according to the <a href="https://nevadaautism.com/national-autism-indicators-report-transition-into-young-adulthood/">2015 National Autism Indicators Report</a>. Those who were employed tended to work part-time in low-wage jobs. </p>
<p>Currently the primary services intended to help young adults with autism are so-called sheltered programs that start them in a segregated work environment with the hope that they will be able to become employed with a regular company down the road. But because they are narrowly focused and usually don’t include training in social cognition, they rarely succeed in this goal. </p>
<p>Frustrated by the lack of transition programs available, I worked with Autism Services and Resources Connecticut (ASRC) to see if there was a better way to help these individuals learn the social and cognitive skills necessary to thrive in the workplace. The results, which involved help people with ASD work in demanding jobs processing patent applications, were encouraging.</p>
<p>First let’s consider why it’s so difficult for individuals with autism to cope in social and work environments in the first place. </p>
<h2>Background on ASD</h2>
<p>Individuals with ASD <a href="https://www.researchgate.net/publication/262178232_Using_Handheld_Applications_to_Improve_the_Transitions_of_Students_with_Autism_Spectrum_Disorders">tend to have difficulties with social interactions</a> and social communication. They may feel lost or anxious if an assigned task isn’t clearly explained or if a sequence of events is not fully understood. </p>
<p>They also struggle with the rapid comprehension required for spoken communication. The fleeting nature of verbal language (once spoken, words disappear) is <a href="http://www.iidc.indiana.edu/styles/iidc/defiles/IRCA/Structured%20Teaching%20Strategies%20Article%202.pdf">especially problematic</a> when the information is complex or lengthy. </p>
<p>The <a href="http://rstb.royalsocietypublishing.org/content/358/1430/345">so-called enactive mind theory</a> was articulated in the early 2000s by researchers at the Yale Child Study Center to try to explain why ASD causes these social deficits. The theory is based on the emerging field of embodied cognitive neuroscience. It posits that the social deficit in autism arises from an atypical developmental trajectory beginning in the first months of life that precludes an individual from having the experiences necessary for normal social development. </p>
<p>When entering new or unfamiliar social and physical environments, individuals with ASD often experience a high level of anxiety that may result in inappropriate behavioral manifestations, such as tantrums or crying, or social withdrawal. This makes it difficult for them to independently enter the workforce. </p>
<h2>Sheltered programs</h2>
<p>Unfortunately, <a href="http://www.socialworktoday.com/archive/090208p12.shtml">few programs exist</a> for helping young adults with ASD to transition effectively to college and the workplace. </p>
<p>There are quite a few programs across the country that provide job coaching or employment opportunities for individuals with ASD, but they tend to be sheltered. That is, the employees start in a segregated work environment with the hope that they will be able to become employed with mainstream employers at a later point. </p>
<p>Sheltered workplaces also tend to focus on a specific skill set and do not provide a curriculum in social cognition. Since they are often subsidized, they are constantly seeking more financial support. They also tend to lack transition planning to help employees find competitive jobs elsewhere.</p>
<p>While they play an invaluable role in helping individuals with ASD, they rarely achieve the goal of true independence.</p>
<h2>‘Falling off a cliff’</h2>
<p>Hoping to find a better solution, Lois Rosenwald, executive director of ASRC, and Julie Hipp, its board president, in 2014 created a for-profit startup called Open Options Partnership to figure out what might better integrate young adults with ASD into the workforce. </p>
<p>The idea was to see if people with ASD could develop and improve crucial social skills while working at a task they might be particularly well-suited for: researching patents. </p>
<p>I was the independent evaluator of the project. Rosenwald and I served together on Connecticut’s Autism Spectrum Disorder Advisory Council’s subcommittee to improve and expand access to training, consultation and learning opportunities for providers, professionals and families. I also <a href="https://www.researchgate.net/publication/262178232_Using_Handheld_Applications_to_Improve_the_Transitions_of_Students_with_Autism_Spectrum_Disorders">recently coauthored</a> a book chapter on using a high-tech application to improve the transitions of students with ASD. I am a community faculty member with the Yale Child Study Center and a researcher with the Center of Excellence on Autism Spectrum Disorders at Southern Connecticut State University. </p>
<p>Rosenwald likened the bleak outlook of young adults with ADS to “falling off a cliff,” a phrase that captures the frustration felt by families who watch their children graduate from college but unable to find a job and soon after reach the cutoff point for after-school ASD services. </p>
<p>At the time of the project, a client was having trouble finding employees who demonstrated competency in patent application reviews, which require manipulating and analyzing large data sets and performing what many would consider tedious work. Some people who are on the high-functioning side of the autism spectrum are particularly well-suited for such tasks because of their comfort with repetitive work tasks, attention to very small details and ability for sustained attention. </p>
<p>Rosenwald and Hipp believed that with the right framework and planning, the barriers to employment could be overcome and that people with ASD would be able to not only survive but thrive in professional, highly competitive work environments. </p>
<p>The project began by selecting four young adults (in their 20’s or early 30’s) who lived in the area served by ASRC. They were deemed able to successfully deal with workplace situations and managers – according to a predictive index used by ASRC’s board president in her executive search and <a href="http://www.impactpartners.com/philosophy/">consulting firm</a> – and assigned them to work with the patent company on an as-needed, contract basis. The availability of contracts was not continuous or guaranteed, nor was a steady paycheck, making it more closely resemble real-world conditions rather than a sheltered program. Not only did the four employees need to learn the high-tech aspects of the work, but also they needed to learn how to work together as a team. </p>
