tag:theconversation.com,2011:/uk/topics/autism-spectrum-disorder-2190/articlesAutism spectrum disorder – The Conversation2024-02-27T05:35:56Ztag:theconversation.com,2011:article/2231942024-02-27T05:35:56Z2024-02-27T05:35:56ZHow to be kind to yourself (without going to a day spa)<figure><img src="https://images.theconversation.com/files/575550/original/file-20240214-26-e51x1x.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C664&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/mature-african-woman-looking-outside-window-2003674943">Ground Picture/Shutterstock</a></span></figcaption></figure><p>“I have to be hard on myself,” Sarah told me in a recent telehealth psychology session. “I would never reach my potential if I was kind and let myself off the hook.”</p>
<p>I could empathise with this fear of self-compassion from clients such as Sarah (not her real name). From a young age, we are taught to be kind to others, but self-kindness is never mentioned.</p>
<p>Instead, we are taught success hinges on self-sacrifice. And we need a healthy inner critic to bully us forward into becoming increasingly better versions of ourselves.</p>
<p>But <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167212445599">research shows</a> there doesn’t have to be a trade-off between self-compassion and success. </p>
<p>Self-compassion can help you reach your potential, while supporting you to face the inevitable stumbles and setbacks along the way.</p>
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Read more:
<a href="https://theconversation.com/self-love-might-seem-selfish-but-done-right-its-the-opposite-of-narcissism-205938">'Self-love' might seem selfish. But done right, it's the opposite of narcissism</a>
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<h2>What is self-compassion?</h2>
<p><a href="https://self-compassion.org/">Self-compassion</a> has <a href="https://www.tandfonline.com/doi/abs/10.1080/15298860309027">three</a> key ingredients.</p>
<p><strong>1. Self-kindness</strong></p>
<p>This involves treating yourself with the same kindness you would extend towards a good friend – via your thoughts, feelings and actions – especially during life’s difficult moments.</p>
<p>For instance, if you find yourself fixating on a minor mistake you made at work, self-kindness might involve taking a ten-minute walk to shift focus, and reminding yourself it is OK to make mistakes sometimes, before moving on with your day.</p>
<p><strong>2. Mindfulness</strong></p>
<p>In this context, mindfulness involves being aware of your own experience of stress or suffering, rather than repressing or avoiding your feelings, or over-identifying with them. </p>
<p>Basically, you must see your stress with a clear (mindful) perspective before you can respond with kindness. If we avoid or are consumed by our suffering, we lose perspective.</p>
<p><strong>3. Common humanity</strong></p>
<p>Common humanity involves recognising our own experience of suffering as something that unites us as being human. </p>
<p>For instance, a sleep-deprived parent waking up (for the fourth time) to feed their newborn might choose to think about all the other parents around the world doing exactly the same thing – as opposed to feeling isolated and alone.</p>
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Read more:
<a href="https://theconversation.com/i-was-an-expert-advisor-on-the-documentary-how-to-thrive-heres-what-happened-after-this-wellbeing-experiment-191500">I was an expert advisor on the documentary 'How to Thrive'. Here's what happened after this wellbeing experiment</a>
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<h2>It’s not about day spas, or booking a manicure</h2>
<p>When Sarah voiced her fear that self-compassion would prevent her success, I explained self-compassion is distinct from self-indulgence.</p>
<p>“So is self-compassion just about booking in more mani/pedis?” Sarah asked. </p>
<p>Not really, I explained. A one-off trip to a day spa is unlikely to transform your mental health.</p>
<p>Instead, self-compassion is a flexible <a href="https://link.springer.com/chapter/10.1007/978-3-031-22348-8_7">psychological resilience factor</a> that shapes our thoughts, feelings and actions. </p>
<p>It’s associated with a suite of benefits to our <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/abs/10.1111/aphw.12051">wellbeing</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/15298868.2011.639548">relationships</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/17437199.2019.1705872">health</a>.</p>
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<a href="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Massage therapist massaging woman's back" src="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.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>
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<span class="caption">A one-off trip to a day spa is unlikely to transform your mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-masseurs-hands-massaging-clients-back-181966475">baranq/Shutterstock</a></span>
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<h2>What does the science say?</h2>
<p>Over the past 20 years, we’ve learned self-compassionate people enjoy a wide range of benefits. They tend to be <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/abs/10.1111/aphw.12051">happier</a> and have <a href="https://doi.org/10.1016/j.cpr.2012.06.003">fewer psychological symptoms</a> of distress.</p>
<p>Those high on self-compassion <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167212445599">persevere</a> following a failure. They say they are more motivated to overcome a personal weakness than those low on self-compassion, who are more likely to give up. </p>
<p>So rather than feeling trapped by your inadequacies, self-compassion encourages a <a href="https://hbr.org/2018/09/give-yourself-a-break-the-power-of-self-compassion">growth mindset</a>, helping you reach your potential.</p>
<p>However, self-compassion is not a panacea. It will not change your life circumstances or somehow make life “easy”. It is based on the premise that life is hard, and provides practical tools to cope.</p>
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Read more:
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<h2>It’s a factor in healthy ageing</h2>
<p>I research menopause and healthy ageing and am especially interested in the value of self-compassion through menopause and in the second half of life. </p>
<p>Because self-compassion becomes important during life’s challenges, it can help people navigate physical symptoms (for instance, <a href="https://www.sciencedirect.com/science/article/pii/S0378512214001649?via%3Dihub">menopausal hot flushes</a>), life transitions such as <a href="https://journals.sagepub.com/doi/10.1177/0956797611429466">divorce</a>, and <a href="https://link.springer.com/chapter/10.1007/978-3-031-22348-8_7">promote healthy ageing</a>.</p>
<p>I’ve also teamed up with researchers at <a href="https://www.autismspectrum.org.au/">Autism Spectrum Australia</a> to explore self-compassion in autistic adults. </p>
<p>We found autistic adults report significantly <a href="https://link.springer.com/article/10.1007/s10803-022-05668-y">lower levels</a> of self-compassion than neurotypical adults. So we developed an online <a href="https://www.autismspectrum.org.au/blog/new-online-self-compassion-program-for-autistic-adults">self-compassion training program</a> for this at-risk population.</p>
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Read more:
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<h2>Three tips for self-compassion</h2>
<p>You <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.21923">can learn</a> self-compassion with these three exercises.</p>
<p><strong>1. What would you say to a friend?</strong></p>
<p>Think back to the last time you made a mistake. What did you say to yourself?</p>
<p>If you notice you’re treating yourself more like an enemy than a friend, don’t beat yourself up about it. Instead, try to think about what you might tell a friend, and direct that same friendly language towards yourself.</p>
<p><strong>2. Harness the power of touch</strong></p>
<p>Soothing human touch <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.555058/full">activates</a> the parasympathetic “relaxation” branch of our nervous system and counteracts the fight or flight response. </p>
<p>Specifically, self-soothing touch (for instance, by placing both hands on your heart, stroking your forearm or giving yourself a hug) <a href="https://www.sciencedirect.com/science/article/pii/S2666497621000655">reduces</a> cortisol responses to psychosocial stress.</p>
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<a href="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Middle-aged man hugging himself" src="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.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>
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<span class="caption">Yes, hugging yourself can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-age-hoary-man-wearing-brown-1667780113">Krakenimages.com/Shutterstock</a></span>
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<p><strong>3. What do I need right now?</strong></p>
<p>Sometimes, it can be hard to figure out exactly what self-compassion looks like in a given moment. The question “what do I need right now” helps clarify your true needs.</p>
<p>For example, when I was 37 weeks pregnant, I woke up bolt awake one morning at 3am.</p>
<p>Rather than beating myself up about it, or fretting about not getting enough sleep, I gently placed my hands on my heart and took a few deep breaths. By asking myself “what do I need right now?” it became clear that listening to a gentle podcast/meditation fitted the bill (even though I wanted to addictively scroll my phone).</p><img src="https://counter.theconversation.com/content/223194/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lydia Brown occasionally works as a clinical psychologist in private practice.</span></em></p>A one-off trip to a day spa is unlikely to transform your mental health. But these expert tips might help you cut yourself some slack.Lydia Brown, Senior Lecturer in Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2181402024-01-03T13:13:02Z2024-01-03T13:13:02ZSchool uniforms may trigger sensory overload in kids who are sensitive to fabrics – our research can help<figure><img src="https://images.theconversation.com/files/563331/original/file-20231204-29-a7dx3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children who experience sensory overload struggle with many items of clothing, including school shirts.</span> <span class="attribution"><span class="source">macniak</span></span></figcaption></figure><p>Many people live with what’s known as <a href="https://www.sciencedirect.com/topics/psychology/overresponsiveness">sensory over-reactivity or over-responsiveness</a>. Those with this condition experience an over-reaction to sensory stimuli, such as touch. When overstimulated, the brain <a href="https://www.mdpi.com/2076-3425/9/7/153">triggers a fight-or-flight response</a>, which can lead to irritability, withdrawing from people, and temper tantrums.</p>
<p>Over time individuals can learn to manage this condition, but children often struggle. This can significantly affect their daily lives, from morning routines to school work and participation in sports. Although anyone can experience these challenges, they are particularly prevalent in children diagnosed with conditions such as attention-deficit/hyperactivity disorder (<a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-8749.2001.tb00228.x">ADHD</a>) and <a href="https://link.springer.com/article/10.1007/s10803-019-04180-0">autism spectrum disorders</a>. </p>
<p>Clothing plays a role in worsening these sensory issues because it remains in constant contact with the skin, providing sensory input. While it is acknowledged in research <a href="https://link.springer.com/article/10.1007/s10803-021-05140-3">literature</a> and by <a href="https://www.theottoolbox.com/clothing-sensitivity-red-flags/#:%7E:text=Clothing%20Sensory%20Issues,-Depending%20on%20preferences&text=Certain%20textures%20can%20feel%20uncomfortable,or%20hairy%20textures%20on%20sweaters">practitioners like occupational therapists</a> that items and elements like socks, shoes, seams and labels are major triggers, research in this area is limited. This is likely due to people underestimating the effects of these seemingly minor everyday elements.</p>
<p>It is important to study clothing items to pinpoint the triggers for sensory over-stimulation. These answers can assist in developing clothing that’s comfortable for every child. By combining the expertise of two distinct disciplines – clothing & textiles and occupational therapy – our multidisciplinary team has initiated a research project focused on exploring the diverse elements inherent in clothing and textiles and their relationship to sensory irritation.</p>
<h2>Our study</h2>
<p>The team’s <a href="https://journals.sagepub.com/doi/abs/10.1177/0887302X231187777">first study focused on school uniforms</a>. Occupational therapists, teachers and parents of children with sensory over-reactivity participated in four focus groups. These were virtual meetings, as we started collecting data during the COVID pandemic. </p>
<p>Sample packs of different seams and fabric swatches typically found in school uniforms were compiled and couriered to participants across South Africa to help prepare them for the discussions.</p>
<p>One of our findings was that the collar of a typical school shirt (a collar with a stand) causes irritation, especially if the top button is fastened and worn with a tie. The main reason for this is that they feel restricted and that the clothes are in very close contact with the skin. Parents also mentioned that children often preferred second-hand school uniforms, which they experienced as softer and more tolerable than new items. Pilling – balls of fluff that form on the surface of textiles – can be very intolerable. However, it can easily be removed with a bobble-off device; these are sold at most pharmacies. In all cases, among the participants, labels were removed or completely unpicked from garments.</p>
<p>Apart from providing rich data about clothing and textiles, the study revealed the effect of the clothing on the participation of a child in their daily activities (such as education). </p>
<p>One participant said of her child:</p>
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<p>When she was in class, with her uniform on, she was very distracted, because she constantly stood up and had to sort out her clothes and sit down again.</p>
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<p>It was also highlighted that children are often misunderstood or wrongly labelled as disobedient when, in reality, the issue could be as simple as <a href="http://hdl.handle.net/2263/90419">discomfort caused by the school uniform</a>. One parent said of their child: </p>
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<p>Teachers had tagged or labelled him as disruptive or, as the one teacher even wrote on the board, that this child is ill-mannered.</p>
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<p>Through our research it became apparent that this issue extended beyond the child to affect parents, caregivers and siblings. Many parents expressed feelings of guilt, fear and constant uncertainty. An everyday task, such as dressing their child in the morning, could badly disrupt family life.</p>
<h2>Simple interventions help</h2>
<p>The good news is that simple interventions can make a substantial, positive difference. Awareness of these realities should be highlighted and interventions should focus on improving outcomes not just for the child but for their entire family. </p>
<p>Teachers should be trained to manage sensory over-reactivity in the classroom. They should understand the importance of allowing exceptions in clothing rules for children who experience difficulties in tolerating existing uniforms.</p>
<p>School management should consider modifying school uniform policies to meet everyone’s needs. </p>
<p>Clothing retailers also have a crucial role to play by sensitising designers, developers and buyers to prioritise comfort. </p>
<p>More comfortable clothing would not disadvantage anyone – in fact it could benefit everyone.</p>
<h2>More to come</h2>
<p>Currently our research team is focusing on underwear and socks, since these are big culprits of sensory irritation. We are also conducting a separate analysis on the tactile properties of various textiles used in children’s wear. In future we would also like to look at sportswear and how clothing might affect participation.</p>
<p><em>The school uniform study was co-authored by Masters student Wenette Jordaan and Leoné Gouws, also a Masters student, is a co-author of the underwear study.</em></p><img src="https://counter.theconversation.com/content/218140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The work is based on the research supported wholly/ in part by the National Research Foundation of South Africa (Grant Number: 129842).</span></em></p><p class="fine-print"><em><span>Karin van Niekerk 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>It is important to study clothing items to pinpoint the triggers for sensory over-stimulation.Lizette Diedericks, Lecturer, University of PretoriaKarin van Niekerk, Senior Lecturer in Occupational Therapy, University of PretoriaLicensed 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>
<blockquote>
<p>spur both the clinical and research global communities to prioritise the needs of this vulnerable and underserved group of autistic people.</p>
</blockquote>
<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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1587117486586986496"}"></div></p>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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/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/1703662021-11-11T18:58:40Z2021-11-11T18:58:40ZGut bacteria don’t cause autism. Autistic kids’ microbiome differences are due to picky eating<figure><img src="https://images.theconversation.com/files/431254/original/file-20211110-17-t6tf1u.jpg?ixlib=rb-1.1.0&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/spoon-fork-on-empty-plate-778735972">Shutterstock</a></span></figcaption></figure><p>There has been much speculation that the community of bacteria living in the gut – known as the microbiome – may be different among people on the autism spectrum than the wider population. This has led some researchers and clinicians to speculate that gut bacteria could cause autism.</p>
<p>But our new research, <a href="https://www.cell.com/cell/fulltext/S0092-8674(21)01231-9">published today</a> in the journal Cell, turns this theory on its head. </p>
<p>Rather than differences in gut bacteria influencing brain development, our research suggests changes in gut bacteria are driven by restricted diets, or “picky eating”. </p>
<p>Restricted diets are more common among children with autism because of their sensory sensitivities and restricted and repetitive interests. Some may have strong preferences for a select few foods, while others find some flavours, smells or textures unpleasant or off-putting. </p>
<h2>What’s the theory?</h2>
<p>You may have heard claims the microbiome is related to autism: it may have a “causal” role, or microbiome “therapies” <a href="https://www.nature.com/articles/s41598-019-42183-0">can alter autistic behaviours</a>. </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>Interest in the autism gut microbiome first came from observations people on the autism spectrum are more likely to experience gut problems, such as constipation and diarrhoea. </p>
<p>Further <a href="https://link.springer.com/article/10.1186/s13099-020-0346-1">studies</a> seemed to suggest children on the autism spectrum had different combinations of bacteria living in their gut.</p>
<figure class="align-center ">
<img alt="Child sits on the end of a bed, clutching their stomach." src="https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431259/original/file-20211110-27-1sjgqag.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">Autistic children are more likely to have restricted diets.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abdominal-pain-preschool-child-poisoning-children-1783437671">Shutterstock</a></span>
</figcaption>
</figure>
<p>These intriguing relationships inspired studies of mice and rats, some of which indicated the <a href="https://pubmed.ncbi.nlm.nih.gov/31150625/">microbiome may cause differences in behaviour</a>. </p>
<p>But the excitement has been misguided. </p>
<h2>Assessing the evidence</h2>
<p>Weighing up all the findings, the evidence linking the microbiome to autism is <a href="https://www.spectrumnews.org/news/despite-flurry-of-findings-doubts-dog-gut-microbes-role-in-autism/">highly inconsistent and many studies have significant problems</a> with their scientific design. </p>
<p>There are also problems in relating mouse studies to humans, because autism does not exist in mice. </p>
<p>Despite the uncertainty in the science, the hype around the microbiome and autism has continued to gather momentum.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1134474617492578305"}"></div></p>
<p>Out of this momentum emerged speculative therapies claiming to support children with autism by altering the microbiome, including faecal microbiota transfers and diet therapies. </p>
<p>These “therapies” were long on hope but short on evidence for efficacy and safety, and come with their own risks and substantial costs.</p>
<h2>What our study did</h2>
<p>We worked with the <a href="https://www.autismcrc.com.au/biobank">Australian Autism Biobank</a>, which includes extensive clinical and biological data from children on the autism spectrum and their families, as well as the <a href="https://qbi.uq.edu.au/QTABproject">Queensland Twin Adolescent Brain Project</a>. </p>
<p>We compared microbial DNA from stool samples of 99 children on the autism spectrum to two groups of non-autistic children: 51 of their siblings and 97 unrelated children. </p>
<p>We also looked at clinical, family and lifestyle information, including about the child’s diet, for a comprehensive, broad look at factors that may contribute to the their microbiome. </p>
<h2>What we found</h2>
<p>We found no evidence for a relationship between autism and measures of the microbiome as a whole, or with microbiome diversity. </p>
<p>Only one bacterial species out of more than 600 showed an association with autism. We found no evidence for other bacterial groups that have previously been reported in autism (for example, <em>Prevotella</em>). </p>
<p>Instead, we found children on the autism spectrum were more likely to be “picky eaters” – consistent with <a href="https://pubmed.ncbi.nlm.nih.gov/15449518/">reports</a> <a href="https://pubmed.ncbi.nlm.nih.gov/23371510/">from</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936505/">earlier</a> <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.668297/full">studies</a> – and this was related to particular traits associated with autism, such as restricted interests and sensory sensitivity.</p>
<p>We also found pickier eaters tended to have a less diverse microbiome, and runnier (more diarrhoea-like) stool. We’ve also known for some time children on the autism spectrum are more likely to have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033224">gastrointestinal</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981895/">issues</a> such as constipation, diarrhoea and abdominal pain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431388/original/file-20211110-19-16o7kq4.png?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">Changes in gut bacteria are driven by restricted diets.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The genetic information told a similar story: autism and restricted interests corresponded to a less-diverse diet, but not directly with the microbiome. </p>
<p>These genetic data are critical, because they rule out other environmental factors that may have influenced the findings.</p>
<p>Overall, our results did not support the popular view that gut microbes cause autism. </p>
<p>What we propose instead is strikingly simple: autism-related traits and preferences are associated with less-diverse diet, leading to a less-diverse microbiome and runnier stool.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=141&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=141&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431407/original/file-20211111-5078-awhy25.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=141&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Here’s how our study maps the effect of diet.</span>
</figcaption>
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<h2>What do our findings mean?</h2>
<p>Our findings have important implications for the autism community. </p>
<p>First, microbiome interventions for autism, such as faecal microbiota transplants, should be viewed with caution. Our findings suggest they are unlikely to be effective and <a href="https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-alert-risk-serious-adverse-events-likely-due-transmission">may do more harm than good</a>.</p>
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Read more:
<a href="https://theconversation.com/these-4-diets-are-trending-we-looked-at-the-science-or-lack-of-it-behind-each-one-136045">These 4 diets are trending. We looked at the science (or lack of it) behind each one</a>
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<p>Our study also draws attention to the importance of diet for children on the autism spectrum. Poor diet in children and young people is a <a href="https://www.aihw.gov.au/reports/food-nutrition/poor-diet/contents/poor-diet-in-children">major public health concern in Australia</a>, with important implications for their well-being, development and health conditions such as obesity. </p>
<p>We need to do more to support families at mealtimes, in particular for families with autistic children, rather than resorting to fad “therapies” that may do more harm than good.</p><img src="https://counter.theconversation.com/content/170366/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chloe Yap receives funding from the University of Queensland, the Cooperative Research Centre for Living with Autism (Autism CRC), and the Australian-American Fulbright Commission. </span></em></p><p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council, and the Autism CRC.</span></em></p><p class="fine-print"><em><span>Jake Gratten receives funding from the Australian National Health and Medical Research Council (NHMRC) and the Cooperative Research Centre for Living with Autism (Autism CRC). </span></em></p>New research dispels the myth that gut bacteria causes autism. Rather, changes in the gut bacteria of some people with autism are driven by restricted diets or ‘picky eating’.Chloe Yap, MD-PhD candidate, The University of QueenslandAndrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western AustraliaJake Gratten, Senior Research Fellow, Mater Research Institute - University of Queensland, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688202021-10-01T19:17:35Z2021-10-01T19:17:35ZTylenol could be risky for pregnant women – a new review of 25 years of research finds acetaminophen may contribute to ADHD and other developmental disorders in children<figure><img src="https://images.theconversation.com/files/424065/original/file-20210930-22-wgb0x.jpg?ixlib=rb-1.1.0&rect=123%2C22%2C1993%2C1387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly 100 scholars and health care professionals are urging women to limit their use of acetaminophen during pregnancy. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-pregnant-woman-holding-her-belly-royalty-free-image/1310443783?adppopup=true"> Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A mounting body of evidence shows that the use of acetaminophen - widely known by its brand name Tylenol - during pregnancy may pose risks to the fetus and to early childhood development. That was the conclusion of a <a href="https://doi.org/10.1038/s41574-021-00553-7">new review study</a> on which I was a lead author. </p>
<p>Acetaminophen, which has the chemical name paracetamol, is a go-to over-the-counter medication that is widely recommended by doctors to relieve pain and reduce fever.</p>
<p>Our study, based on an assessment of 25 years of research in the areas of human epidemiology, animal and in-vitro studies, concludes that prenatal acetaminophen exposure may increase the risks of reproductive organs developing improperly. We identified a heightened risk of <a href="https://doi.org/10.1111/ppe.12632">neurodevelopmental disorders</a>, primarily attention deficit hyperactivity disorder and related behaviors, but also autism spectrum disorder, as well as language delays and decreased IQ. </p>
<p>In our consensus statement – a broad agreement by our multidisciplinary international panel of experts – published in Nature Reviews Endocrinology in September 2021, 91 clinicians and researchers are calling for caution and additional research.</p>
<h2>Why it matters</h2>
<p>Acetaminophen is an active ingredient in <a href="https://www.chpa.org/our-issues/otc-medicines/acetaminophen">over 600 prescription and over-the-counter medications</a>, including Tylenol. It is used by more than <a href="https://doi.org/10.1002/aur.1591">50% of pregnant women</a> worldwide and at least <a href="https://doi.org/10.1016/j.ajog.2005.02.100">65% of pregnant women</a> in the U.S. Research suggests that acetaminophen is an endocrine disruptor and may interfere with the hormones essential for healthy neurological and <a href="https://doi.org/10.1289/EHP2478">reproductive development</a>.</p>
<p>A spokeswoman for Johnson & Johnson, which makes Tylenol, <a href="https://www.cnn.com/2021/09/23/health/acetaminophen-pregnancy-wellness/index.html">told CNN</a> in September that the product label tells women who are pregnant or breastfeeding to ask a health care professional before using it.</p>
<p>Current <a href="https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/">guidance recommends</a> acetaminophen as the pain reliever of choice during pregnancy, as <a href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/aspirin-during-pregnancy/faq-20058167">other pain relievers</a> such as <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic">ibuprofen and aspirin are not considered safe</a> after <a href="https://mothertobaby.org/fact-sheets/ibuprofen-pregnancy/">midpregnancy</a>.</p>
<p>Rates of <a href="https://doi.org/10.1152/physrev.00017.2015">reproductive disorders</a> and neurodevelopmental disorders, <a href="https://www.cdc.gov/ncbddd/adhd/timeline.html">such as ADHD</a> and <a href="https://autismsciencefoundation.org/what-is-autism/how-common-is-autism/">autism spectrum disorder</a>, have <a href="https://doi.org/10.1542/peds.2019-0811">been increasing</a> over the last 40 years. </p>
<p>Over the same time period, the use of acetaminophen during pregnancy <a href="https://doi.org/10.1016/j.ajog.2005.02.100">has gone up</a>. We conclude that because <a href="https://doi.org/10.1016/j.annepidem.2017.09.003">acetaminophen is so commonly taken during pregnancy</a>, if its use is responsible for even a small increase in individual risk, it could contribute substantially to these disorders in the <a href="https://doi.org/10.1136/bmj.k757">overall population</a>.</p>
<h2>What still isn’t known</h2>
<p>It’s unethical to do experiments that could harm a human life, so to gain a better understanding of the direct effects of acetaminophen during pregnancy, we must rely on human observational and experimental studies to assess the possibility of causal connections. But to really get at these questions, we need human cohort studies that can precisely capture when and why acetaminophen is taken during pregnancy. Additionally, we would like to see research that gives us a better understanding of the biologic pathways. </p>
<p>Notably, acetaminophen is also the medication <a href="https://doi.org/10.1542/peds.2008-2869">most commonly</a> <a href="https://doi.org/10.1016/j.jped.2014.03.004">given to infants</a>. More research is needed to determine whether this practice is safe for the developing brain. </p>
<h2>What’s next</h2>
<p>The current near-ubiquitous use of acetaminophen during pregnancy is due in part to the <a href="https://doi.org/10.2174/1381612825666190321110420">widespread perception</a> – even among doctors – that it has limited side effects and negligible risk. But a growing body of research suggests that the <a href="https://doi.org/10.1016/j.yhbeh.2018.01.003">indiscriminate use</a> of acetaminophen during pregnancy – especially for conditions such as <a href="https://doi.org/10.1111/bcpt.12527">chronic pain</a>, <a href="https://doi.org/10.1002/14651858.CD012230">low back pain</a> and <a href="https://doi.org/10.1002/14651858.CD011889.pub2">headaches</a> – may be unwarranted and unsafe.</p>
<p>In our consensus statement, we urge education of health professionals and pregnant women about the risks and benefits of acetaminophen use during pregnancy.</p>
<p>Based on our extensive review of the evidence – and the recognition that there are limited alternatives for the necessary treatment of high fever and severe pain – we recommend that pregnant women refrain from using acetaminophen unless it is medically recommended by a doctor. Women should also minimize risk to the fetus by using the lowest effective dose for the shortest possible time.</p>
<p><em>This article was updated on Oct. 4, 2021, to include a statement from Johnson & Johnson.</em></p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Z. Bauer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tylenol has long been considered a go-to medication for low to moderate pain and for fever reduction, even during pregnancy. But mounting evidence suggests that it is unsafe for fetal development.Ann Z. Bauer, Postdoctoral Fellow in Epidemiology, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671462021-09-20T20:09:46Z2021-09-20T20:09:46ZTherapy for babies showing early signs of autism reduces the chance of clinical diagnosis at age 3<figure><img src="https://images.theconversation.com/files/422004/original/file-20210919-48420-z0o1lv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">Shutterstock</a></span></figcaption></figure><p>A therapy for infants showing early signs of autism reduces the chance of the child meeting diagnostic criteria for autism at three years of age. That’s according to our new research, published today in the journal <a href="https://jamanetwork.com/journals/jamapediatrics">JAMA Pediatrics</a>.</p>
<p>Therapy for children with autism often begins after receiving a diagnosis, which usually doesn’t occur until after the child turns two.</p>
<p>Our findings suggest starting therapy during the first year of life, when the brain and mind are developing rapidly, may provide even greater benefits.</p>
<p>Infants who received the therapy at 12 months of age were re-assessed at age three. They had fewer behaviours of autism, such as social communication difficulties and repetitive behaviours, compared to infants who didn’t receive the therapy. </p>
<p>Infants who received the therapy were also less likely to meet criteria for an overall diagnosis of autism when they were three.</p>
<h2>Autism diagnosis</h2>
<p>Like all neurodevelopmental conditions, autism is diagnosed using “deficit-focused” diagnostic criteria. In other words, children are assessed on what they can’t do. </p>
<p>The <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostics and Statistical Manual</a> is the authoritative guide describing the behaviours we use to diagnose neurodevelopmental and psychiatric conditions. It specifies individuals must have “persistent deficits” in social communication and behavioural interaction to receive a diagnosis of autism spectrum.</p>
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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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<p>Significantly more children are now recognised as having difficulties learning social communication skills than previously. This has led to an increase in the numbers of children being diagnosed with autism – now estimated to be <a href="https://journals.sagepub.com/doi/abs/10.1177/0004867415595287">2% of the population</a>. </p>
<p>These social and communication difficulties, restricted behavioural repertoire and sensory issues, can present significant barriers to relationships, education and employment as they mature. So reducing these challenges can be important to helping individuals thrive into adulthood.</p>
<p>The aim of the therapy we trialled in our study was to help support social communication skills early in life, with the aim of reducing these long-term barriers.</p>
<h2>The therapy</h2>
<p>The therapy, called iBASIS-VIPP, was based on the <a href="https://www.youtube.com/watch?v=iiC-3uxwgDM">Video Interaction for Positive Parenting</a> (VIPP) program. This program was adapted by our colleagues in the United Kingdom to specifically support social communication development.</p>
<p>The therapy is parent-led, which means parents and caregivers, who are the most prominent and important people in their babies’ lives, are trained to deliver it.</p>
<p>iBASIS-VIPP uses video-feedback to help parents recognise their baby’s communication cues so they can respond in a way that builds their social communication development. </p>
<figure class="align-center ">
<img alt="A man talks to his baby who lays on a bed." src="https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422005/original/file-20210919-25-1w9sucd.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">
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<span class="caption">Parents are taught to recognise their baby’s communication cues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-toddler-girl-on-bed-home-1085344445">Shutterstock</a></span>
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<p>Parents are videoed interacting with their baby in everyday situations, such as feeding and playing. The trained therapist then provides guidance to the parent about how their baby is communicating with them, and they can communicate back to have back-and-forth conversations.</p>
<p>We know these back-and-forth conversations are crucial to support early social communication development, and are a precursor to more complex skills, such as verbal language.</p>
<p>Importantly, parent-infant interactions are in no way the “cause” of autism. Infants are born with developmental vulnerabilities, which other studies tell us are likely of genetic origin. </p>
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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>
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<p>This therapy focuses on supporting parent-child interactions as a way of enriching their social environment, creating learning opportunities for the child. And this is tailored to the child’s unique abilities.</p>
<p>The therapy takes the approach that children who develop differently experience the world and learn skills in different ways. By understanding unique abilities and interests of each baby, we can use these strengths as a foundation for future development.</p>
<h2>What we found</h2>
<p>In our study, we identified 103 infants in Perth and Melbourne who were showing early behavioural signs of autism, such as reduced eye contact, imitation or social smiling.</p>
<p>Fifty of the infants were randomised to receive the iBASIS-VIPP therapy for five months. The other 53 infants received the usual services they would receive in their local community, such as allied health therapy, working with psychologists, speech pathologists and occupational therapists. </p>
<p>The babies then received developmental assessments at around 18 months of age, two years, and three years. </p>
<p>When the babies were aged three, independent clinicians who did not know which therapies the children had received, reviewed all of the developmental information collected. And they determined whether the children met diagnostic criteria for autism.</p>
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<img alt="Two babies play together." src="https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422006/original/file-20210919-25-1i2qm00.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">
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<span class="caption">Half the babies in the study received the therapy, with the other half treated as usual.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/babys-playing-together-kindergarten-543939718">Shutterstock</a></span>
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<p>The iBASIS-VIPP therapy was so effective in supporting children to learn social communication skills that only 6.7% of the children met diagnostic criteria for autism at age three years, compared to 20.5% of children who did not receive the therapy. That’s a reduction of two-thirds.</p>
<p>While most children in the study still had some level of developmental difficulties, the therapy supported the development of social communication skills. This meant they no longer met the criteria for a diagnosis.</p>
<p>The iBASIS-VIPP therapy led to increased parental responsiveness to their child’s unique communication. It also improved parent-reported language development, compared to the control group.</p>
<p>This is the first time a “pre-emptive” therapy – that is, a therapy provided before diagnosis – has shown an effect on autism diagnostic outcomes. </p>
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Read more:
<a href="https://theconversation.com/we-examined-the-research-evidence-on-111-autism-early-intervention-approaches-heres-what-we-found-150085">We examined the research evidence on 111 autism early intervention approaches. Here's what we found</a>
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<h2>What do the findings mean?</h2>
<p>This therapy represents a new way of providing support to infants showing early developmental difficulties.</p>
<p>Many therapies for autism try to improve development by working with children directly to shape more “typical” behaviours. </p>
<p>By contrast, this therapy does not work with the child directly but with the social environment around the child. It adapts to each child’s unique differences, and helps them learn in a way that is best for them.</p>
<p>By doing so, this therapy was able to support social communication skills and behavioural expression to the point that infants were less likely to meet the “deficit-focused” diagnostic criteria for autism.</p>
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<img alt="Children and educators sit around a low table, playing with blocks and rings." src="https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422007/original/file-20210919-25-q0llu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Each child is different and treatment needs to be tailored to them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nursery-children-playing-teacher-classroom-1240454104">Shutterstock</a></span>
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<p>This finding provides strong evidence for a new model of how we provide clinical support to children with developmental differences. </p>
<p>Rather than waiting until a diagnosis to start therapy – typically at two years of age at the earliest – we need to identify developmental differences as early as possible. Then we need to provide developmental supports that nurture each child’s strengths.</p>
<p>At its most basic, this is a change of clinical support from “wait and see” to “identify and act”.</p>
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Read more:
<a href="https://theconversation.com/treating-suspected-autism-at-12-months-of-age-improves-childrens-language-skills-120331">Treating suspected autism at 12 months of age improves children's language skills</a>
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<p>The finding also emphasises the importance of providing supports to children based on functional difficulties, rather than the presence or absence of a diagnosis. This approach is consistent with Australia’s <a href="https://www.ndis.gov.au/community/have-your-say/interventions-children-autism-spectrum">National Disability Insurance Scheme</a>.</p>