<p>Open Options, funded by grants from the <a href="http://www.jhnapierfdn.org/index.html">Napier Foundation of Meriden</a> and Wallingford, provided the employees with social cognition training, including social skills in the workplace, pragmatic language skills, behavioral regulation and executive functioning. A social cognition specialist worked with the employees to develop an employee handbook governing proper workplace behavior and establish goals to help them learn to self-regulate their emotions and handle stress on the job. </p>
<h2>The results</h2>
<p>The study ran for about a year and used the <a href="http://www.jecei.org/pdf_impact/16%20Comerfulltext.pdf">CEDAR Social Cognition Scale</a> – which uses a point system to measure cognition and self-regulation – and employer evaluations to demonstrate progress. </p>
<p>The CEDAR scale includes 51 items or statements, scored from 1-9, such as: </p>
<blockquote>
<p>Expresses needs and feelings in a way that is likely to result in good outcomes, and</p>
<p>When receiving feedback, tends to respond with arguments and explanations rather than acceptance.</p>
</blockquote>
<p>All four employees saw steady growth on the scale, particularly in terms of openness to new ideas and experiences, ability to transition from one activity to another and willingness to accept feedback. </p>
<p>Their evaluations by the employer also showed improvement. For example, one employee started off at “meets minimum requirements” and finished the program at “exceeds requirements.” He is now working at least 20 hours a week in an internship in a related field, and is being considered for a competitive position with the company. </p>
<h2>The need for predictable schedules</h2>
<p>One important finding of the project, and the reason it ended earlier than planned, was that the key to supporting individuals with ASD in a workplace setting involves some degree of predictability. Consistent work schedules are one of the most important certainties that employees with ASD need for their success in the world of work. But this was often not the case. </p>
<p>The client was unable to determine in advance how many hours it needed the employees to work on a day to day basis. On some weeks, the employees would work eight hours on the first day, have two days off, and then be notified a couple hours ahead of time that they were needed on the fourth day. </p>
<p>Overall, the study underlined the importance of providing social cognition training for the business environment in order for individuals with ASD to succeed in competitive workplaces. In this project, ASRC’s role as its backbone was critical to making it work. </p>
<p>With the proper training and accommodations, people with ASD could become productive and indeed sought-after employees in the workplace, making them truly independent. </p>
<p><em>Lois Rosenwald, executive director of Autism Services and Resources Connecticut, Renee DePastino, a social cognition specialist at Autism Services & Resources Connecticut, and Patrick Iben, a senior research assistant at Southern Connecticut State University, coauthored this article.</em></p><img src="https://counter.theconversation.com/content/56481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The evaluation was funded by the Connecticut Developmental Disabilities Council.</span></em></p>The outlook can be bleak for people with ASD who have difficulty navigating the stressful work world. A trial project in Connecticut sought to find a new way to help them become truly independent.Michael Ben-Avie, Director of the Office of Assessment and Planning, Southern Connecticut State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/539772016-02-18T19:20:13Z2016-02-18T19:20:13ZWhat causes autism? What we know, don’t know and suspect<figure><img src="https://images.theconversation.com/files/110250/original/image-20160204-5853-11j9tr8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The revelation that autism didn't have one cause helped researchers change their thinking.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is a long read, enjoy. Andrew will be answering reader questions from 4pm-5pm AEDST on Friday, February 19.</em></p>
<hr>
<p>One of the great and enduring mysteries of autism is what causes the brain to develop so differently. The behavioural differences of many individuals with autism are so apparent that it seems intuitive that the causes would also be obvious. </p>
<p>But research over the past 70 years has indicated this isn’t so. Into this knowledge gap have come all sorts of weird and wacky ideas about the causes of autism: television, power lines, vaccines and sex position during conception. None have any credence, but have fuelled the mystery surrounding what may cause autism.</p>
<p>In the 1950s and 1960s, there was a <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=489479">widely held belief</a> that autism was caused by parental coldness towards the child. The term “refrigerator mother” was often directed towards the mothers of these children. </p>
<p>Leo Kanner, the man who <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1939-0025.1949.tb05441.x/abstract">first described the behaviours</a> that characterise autism, explored “a genuine lack of maternal warmth” as a possible explanation for autism. This inaccurate belief left a legacy of shame and guilt in the autism community for at least the following two decades.</p>
<p><a href="https://embryo.asu.edu/pages/infantile-autism-syndrome-and-its-implications-neural-theory-behavior-1964-bernard-rimland">Several eminent scientists</a> eventually extinguished the myth. Two of them were themselves parents of children with autism, and they highlighted a major flaw in the theory: parents who fitted the “refrigerator” stereotype also had children who did not have autism. </p>
<p>Since this time, research has focused on biological factors that may lead to autistic behaviours. This has found very clearly there is no one cause of autism. </p>
<p>A variety of genetic factors are likely to be the ultimate cause of most cases of autism. These may work by themselves, or in combination with environmental factors, to lead a child’s brain to develop differently and result in autistic behaviours.</p>
<h2>Genetics</h2>
<p>To examine the influences of nature (genetics) and nurture (environment) on a given human quality, scientists study twins. </p>
<p>To appreciate how these studies work, it’s first important to understand there are two types of twins. Identical twins share all of their DNA and, assuming they grow up in the same household, they will also share all of their environment. Fraternal twins also share all of their environment, but only around half of their DNA, just like non-twin siblings.</p>
<p>Twin studies start by defining a clear population, say the metropolitan area of a city, and finding as many sets of twins as possible in that area where one or both of the twins have the given trait of interest – in this case, autism. </p>
<p>Scientists then look at the “concordance” of that trait – that is, the percentage chance that if one twin has autism, the other twin will also have autism. If the concordance is higher for identical twins than fraternal twins, then we can say the difference is due to the increased amount of genetic material shared by the identical twins, and that autism is influenced by genetics.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111877/original/image-20160218-1264-107lv0c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Twin studies provided the first evidence autism may be genetic.</span>
<span class="attribution"><span class="source">Choku/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1977.tb00443.x/abstract">first twin study of autism</a> was conducted in 1977 on 11 identical and ten fraternal twins across Great Britain, where at least one of the twins had autism. Concordance for identical twins was 36%, compared to 0% for the fraternal twins. </p>
<p>While the study was only small in size, it provided the first evidence that autism may be genetic in origin. Since this pioneering study, more than a dozen <a href="http://link.springer.com/chapter/10.1007%2F978-1-4614-9509-3_2#page-1">further twin studies</a> have confirmed this original observation. </p>
<p>The best current estimate is that there is a 50-80% concordance for identical twins and a 5-20% concordance for fraternal twins. This indicates a strong genetic component to the condition. The figure for fraternal twins – 5-20% – also represents the chance of a couple who already have a child with autism having a second child with autism (referred to as the “recurrence risk”).</p>
<p>Once scientists have established that the cause of a disorder is influenced by genes, the next task is to identify the exact genes that might be involved. However, after several decades of intensive research, scientists could find no one genetic mutation that all individuals diagnosed with autism shared. </p>
<p>It was these <a href="https://www.mja.com.au/journal/2013/198/6/autism-one-or-multiple-disorders">findings</a> (or lack of findings) that led scientists to stop thinking of autism as one condition with one cause. They started viewing it as many different conditions which all have relatively similar behavioural symptoms.</p>
<p>This new view of autism has proved extremely fruitful in discovering subtypes of autism. For example, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24468882">number of conditions</a> have very clear genetic or chromosomal abnormalities that can lead to autistic behaviours. </p>
<p>These include disorders that have abnormalities of the chromosomes, such as Down syndrome. While no chromosomal condition itself accounts for any more than 1% of individuals with autism, when combined they account for approximately 10-15% of all individuals diagnosed with autism.</p>
<p>The exact genetic abnormalities that may lead to the remaining cases of autism are not completely clear. There are two reasons for this. </p>
<p>The first is that the genetic regions involved are likely to be very complex. Scientists have needed to develop new techniques to examine them. </p>
<p>The second is that it is probable the genetic mutations are very rare and complex. The DNA chain that forms our chromosomes contains more than 3 billion building blocks. To identify small pieces of DNA that may be linked to the development of autism among so many base pairs, scientists need to study a very large number of people with autism. </p>
<p>To date, no study has been able to examine the thousands of people necessary to identify with accuracy all of the small mutations that might lead to autism.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111879/original/image-20160218-1276-dzmm3p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">With more than 3 billion building blocks in the DNA chain that forms our chromosomes, it’s difficult for scientists to isolate genes that could cause autism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/saynine/456229624/">James Gentry/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>However, with genetic technologies improving at an astronomical pace, as well as global scientific cooperation that will lead to large numbers of people being studied, major advances in the understanding of the causes of autism are likely in the very near future.</p>
<p>A likely prospect is that many cases of autism will be related to what is called “<a href="http://www.nature.com/ng/journal/v46/n8/full/ng.3039.html">common genetic variation</a>”. This refers to differences in genes that are also found in many individuals who do not have autism and which by themselves are not sufficient to lead to autism. However, when multiple genetic risk factors are found in the same person, they combine to have a major effect on how the brain develops. </p>
<p>A <a href="http://www.nature.com/nature/journal/v485/n7397/full/nature10945.html">small proportion</a> of autism cases are also likely to be caused by what are known as <em>de novo</em> (“new”) mutations. Most often, the egg and sperm that create a baby contain genetic material that is present in the mother and father, respectively. However, in rare cases, the egg and sperm may contain genetic material that is not found in either parent. There is now good evidence that some people with autism may have inherited <em>de novo</em> genetic mutations that have an effect on brain development.</p>
<h2>Environmental causes</h2>
<p>Recognition <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548163/">has grown</a> over the past decade that aspects of our environment may also contribute to autism. However, despite substantial research, no one environmental factor has yet been found to be a definite cause of autism. </p>
<p>The most widely used research technique to examine environmental risk factors for autism is epidemiology, which examines how often, and why, diseases occur in different groups of people.</p>