<p>By understanding who a child is (their strengths and challenges) rather than what they are (a diagnostic label), we can provide individualised therapy supports that will help them towards their full potential.</p><img src="https://counter.theconversation.com/content/167146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council, the Autism Cooperative Research Centre, the Angela Wright Bennett Foundation, the McCusker Charitable Foundation and JVCKENWOOD Corporation. </span></em></p><p class="fine-print"><em><span>Jonathan Green receives funding from the UK Medical Research Council, the UK National Institute for Health Research and the Telethon-Perth Children’s Hospital Research Fund. He is Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. Hon Consultant, Royal Manchester Children’s Hospital, and NIHR Senior Investigator. The views expressed are his and do not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Kristelle Hudry works for La Trobe University. She has received funding from two La Trobe University Research Focus Areas (Understanding Disease, Building Health Communities), the Cooperative Research Centre for Living with Autism (AutismCRC), the Australian Government Department of Social Services (DSS), the National Disability Insurance Agency (NDIA), and JVCKENWOOD Corporation. She receives consultancy fees for training on the Autism Diagnostic Observation Schedule (ADOS) and for her Associate Editor role with Research in Developmental Disabilities (RIDD).</span></em></p>While most children still had some level of developmental difficulties, the therapy boosted their social communication skills, leaving them less likely to meet the criteria for an autism diagnosis.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western AustraliaJonathan Green, Professor of Child/Adolescent Psychiatry, University of ManchesterKristelle Hudry, Associate Professor of Developmental Psychology, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648592021-09-08T04:12:19Z2021-09-08T04:12:19ZNeurodiversity can be a workplace strength, if we make room for it<figure><img src="https://images.theconversation.com/files/416249/original/file-20210816-17-1is8xri.jpg?ixlib=rb-1.1.0&rect=0%2C413%2C3500%2C1723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">igor kisselev/Shutterstock</span></span></figcaption></figure><p>Emma can recognise patterns within complex code. James can develop several different solutions when faced with complicated problems. But it is unlikely either will find a job where they can put their specialist skills to work — or any job, actually. </p>
<p>Emma has dyslexia. James has been diagnosed with attention deficit hyperactivity disorder. These conditions mean communicating can be a challenge, particularly in a stressful situation such as a job interview. They may also find it difficult to work in a typical office environment with noise and bright lights. </p>
<p>But often the significant challenge is other people assuming they will be less capable or difficult to work with.</p>
<p>About 15-20% of the <a href="https://academic.oup.com/bmb/article/135/1/108/5913187">global population</a> are “neurodiverse”. This term, coined by Australian <a href="https://www.autismawareness.com.au/news-events/aupdate/in-conversation-with-judy-singer/">sociologist Judy Singer</a> in 1998, conveys <a href="https://autismawarenesscentre.com/un-adopts-new-goals-disabilities/">the idea</a> that the neurological differences shaping how people think and interact are natural variations to the human genome. Neurodiversity therefore isn’t something to be “fixed” but understood and accommodated.</p>
<p>Despite this understanding, and the gains made more generally in promoting workplace diversity, prejudices keep the employment prospects for neurodiverse individuals shockingly low. </p>
<p>The cost is personal — denying individuals the chance to do meaningful work — as well as social, sending individuals to the dole queue. It also means workplaces are failing to benefit from highly valuable employees, and missing the opportunity to become better organisations in the process.</p>
<h2>What neurodiversity covers</h2>
<p>Neurodiversity is often referred to as an ‘invisible disability’ and covers a range of conditions. The most common are:</p>
<ul>
<li><p><strong>Attention Deficit Hyperactivity Disorder</strong> (or ADHD) manifests as inattention, distractability and impulsivity. It affects about <a href="https://www2.deloitte.com/au/en/pages/economics/articles/social-economic-costs-adhd-Australia.html">4% of children and 3% of adults</a>.</p></li>
<li><p><strong>Autism Spectrum Disorder</strong> (or ASD) typically involves degrees of difficulty in communicating with others and sensory overload. About <a href="https://www.autism-society.org/what-is/facts-and-statistics/">1% of the global population</a> is estimated to be on the spectrum, with higher rates being diagnosed among children.</p></li>
<li><p><strong>Dyslexia</strong> involves difficulties with reading and spelling. There is no agreed diagnosis. Estimates of its prevalence range from 3% to 20% (with <a href="https://dyslexiaassociation.org.au/dyslexia-in-australia/">10-15%</a> commonly cited).</p></li>
<li><p><strong>Dyspraxia</strong> involves challenges with coordinating physical movements, including muscles for speaking. About 2% of the population are severely affected, with <a href="https://adc.bmj.com/content/archdischild/92/6/534.full.pdf?casa_token=s2n80xJNuhAAAAAA:kzF2QsFQRlR_rmpi80YkV9N8Lp8YT9bIXb1cwOEbaiZUm3f5KfRO4xPk8_F2YoXm6-bM7rHANPkqIQ">6-10%</a> estimated to be affected to some degree.</p></li>
<li><p><strong>Dyscalculia</strong> involves challenges with numbers. It affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461157/">up to 10%</a> of the population, with <a href="https://www.dyslexia.uk.net/specific-learning-difficulties/dyscalculia/">3-6%</a> commonly cited.</p></li>
<li><p><strong>Tourette syndrome</strong> causes involuntary physical and vocal “tics”. It affects an estimated <a href="https://tourette.org/spectrum-tourette-syndrome-tic-disorders-consensus-scientific-advisors-tourette-association-america/">0.6% of the population</a>.</p></li>
</ul>
<h2>High unemployment</h2>
<p>The capabilities of neurodivergent people can vary considerably from severely challenged to gifted. Some are nonverbal and fully reliant on care givers. Others have special abilities in things such as <a href="https://hbr.org/2017/05/neurodiversity-as-a-competitive-advantage">pattern recognition, memory or mathematics</a>.</p>
<p>Yet even those with exceptional talents find it hard to get and hold a job. While unemployment estimates are imprecise, they suggest these conditions are the least accepted in the working world.</p>
<p>For autistic adults aged 16-64, for example, UK statistics suggest <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/outcomesfordisabledpeopleintheuk/2020">78% are unemployed</a>. This is the highest unemployment rate of any group, compared with 48% for all disabled people and 19% for all adults.</p>
<p>Australian statistics put the unemployment rate for people with autism <a href="https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release">at 34%</a>. That’s still more than three times the unemployment rate of 10% for people with disabilities and almost eight times the 4.6% rate for people without disabilities.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/expecting-autistic-people-to-fit-in-is-cruel-and-unproductive-value-us-for-our-strengths-103888">Expecting autistic people to 'fit in' is cruel and unproductive; value us for our strengths</a>
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</em>
</p>
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<h2>Supporting neurodiversity at work</h2>
<p>One problem, as Joanna Szulc and her fellow researchers at the University of Huddersfield <a href="https://pure.hud.ac.uk/en/publications/amo-perspectives-on-the-well-being-of-neurodivergent-human-capita">have put it</a>, is “management practices frequently overlook the relationship between the above-average human capital of neurodivergent employees, their subjective well-being in the workplace and performance outcomes”. </p>
<p>In other words, with understanding colleagues and a flexible work culture, neurodiverse individuals can reach their potential and be recognised as highly valuable employees.</p>
<p>One case study demonstrating this is professional services giant Ernst and Young, which globally employs close to 300,000 people. </p>
<p>In 2016 it established its first “<a href="https://www.ey.com/en_us/diversity-inclusiveness/how-neurodiversity-is-driving-innovation-from-unexpected-places">Neurodiversity Center of Excellence</a>” as part of a pilot program to offer jobs to neurodiverse candidates. </p>
<p>The company says it “considered business metrics only” in evaluating the program. It concluded the neurodiverse employees were comparable to neurotypical staff in work quality, efficiency and productivity. The bonus was “the neurodiverse employees excelled at innovation”.</p>
<p>Australia’s Department of Defence has employed high-performing autistic individuals in its <a href="https://www.defence.gov.au/annualreports/16-17/Features/CyberCapabilityTalentAutism.asp">cyber security</a> work. Their strengths for this work include “a remarkable eye for detail; accuracy and consistency; a logical and analytical approach to detecting irregularities; pattern-matching skills; and a high tolerance for repetitive mental tasks”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/neurodiversity-at-work-benefits-everyone-why-companies-are-hiring-autistic-people-146788">Neurodiversity at work benefits everyone – why companies are hiring autistic people</a>
</strong>
</em>
</p>
<hr>
<p>These lessons are being taken on board by others. In July, Google’s cloud computing division announced its <a href="https://cloud.google.com/blog/topics/inside-google-cloud/google-cloud-launches-a-career-program-for-people-with-autism">Autism Career Program</a>, which includes training up to 500 managers “to work effectively and empathetically with autistic candidates”.</p>
<p>We all vary naturally. By understanding and encouraging neurodiverse individuals to be fully engaged in society, we will all reap the rewards.</p><img src="https://counter.theconversation.com/content/164859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Russo is a Non-Executive Director with Autism Spectrum Australia (Aspect), Australia’s largest autism-specific service provider. A not-for-profit organisation, Aspect works in partnership with people of all ages on the autism spectrum, and their families to deliver evidence-informed solutions that includes, among other things, employment services. The views expressed in this article are her own and those of her co-authors, and do not necessarily represent the view of Aspect.</span></em></p><p class="fine-print"><em><span>Dana L. Ott and Miriam Moeller 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>Despite progress in promoting workplace diversity, prejudices keep the employment prospects for neurodiverse individuals shockingly low.Miriam Moeller, Senior Lecturer, International Business, The University of QueenslandDana L. Ott, Lecturer, International Management, University of OtagoEmily Russo, Industry Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1411572020-07-01T10:40:06Z2020-07-01T10:40:06ZAutistic doctors – we’re not exactly as portrayed on TV<figure><img src="https://images.theconversation.com/files/344786/original/file-20200630-103677-1cldaq9.jpg?ixlib=rb-1.1.0&rect=11%2C11%2C3835%2C2566&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/female-doctor-mask-examines-xray-mri-1721281114">Orion Production/Shutterstock</a></span></figcaption></figure><p>When I open up about my referral for an autism spectrum disorder assessment, I draw on examples from the only popular reference I have for an autistic doctor – what’s portrayed on TV.</p>
<p>You have probably seen these medical dramas – The Good Doctor, House, Grey’s Anatomy. There are more. They all have or allude to a stereotype of autism in certain characters. </p>
<p>The Good Doctor himself, Dr Shaun Murphy, is a surgical trainee with excellent memory recall and attention to detail who faces stigma but often saves the day because of his traits, proving those who doubted him wrong. Dr Virginia Dixon was briefly head of cardiothoracic surgery in Grey’s Anatomy, with her special interest advertised by her relaying of heart-based facts and a tendency to over-explain procedures to patients, as well as a dislike of physical contact and the wearing of extra protective gear during surgery.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=405&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=405&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344787/original/file-20200630-103677-1evbhtg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=405&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr Shaun Murphy, a stereotypical autistic doctor.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/w/index.php?curid=54028354">Wikimedia Commons</a></span>
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</figure>
<p>While I can relate to some aspects of these characters – both struggles and strengths – my reality seems to be more exhausting and hidden. Battles such as sensitivity to noise, struggling with small talk, getting lost in the hospital, developing coping mechanisms for organisation, or painfully scrutinising my replies to emails are what I bury and mask with a smile during the working day. Struggles aside, I also feel that some of my “traits” will allow me to be a great doctor.</p>
<p>I watch (and love!) these TV shows, but also see a lot of glamorous misconceptions and failure to do justice to the autistic community. The range of signs and diagnosis paths varies significantly between individuals, so the stereotypical TV autistic doctor isn’t always a portrayal of who we are.</p>
<p>And there is a “we” – though my experience is my own, and I cannot speak for all. Absolute numbers of autistic doctors practising in the profession are unknown. One study <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/tct.12743">suggests a 1% prevalence</a> in general practitioners and may vary between speciality with different traits drawn towards different specialities from pathology to neurosurgery.</p>
<p>Things that may serve me well in a career as a doctor include attention to detail, hyper-focus, and creativity in diagnosis and treatment. Increased empathy is often not portrayed on TV – or expected – and is something I use in every patient or colleague encounter. </p>
<p>As a stickler for rules and regulations, I find myself poring over <a href="https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines">Nice guidelines</a> – which helps in exams. Special interests can form – my own being how the human body adapts to being in space. So much so that I’ve spoken at conferences, attended society lectures, carried out research projects, completed courses at the European Space Agency, and am finishing up taking a year from medical training to research the subject. An interest which is so varied from typical work in the hospital, and my intensity of interest in it, results in conversations and bonds with colleagues and patients.</p>
<p>I’ve found out because of my space-themed stethoscope, that the doctor running a clinic I was shadowing is a qualified aviation medical examiner, who then helped me gain work experience opportunities in that field. I’ve also shared this passion with a patient whose grandchild wants to be an astronaut, and we joked that I could be doing their physical exam at a space agency one day. My love for space and academia is not new; I have a degree in astrophysics and a PhD in physics. </p>
<p>In terms of difficulties, for me, moving every few weeks for placement and living in shared hospital accommodation has been taxing. I’m often exhausted when peers are not, due to the extra mental workload of masking all day. Together with noise sensitivity, it can leave me burnt out. Many autistic people suffer from mental health conditions and have special learning disabilities. It is vital to have the right support, treatment and adjustments for these. Which leads us to the endless paperwork and meetings needed in order to get that support. And, of course, a diagnosis is needed first, which is involves lots of waiting for appointments. While I’m grateful that the support is there, the barriers to it are real. </p>
<p>There is also the fear of prejudice, and a constant fight to keep up in a training programme designed for non-autistic doctors. Medical training is challenging for everyone – and even more so for us.</p>
<h2>Overlooked assets</h2>
<p>Only recently, after searching online, did I find colleagues to relate to. I joined a Facebook group for autistic doctors and another for medical students. To have a space to discuss problems and learn how others have dealt with difficulties is welcome. These online spaces were pioneered by an autistic doctor, who openly <a href="https://www.rcplondon.ac.uk/news/doctor-can-autistic-doctor">detailed her experience</a> recently in a series by the Royal College of Physicians called This Doctor Can. </p>
<p>While what you see on TV may be entertaining – and this sort of representation is essential – I think we should welcome, champion and enable real-life autistic doctors to succeed in the ever-changing and increasingly challenging world of medicine. These thoughts were echoed in <a href="https://pubmed.ncbi.nlm.nih.gov/32199503/">The Lancet Psychiatry</a> earlier this year, terming us “overlooked assets to medicine”. </p>
<p><em>If you think you may need an ASD assessment, speak to your doctor or occupational health team.</em></p><img src="https://counter.theconversation.com/content/141157/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nina Purvis 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>Dr Shaun Murphy, Dr House, Dr Virginia Dixon are all great characters. But their reality doesn’t always chime with my own.Nina Purvis, Student Doctor and Researcher in Space Medicine, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1265502019-12-11T10:34:33Z2019-12-11T10:34:33ZUnderstanding autism: new research dispels common assumptions<figure><img src="https://images.theconversation.com/files/306098/original/file-20191210-95115-1j9iymd.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5310%2C3272&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many common assumptions about autism aren't true, as our new book shows.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/concept-autism-autistic-development-disorder-symbol-1094127335?src=876724d4-2a0b-46ff-b003-bc627697c6b4-1-26&studio=1">Lightspring/ Shutterstock</a></span></figcaption></figure><p>Sixteen-year-old climate activist Greta Thunberg has made headlines not just for her <a href="https://www.theguardian.com/environment/video/2019/sep/23/greta-thunberg-to-world-leaders-how-dare-you-you-have-stolen-my-dreams-and-my-childhood-video">passionate climate activism</a>, but because she is outspoken about having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">autism</a>. However, her treatment by some members of the media – even being called “<a href="https://www.thedailybeast.com/fox-news-guest-calls-greta-thunberg-mentally-ill-swedish-child-as-right-wing-unleashes-on-climate-activist">mentally ill</a>” – shows that many <a href="https://otsimo.com/en/10-myths-autism">harmful myths</a> about autism still persist, despite increased awareness. </p>
<p>About one in every 60 people has <a href="https://www.cdc.gov/ncbddd/autism/data.html">autism</a>. Although each person is unique, autistic people share some common characteristics. These include difficulty with social interactions, repetitive behaviour and <a href="https://iancommunity.org/cs/challenging_behavior/challenging_behavior_restricted_interests">restricted interests</a>, which are present from early childhood and limit everyday functioning. Autism is a <a href="https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml">spectrum condition</a>, which means the type and severity of symptoms varies depending on the person. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1167916177927991296"}"></div></p>
<p>In <a href="https://www.routledge.com/Thinking-Reasoning-and-Decision-Making-in-Autism-1st-Edition/Morsanyi-Byrne/p/book/9781138481176">our new book</a>, we invited leading experts in cognitive science and autism to present their research. This research gives new insights into the autistic mind and what it’s like to have autism. It dispels common assumptions about this form of atypical development. </p>
<h2>Can autistic people make good decisions?</h2>
<p><a href="https://www.autism.org.uk/about/family-life/everyday-life.aspx">Everyday activities</a>, such as going shopping or visiting the hairdresser, can often be challenging for autistic people. For example, they are more likely than the average person to report <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-3">buying things they don’t use</a>. They often find it difficult to make small decisions such as what clothes to wear or what to eat. But when it comes to making big decisions, such as about who to marry or where to work, they do so in the same way as a typical person.</p>
<p>In our book, we present research showing that autistic people tend to base their decisions on careful reflection. This might be because they’re less likely to rely on their <a href="https://www.thinkadvisor.com/2018/11/16/daniel-kahneman-do-not-trust-your-intuition-even-f/?slreturn=20191108041704">feelings and intuitions</a> compared with the average person. As a result <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-2">they take longer to make decisions</a> and they don’t tend to jump to conclusions as much as the typical person. </p>
<p>These examples show that whether someone with autism makes “better” or “worse” decisions compared to others depends on the kind of decision they’re making. Indeed, in many cases, their choices aren’t better or worse than the typical person’s – just different. For example, they’re more likely to buy something from an ad that features <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-3">a person enjoying the product on their own</a> rather than with others.</p>
<h2>Can autistic people be imaginative?</h2>
<p>It’s often assumed that <a href="https://planetautismblog.wordpress.com/2018/01/02/autistic-imagination/">autistic people lack imagination</a> because of their focus on exact details and facts. For the average person, being able to imagine alternatives to reality is easy, whether ruminating on past events or daydreaming about how the future might unfold. Even very young children, between one-and-a-half to two years old, begin to engage in <a href="https://en.wikipedia.org/wiki/Make_believe">pretend play</a>. </p>
<p>Contrary to common belief, children with autism do develop these <a href="https://reasoningandimagination.com/the-rational-imagination/">rational imagination skills</a> – although it might take them <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-5">two or three years longer</a> than other children. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306099/original/file-20191210-95165-1u1yzsq.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">Autistic people have a rich imagination, contrary to popular assumptions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thinking-man-bubble-on-blackboard-background-356650643">ChristianChan/Shutterstock</a></span>
</figcaption>
</figure>
<p>Likewise, analogical thinking, in which a person compares two objects or events, is considered essential to <a href="https://www.mitchmedical.us/thinking-reasoning/the-roles-of-analogy-in-scientific-thinking.html">creativity</a> and for understanding new concepts. Remarkably, autistic people often show outstanding skills at solving <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-4">pictorial analogies</a> – such as finding the hidden pattern in the <a href="https://en.wikipedia.org/wiki/Raven%27s_Progressive_Matrices">Raven’s Matrices</a> test. Despite some differences in the development of creative thought, autistic people have as rich an imaginative mental life as anyone. </p>
<h2>Do autistic people interpret things literally?</h2>
<p>There’s a persistent idea that autistic people interpret everything <a href="https://www.psychologytoday.com/us/blog/the-gift-aging/201304/people-autism-spectrum-disorder-take-things-literally">literally</a>. In fact, an inability to understand metaphors and other forms of non-literal language is part of the <a href="https://www.autismspeaks.org/autism-diagnosis-criteria-dsm5">diagnostic criteria for autism</a>. </p>
<p>But autistic people do <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-6">understand the real meaning of metaphors</a> just as non-autistic people do, when they are compared with people with similar language abilities. They also understand that indirect requests, such as: “Can you close the window?”, require an action rather than a “yes” or “no” answer. </p>
<p>Autistic people can rely on background knowledge to know which logical inferences to make – though they sometimes do so differently from the average person. For example, if they’re told: “If Lisa has an essay to write she will study late in the library” and: “If the library stays open she will study late in the library”, <a href="https://www.taylorfrancis.com/books/e/9781351060912/chapters/10.4324/9781351060912-7">they often infer</a> that: “She will study late in the library”. Given the same information, the average person doesn’t usually infer that Lisa will study late in the library, because they recognise that they don’t know whether the library stayed open or not. </p>
<p>Autistic people sometimes differ from others in how they combine different sorts of knowledge. Nevertheless, in most cases they get the big picture and can usually uncover the hidden meaning of what someone has said to them.</p>
<p>These new discoveries contradict some current stereotypes of autism, revealing that the thought processes of autistic people are not entirely different from the average person’s. They also show how these differences can be advantageous in some situations. For example, careful decision making is useful when deciding who to vote for, or what investment to make. But it can be a drawback in a situation that calls for a rapid response, such as when a person needs to think on their feet in a job interview. </p>
<p><a href="https://psychcentral.com/news/2012/03/30/is-autism-an-epidemic/36729.html">Autism diagnoses are steadily increasing</a> around the world, though many people still remain <a href="https://www.verywellhealth.com/high-functioning-autism-260305">undiagnosed</a>. The discoveries in our book help build a deeper understanding of the autistic mind – although the reasons for some autistic characteristics still remain unknown. The contribution of <a href="http://www.thinkingautismguide.com/p/about.html">autistic people</a> discussing their experiences with autism, helps dispel persistent misconceptions about this form of atypical development.</p>
<p><em>Amendment. The term “people with autism” has been replaced throughout with “autistic people”. And the term “developmental disorder” has been replaced with “atypical development”.</em></p><img src="https://counter.theconversation.com/content/126550/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 new book explores the autistic mind – and shows that we’re not as different as we might thinkRuth Byrne, Professor of Cognitive Science in the School of Psychology and Institute of Neuroscience, Trinity College DublinKinga Morsanyi, Lecturer in the School of Psychology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1250532019-11-12T19:03:39Z2019-11-12T19:03:39ZIt’s 25 years since we redefined autism – here’s what we’ve learnt<figure><img src="https://images.theconversation.com/files/300582/original/file-20191107-12521-1pg5b01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The frequency and intensity of repetitive behaviours vary between mild and severe, which is why it's called a spectrum.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-headphones-looking-out-window-airport-219436822?src=4360f59d-f1ce-4544-ab94-e99b723f70cc-2-6">Dubova/Shutterstock</a></span></figcaption></figure><p>It’s 25 years since the fourth edition of the <a href="https://theconversation.com/explainer-what-is-the-dsm-14127">Diagnostic and Statistical Manual</a> (DSM-IV) was published. The manual is the clinical “bible” that defines the criteria for the diagnosis of psychiatric and neurodevelopmental conditions, and was a landmark document for autism spectrum disorder.</p>
<p>The first mention of autism came in the third edition of the DSM in 1980, with the introduction of the diagnostic category of “<a href="https://www.ncbi.nlm.nih.gov/pubmed/3716967">infantile autism</a>”. This label was generally only applied to children with substantial language impairment and intellectual disabilities.</p>
<p>In 1994, the DSM-IV recognised people could also show the core behaviours of autism without having significant language impairment or any intellectual disability. This change in how we described autism contributed to a <a href="https://theconversation.com/do-more-children-have-autism-now-than-before-4497">surge in diagnoses</a>. </p>
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<a href="https://theconversation.com/do-more-children-have-autism-now-than-before-4497">Do more children have autism now than before? </a>
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<p>There was also a surge in autism research, from around <a href="https://www.ncbi.nlm.nih.gov/pubmed?term=(Autism%5BTitle%5D)%20AND%20(%221994%2F01%2F01%22%5BDate%20-%20Publication%5D%20%3A%20%221994%2F12%2F31%22%5BDate%20-%20Publication%5D)">96 studies</a> in 1994, to <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=(Autism%5BTitle%5D)+AND+(%222000%2F01%2F01%22%5BDate+-+Publication%5D+%3A+%222000%2F12%2F31%22%5BDate+-+Publication%5D)">207</a> in 2000, and then <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=(Autism%5BTitle%5D)+AND+(%222018%2F01%2F01%22%5BDate+-+Publication%5D+%3A+%222018%2F12%2F31%22%5BDate+-+Publication%5D)">2,789</a> in 2018.</p>
<p>So, 25 years on, what have we learnt about autism?</p>
<h2>The autism concept</h2>
<p>In the 1990s, we viewed autism as one condition, with all children showing similar, severe difficulties with social and communication skills. </p>
<p>We now know the reality is very different.</p>
<p>In its most literal sense, autism is diagnosed when a person displays a set of behaviours typified by difficulties in social interaction and communication, as well as having more restricted interests and repetitive behaviours than we typically expect.</p>
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<a href="https://theconversation.com/why-do-some-people-with-autism-have-restricted-interests-and-repetitive-movements-94401">Why do some people with autism have restricted interests and repetitive movements?</a>
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<p>The severity of the behaviours that characterise autism <a href="https://journals.sagepub.com/doi/abs/10.1177/1362361319852831">vary considerably</a> between people. Social interaction and communication difficulties, for example, can range from having no verbal language to highly fluent language. </p>
<p>The frequency and intensity of autism behaviours – such as repetitive play with objects and repeated body movements like rocking and hand flapping – vary between mild and severe. </p>
<p>And intellectual abilities can range from significant disability to a very high IQ.</p>
<p>This variation is the so-called “autism spectrum”, which has also led to the worldwide movement of “<a href="https://journals.sagepub.com/doi/full/10.1177/1362361318820762">neurodiversity</a>”. This views neurological conditions such as autism as part of the natural spectrum of human diversity, and posits that this diversity should be respected rather than pathologised. </p>
<p>Neurodiversity challenges the medical model of autism as a disorder, instead viewing autism as an inseparable aspect of identity.</p>
<p>Autism is diagnosed by a team of clinicians, through a <a href="https://theconversation.com/new-autism-guidelines-aim-to-improve-diagnostics-and-access-to-services-104929">consistent and rigorous diagnostic process</a>. While the dividing line between “typical” and “atypical” can be blurry, a diagnosis is made when the core behaviours of autism have a functional impact on an individual’s daily life. </p>
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<img alt="" src="https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301055/original/file-20191111-194665-o65yvq.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">
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<span class="caption">Some people with autism have very high IQs.</span>
<span class="attribution"><span class="source">LDprod/Shutterstock</span></span>
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<p>It’s now clear that autism is not one condition in the sense that there is a <a href="https://www.mja.com.au/system/files/issues/whit11667.pdf">common cause</a> shared by all people on the autism spectrum. </p>
<p>Instead, autism is best thought of as an <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Autism_spectrum_disorder/">umbrella term</a> which describes a range of different people, all with relatively similar behaviours, which may or may not be caused by the same biological factors.</p>
<p>Critically, autism is not just a childhood condition. While the behavioural characteristics of autism first emerge during childhood, they almost always persist into adolescence and adulthood, but often present in a different form. </p>
<p>Social difficulties in childhood might be shown through a preference to play alone, for example, while in adulthood this may be reflected by difficulty in maintaining social relationships.</p>
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Read more:
<a href="https://theconversation.com/we-need-to-stop-perpetuating-the-myth-that-children-grow-out-of-autism-119540">We need to stop perpetuating the myth that children grow out of autism</a>
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<p>The dramatic refinement of our understanding of autism from a severe childhood condition, to a cluster of complex and variable conditions that endure into adulthood, is a great achievement of scientific research and has driven all other research and policy advances. </p>
<h2>Causes</h2>
<p>In 1994, there was already a good understanding that autism originated from <a href="https://www.ncbi.nlm.nih.gov/pubmed/562353">genetic differences</a>.</p>
<p>Advances in genetic research in the late 1990s and 2000s – first by sequencing the human genome, then the dramatic reduction in the cost of this sequencing – led scientists to believe they would soon find the single gene that causes the brain to develop differently.</p>
<p>But after several decades of intensive research, the picture turned out to be far <a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">more complex</a>. </p>
<p>There is now <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650984/">consensus</a> that there is no one genetic difference shared by all individuals with autism. And rarely does one person possess a single genetic factor that leads the brain to develop differently. </p>
<p>There is also evidence to suggest other biological factors may play a role in the development of autism, including <a href="https://theconversation.com/bugs-and-allergies-in-pregnancy-linked-to-child-developmental-disorders-like-autism-and-adhd-87358">inflammation</a> and <a href="https://theconversation.com/extreme-male-brain-theory-of-autism-confirmed-in-large-new-study-and-no-it-doesnt-mean-autistic-people-lack-empathy-or-are-more-male-106800">hormonal factors</a>. But the evidence for these factors remains preliminary.</p>
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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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<p>We now know a range of conditions, including Fragile X syndrome and tuberous sclerosis, have very clear genetic or chromosomal differences that can lead to autistic behaviours. In total, these conditions account for around <a href="https://www.ncbi.nlm.nih.gov/pubmed/22089167">10%</a> of all people on the autism spectrum.</p>
<p>Genetic factors are still very likely to underpin autism in the remaining majority of people. But the genetic differences are likely more complex, and require advances in statistical techniques to better understand why the brain develops differently for some children.</p>
<h2>Therapies and treatments</h2>
<p>In the 1990s, behavioural interventions for autism were dominated by applied behaviour analysis (<a href="https://theconversation.com/behavioural-method-is-not-an-attempt-to-cure-autism-19782">ABA</a>), an approach to therapy that helps children learn new skills.</p>
<p>While ABA remains prominent throughout the world, other therapeutic models have emerged, such as those based on <a href="https://raisingchildren.net.au/autism/therapies-guide/teacch">developmental principles</a>, those that target <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755315/">communication</a> and those that use a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121131/">combination of approaches</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301054/original/file-20191111-194650-xqkdi3.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">
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<span class="caption">Therapies have come a long way.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-little-child-during-therapy-school-755297134">Photographee.eu/Shutterstock</a></span>
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<p>While these therapies help the development of some children with autism, no one therapy model will be effective for all. The great advance of the last 25 years has been to provide families with <a href="https://theconversation.com/a-guide-for-how-to-choose-therapy-for-a-child-with-autism-64729">alternate options</a> if their original choice of therapy isn’t as beneficial as they hoped.</p>
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Read more:
<a href="https://theconversation.com/a-guide-for-how-to-choose-therapy-for-a-child-with-autism-64729">A guide for how to choose therapy for a child with autism</a>
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<p>But pharmacological (drug) treatments have not seen as much progress. Despite substantial research investment, there remains <a href="https://journals.sagepub.com/doi/full/10.1177/0269881117741766">no medication with good evidence</a> for reducing the disability associated with the core social and communication difficulties of autism. </p>
<p>Pharmacological intervention in autism is primarily used to assist with other challenges that can be associated with autism such as anxiety, attention problems, epilepsy and sleeping difficulties.</p>
<h2>Where to next?</h2>
<p>Despite progress over the past 25 years, health and disability challenges remain pervasive for people on the autism spectrum, and our policy responses continue to be fragmented across health, disability and education systems.</p>
<p>Given the ever-marching advance of science, it’s impossible to predict the next 25 years of research. A key challenge for scientists is how we use the knowledge we create to lead to clear and tangible benefits for humanity.</p>
<p>This will likely require meaningful partnerships with autistic people and their families to better understand their priorities for their lives. We need to learn how the knowledge we’ve obtained, and that still to come, can best support each person to discover their own strengths and what they want for their lives.</p><img src="https://counter.theconversation.com/content/125053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council and the Australian Research Council.</span></em></p>It’s been 25 years since autism was redefined and the surge in diagnoses and research began. But while we’ve come along way in our understanding of the spectrum, advances in drug therapies has lagged.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/1195402019-09-10T20:05:06Z2019-09-10T20:05:06ZWe need to stop perpetuating the myth that children grow out of autism<figure><img src="https://images.theconversation.com/files/290620/original/file-20190903-175710-137r8wx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3478%2C2086&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Autism is a lifelong condition, though some people who weren't accurately diagnosed may lose their diagnosis. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-headphones-260857394?src=-1-38">Dubova/Shutterstock</a></span></figcaption></figure><p>Around 1% of the population has an autism spectrum disorder, with estimates <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">ranging from one in 150</a> <a href="https://www.autismspectrum.org.au/news/autism-prevalence-rate-up-by-an-estimated-40-to-1-in-70-people-11-07-2018">to one in 70</a>.</p>
<p>While people differ in the range and severity of their symptoms, common features include difficulties with communication and social interaction, <a href="https://theconversation.com/why-do-some-people-with-autism-have-restricted-interests-and-repetitive-movements-94401">restrictive and repetitive behaviours and interests</a>, and sensory sensitivities. </p>
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<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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<p>According to the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">2017 Autism in Australia</a> report, autism is most prevalent among children aged five to 14, with 83% of Australians with an autism diagnosis aged under 25.</p>
<p>But while children are more likely to have a diagnosis of autism than adults, this doesn’t mean children “<a href="http://www.onethingforautism.com.au/wp-content/uploads/2018/05/Autism-research-report-General-awareness-knowledge-and-understanding-of-autism-and-social-isolation-1.pdf">grow out</a>” of autism. </p>
<h2>Why are rates higher among children?</h2>
<p>There are a number of reasons why the prevalence of autism is higher among school-aged children than adults, starting with the measurement. </p>
<p>“Prevalence” refers to the rate of diagnosis and/or self-reports, not the rate of actually having autism. As autism is a lifelong condition, it’s more likely the rates of actually having autism are stable across adults and children. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0736574815000519">Diagnostic techniques and awareness of autism</a> have improved dramatically in recent times. Many autistic adults would not have been given a formal diagnosis, but rather misdiagnosed or just seen as “weird”.</p>
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<a href="https://theconversation.com/do-more-children-have-autism-now-than-before-4497">Do more children have autism now than before? </a>
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<p>These days, there are clear benefits of having and reporting a diagnosis for school-aged children; including <a href="https://www.autismawareness.com.au/financial-support/">access to funding</a> and educational support. This means parents who suspect their child has autism may seek out a diagnosis when in previous generations they would not.</p>
<p>There are far fewer benefits to having and reporting a diagnosis for adults, and many more barriers, including <a href="https://www.tandfonline.com/doi/full/10.1080/09687590802535345">stigma and discrimination</a>.</p>
<h2>Some children lose their diagnosis</h2>
<p>Autism is a lifelong condition. However, a small number of studies suggest a minority of children may “lose” their autism diagnosis.</p>
<p>A <a href="https://journals.sagepub.com/doi/pdf/10.1177/1362361315607724">2011 analysis of American national survey data</a> found 13% of children diagnosed with autism (187 of the 1,576 whose parents responded to the question) had “lost” their diagnosis. </p>
<p>The most common reason was “new information”, such as being diagnosed with another developmental, learning, emotional, or mental health condition. </p>
<p>Only 21% of the 187 parents reported their child had lost their diagnosis due to treatment or maturation; and only 4% (eight children) had a doctor or other professional confirm the child did not have ASD and did not have any other developmental, learning, emotional, or mental health condition.</p>
<p>A recent study in the <a href="https://journals.sagepub.com/doi/10.1177/0883073819834428">Journal of Child Neurology</a> examined the records of 569 children diagnosed with autism between 2003 and 2013. It found 7% (38 of the 569) no longer met the diagnostic criteria. </p>
<p>However, most were diagnosed with another behaviour disorder (such as attention-deficit hyperactivity disorder) or a mental health condition (such as anxiety disorder). </p>
<p>Just three children out of 569 did not “warrant” any alternative diagnosis.</p>
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<img alt="" src="https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290822/original/file-20190904-175663-1oo2fiy.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">
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<span class="caption">Many autistic children learn to mask their symptoms and act like their neurotypical peers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/219008878?src=-1-15&size=huge_jpg">Pressmaster/Shutterstock</a></span>
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<a href="https://theconversation.com/five-myths-about-autism-4203">Five myths about autism</a>
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<p>The few studies that report on children who no longer met the criteria for a diagnosis of either autism or another condition are typically small-scale <a href="https://www.ctu.mrc.ac.uk/patients-public/about-clinical-trials/what-is-an-observational-study/">observational studies</a>. </p>