<p>Several environmental factors during prenatal life have been linked with autism. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20414802">Bacterial</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/22562209">viral</a> infections in the mother during pregnancy have been found to slightly increase the risk of autism in the offspring. This could be due to the passage of harmful infectious organisms from the mother to the fetus through the placenta, or because the immune response of the mother may be detrimental to the developing brain of the fetus.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111880/original/image-20160218-1264-1mmuauz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older fathers are said to increase the risk of autism.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>Other factors in the mother that may be related to offspring autism include a <a href="http://jama.jamanetwork.com/article.aspx?articleid=1570279">folic acid deficiency</a> at the time of conception, the presence of <a href="http://jama.jamanetwork.com/article.aspx?articleid=2247143">gestational diabetes</a> and the use of <a href="http://pediatrics.aappublications.org/content/early/2014/04/09/peds.2013-3406">certain antidepressants</a> during pregnancy, but no conclusive evidence exists for any of these links.</p>
<p>Being an older parent, particularly an older father, is also thought to increase the risk of having a child with autism. As males get older, the number of sperm that contain <em>de novo</em> genetic mutations increases. </p>
<p>Some of the <em>de novo</em> genetic mutations will have minimal or no effect on the resulting baby, but some mutations can lead to the brain developing differently. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25662027">Several studies</a> have found that fathers who are over 50 at the time of conception have a greater chance of passing on de novo mutations and also a greater risk of having a child with autism.</p>
<p>An obvious, but very important, observation is that not all people who are exposed to these factors are diagnosed with autism. One possible explanation for this is a phenomenon called gene-environment interaction, which is when the genetic make-up of two different people leads them to respond differently to an environmental factor.</p>
<h2>Brain development</h2>
<p>For a considerable time scientists were searching for one clear brain difference that may lead to autistic behaviours. However, this hope has yet to be fulfilled, with few studies identifying brain characteristics that are shared by different individuals diagnosed with autism. </p>
<p>This may be a further indication that autism has many different causes, but it may also be a reflection of the difficulties in studying the brain. </p>
<p>Currently, scientists use a variety of clever techniques to understand the structure and function of the brain, such as magnetic fields, X-rays and radioactive chemicals. As ingenious as these methods are, they are unable to provide a full measure of the tremendous complexity of how the brain operates.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111882/original/image-20160218-1252-1y5wivd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Few studies have identified brain characteristics that are shared by different individuals diagnosed with autism.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>It is also unlikely that autism affects just one area of the brain alone. The complex behaviours of individuals with autism, which include cognitive, language and sensory difficulties, make it difficult to pinpoint just one brain region that may be affected. Nevertheless, some promising leads have shown how different brain pathways may lead to autistic behaviours.</p>
<p>There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/17555719">increasing evidence</a> that differences in brain development may begin prenatally in some individuals with autism. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20414801">Several studies</a> of prenatal ultrasound measurements have found evidence for differences in the growth patterns of the brain in foetuses later diagnosed with autism. Newborns later diagnosed with autism are often also reported to have large heads at birth (“macrocephaly”).</p>
<p>Another research technique has been to dissect the brains of individuals with autism who have prematurely died, so-called post-mortem studies. A <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1307491">recent study</a> that examined the brains of 11 autistic individuals at the microscopic level found changes in the structure and organisation of the brain cells that form during foetal life, indicating differences in brain development that begin very soon after conception.</p>
<p>Another well-studied area in autism is head circumference growth in the first years of life. This research dates back to 1943 and Leo Kanner’s <a href="http://simonsfoundation.s3.amazonaws.com/share/071207-leo-kanner-autistic-affective-contact.pdf">original study</a> that found five of the 11 children with autism he examined had large heads. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/9031582">Several</a> small <a href="http://www.ncbi.nlm.nih.gov/pubmed/8894947">studies</a> throughout the 1990s and 2000s searched the medical records of relatively small groups of children with autism. These found that a key period was the first two years of life, in which a minority of children later diagnosed with autism had a marked increase in the rate of growth of their head. </p>
<p>During the first two years of life, the size of an infant’s head is a reasonable indicator of total brain size, and for many years “brain overgrowth” during very early development was seen as a risk factor for a later diagnosis of autism.</p>
<p>However, more recently, this view has been <a href="http://www.jaacap.com/article/S0890-8567(14)00529-2/abstract">challenged</a> by the release of the largest ever study in this area, which found no link between infant head circumference growth and autism.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=354&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=354&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=354&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=444&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=444&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111883/original/image-20160218-1236-1acrds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=444&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Head size has nothing to do with autism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/merwing/516164481/">Aimee Ray/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><a href="http://www.sciencedirect.com/science/book/9780123919243">Studies</a> using brain imaging machines have <a href="http://www.ncbi.nlm.nih.gov/pubmed/25850620">examined</a> whether parts of the brains of individuals with autism may be different in size, shape or function. </p>
<p>However, the only consistent finding is just how much inconsistency there is. Not every individual with autism has differences in the size or pattern of growth of different brain regions. For those individuals who do, it is unclear how this may relate to their autistic behaviours.</p>