<p>In 2014, for example, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547539/">US psychiatry researchers</a> studied 34 people aged eight to 21 years who were diagnosed with autism before the age of five but no longer met the criteria for a diagnosis. This was defined as the “optimal outcome”. </p>
<p>The researchers found the “optimal outcome” group did not differ from “typically developing” children on socialisation, communication, most language sub-scales and only three had below-average scores on face recognition.</p>
<p>So, a very very small number of children lose their diagnosis and appear to function normally. But these small-scale studies don’t have the capacity to differentiate between “growing out of” and “learning to mask” autism-related behaviours.</p>
<h2>Masking symptoms</h2>
<p>The diagnostic and statistical manual (DSM-5) used to classify mental health disorders states <a href="https://www.autismspeaks.org/autism-diagnosis-criteria-dsm5">symptoms of autism</a> start early and continue throughout life, though adults may be able to “mask” their symptoms – at least in some situations. </p>
<p>One of the unexpected findings of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547539/">2014 study of people who lost their autism diagnosis</a> is they tended to have high IQs. The researchers suggest high levels of cognition allowed this group of autistic people to identify and compensate for their social differences. </p>
<p>Many autistic people learn to <a href="https://link.springer.com/article/10.1007/s10803-017-3166-5">mask their behaviours</a> and thought patterns from a young age; and this is particularly <a href="https://journals.sagepub.com/doi/full/10.1177/1362361316671845">common with girls</a>. They learn that to fit in and be accepted by their peers they need to act and speak like neurotypical people. </p>
<p>Masking is physically and emotionally draining, and leads to a <a href="https://www.neurologyadvisor.com/topics/autism-spectrum-disorder/the-consequences-of-compensation-in-autism/">range of negative outcomes</a> such as exhaustion, burnout, anxiety, and depression – as well as negative self-perception and low self-esteem.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/autistic-people-arent-really-accepted-and-its-impacting-their-mental-health-86817">Autistic people aren't really accepted – and it’s impacting their mental health</a>
</strong>
</em>
</p>
<hr>
<h2>Why are these myths so harmful?</h2>
<p>Many parents <a href="https://www.questia.com/library/journal/1G1-537853432/mother-s-reaction-to-autism-diagnosis-a-qualitative">struggle with their child’s diagnosis of autism</a>, as they face the realisation their child’s life may be very different from the one they imagined. </p>
<p>The myth that children can grow out of autism – if their parents do a good enough job of educating or changing them – is harmful for the whole family. </p>
<p>It can prevent parents from seeing and accepting their child as the wonderful human being they are and recognising their strengths. </p>
<p>Sadly, it can also lead to a lifetime of the autistic person perceiving themselves to be a <a href="https://link.springer.com/article/10.1007/s10803-017-3342-7">failed neurotypical person</a> rather than a <a href="http://dsq-sds.org/article/view/5053/4412">successful autistic person</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290824/original/file-20190904-175705-h6ekyx.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">Parents of children newly diagnosed with autism have to adjust to the idea their child’s life may be different from what they imagined.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1402275035?src=-2-1&size=huge_jpg">Natalia Lebedinskaia/Shutterstock</a></span>
</figcaption>
</figure>
<p>Australia, like many countries, has made great strides in the provision of educational supports for these students in primary and secondary school. Then we stop. </p>
<p>Of those who complete secondary school, <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4428.0Main%20Features52012?opendocument&tabname=Summary&prodno=4428.0&issue=2012&num=&view=">only 19% receive a post-school qualification</a>. This compares with 59% of those with any form of disability and 68% of those without a disability. </p>
<p>In terms of work, ABS data from 2015 shows the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4430.0Main%20Features752015">unemployment rate for people with an autism diagnosis</a> was 31.6%; more than three times the rate for people with any disability (10%) and almost six times the rate of people without disability (5.3%). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/expecting-autistic-people-to-fit-in-is-cruel-and-unproductive-value-us-for-our-strengths-103888">Expecting autistic people to 'fit in' is cruel and unproductive; value us for our strengths</a>
</strong>
</em>
</p>
<hr>
<p>Autistic children don’t grow into neurotypical adults, they grow into autistic adults who are <a href="https://www.ncbi.nlm.nih.gov/pubmed/22914775">under-serviced</a>, isolated and stigmatised. </p>
<p>Until our employers, educational institutions, governments and communities fully understand this, we will continue to fail to provide them with appropriate educational and employment opportunities.</p>
<p>So, will your child grow out of their autism? Probably not, but with the right support, encouragement and understanding they might grow into it.</p><img src="https://counter.theconversation.com/content/119540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Jones 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 myth that children grow out of autism can prevent parents from seeing and accepting their child as the wonderful human being they are and recognising their strengths.Sandra Jones, Pro Vice-Chancellor, Engagement, Australian Catholic UniversityLicensed 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">
<figcaption>
<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>
</figcaption>
</figure>
<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/1224732019-08-28T20:03:17Z2019-08-28T20:03:17ZThere’s no evidence caesarean sections cause autism or ADHD<figure><img src="https://images.theconversation.com/files/289753/original/file-20190828-184222-12ywzar.jpg?ixlib=rb-1.1.0&rect=35%2C53%2C3958%2C2940&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caesarean delivery alone does not contribute to the odds of a child developing autism or ADHD.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/5zp0jym2w9M">Aditya Romansa</a></span></figcaption></figure><p>A <a href="https://doi.org/10.1001/jamanetworkopen.2019.10236">new study</a> that combines data from over 20 million births has found that a caesarean section delivery is associated with autism spectrum disorder (autism) and attention-deficit hyperactivity disorder (ADHD). </p>
<p>However, the study does not indicate that caesarean section deliveries cause autism or ADHD. The truth is much more difficult to decipher, and provides an excellent case study for the old adage that correlation doesn’t equal causation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, what are these disorders?</h2>
<p>Autism and ADHD are what we call neurodevelopmental disorders. This means they have clear differences in behavioural development, which we presume are due to brain differences. </p>
<p>In the case of autism, behavioural differences occur in the part of the brain primarily responsible for social and communication development. For ADHD, these differences affect the ability to control and direct attention. </p>
<p>The exact reasons why the brain develops differently are not entirely clear. Studies in twins, which are able to help us understand the role of genetic and environmental influences on a given trait, have shown that both autism and ADHD involve a large genetic component. </p>
<p>However, these studies have also indicated that environmental influences, such as <a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">bacterial or viral infections</a> during pregnancy, may play a role in the development of these conditions, most likely through interactions with genetic make-up.</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>
<h2>What did this study find?</h2>
<p>The association between certain caesarean sections and autism has been <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/482014">known for close to two decades</a>. Any possible link with ADHD has received comparatively less research, but there have still be numerous studies in this area. </p>
<p>Today’s study, <a href="https://doi.org/10.1001/jamanetworkopen.2019.10236">published in the journal JAMA Network Open</a>, combines all of the studies conducted previously into a single analysis. This “meta-analysis” then allows the researchers to come up with a single estimate of how strong the association between caesarean sections, autism and ADHD may be. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.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">The researchers were looking for a pattern that warrants further investigation.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/xTedodxYTuQ">freestocks.org</a></span>
</figcaption>
</figure>
<p>In this case, the meta-analysis included over 20 million people. It found children born via caesarean section had an increase in odds of being diagnosed with autism or ADHD in early childhood. </p>
<p>The associations were scientifically robust, but very small. Children delivered via caesarean section were 1.33 times more likely to be diagnosed with autism and 1.17 times more likely to be diagnosed with ADHD.</p>
<p>When the prevalence of these conditions is already relatively low (around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919599/">1%</a> for autism, and <a href="https://pediatrics.aappublications.org/content/135/4/e994.short">7%</a> for ADHD), this increase in odds is not substantial. In the instance of autism, this is a shift in odds from a 1% prevalence to 1.33%. This shift is not consequential and certainly does not call for any change in our clinical practice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-you-need-to-know-to-understand-risk-estimates-67643">What you need to know to understand risk estimates</a>
</strong>
</em>
</p>
<hr>
<p>This association was similar for children born by either elective or emergency caesarean section. </p>
<h2>But what does it mean?</h2>
<p>The temptation with findings like this is to draw a causal link between one factor (caesarean section) and the other (autism or ADHD). Unlike so many other areas of science, the conclusions are easily understood and the implications appear obvious. </p>
<p>But the simplicity is deceptive, and says more about our desire for simple answers than it does about the truth of the science. </p>
<p>The studies included in this meta-analysis used a branch of science called epidemiology, which is concerned with how often conditions and diseases occur in different groups of people and why, and how to prevent or manage them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/epidemiology-and-the-media-15972">Epidemiology and the media </a>
</strong>
</em>
</p>
<hr>
<p>Epidemiological studies survey a large population and find a pattern of results that indicate a certain factor may be coinciding with a certain disease more often than we would expect by chance. </p>
<p>In this case, there is the observation that people with autism or ADHD are more likely to be born by caesarean section than we would otherwise typically expect. </p>
<p>But this kind of epidemiological study is unable determine if one factor (caesarean section) causes another (ADHD or autism). </p>
<p>There are two key reasons why. </p>
<p>First, we can’t rule out that a third factor may be influencing this association. We know, for example, that caesarean sections are more common for pregnant women who are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937803019240">obese</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00409.x">older</a>, and who have a <a href="https://www.tandfonline.com/doi/abs/10.3109/14767058.2013.847080">history of immune conditions</a> such as asthma. </p>
<p>All of these factors have also been linked with an increased chance of having a child with autism, and it is entirely possible – and some would argue, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12351">probable</a> – that it is more likely these factors underlie the relationship between caesarean section and neurodevelopmental disorders. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The link might be due to other factors such as the mother’s age or weight.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/I0ItPtIsVEE">Christian Bowen</a></span>
</figcaption>
</figure>
<p>The second reason is that these kind of epidemiological studies are unable to provide what scientists call “a mechanism” – that is, a biological explanation as to why this association may exist. </p>
<p>A mechanism study in this area may be to explore biological differences in newborns either born via vaginal or caesarean delivery, and understand how these differences may lead to atypical behavioural development.</p>
<p>Without a strong body of evidence from these kinds of studies, there is simply no scientific basis for concluding a causal link between caesarean section and neurodevelopmental disorders. </p>
<h2>So what should we take away from this study?</h2>
<p>The study provides a strong basis for concluding there is a statistical association between caesarean section delivery on one hand, and autism and ADHD on the other. But that’s about it. </p>
<p>Why this link exists remains unknown, but it is almost certain that a caesarean delivery alone does not contribute to the odds of a child developing autism or ADHD. </p>
<p>Instead, it is likely that other pregnancy factors play a role in this relationship, as well as genetic factors that may interact with the environmental influences during pregnancy to contribute to brain development. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/adhd-prescriptions-are-going-up-but-that-doesnt-mean-were-over-medicating-108474">ADHD prescriptions are going up, but that doesn't mean we're over-medicating</a>
</strong>
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<img src="https://counter.theconversation.com/content/122473/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council and the Autism CRC.</span></em></p>A new study has found a link between being born by caesarean section and having a greater chance of being diagnosed with autism or ADHD. But there’s no evidence caesarean sections cause them.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, Univeristy of Western Australia, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1177862019-08-08T13:15:02Z2019-08-08T13:15:02Z5 tips for parents to build communication skills with children with autism spectrum disorder<figure><img src="https://images.theconversation.com/files/287236/original/file-20190807-144868-1ejdomz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Knowing the right strategies can help parents of children with autism spectrum disorder boost their children's communication skills.</span> <span class="attribution"><span class="source">College of Education & Human Development, Texas A&M University</span></span></figcaption></figure><p>We are <a href="https://scholar.google.com/citations?user=RBO_UcwAAAAJ&hl=en&oi=sra">researchers</a> who <a href="https://autism.tamu.edu/">coach parents</a> to <a href="https://journals.sagepub.com/doi/abs/10.1177/0145445519858272">communicate with children with disabilities</a>.</p>
<p>Here are five <a href="https://fpg.unc.edu/node/6614">strategies</a>
families can use to help children with autism spectrum disorder build their communication skills, along with examples of how to use them. </p>
<p>Autism affects an estimated <a href="https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm?s_cid=ss6706a1_w">1 in 59 children</a> nationwide.</p>
<h2><strong>1. Motivate the child to communicate</strong></h2>
<p>Create opportunities for your child to <a href="https://doi.org/10.1044/persp1.SIG1.144">practice communication skills</a>. Show your child one of their favorite items and encourage your child to ask for it. Children are more likely to be engaged and communicate when activities are based on their interests. Compliment your child when they communicate. For instance, say “that’s a good question!” or “good job asking me for help!” </p>
<p><em>Delicia, whose 3-year-old child, Pacho, has minimal verbal skills, motivates her child to speak by placing a cookie in a jar. Pacho can see the cookie but he cannot get it by himself. He has to ask for it. After Delicia teaches him how to ask for it, she will give him the cookie and praise him by saying “Good job telling me.”</em></p>
<h2>2. Model communication skills</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25737021">Model communication skills</a> by speaking, using gestures and facial expressions. Your child will imitate them. While modeling, sit near your child and respond to the child’s imitation with praise for using the new skill.</p>
<p><em>Pacho cannot open the cookie jar, so he hands the jar to Delicia. Delicia models by saying “Cookies, please” or “Open, please.”</em></p>
<p>For children with autism spectrum disorder with nonverbal communication or who have <a href="https://journals.sagepub.com/doi/10.1177/0145445519858272">complex communication needs</a>, consider using a tool, called an <a href="https://www.ncbi.nlm.nih.gov/pubmed/25995080">augmentative and alternative communication</a> device, to supplement their speech.</p>
<p>This kind of communication can be low-tech, such as exchanging <a href="https://journals.sagepub.com/doi/abs/10.1177/108835769400900301">pictures</a> to communicate. Or, it can be as high-tech as a communication app on a tablet.</p>
<p><em>Archie, a 10-year-old with autism spectrum disorder who cannot yet speak, screams when asked to eat vegetables. His father places the vegetables on his dish and his mother models pressing an icon on an app to say, “No, thank you,” and waiting for his response. The mother also says “No, thank you” to give him a verbal model and waits for his response.</em></p>
<h2>3. Prompt the child to use new communication skills</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25737021">Prompt new communication skills</a> by using verbal, visual or physical guidance.</p>
<p><em>Fabiana, Archie’s mom, physically prompts him to use the communication device by holding his hand to press the “No, thank you” icon on his <a href="https://journals.sagepub.com/doi/abs/10.1177/1053451219833012">app</a>. Then, Fabiana takes away the vegetables and immediately offers something he likes.</em></p>
<h2>4. Allow the child to communicate independently</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25737021">Slowly remove the prompts</a> so children don’t become dependent on them. You can do this by <a href="https://fpg.unc.edu/node/6614">waiting</a> one or two seconds before using a prompt in order to give the child an opportunity to communicate independently.</p>
<p><em>After Pacho requests cookies several times, Delicia waits for one second before using modeling or prompting strategies. Delicia will periodically increase the time delay by one or two seconds until finding a delay that encourages independent responding.</em> </p>
<p><em>Archie says “No, thank you,” with the app when Fabiana prompts him, so she starts waiting for one second before using modeling or prompting. Fabiana will increase the time delay by one or two seconds each day.</em></p>
<h2>5. Expand and generalize to other people, settings and activities</h2>
<p>Using modeling and prompting strategies to <a href="https://journals.sagepub.com/doi/abs/10.1177/0271121415621027">add new words</a> to phrases the children have already mastered.</p>
<p><em>When Pacho can independently asks for cookies by saying “Cookies, please” several times, Delicia teaches him a new word by adding “Want cookies, please.”</em></p>
<p><em>When Archie can independently use the communication app to say “No, thank you,” several times, Fabiana teaches him a new word by adding “No carrot, thank you.”</em></p>
<p>Use these strategies during your children’s everyday activities, such as brushing their teeth, having lunch, going to the park or riding in a car.</p>
<p>It is essential to use these strategies with different people and in different settings consistently over time. </p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/117786/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. B. Ganz receives funding from the U.S. Department of Education (Institute of Education Sciences, Office of Special Education Programs) and the Texas Higher Education Coordinating Board. </span></em></p><p class="fine-print"><em><span>Sanikan Wattanawongwan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Specialists offer a series of tips on how parents of children with autism spectrum disorder can help their children communicate with more people and in different places.Sanikan Wattanawongwan, Graduate Research Assistant, Texas A&M UniversityJ. Ganz, Professor of Special Education, Autism & DD, Texas A&M 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/1203312019-07-16T18:45:29Z2019-07-16T18:45:29ZTreating suspected autism at 12 months of age improves children’s language skills<figure><img src="https://images.theconversation.com/files/284210/original/file-20190716-173347-1yrfe7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The theory is that if therapies are started early enough, it might be possible to alter the trajectory of autism.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/497291152?studio=1&size=medium_jpg">Shutterstock</a></span></figcaption></figure><p>Therapies given to infants before they receive a diagnosis of autism may lead to important improvements in their language abilities, according to our new research published today in the journal <a href="http://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(19)30184-1/fulltext">Lancet Child and Adolescent Health</a>.</p>
<p>Children with autism typically begin therapy after receiving a diagnosis, which usually doesn’t occur until at least two years of age. </p>
<p>However, our new study suggests that starting therapy with 12-month-old infants who show early behavioural signs of autism may provide additional benefit. </p>
<p>Parents of toddlers who received six months of early therapy reported that their child understood an average of 37 more words, and spoke an average of 15 more words, than those who didn’t receive the therapy.</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>
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</em>
</p>
<hr>
<h2>How is autism diagnosed?</h2>
<p>Autism is diagnosed on the basis of behavioural differences. These include difficulties in social communication and interaction, and the presence of restricted and repetitive behaviours or interests. </p>
<p>A diagnosis based on behaviour is an inherently subjective task. The dividing line between “typical” and “atypical” is often blurry and can lead to considerable debate. </p>
<p>These challenges led to the development in 2018 of new <a href="https://theconversation.com/new-autism-guidelines-aim-to-improve-diagnostics-and-access-to-services-104929">Australian guidelines for autism assessment and diagnosis</a>, with the hope of addressing inconsistencies in autism diagnosis across Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-autism-guidelines-aim-to-improve-diagnostics-and-access-to-services-104929">New autism guidelines aim to improve diagnostics and access to services</a>
</strong>
</em>
</p>
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<p>We don’t tend to diagnose autism until two years of age at the very earliest. Two is the earliest age at which a diagnosis is relatively stable. In other words, when a child receives a diagnosis of autism at age two, they’re also very likely to have that diagnosis if they’re reassessed in later childhood. This is not necessarily the case for children younger than two.</p>
<p>In most health systems around the world, including in Australia, therapy for children with autism typically begins after receiving a diagnosis. This is often a straight economic decision for a finite disability funding pool: the limited funding for therapies goes to children who need it most. And we can guarantee that children with a diagnosis of autism need these therapies. </p>
<p>But this model doesn’t allow therapies to take advantage of the first two years of life. These are crucial years for brain development, and early therapies may be more effective in reducing child disability. </p>
<p>The theory is that if therapies are started early enough, particularly when the brain is so young, it might be possible to alter the trajectory of autism, or even prevent the development of the condition in some infants.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284208/original/file-20190716-173355-z9tlm6.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">The early years are crucial for brain development.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/babys-playing-together-kindergarten-543939718?src=hXO_u2G46_AGdl0XqgY1Tw-1-16&studio=1wpixel.com">Santypan/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Our study</h2>
<p>Our study is one of the first rigorous tests of this theory. </p>
<p>We recruited 103 infants from Perth and Melbourne, aged between 9 and 14 months, who were showing early behavioural signs of autism, such as not responding to their names, poor eye contact, and few social smiles.</p>
<p>Half the children were randomly assigned to receive an <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00091-1/fulltext">intervention</a> that helps parents understand their infant’s communication cues, and helps them respond in a way that promotes back-and-forth interactions. </p>
<p>By creating a socially rich environment around the infant that is tailored to their specific needs, we may help support the development of the neural pathways involved in language and social development.</p>
<p>The therapy is considered “low intensity” in the number of contact hours with a therapist (one hour per fortnight). This contrasts with “high intensity” therapies for older children with a diagnosis of autism, which often require at least ten contact hours per week.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284217/original/file-20190716-173329-mwb4x.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">The therapy promoted back-and-forth interactions between the infants and their parents.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/130240259?src=kNyzAgpRcWCu3Zxpge0Gnw-1-11&studio=1&size=huge_jpg">Pavla/Shutterstock</a></span>
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</figure>
<p>The other half of the group was randomly assigned to receive standard community care. This is often restricted to a parent information session, a few sessions with allied health professionals, or no intervention at all. This group served as the control group. </p>
<p>We then assessed the infants’ development either side of a six-month therapy period. </p>
<h2>What did we find?</h2>
<p>The intervention group did not show a significant reduction in early autism behaviours compared with the control group. This finding is consistent with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28861651">previous study</a> that found it’s not easy to change the symptoms of autism.</p>
<p>However, after treatment, parents in the treatment group rated their infants as having better communication skills than those in the control group. </p>
<p>In the six-month therapy period, the treatment group improved in understanding an average of 37 more words and saying an average of 15 more words compared with the control group. Most children were not saying any words at the start of the therapy period, and so these language gains reported by parents are an important improvement. </p>
<p>This finding has an important caveat: parents could not be “blinded” to the therapy. It’s therefore possible the finding reflects “rater bias”, whereby parents whose children received the intervention hoped there was a developmental improvement, and rated their infants accordingly.</p>
<h2>What does this mean for the NDIS?</h2>
<p>This study is an important milestone in our understanding of how (and whether) to provide therapy to young infants who show early signs of autism. </p>
<p>Our findings suggest that these therapies do not reduce the core autism symptoms, but may improve language skills. These gains may be especially important for reducing long-term disability and helping each child reach their full potential.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284206/original/file-20190716-173342-oloef7.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">It’s unclear whether the difference will remain when the children are older.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-toddler-girl-playing-home-1348098188?studio=1">Shutterstock</a></span>
</figcaption>
</figure>
<p>The long-term test will be whether these improvements are still evident when the infants are older. </p>
<p>Few studies have found long-term developmental changes as a result of infant therapies, and we are currently in the process of reassessing the children in our study when they turn three. </p>
<p>If we find that pre-diagnostic therapy leads to longer-term developmental changes, this has important implications for health and disability services. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/young-children-with-autism-can-thrive-in-mainstream-childcare-104936">Young children with autism can thrive in mainstream childcare</a>
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</p>
<hr>
<p>People on the autism spectrum currently represent <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">29% of all participants</a> enrolling in Australia’s National Disability Insurance Scheme (NDIS). </p>
<p>A key plank of the NDIS is the Early Childhood Early Intervention pathway, which provides resources to support intervention for children up to seven years of age. </p>
<p>The pathway is very well conceived, but there are currently long <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">wait lists</a>. </p>
<p>The federal government recently <a href="https://ministers.dss.gov.au/media-releases/4981">announced</a> a plan to resolve these delays, which indicates a recognition of the importance of early intervention for children with a confirmed diagnosis in reducing long-term disability in these children. </p>
<p>The follow-up of the children in the current study to three years of age will provide a litmus test as to whether very early intervention for infants should be an even higher priority.</p><img src="https://counter.theconversation.com/content/120331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council, Autism CRC, and the Angela Wright Bennett Foundation. </span></em></p><p class="fine-print"><em><span>Kristelle Hudry receives funding from the Autism CRC, Department of Social Services, and La Trobe University Research Focus Areas (Understanding Disease and Building Healthy Communities). </span></em></p><p class="fine-print"><em><span>Kandice Varcin 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>Children with autism don’t usually begin therapy until they’re given a diagnosis, which rarely occurs before the age of two. But new research shows there’s benefit to starting early.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, Univeristy of Western Australia, The University of Western AustraliaKandice Varcin, Postdoctoral Fellow in the Autism Research Team, Telethon Kids InstituteKristelle Hudry, Senior Lecturer in Developmental Psychology, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1157082019-04-26T10:51:39Z2019-04-26T10:51:39ZA drug for autism? Potential treatment for Pitt-Hopkins syndrome offers clues<figure><img src="https://images.theconversation.com/files/270163/original/file-20190419-28119-1d3izfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rylie, age 10, is one of the nearly 1000 children diagnosed with Pitt-Hopkins Syndrome, a rare form of autism. Photo curtesy of Pitt Hopkins Research Foundation. </span> <span class="attribution"><span class="source">Photo credit: Christa Michelle Photography</span></span></figcaption></figure><p>In 2019, geeks are cool, and the idea that they might be on the autism spectrum is celebrated. Nowhere is this truer than in Silicon Valley, one of the few places in America where social quirkiness and laser focus attention to detail are more often rewarded than criticized. Often lauded as an example of a success story in autism circles, renowned scientist Temple Grandin, <a href="https://www.mercurynews.com/2014/01/21/temple-grandin-half-of-silicon-valleys-got-mild-autism/">once told a California newspaper</a>, “Half of Silicon Valley’s got mild autism, they just avoid the labels.”</p>
<p>I’m not one for diagnosing entire subcultures from newspaper articles, but the <a href="https://www.thehindu.com/society/how-people-with-autism-are-finding-freedom-and-fame-in-the-creative-arts/article26897631.ece">recent change</a> <a href="https://www.usnews.com/news/best-states/florida/articles/2018-05-26/child-prodigy-wants-people-to-know-having-autism-is-cool">in discourse around autism</a> is good because it will hopefully push society to treat people with autism with more compassion. But this might also obscure a darker truth that the challenges and struggles for affected individuals and their families are at times overwhelming. </p>
<p>Current approaches to help children with autism are of limited impact, but scientists are beginning to imagine that treatments will soon be based on an understanding of specific causes. </p>
<p>I am the director of the Lieber Institute for Brain Development and the Maltz Research Laboratories at the Johns Hopkins University School of Medicine, where scientists study how genes and the environment shape the development of the human brain. We have identified a drug that works in individual cells and rodents of one form of autism known as Pitt-Hopkins syndrome, which is caused by a specific genetic mutation. We hope to begin human trials in a year. </p>
<h2>Pitt-Hopkins syndrome</h2>
<p>Many individuals who meet the criteria for <a href="https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml">autism spectrum disorder</a> (ASD) are, despite any stereotypes, not high functioning math whizzes eagerly recruited by technology companies for their unique cognitive skills. In fact, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362908/">research shows</a> that adults with ASD are more economically, educationally and socially disadvantaged than adults with other developmental or intellectual disabilities. </p>
<p>In severe forms of ASD, such as <a href="https://ghr.nlm.nih.gov/condition/pitt-hopkins-syndrome">Pitt-Hopkins syndrome</a>, children learn to walk between 4 and 6 years old and most individuals are unable to speak. But a rare condition like Pitt-Hopkins might offer clues for treating a range of ASD and provide insight into why those “on the spectrum” are so unique.</p>
<p>The term autism describes a range of disorders where the brain functions differently. This is analogous to how the term cancer describes a collection of diseases characterized by out-of-control cell growth. The diagnosis of autism is typically made at around 2 to 3 years of age as children show repetitive behaviors and have trouble socializing. Until relatively recently, ASD was regarded as uncommon and thought to be caused by bad parenting, but we now know that autism is a neurodevelopmental disorder that <a href="https://www.cdc.gov/ncbddd/autism/data.html">occurs in about 1 in 59 people</a> and is not the result of parental behavior. </p>
<p>The exact causes remain unknown, but some <a href="https://www.nichd.nih.gov/health/topics/autism/conditioninfo/causes">mix of environmental factors and a plethora of usually tiny genetic differences</a> combine to alter brain development beginning in infancy. This pushes brain development onto a trajectory that is different from what we perceive to be normal.</p>
<p>The many factors that contribute to ASD make them particularly tricky to understand. The number of variables is high, making it almost impossible to examine any single factor in isolation. For this reason, a rare condition like Pitt-Hopkins is a valuable case for autism research and the findings may yield insights into other types of ASD. Pitt-Hopkins syndrome is caused by a mutation within a gene on the 18th chromosome. Besides creating problems with walking and speech, this mutation also causes distinct facial features and sometimes makes it hard for people to breathe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271003/original/file-20190425-121249-14zitcg.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"></a>
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<span class="caption">Early signs that a child may be suffering from an autism spectrum disorder.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/autism-early-signs-syndrome-children-spectrum-1175748292?src=szCWj3vo4Ge5mXU1IYMzdA-1-93">KateDemianov/Shutterstock.com</a></span>
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<h2>A first specific treatment for autism?</h2>
<p>Because the genetic cause of Pitt-Hopkins is known, we can study the mutation in the lab to better understand how it changes brain function. The name of the mutated gene is transcription factor 4 (TCF4). It is highly active during early brain development in infancy. When the gene is turned on, it increases the production of two ion channels. These proteins allow ions (specifically, sodium and potassium) to travel in and out of the cell and are found on the membrane of the brain’s neurons. </p>
<p>Specifically, these ion channels become overly active, modifying how nerve cells function and how they respond to signals from other neurons, and therefore how the brain works. When we tested this in rodent and cell models, <a href="https://doi.org/10.1016/j.neuron.2016.02.021">we found</a> that the Pitt-Hopkins mutation alters the function of the brain’s neurons, which are ultimately responsible for the cognitive and social abnormalities that we find in people. In these cell and animal models, nerve cells responded abnormally to being stimulated. Instead of sending back signals when stimulated, they tended to shut down. </p>
<p>With this knowledge, a team of investigators here at the <a href="https://www.libd.org/">Lieber Institute</a> began searching for a drug that could block the activity of these ion channels and effectively change the behavior of the neurons. As it turned out, several pharmaceutical companies had created drugs to target one of these ion channels, one of which we found to work in the abnormal nerve cells and animals. We are in the final stages of licensing this compound for a human trial in young adults with Pitt-Hopkins syndrome, which we hope to start in about a year. </p>
<p>This would then become the first treatment for autism based on understanding a specific causative mechanism. </p>
<p>This doesn’t fix everything of course. By altering how each nerve functions from the time of early development, Pitt-Hopkins also forever changes the brain’s architecture. But if we can fix how the neurons operate, we may rescue normal brain activity for people with this condition.</p>
<p>To be clear, children and young adults with Pitt-Hopkins syndrome face significantly different challenges compared to, say, an individual with Asperger’s, who is socially awkward but highly functional and gainfully employed. But no matter where we look on the spectrum, in order to better understand all forms of autism we have to start uncovering the underlying biology of these conditions. It’s opening a crack in a tiny window that can help explain what is happening.</p><img src="https://counter.theconversation.com/content/115708/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel R. Weinberger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The complexity of autism makes research difficult, but understanding even rare forms of autism is leading to greater insight into the biology of these disorders and potential new treatments.Daniel R. Weinberger, Director of the Lieber Institute for Brain Development and Professor, Departments of Psychiatry, Neurology, Neuroscience and The Institute of Genetic Medicine, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1130512019-03-07T13:49:24Z2019-03-07T13:49:24ZDVLA U-turn over autistic drivers highlights the ongoing issue of autism discrimination<figure><img src="https://images.theconversation.com/files/262663/original/file-20190307-82669-10exdrz.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>Without consultation or warning, the UK Driver and Vehicle Licensing Agency (DVLA) <a href="https://www.theguardian.com/society/2019/mar/05/dvla-u-turns-on-autism-disclosure-policy-after-uproar">recently changed its website guidance</a> for drivers with an autistic spectrum disorder. It stated that such drivers need to declare to the DVLA that they are autistic regardless of whether or not this affects their driving. And with no publicity for the change, this immediately put many autistic drivers in the position of unknowingly <a href="https://www.theguardian.com/society/2019/mar/03/autistic-people-angry-at-having-to-disclose-diagnosis-to-dvla-even-if-driving-not-affected">breaking the law by continuing to drive</a>. </p>
<p>The change required <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/777403/m1-online-confidential-medical-information.pdf">autistic drivers to complete a form</a> and detail levels of alcohol and drug use, name their doctor and specialist consultant, as well as what clinics they attend and when. Drivers also had to agree to these medical professionals being contacted for information – even though their doctor’s specific understanding of what it means to be autistic might be limited. </p>
<p>The declaration also meant that autistic drivers had to prove they were fit to drive or face a £1,000 fine and possible prosecution in the event of an accident – and in some instances have their licence revoked. </p>
<p>But thankfully, <a href="https://www.independent.co.uk/voices/autism-dvla-driving-jess-phillips-a8807096.html">a successful challenge to the DVLA</a> over the practice of treating autistic drivers differently was launched and the decision was overturned. The challenge centred on the idea that the requirement of disclosure is against the human rights of autistic people as it treats them differently. </p>
<h2>Being different</h2>
<p>But herein lies part of the problem, because it is the autistic community and its allies that have promoted this very idea of autistic people being different.</p>
<p>Many people, the DVLA included, use the term <a href="https://www.autism.org.uk/about/what-is/asd.aspx?gclid=EAIaIQobChMIg4ec9ovw4AIVxZ3tCh1C1gonEAAYASAAEgIYc_D_BwE">autistic spectrum disorder</a>. It is unsurprising, then, that this raises questions about whether people who are considered to be “disordered” are safe to drive on the roads. </p>
<p>Autistic people and their supporters challenge the use of the term “disorder”, claiming it to be misleading, demeaning and an attack on self-esteem. Instead, many autistic self-advocates identify as <a href="https://ollibean.com/autism-disability-difference/">“different” rather than “disordered”</a>. The National Autistic Society (NAS) supports this notion of difference but also refers to <a href="https://www.autism.org.uk/about/what-is/asd.aspx">autism as a “condition”</a>. </p>
<p>But for autistic drivers, this is probably no more helpful than the term “disorder”, as the DVLA is as likely to be concerned about people driving with a “condition” as a “disorder”. Nor will the idea of being “different” be of any more help to autistic drivers – as it is not clear who or what autistics are different from. Difference therefore becomes just another term that marginalises autistic people. It sets them apart as “other” and makes them vulnerable to particular regulation.</p>
<h2>Not all the same</h2>
<p><a href="https://www.shu.ac.uk/about-us/our-people/staff-profiles/nicholas-hodge">My own research</a> has long been concerned with how this notion of difference has the potential to take those who identify as autistic outside of being human. In doing so, people who identify as autistic are then left without the protection of rights that are the <a href="https://www.sheffieldtelegraph.co.uk/news/opinion/education-education-system-should-help-autistic-pupils-achieve-potential-1-8365121">entitlement of all human beings</a>. </p>
<p>Fortunately, the DVLA has made a U-turn in this case and now drivers only have to declare that they are autistic if this will impede their driving. But this lucky escape should be a warning to us all to think more carefully about claiming difference. </p>
<p>I worry, though, that this regulation change from the DVLA is just one example of how being different can lead to being treated differently. The panic that has resulted from this action of the DVLA clearly demonstrates how devastating the effects of being denied the protection of human rights can be.</p>
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<p>It is time we moved way from celebrating and promoting this concept of difference. We need instead to assert the humanity of people who identify as, or have been categorised as, autistic. This will involve the identification and celebration of the qualities and contributions that all its members bring to society as well as recognising the challenges and barriers they face. </p>