<p>A great deal of brain imaging research has examined the connections within the brain of individuals with autism. Connectivity is a measure of how well and how much two brain areas communicate with each other. In the study of autism, scientists distinguish between short-range connections (between neighbouring brain areas) and long-range connections (between brain areas further apart). </p>
<p>One <a href="http://www.ncbi.nlm.nih.gov/pubmed/22018722">prominent theory</a> that has emerged from brain imaging studies is that some individuals with autism may have under-connectivity in long-range connections, but over-connectivity in short-range connections. </p>
<p>If found to be accurate, these brain differences may be able to explain why some individuals with autism have difficulties with complex tasks that require the integration of information from multiple brain regions (such as cognitive and social abilities), but have no difficulties, or even enhanced abilities, for tasks that require less integration across brain areas (such as sensory processing).</p>
<h2>Other biological factors</h2>
<p>There is preliminary <a href="http://www.nature.com/mp/journal/v20/n3/full/mp201448a.html">evidence</a> some <a href="http://jneurodevdisorders.biomedcentral.com/articles/10.1186/1866-1955-4-25">but not all</a> individuals with autism are exposed to higher levels of testosterone in the womb. Excessively high testosterone concentrations in the bloodstream can be harmful and cause cells to die, particularly within the brain, which is highly sensitive to changes in hormone levels. </p>
<p>One thought is that the pattern of cell death caused by high testosterone levels may alter brain development in a way that leads to autistic behaviours in childhood. This theory is still to be proven. Again, it is certain that not all individuals with autism are exposed to excessive levels of testosterone in the womb.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=663&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=663&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=663&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=833&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=833&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111884/original/image-20160218-1243-url3jz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=833&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some scientists believe a disruption of good gut bacteria may be a potential cause for autism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/wellcomeimages/15385435563/">Wellcome Images/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The link between gastrointestinal (“gut”) problems and autism is another scientific area that has received a great deal of attention. It is now well known that between <a href="http://pediatrics.aappublications.org/content/124/2/680">30% and 50%</a> of individuals with autism experience significant gastrointestinal problems, such as diarrhoea, constipation and an irritable bowel. </p>
<p>It has long been a mystery why, but there is now extremely good evidence that the complex community of microbes in the gut plays an important role in human development and is essential for healthy immune and endocrine systems, as well as the brain. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564498/">Some scientists believe</a> a disruption in the natural balance of these “good” bacteria may be a potential cause of autism. Antibiotics, for example, are commonly used with infants in Western societies and are known to kill “good bacteria” along with the “bad” bacteria for which they were prescribed.</p>
<p>A difference in the community of microbes, which humans have evolved to rely upon, may disrupt brain development and lead to autism. At the present time, the evidence for this potential cause of autism is not strong, but there will be substantial research in this area in coming years.</p>
<p>Autism has no one single cause, both in terms of genes and the brain. In a minority of cases, there are very clear genetic abnormalities that cause autism. In other cases, the genetic differences are more complex and yet to be discovered.</p>
<p>While there is currently no evidence for any environmental causes, it is possible subtle influences of the environment may affect individuals differently depending on their genetic make-up, leading to autism in some children. These relationships are also yet to be discovered.</p>
<hr>
<p><em>Andrew will be on hand for an Author Q&A between 4 and 5pm AEDT on Friday, February 19, 2016. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/53977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the NHMRC, ARC and Autism CRC. </span></em></p>One of the great and enduring mysteries of autism is what causes the brain to develop so differently.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/537312016-01-28T19:24:34Z2016-01-28T19:24:34ZThe difficulties doctors face in diagnosing autism<figure><img src="https://images.theconversation.com/files/109306/original/image-20160127-19649-1cs5xqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms that can signify autism can also mean other things.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.13029/abstract">recent survey</a> of paediatricians found they often lacked enough information to accurately diagnose an autism spectrum disorder (ASD) in children. ASD is an important diagnosis not to miss. But it is equally important not to make the diagnosis when it is not truly present.</p>
<p>ASD used to be split into groupings including autistic disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified. However, these diagnoses are now collapsed into a single ASD diagnosis with a range of severity along the “spectrum”.</p>
<p>To be diagnosed on this autistic spectrum, the individual must have difficulties in two areas. </p>
<p>First, they must have persistent problems in social communication and interaction. This includes deficits in empathy, body language, facial expression and eye contact; and difficulties or lack of interest in social relationships and making friends. </p>
<p>Second, they must exhibit restricted, repetitive patterns of behaviour, interests or activities such as insistence on rigid routines, fixation on certain topics, sensory hypersensitivities such as noise sensitivity and sometimes hyposensitivities – such as a high pain threshold.</p>
<p>The problems must be severe enough to cause impairment in everyday life. Many people with ASD also often have areas of extraordinary giftedness.</p>
<p>The rate of ASD diagnosis has <a href="http://anp.sagepub.com/content/47/12/1116.extract">risen significantly</a> in recent years. Studies between 1960 and 1980 found a prevalence of 0.02% to 0.05%. By the early 2000s rates were between 0.3% and 0.6%; by 2006 0.5% to 1.14%. A <a href="http://journals.cambridge.org/action/displayAbstract?aid=9495906&fileId=S003329171400172X">meta-analysis</a> suggested a steady rate between 1990 and 2010 of 0.75%. </p>