<p>We should, of course, highlight and protest against physical and social environments when they are constructed in ways that disable some people. But this happens because society often only considers the needs of some, rather than all, of its members. It is not because some beings are essentially and distinctly different. Along with the concepts of “disorder” and “condition”, the action of the DVLA has highlighted how “difference” can be an equally dangerous road to take.</p><img src="https://counter.theconversation.com/content/113051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Hodge 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>This is just one example of how being ‘different’ can lead to being treated differently.Nick Hodge, Professor of Inclusive Practice, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1110382019-02-28T11:41:32Z2019-02-28T11:41:32ZListening in to brain communications, without surgery<figure><img src="https://images.theconversation.com/files/261327/original/file-20190227-150698-1llaktf.jpg?ixlib=rb-1.1.0&rect=1320%2C0%2C3172%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Signals from inside the brain can reveal what's happening in nerve cells.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/abstract-glowing-polygonal-head-background-neurons-754506796">Peshkova/Shutterstock.com</a></span></figcaption></figure><p>Plenty of <a href="https://www.penguinrandomhouse.com/books/566048/my-plastic-brain-by-caroline-williams/9781633883918/">legitimate science</a> – plus a whole lot of <a href="https://www.penguinrandomhouse.com/books/538861/neuromancer-by-william-gibson/9780143111603/">science fiction</a> – discusses ways to “<a href="https://www.theatlantic.com/magazine/archive/2015/06/brain-hacking/392084/">hack the brain</a>.” What that really means, most of the time – even in the <a href="http://www.michaelcrichton.com/the-terminal-man/">fictional examples</a> – <a href="https://www.wired.com/2016/01/phil-kennedy-mind-control-computer/">involves surgery</a>, opening the skull to implant wires or devices <a href="https://www.wired.com/story/inside-the-race-to-build-a-brain-machine-interface/">physically into the brain</a>. </p>
<p>But that’s difficult, dangerous and potentially deadly. It would be smarter to work with the brain without needing to open patients’ skulls. Neurological disorders are common, affecting <a href="https://news.un.org/en/story/2007/02/210312-nearly-1-6-worlds-population-suffer-neurological-disorders-un-report">more than a billion people worldwide</a>, of all ages, genders, and educational and income levels. <a href="https://scholar.google.com/citations?user=7z-nA_kAAAAJ&hl=en">My neural engineering team’s research</a>, as part of a wider effort across the <a href="https://www.asme.org/engineering-topics/articles/bioengineering/top-5-advances-medical-technology">bioengineering</a> discipline, is working toward understanding and easing various neurological dysfunctions, such as multiple sclerosis, autism spectrum disorder and Alzheimer’s disease.</p>
<p>Identifying and influencing brain activity from outside the skull could eventually permit doctors to diagnose and treat a wide range of debilitating nervous system diseases and mental disorders without invasive surgery. </p>
<h2>Wireless connections within the brain</h2>
<p>My group believes we are the first to have discovered a new way nerve cells communicate with each other. Nerves are well known to connect through physical links – or what might be called “wired” connections – in which the axons of one nerve cell send electrical and chemical signals to the dendrites of a neighboring cell.</p>
<p>Our research has found that <a href="http://doi.org/10.5772/intechopen.71945">nerve cells also communicate wirelessly</a>, by using the wired activity to create tiny electric fields of their own, and sensing the fields neighboring cells create. This creates the possibility of many more neural pathways and can help explain why different parts of the brain connect so quickly during the execution of complicated tasks.</p>
<p>We have been able to monitor these electric fields from outside the skull, effectively listening in on nerve communications. We hope that will help us find alternate, healthy connections for nerves damaged by multiple sclerosis, or rebalance nerve activity due to autism spectrum disorder, or prime neurons to fire together in specific patterns and restore long-term memories lost as a result of Alzheimer’s disease.</p>
<p>Specifically, we have found when an insulated, or myelinated, nerve fiber in the brain is active and sending signals along its length known as action potentials, <a href="https://doi.org/10.1109/EMBC.2015.7318854">special regions</a> along its length generate a <a href="https://doi.org/10.1063/PT.3.1167">very small</a> <a href="http://doi.org/10.5772/intechopen.71945">electric field</a>. The cellular regions where this happens, called <a href="https://www.britannica.com/science/node-of-Ranvier">nodes of Ranvier</a>, act like small antennas that can transmit and receive electrical signals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=323&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=323&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=323&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=406&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=406&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260842/original/file-20190225-26171-1u1sxaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=406&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A nerve cell diagram.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Neuron.svg">Dhp1080/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Any disruption of the two highly specialized structures – the myelin sheath or the node of Ranvier – not only <a href="https://doi.org/10.1042%2FAN20130025">results in neurological dysfunction</a>, but the surrounding electric field changes too.</p>
<h2>Listening to nerves</h2>
<p>The technological challenge involves precisely targeting specific parts of the brain to listen in on. The device must receive signals from areas roughly the diameter of a human hair, several centimeters deep within the brain.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=653&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=653&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=653&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=821&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=821&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259734/original/file-20190219-43270-15ejl78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=821&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patch antennas on the skull could listen in on nerve communications at a specific location within the brain.</span>
<span class="attribution"><span class="source">Salvatore Morgera</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>One way is to place a small number of flexible antenna patches on the skull to create what we call a “brain lens.” Comparing readings from several patches lets us electronically target exactly the nerves to listen in on. We are designing and experimenting with <a href="http://www.setcor.org/conferences/Nanotech-France-2018">metamaterials</a> – materials engineered at the molecular level – that are especially good at serving as <a href="https://doi.org/10.1364/OPN.15.9.000032">high-accuracy antennas</a> that can be tuned to receive signals from very specific locations.</p>
<h2>No pain, but potentially great gain</h2>
<p>By listening in on wireless communications between nerves, we can identify areas of the brain where the electric fields indicate there are problems. The detailed characteristics of a nerve’s activity – or lack of activity – can offer clues about what specific problem is occurring in the brain. These findings could help diagnose potential medical conditions far more easily than current methods.</p>
<p>Look, for instance, at the actual case of one patient, a 38-year-old woman we’ll call “Bianca,” who has been diagnosed with multiple sclerosis, a degenerative disease of the brain and spinal cord that has no known cure. Multiple sclerosis patients’ immune systems damage the myelin sheath between the nodes of Ranvier, causing communication problems between the brain and the rest of the body. This damage radically alters the activity in the affected nerves.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/261294/original/file-20190227-150708-1yxvau7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Multiple sclerosis damages the myelin around nerve cells, disrupting communications and changing a nerve’s electric field.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/multiple-sclerosis-ms-autoimmune-disease-nerves-239380201">Designua/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>To monitor the progress of her disease, Bianca has had spinal taps to see if her spinal fluid has high levels of particular antibodies associated with MS. She has also had MRI scans to reveal the areas of her brain where the myelin is damaged, and will face additional testing to determine how fast information flows through her nervous system. </p>
<p>Using a brain lens device would let doctors monitor Bianca’s brain without painful spinal taps and uncomfortable and time-consuming MRIs and CT scans. It may some day allow Bianca to monitor her own brain and send the data to her specialist for evaluation.</p>
<h2>Therapeutic treatment without drugs and surgery</h2>
<p>In addition, we’re hoping that our approach can lead to new therapies that are also easier on patients. At the moment, Bianca is taking several drugs that carry significant health risks and often make her feel nauseated and fatigued. She is one of many, who want to try a different therapy option.</p>
<p>This work plans to go beyond identifying the regions of her brain where the electric fields indicate unhealthy conditions. Inspired by computer network management and <a href="https://theconversation.com/advanced-digital-networks-look-a-lot-like-the-human-nervous-system-108319">advanced digital networks</a>, which route signals around areas that are damaged or interrupted, we are developing a method by which our scalp patch system could <a href="https://scientificfederation.com/biomedical-engineering-2018/">send messages into the brain</a> as well.</p>
<p>Each damaged nerve fiber is generally one of thousands packed together into a tract of nerve fibers where neighboring nerve fibers are typically healthy. Our device could help identify sites with myelin damage and follow those nerve fibers back before the point of damage, to pick up their undisturbed signals. Then we would use the brain lens to transmit complementary electric fields into the brain, sending those healthy signals to the areas around the myelin damage, to encourage neighboring nerve fibers to carry the messages the damaged fiber can’t.</p>
<p>So far, we have been able to simulate this approach in a super-computing environment where brain nerve parameters have been provided by clinical research laboratories. In the coming months, we will build and test a brain lens prototype. Listening in to the brain and communicating with it offers a fascinating new set of possibilities for medical diagnosis and treatment without surgery.</p><img src="https://counter.theconversation.com/content/111038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Salvatore Domenic Morgera has received research funding in networks from the Natural Sciences and Engineering Research Council of Canada, The Fonds de recherche du Québec - Nature et technologies, National Science Foundation, and the United States Special Operations Command.</span></em></p>When nerve cells in the brain pass electrical signals to each other, they create tiny electric fields that can be sensed from outside the skull.Salvatore Domenic Morgera, Professor of Electrical Engineering and Bioengineering, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1083192018-12-18T11:48:58Z2018-12-18T11:48:58ZAdvanced digital networks look a lot like the human nervous system<figure><img src="https://images.theconversation.com/files/251002/original/file-20181217-185240-8tynvo.jpg?ixlib=rb-1.1.0&rect=594%2C189%2C4742%2C2888&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studying digital and biological connections can shed light on both fields.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/ai-artificial-intelligence-concept-machine-learning-1012126252">MY stock/Shutterstock.com</a></span></figcaption></figure><p>Parents have experienced how newborns grab their finger and hold tight. This almost instantaneous response is one of the sweetest involuntary movements that babies exhibit. The newborn’s nerves sense a touch, process the information and react without having to send a signal to the brain. Though in people this ability fades very early in life, the system that enables it offers a useful example for digital networks connecting sensors, processors and machinery to translate information into action.</p>
<p><a href="https://scholar.google.com/citations?user=7z-nA_kAAAAJ&hl=en">My research</a> on both the human nervous system and advanced telecommunications networks has found some striking parallels between the two, including the similarity between babies’ nervous systems and the rapid-response networks now being developed to handle always-on, always-connected networks of sensors, cameras and microphones throughout <a href="https://theconversation.com/do-i-want-an-always-on-digital-assistant-listening-in-all-the-time-92571">people’s homes</a>, <a href="https://interestingengineering.com/the-technologies-building-the-smart-cities-of-the-future">communities</a> and <a href="https://www.industryweek.com/technology/dawn-smart-factory">workplaces</a>. </p>
<p>These insights can suggest new ways to think about designing future telecommunications systems, as well as provide new ideas for diagnosing and <a href="https://brain.ieee.org/newsletter/2018-issue-3/discovery-of-new-neurological-networks/">treating neurological disorders</a> like multiple sclerosis, autism spectrum disorder and Alzheimer’s disease.</p>
<h2>A view of human neurology</h2>
<p>Generally speaking, the nervous system has three main components: the brain, the spinal cord and the peripheral nervous system. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1109&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1109&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1109&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1394&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1394&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251037/original/file-20181217-185240-at9go0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1394&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 human nervous system can be understood as a network of interconnected sensors and processors.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/121935927@N06/13578831923">Siyavula Education/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>The <a href="https://emedicine.medscape.com/article/1948687-overview">peripheral nervous system</a> is distributed throughout the entire body, sensing inputs like pressure, heat and cold, and conveying that information through the spinal cord to the brain. This system also handles the responses from the brain, controlling voluntary movements, and does some local regulation of involuntary body functions like breathing, digestion and keeping the heart beating.</p>
<p>The <a href="https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/biology-of-the-nervous-system/spinal-cord">spinal cord</a> handles large numbers of sensory inputs and action responses passing back and forth between the brain and the body. It also handles involuntary muscular movements called <a href="https://www.bbc.com/bitesize/guides/ztjrng8/revision/3">reflex arcs</a>, such as the knee jerk reflex when the doctor performs an examination or the rapid “pull away” of a hand when something hot is touched. </p>
<p>The brain, the center of most of the nervous system’s processing power, has several <a href="https://www.health.harvard.edu/blog/right-brainleft-brain-right-2017082512222">specialized regions</a> in its right and left hemispheres. These areas take input from sensors such as the eyes, ears and skin, and return outputs in the form of thoughts, emotions, memories and movement. In many cases, these outputs <a href="https://www.huffpost.com/entry/how-your-thoughts-change-your-brain-cells-and-genes_b_9516176">are also used by other parts of the brain as inputs that enable</a> refinement and learning.</p>
<p>In healthy people, these elements work together in extraordinary harmony by combining networks of cells that respond to specific chemicals, mechanical changes, light characteristics, temperature changes and pain through a process called <a href="https://www.ncbi.nlm.nih.gov/books/NBK21661/">sensory transduction</a>. This complexity makes even one of the smallest components of the nervous system, the <a href="https://doi.org/10.1016/S0960-9822(06)00203-X">nerve fiber, or axon</a>, a challenge to study. </p>
<p>Some of the nervous system’s interconnections, long thought to only be <a href="http://www.humanconnectomeproject.org/">physical</a>, may also be <a href="http://doi.org/10.5772/intechopen.71945">effectively wireless</a>. The brain generates a <a href="https://doi.org/10.1109/EMBC.2015.7318854">highly specialized electric field</a> at certain nerve fiber sites during the normal course of its operation. Measuring the characteristics of this field can offer indications that a brain is healthy, or that it may have certain neurological disorders.</p>
<h2>Inside telecommunications networks</h2>
<p>The current generation of advanced telecommunications networks, known as <a href="https://theconversation.com/what-is-5g-the-next-generation-of-wireless-explained-96165">5G</a>, is wireless, and has three similar categories of components.</p>
<p>The digital equivalent of the peripheral nervous system is the “internet of things.” It is a vast and growing network of devices, vehicles and home appliances that contain electronics, software and connectivity that let them connect with each other, <a href="https://readwrite.com/2016/06/28/proglove-brings-smart-gloves-to-the-factory-floor-it1/">interacting and exchanging data</a>.</p>
<p>The technological equivalent of the brain is the “<a href="https://www.pcmag.com/article2/0,2817,2372163,00.asp">cloud</a>,” an internet-connected group of powerful computers and processors that store, manage and process data. They often work together to handle complex tasks involving large amounts of input and processing, before delivering outputs back over the internet. </p>
<p>In between those two types of components is the spinal-cord equivalent, a new type of network called a “<a href="https://doi.org/10.1109/JIOT.2016.2584538">fog</a>” – a play on the fact that it’s a thinly distributed cloud – set up to shorten network connections and the resulting processing delays between the cloud and remote devices. The processors and storage devices in the fog can handle tasks that require especially rapid reactions.</p>
<h2>Striking similarities</h2>
<p>In building technological networks throughout the modern world, people have apparently – and likely unconsciously – mirrored human neurology. </p>
<p>This offers opportunities to identify technological solutions to networking problems that could be adapted into medical treatments for neurological disorders that have no known cures. </p>
<p>Autism spectrum disorder, for example, is a serious developmental condition that impairs people’s ability to communicate and interact. It’s believed to occur as a result of an imbalance between <a href="https://knowingneurons.com/2017/01/25/excitation-inhibition/">two types of neural communications</a>: People with autism spectrum disorder have too much activity in neurons that excite other neurons and too little activity in neurons that quiet other neurons down. This is like what happens when some links in a telecommunications networks get overloaded, while others are not busy at all. Software tools that manage large cloud and fog networks can even out demand and minimize telecommunication delays. These programs can also simulate – and suggest ways to reduce – the network imbalances in <a href="http://asdnet.fmhi.usf.edu/faculty/morgera.html">autism-related</a> impairments.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Jg50wEHqpas?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Salvatore Domenic Morgera explains the network of the nervous system.</span></figcaption>
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<p>Multiple sclerosis is an often disabling disease in which the body’s immune system eats away at nerve fibers’ protective coverings. This disrupts the flow of information within the brain, and between the brain and the body. Technologically, this is similar to outages at particular network connection points, which is regularly dealt with by sending messages by other routes that have working connections. Perhaps medical research can identify ways to reroute nerve messages through nearby links when some nerves aren’t working properly.</p>
<h2>Using software and medicine together</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1000&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1000&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1000&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1257&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1257&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251042/original/file-20181217-185268-j6nq7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1257&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Neural communications break down when affected by Alzheimer’s disease.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Blausen_0017_AlzheimersDisease.png">BruceBlaus/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Alzheimer’s disease is a type of dementia that causes problems with memory, thinking and behavior. In 2015, I presented work by my <a href="https://www.usf.edu/engineering/ee/faculty-staff/index.aspx">research lab</a> on the discovery of <a href="https://www.bmes.org/files/Annual%20Meeting%20Program%20Guides/2015AnnualMeetingProgram.pdf#page=191">new networks in the brain</a> whose behavior indicated that Alzheimer’s disease might be an autoimmune disease, like MS is. This suggests a brain with Alzheimer’s could be like a telecommunications network being attacked by an intruder changing not just data within the network, but also the network’s structure itself.</p>