<p>However, by 2009, the rate of children diagnosed with ASD in Queensland schools had become as high as one in 50 students (2.05%), according to Queensland Education Department statistics reported in the <a href="http://www.couriermail.com.au/news/queensland/autism-rates-soaring-among-queensland-school-children/story-e6freoof-1225852008088">Courier Mail</a> (obtained by Freedom of Information).</p>
<p>This has led to controversy about whether this is an uncovering of cases that in the past would have been missed, an epidemic of ASD caused by environmental toxins affecting the early developing brain, or a false “epidemic” due to over-diagnosis.</p>
<h2>What makes diagnosis so hard</h2>
<p>In my experience as a child and adolescent psychiatrist, it is apparent there is an over-diagnosis problem. In addition, there are still children, particularly girls, whose ASD diagnosis is tragically missed until late in their development and schooling. Many child psychiatrist and paediatrician colleagues offer similar observations.</p>
<p>One factor is the funding model. Funding (Medicare and Centrelink rebates and special education resources) is skewed towards children diagnosed with ASD. Doctors have admitted to feeling <a href="http://www.ncbi.nlm.nih.gov/pubmed/16101973">under pressure</a> to make the diagnosis to get extra support for children.</p>
<p>ASD-like symptoms can occur to a mild degree in children who are stressed, anxious and depressed. Reasons may include trauma in their early life or “insecure attachment”, where neglect or abuse has hindered early bonding with parents, or because their mother is suffering from depression or anxiety. Eye contact and a sense of care and safety that allows them to develop their natural social skills may be lacking. This will later look like ASD symptoms. </p>
<p>ASD symptoms such as social avoidance and restricted interests can also be coping mechanisms for children with other learning difficulties, including intellectual disabilities, dyslexia and speech and language disorders.</p>
<p>Relying on an ASD diagnosis for extra resources is leading to false-positive ASD diagnoses. For the child misdiagnosed with ASD the result can be unnecessary stigma and reduced expectations of self and others. Linking funds to ASD can discriminate against children who do not have ASD but may have similarly severe developmental, learning, emotional and behavioural problems.</p>
<p>Paediatricians Michael McDowell and Mick O’Keeffe have referred to this as “<a href="http://www.ncbi.nlm.nih.gov/pubmed/22250827">discrimination by diagnosis</a>”. They proposed a model based on the severity of behaviour to correct the problems of funding inequity and diagnostic inaccuracy.</p>
<p>A specialised ASD diagnostic test is the Autism Diagnostic Observation Schedule (<a href="http://infantlab.fiu.edu/articles/lord,%20risi%20et%20al%202000%20JADD.pdf">ADOS</a>). This is a 30- to 60-minute test in which the examiner provides the subject with a series of opportunities to show social and communication behaviours, such as responding to their name, smiling, or commenting on other’s emotions.</p>
<p>This goes a long way to standardising the diagnostic process. But it is still dependent at some level on subjective perspectives of the clinicians (psychologists, speech pathologists, paediatricians, psychiatrists) who have been trained in using it and on the wider context of the pressures to diagnose. </p>
<p>Allied health staff such as psychologists and speech pathologists can make an ADOS diagnosis of ASD, but often further diagnosis is required from a psychiatrist or paediatrician. Problems can arise when the doctor disagrees with the diagnosis, rather attributing ASD behaviours to trauma or abuse as described above.</p>
<p>Ideally, the test should take place with a more <a href="https://www.autismspectrum.org.au/content/how-autism-diagnosed">comprehensive assessment</a> of the child in different settings, including school.</p>
<p>Child psychiatrists receive adequate training in recognising autism. But other health professionals have <a href="http://www.ncbi.nlm.nih.gov/pubmed/16101974">requested more training</a> in this area.</p>
<h2>A broad approach to diagnosis</h2>
<p>Accurate diagnosis of ASD and/or other childhood developmental learning problems and mental disorders is important. But so is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21790830">full perspective</a> of their strengths, and a consideration of home and school stressors and supports.</p>
<p>The ASD diagnosis may be obvious in some cases and ambiguous in others. However, related strengths and weaknesses usually require further investigation. Where there is intellectual disability, searching for metabolic and genetic causes is important. </p>
<p>A full assessment may include a physical examination, genetic and other blood tests and brain scans, a thorough family and developmental history, an assessment of parenting and family dynamics, a similar assessment of the child’s experience of school, psychometric, speech and language testing, structured testing such as the ADOS and hearing tests if needed.</p>
<p>Following a comprehensive assessment and accurate diagnosis, support for the child, family and school can be given most beneficially and cost-effectively. Such accuracy requires time and assessment across different contexts. It is more than just tick the criteria and get the funding.</p><img src="https://counter.theconversation.com/content/53731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Parry is affiliated with Healthy Scepticism (<a href="http://www.healthyscepticism.org">www.healthyscepticism.org</a>). </span></em></p>A recent survey of paediatricians found they often lacked enough information to accurately diagnose an Autism Spectrum Disorder in children.Peter Parry, Senior Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/519902016-01-10T19:15:42Z2016-01-10T19:15:42ZMindfulness can improve living with a disability<figure><img src="https://images.theconversation.com/files/105156/original/image-20151209-15547-17fhjfz.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mindfulness has been found to improve negative behaviours from intellectual disability and autism spectrum disorder.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/vinothchandar/4282241642/">Vinoth Chandar/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Mindfulness, a meditative practice focusing on attention and awareness training, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24020487">has been shown</a> to have positive effects on mental and physical wellbeing. A <a href="http://www.springer.com/us/book/9783319189611">recent review</a> of studies has also shown that mindfulness meditation helps people with intellectual disabilities and autism spectrum disorder reduce their mental and physical problems.</p>
<p>Challenging behaviour is the most prevalent problem faced by people with these disabilities. It includes aggressive, self-injurious, destructive and disruptive behaviour. </p>
<p><a href="http://www.tandfonline.com/doi/abs/10.1080/19315860802611415">These behaviours occur</a> in as many as 15% of people with intellectual disabilities. Up to 95% of people with autism spectrum disorder also show some form of challenging behaviour. </p>
<p>Challenging behaviour is a major threat to the education of children with these conditions. It is also a major reason leading them to criminal pathways.</p>
<h2>What is mindfulness?</h2>
<p>Mindfulness teaches how to be aware of what is happening to us in the present, both physically (such as breathing) and mentally (such as emotion). A total of 254 individuals with disability aged between 13 and 61 from 21 studies participated in this review.</p>
<p>The review reported two approaches to teaching mindfulness. The first was developed specifically for people with intellectual disabilities and autism spectrum disorder and is often used to self-manage physical and verbal aggression. One example is the “Soles of Feet” technique. </p>
<p>Students are asked to breath naturally and remember an anger-provoking incident. They are told to imagine and experience the anger, and then shift all of their attention to the soles of their feet. Students keep breathing and focusing on the soles of their feet until they feel calm. </p>
<p>The other approach employs preexisting mindfulness programs such as mindfulness-based cognitive therapy (a psychological therapy designed to prevent relapse into depression by changing the way you think with meditation), mindfulness-based stress reduction (intensive meditation and yoga focusing on greater awareness of the mind and body), acceptance and commitment therapy (a psychological intervention using mindfulness to increase psychological flexibility), and dialectical behaviour therapy (a specific type of cognitive-behavioural psychotherapy initially developed to treat borderline personality disorder).</p>
<h2>What the study found</h2>
<p>The review showed mindfulness meditation was effective for reducing aggression, both physical and verbal, reducing deviant sexual arousal, and for quitting smoking and losing weight in people with these conditions.</p>
<p>Mindfulness meditation also alleviated anxiety, depression, and stress-related physiological symptoms such as salivary cortisol (a stress hormone found in saliva) and alpha-amylase (a digestive enzyme sensitive to stress). </p>
<p>These effects were either assessed against the condition of participants before their mindfulness training or individuals with similar disabilities who did not learn mindfulness.</p>
<p>No side effects were reported for people with intellectual disabilities and autism spectrum disorder from learning mindfulness meditation. However, mindfulness was only effective under certain conditions. Since mindfulness meditation is attention and awareness training, it can’t be forced, and participants have to choose to learn.</p>
<p>Sustained engagement and long-term practice are essential for any positive effects mindfulness may have. People with intellectual disabilities and autism spectrum disorder require support to be engaged in learning. Training in mindfulness can be both labour intensive and time consuming. This is more so for people whose disability is more severe.</p>
<p>Mindfulness instructors need to have both experiential and intellectual knowledge of mindfulness. In addition, teaching people with disability requires knowledge of disability and the capacity to adjust mindfulness training methods to meet a wide variety of learning needs.</p><img src="https://counter.theconversation.com/content/51990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yoon-Suk Hwang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A recent review of studies has shown that mindfulness meditation helps people with intellectual disabilities and autism spectrum disorder reduce their mental and physical problems.Yoon-Suk Hwang, Research Fellow at the Learning Sciences Institute Australia, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/498082015-10-27T19:19:52Z2015-10-27T19:19:52ZOxytocin may benefit some children with autism, but it’s not the next wonder drug<figure><img src="https://images.theconversation.com/files/99784/original/image-20151027-4985-1ncrcru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The effects observed in the study are still small and inconsistent. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-222984865/stock-photo-young-boy-sitting-watching-something-off-to-the-left-of-the-frame-resting-his-head-on-his-crossed.html?src=56GH1KBvSv6zp4n19Pskaw-6-99">racorn/Shutterstock</a></span></figcaption></figure><p>A synthetic version of the “trust” hormone oxytocin, delivered as a nasal spray, has been shown to improve social responsiveness among some children with autism, researchers from the University of Sydney have found. </p>
<p>Published today in the journal <a href="http://www.nature.com/mp/journal/vaop/ncurrent/full/mp2015162a.html">Molecular Psychiatry</a>, the trial is the first to rigorously examine the effects of oxytocin over a long time period in young children with autism spectrum conditions (ASC). ASC affect many aspects of a child’s development, including social and communication development.</p>
<p>But while it’s an important step forward, the effects observed in the study are simply too small and too inconsistent – and the stakes are simply too high – for anyone to herald a new autism wonder drug. </p>
<h2>Current treatments</h2>
<p>Behavioural therapies are considered the first line of therapies for ASC, and on many fronts these have proven to be effective. The drawbacks, which are not discussed as often as they should, are the considerable costs.</p>
<p>Consider for a moment that one recommended regimen of behavioural therapy is upwards of 20 hours per week. Highly trained therapists cost approximately A$150 for every one hour session, and so the financial burden adds up very quickly. Only a small number of families have the capacity to allocate the necessary resources to these kind of programs. This leaves the majority of families seeking therapy alternatives.</p>
<p>The search for effective pharmaceutical therapies is not just due to the financial and time costs associated with behavioural interventions, but also because these behavioural therapies are not highly effective for all children with ASC.</p>
<p>Autism has had a faddish relationship with pharmaceuticals. Numerous drugs over the past half a century have shown promise for benefiting individuals with ASC, and almost instantaneously achieve world-wide fame. But without fail, after further rigorous research, each of these drugs have been found to be no more effective than a placebo. </p>
<p>Other drugs have been found to be ineffective in reducing core ASC behaviours, such as social and repetitive behaviours, but may provide benefits for associated difficulties, such as sleep or anxiety.</p>
<p>Fads come and go. Hope gets raised and inevitably dashed. It was into this landscape that oxytocin began being tested as a potential pharmaceutical for ASC.</p>
<h2>What is oxytocin?</h2>
<p>Oxytocin is a hormone that affects social cognition and behaviour, and has been the “molecule of the moment” for close to a decade. The human brain produces oxytocin naturally, and is involved in promoting childbirth and lactation reflexes.</p>
<p>Research in ASC has focused on the possible effects of providing the brain with a dose of synthetic oxytocin. In studies of adults, the administration of oxytocin as a nasal spray has been found to improve <a href="http://www.nature.com/nature/journal/v435/n7042/full/nature03701.html">trust</a> as well as several aspects of social ability, including <a href="http://www.ncbi.nlm.nih.gov/pubmed/17888410">eye gaze</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Oxytocin+increases+retention+of+social+cognition+in+autism">emotion recognition</a>. These latter abilities are characteristic difficulties of individuals with ASC, and so oxytocin was very quickly examined as a potential pharmaceutical therapy for ASC.</p>
<p>Until this point, studies examining the effects of oxytocin on individuals with ASC have produced contradictory findings. Several research groups have identified small improvements in social behaviours in <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Intranasal+oxytocin+versus+placebo+in+the+treatment+of+adults+with+autism+spectrum+disorders%3A+a+randomized+controlled+trial">adults</a> with ASC, while others have identified little to no benefits (in <a href="http://www.ncbi.nlm.nih.gov/pubmed/25087908">studies of adults</a> children, and adolescents).</p>
<h2>The new study</h2>
<p>The study included 31 children with an ASC aged between three and eight years of age. </p>
<p>The study used what is called a “cross-over” design, which involves two phases of drug administration. In the first phase, each child is allocated into receiving either oxytocin or the placebo. After five weeks of taking the drug, the groups then switch, so that the group that received the oxytocin in the first phase now receives the placebo, and vice versa for the group that initially received the placebo. </p>
<p>This is a neat design because it means that participants act as their own “control”. This enables scientists to directly compare each child’s abilities after taking oxytocin with their abilities after taking the placebo.</p>
<p>The children received the oxytocin or a placebo through a nasal spray bottle. The placebo looked and smelled exactly like the oxytocin spray, but contained none of this active ingredient. Children received one spray of the relevant bottle in each nostril, morning and night. </p>
<p>Importantly, the study was “double blind”, which meant that neither the family nor the investigators knew what was in the spray bottle during each phase until the conclusion of the trial. After the trial finished, the researchers were “unblinded” to the content of the spray bottles. </p>
<p>The key finding was that the children with ASC showed significant improvements in “social responsiveness” after a period receiving oxytocin, but no improvements after a period receiving the placebo. Social responsiveness refers to abilities such as social awareness, reciprocal social interaction and social anxiety avoidance. In this study, social responsiveness was assessed by the parent using a widely used <a href="http://www.ncbi.nlm.nih.gov/pubmed/12959421">questionnaire</a>.</p>
<p>However, oxytocin was found to be no more effective than the placebo in its effect on measures of repetitive behaviours and emotional difficulties.</p>
<h2>What does this mean?</h2>
<p>This was a rigorously conducted trial, and the results indicate that oxytocin may provide small benefits to some children with ASC.</p>
<p>There are limitations to this study that must be acknowledged. While the number of children included in this trial is among the largest of any previous study – particularly given the “cross-over” design, which increases the statistical power – the sample size is too small to make any sweeping conclusions about the importance of oxytocin in ASC intervention.</p>
<p>But the study does provide a strong platform upon which further science can be conducted.</p>
<p>Larger studies of oxytocin as a potential therapeutic for ASC are currently underway in both the United States and Australia, and will provide a greater evidence base in this area, as will studies examining the effect of oxytocin in conjunction with more traditional behavioural therapies.</p>
<p>However, despite these preliminary positive findings, it is important to remain keen observers of the complicated history between ASC and the limited progress into new pharmaceuticals. </p>
<p>And in that context, the decade of research on oxytocin that has preceded this study is highly instructive. Oxytocin may provide benefit to some children with ASC, but it is not a panacea and it cannot yet be recommended for children until further studies are conducted.</p><img src="https://counter.theconversation.com/content/49808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the NHMRC, ARC, Autism CRC, Telethon-Perth Children's Research Fund, and the Perpetual Trust. Andrew Whitehouse is a scientific collaborator of the study's senior author, and is a chief investigator on a trial examining the effects of oxytocin in children with autism in Perth and Sydney (funded by the NHMRC). </span></em></p><p class="fine-print"><em><span>Gail Alvares receives funding from the Autism CRC and Perpetual Philanthropic.Gail Alvares is a scientific collaborator of the study's senior author and has previously co-authored publications with the study's senior author on the effects of oxytocin in autism and other psychiatric disorders.</span></em></p>A synthetic version of the hormone oxytocin has been shown to improve social responsiveness among some children with autism.Andrew Whitehouse, Winthrop Professor, Telethon Kids Institute, The University of Western AustraliaGail Alvares, Postdoctoral Research Fellow, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.