<p>My research group then used the <a href="https://doi.org/10.1109/ACCESS.2018.2866962">human immune system as inspiration</a> for <a href="https://doi.org/10.1109/SURV.2013.050113.00191">developing software to defend computer networks</a> against malicious attacks. This software can, in turn, be used to simulate the progress of Alzheimer’s disease in a patient, perhaps highlighting ways to reduce its effects.</p>
<p>The nervous system’s involvement in other autoimmune diseases, such as Type 1 diabetes and rheumatoid arthritis, may offer opportunities for additional insights into digital networks, or ways sensors and software solutions might help patients. In my view, software models, made more realistic by clinical research, will help researchers understand the structure and function of the human nervous system and, along the way, make telecommunications networks and services faster and more reliable and secure.</p><img src="https://counter.theconversation.com/content/108319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Salvatore Domenic Morgera has received R&D funding for networks from the Natural Sciences and Engineering Research Council, Fonds de recherche du Québec, National Science Foundation, and the United States Special Operations Command. </span></em></p>Biological research can inspire technological innovation. Also, software that models computer networks can inform health care for patients with neurological disorders.Salvatore Domenic Morgera, Professor of Electrical Engineering and Bioengineering, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1049362018-11-29T19:06:13Z2018-11-29T19:06:13ZYoung children with autism can thrive in mainstream childcare<figure><img src="https://images.theconversation.com/files/246618/original/file-20181121-161627-y6mymc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This study found children with autism could be effectively supported in mainstream childcare.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Much of the research about including children with autism in mainstream classrooms is focused on school-aged children. Growing numbers of children with autism are <a href="https://www.mja.com.au/journal/2015/202/6/mapping-diagnosis-autism-spectrum-disorders-children-aged-under-7-years">diagnosed in toddlerhood</a>, so there is increasing relevance for the early-childhood sector. Our <a href="http://journals.sagepub.com/doi/full/10.1177/1362361318801341">new research shows</a>, with support, educators can effectively include and teach children on the spectrum in mainstream childcare, alongside their non-autistic peers.</p>
<p>Programs to support learning in key areas - language, cognition and independence skills - have been found to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/25737021">effective for many children with autism</a>. But we need options that are also affordable and accessible within children’s local communities. Many families ferry children around to appointments with different professionals, employ therapists to come into the home, or travel long distances to specialist centres.</p>
<p>Building capacity for evidence-based intervention to occur within children’s local childcare settings is a good option. This could be more affordable and accessible for families. </p>
<h2>Best-practice guidelines for early childhood support</h2>
<p>Young children with autism have difficulty learning communication and independence skills that come more easily to others. Early intervention can help by targeting their unique developmental needs.</p>
<p>A minimum of <a href="https://www.dss.gov.au/sites/default/files/documents/10_2014/review_of_the_research_report_2011_0.pdf">15-25 hours per week</a> of early intervention is recommended to support communication and independence skills in young autistic children. This is usually achieved through specialist centre- or home-based services. But this level of intensity is expensive, and unaffordable for many families.</p>
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<img alt="" src="https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246622/original/file-20181121-161638-rc6vv1.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">
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<span class="caption">The evidence shows there were no negative impacts on the learning environment for non-autistic peers in mainstream settings.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>Some children on the spectrum may attend mainstream childcare, which is more affordable. But if staff don’t know how to meet their particular learning needs, the child may simply be present but missing out on learning and interacting with other children.</p>
<p>The <a href="https://www.ndis.gov.au/html/sites/default/files/documents/Research/NDIA-ECEI-Approach-1.pdf">National Disability Insurance Agency</a> (NDIA) advocates choice and control and that young children should be supported in their local communities. But currently, options may be <em>either</em> attending local care with peers <em>or</em> receiving intensive early intervention.</p>
<p>Our team wondered whether we could successfully integrate evidence-based intervention within mainstream care. In 2015, with NDIA and Department of Social Services (DSS) support, we began a study to test this idea.</p>
<h2>Quality early intervention in mainstream settings</h2>
<p>Our study engaged 44 young children, each for one year. Half were placed in specialised care and half in mainstream care.</p>
<p>Specialised playrooms included only autistic children, at the Victorian Autism Specific Early Learning and Care Center (ASELCC). Mainstream playrooms - at the La Trobe University Community Children’s Centre and Gowrie Victoria - included mostly children without autism.</p>
<p>Children received the Group-Early Start Denver Model (G-ESDM). This is an intervention developed and evaluated <a href="https://link.springer.com/article/10.1007%2Fs10803-014-2168-9">by the Victorian ASELCC team</a>. Each child’s personalised learning goals are targeted within natural routines and activities across the childcare day. For example, at snack time staff may help a child develop interest in what peers are doing, practice communication skills such as requesting food, and practice independence skills such as using a spoon and waiting their turn.</p>
<p>We found this specialised intervention <a href="http://journals.sagepub.com/doi/full/10.1177/1362361318801341">could be delivered in mainstream childcare</a>. Educators learned the G-ESDM strategies and used these in everyday playroom activities. On average, the children’s social interaction, imitation, language and independence skills improved across the year. Encouragingly, gains were similar in both settings.</p>
<p>Other researchers - separate from our team, and unaware of what our study was about - rated the educational environment. They reported high quality teaching and learning practices across all playrooms. This suggests our program had no negative impact on the mainstream environments.</p>
<h2>Rigorous research in the real world</h2>
<p><a href="https://link.springer.com/article/10.1007/s10803-013-1877-9">Other studies on this topic</a> have recruited children who are already enrolled in a particular setting and/or compared mainstream and specialised settings offering different intervention programs. So, we can’t be sure whether the results are about the type of intervention program, the specific setting, or some other factor.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246623/original/file-20181121-161618-1voqva3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&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">Support for children on the spectrum delivered in mainstream settings could be more accessible for families.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>We wanted a rigorous test of the setting, so we used the gold-standard randomised trial approach. For families keen to be involved, we more-or-less used a coin-toss to decide which children would be in the mainstream or specialised settings. </p>
<p>Implementing evidence-based practice into real-world settings <a href="https://onlinelibrary.wiley.com/doi/10.1002/aur.1900">is challenging</a>. This research occurred through genuine collaboration with early childhood educators, G-ESDM specialists, centre managers and researchers as equal partners. </p>
<h2>Continuous improvement</h2>
<p>This is a first step toward showing that quality early-intervention can occur within mainstream settings – without compromising child outcomes or the learning environment for peers. </p>
<p>The ultimate goal is for autistic children to access quality supports in their local communities including within mainstream settings, if that’s the best choice. But, just as no two children on the spectrum are alike, what works best for one will not be the solution for another.</p>
<p>Across both settings, we saw stronger gains for some children than others. Research with a larger sample would inform which individual children might be best supported within mainstream or specialised settings.</p>
<p>Delivering G-ESDM in mainstream settings also requires substantial resources such as time for initial training and ongoing support for staff. From 2019, we will begin to investigate whether a more streamlined approach might be more affordable but similarly beneficial for children and families. </p>
<hr>
<p><em>The authors would like to acknowledge the two childcare centres, La Trobe University Community Children’s Centre and Gowrie Victoria, involved in <a href="https://journals.sagepub.com/doi/abs/10.1177/1362361318801341?journalCode=auta">the study</a> this article is based on.</em></p><img src="https://counter.theconversation.com/content/104936/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristelle Hudry works for La Trobe University and is currently on secondment as Senior Research Fellow to the Victorian Autism Specific Early Learning and Care Centre (ASELCC) at the La Trobe University Community Children's Centre. She has recieved funding from the Australian Government Department of Social Services (DSS), the National Disability Insurance Agency (NDIA), and the Autism Cooperative Research Centre (Autism CRC).</span></em></p><p class="fine-print"><em><span>Catherine works for the Victorian Autism Specific Early Learning and Care Centre (ASELCC) at La Trobe University. She has received funding from the Australian Government Department of Social Services (DSS) and the National Disability Insurance Agency (NDIA).</span></em></p>A recent study has shown educators can include and teach children on the spectrum in mainstream childcare, alongside their non-autistic peers.Kristelle Hudry, Senior Research Fellow, and Senior Lecturer in Developmental Psychology, La Trobe UniversityCathy Bent, Research Fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1020822018-09-20T12:25:11Z2018-09-20T12:25:11ZAutistic children need the world to acknowledge the significance of the challenges they face<figure><img src="https://images.theconversation.com/files/236871/original/file-20180918-158246-oea5dw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/girl-in-white-long-sleeve-shirt-and-black-skirt-sitting-on-swing-during-day-time-12165/">Pexels</a></span></figcaption></figure><p>Autistic children are increasingly being suspended or expelled from school, because of “behavioural problems” official figures show. Some regions in the UK have seen a <a href="https://www.tes.com/news/exclusions-autistic-pupils-60-cent">100% increase</a> in these types of exclusions since 2011.</p>
<p><a href="http://shura.shu.ac.uk/11825/3/Hodge%20-%20I%20didn%27t%20stand%20a%20chance.pdf">Research</a> carried out by myself and colleagues at Sheffield Hallam University demonstrates the devastating consequences these exclusions have for disabled children and their families. </p>
<p>A landmark legal ruling in August stated that the <a href="https://www.bbc.co.uk/news/education-45182213">exclusion of autistic children</a> from school is a violation of their human rights. This decision by the upper tribunal should bring to a halt the alarming rise in the number of <a href="https://www.standard.co.uk/news/education/surge-in-exclusions-of-autistic-pupils-set-to-be-halted-after-landmark-legal-ruling-a3914051.html">school exclusions</a> of autistic pupils. </p>
<p>Schools can no longer exclude pupils for aggression if this results from the pupil being autistic and is not, therefore, an act of choice.</p>
<h2>Autism as a problem</h2>
<p>The ruling means that schools are now legally obliged to make reasonable adjustments under the Equality Act 2010 to support autistic children whose behaviour they find challenging. </p>
<p>But while the results of the tribunal are to be welcomed, some elements of the reported ruling reproduce the fundamental misrepresentation of autism that gives rise to these exclusions – for example, Judge Rowley <a href="https://www.theguardian.com/education/2018/aug/14/school-discriminated-against-expelled-autistic-boy-judge-rules">asserted that</a>: “aggressive behaviour is not a choice for children with autism”. In doing so, Judge Rowley seems to imply that acting aggressively is an expected characteristic of being autistic.</p>
<p><a href="https://www.tes.com/news/tes-magazine/tes-magazine/labels-autism-and-adhd-are-nothing-shout-about-0">Thinking about “problem” behaviour</a> as a characteristic of autism has predominated within society since the condition was first formulated over 70 years ago. The American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (<a href="https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_AutismSpectrumDisorder.pdf">DSM-5</a>) sets out the personal characteristics that warrant a diagnosis of autism. This defines autistic people through terms such as “deficit” and “failure”. Their behaviour is represented as abnormal and a problem: </p>
<blockquote>
<p>Persistent deficits in social communication and social interaction … Deficits in social-emotional reciprocity … abnormal social approach and failure of normal back-and-forth conversation … inflexible adherence to routines.</p>
</blockquote>
<p>In this way, autism is made a personal problem with social rules and practices, as well as issues with communication and coping readily with change. Thinking of autism in this way has engendered a multi-million pound <a href="https://blog.marketresearch.com/autism-treatment-programs-are-growing-a-1.8-billion-market-in-the-u.s">industry</a> that depends on selling the idea that autistic children are in desperate need of a cure.</p>
<h2>Misunderstood and misrepresented</h2>
<p>This dominant mode of thinking about autism is often referred to as the <a href="https://disability-studies.leeds.ac.uk/wp-content/uploads/sites/40/library/Oliver-in-soc-dis.pdf">Individual Model of Disability </a>. This is the view that a person has a disability because in some critical way their body fails them. And it is this understanding of autism that is failing autistic children and young people. </p>
<p>You only have to look at the issue of school exclusions, the prevalence of <a href="https://www.autism.org.uk/about/health/mental-health.aspx">mental health issues</a> and the disturbingly high level of <a href="https://www.spectrumnews.org/features/suicidal-thoughts-alarmingly-common-in-people-with-autism/">suicides</a> in autistic adults to know that it is time to think differently about autism.</p>
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<p>Ask autistic people what the problem is and they won’t answer that it is because there is something wrong with them. Instead they will tell you about how other people don’t understand them and so reject and exclude them.</p>
<p>It is reported that only 16% of autistic adults in the UK are in full-time, paid <a href="https://www.theguardian.com/society/2017/oct/09/autism-working-spectrum-capable-employees-talent">employment</a>. This is not because autism makes you unable to work. It is because employers have a very limited concept of what an employee should look like and how they should behave.</p>
<h2>Wider acceptance</h2>
<p>This is why the “problem” of autism needs to be reframed – making it less about the individual and more about the way society relates to and views autistic people. This approach is known as the Social Model of Disability. </p>
<p>Through my <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9604.2009.01433.x">research</a>, I encourage education practitioners to shift from <a href="https://www.tes.com/news/tes-magazine/tes-magazine/labels-autism-and-adhd-are-nothing-shout-about-0">thinking about “problem” behaviour</a> as a characteristic of autism. I ask them instead to reflect on how a child might be experiencing what is happening to them at school and why that might result in unwanted behaviours. To help with this, I offer practitioners an alternative, <a href="https://www.sheffieldtelegraph.co.uk/news/opinion/education-education-system-should-help-autistic-pupils-achieve-potential-1-8365121">rights-based</a> definition of autism to the deficit focused one presented by the DSM 5.</p>
<p>This still acknowledges the significance of the challenges that autistic people face. However, in this new definition, the responsibility and focus for change is placed with school practices rather than with the child. In this different way of thinking about autism it becomes defined as:</p>
<blockquote>
<p>Profound and fundamental challenges with: knowing and/or applying customary social rules and practices if these are not made clear; accessing commonly available communication systems; adapting quickly to unexpected and enforced change.</p>
</blockquote>
<p>It is critical to think about autism in terms of the need for schools to develop more responsive practices to meet a diverse range of pupils – rather than a fundamental problem with a child. Doing so will compel schools to recognise where the problem of behaviour really lies.</p><img src="https://counter.theconversation.com/content/102082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Hodge 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>Autism doesn’t have to be viewed as a disability or disorder.Nick Hodge, Professor of Inclusive Practice, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/944012018-06-26T04:51:06Z2018-06-26T04:51:06ZWhy do some people with autism have restricted interests and repetitive movements?<figure><img src="https://images.theconversation.com/files/224825/original/file-20180626-19382-ka082i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety can drive obsessions and resistance to change.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-counts-sticks-374827933?src=yv9Uc0Pd-gUl0g8pgwmO9w-1-95">Shutterstock</a></span></figcaption></figure><p>As a society, we’ve come a long way in our understanding of the challenges people with autism face with social communication. But there is a large gap in our understanding of another cluster of behaviours that form part of an autism diagnosis: restrictive and repetitive behaviours and interests (RRBs). </p>
<p>These behaviours and interests appear to be made up of two dimensions. The first is a pattern of overly regulated thinking: obsessions and intense interests; a strong preference for maintaining sameness; and ritualistic or habitual patterns of behaviour, such as fiddling, or motor tics like blinking or throat clearing. </p>
<p>The second dimension is the rocking, twisting, flapping behaviour often associated with early depictions of severe autism in the media. </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>
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<p>The origin, or function, of the behaviour in each dimension appear to be different. </p>
<p>And while behaviours in the first dimension are particular to autism, behaviours in the second are related to cognitive development and sensory stimulation. They are common in typically developing pre-school-age children but, when sustained past school age, <a href="https://www.omicsonline.org/open-access/conceptualization-of-a-heuristic-to-predict-increase-in-restricted-and-repetitivebehaviour-in-asd-across-the-short-to-medium-term-2165-7890-1000200.php?aid=86558">may indicate</a> an intellectual disability.</p>
<h2>First dimension: thinking style</h2>
<p>Autism is a behavioural diagnosis. This means it is diagnosed by recognising the cluster of behaviours and the intensity and frequency of them. However, to understand how restrictive and repetitive behaviours and interests work, it’s important to understand the different thinking style associated with autism. </p>
<p>Contrasted with neurotypical thinkers (those without autism), people with autism have less abstract thought. They tend to be visual processors of information, with less strength in linguistic coding, or using language to explain their thoughts. </p>
<p>They are also less able to put themselves figuratively in other people’s shoes and guess what they’re thinking and feeling. </p>
<p>In effect, people with autism think of concrete stuff rather than the abstract self-talk related to feelings. Without a conscious effort, they’re less likely to generalise and have more difficulty recognising like or similar situations. The impact is a thinking style that is not concept-based but, rather, compartmentalised.</p>
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<img alt="" src="https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224831/original/file-20180626-19399-1199jip.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">
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<span class="caption">People with autism generally have more structured thoughts than their neurotypical peers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-doing-homework-520404748">Jacek Chabraszewski/Shutterstock</a></span>
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<p>When faced with change, the difficulty people with autism have in recognising like or similar experiences – out of their familiar thought compartment – results in anxiety. This anxiety is not labelled and, as an abstract concept, is not recognised. </p>
<p>The information that people with neurotypical patterns of thought take for granted, such as how people around them may be feeling and the link to expectations, is missing or dampened in people with autism.</p>
<h2>Second dimension: pushy anxiety and getting locked in</h2>
<p>Even though people with autism are more likely to think about concrete stuff rather than abstract feelings, anxiety still exists and, if not recognised, continues unmediated in the background. </p>
<p>Anxiety is a very pushy feeling. Think of the cave people and the flight or fight response. In more recent times, think of the thing that is created by deadlines and pushes you into activity when your threshold level has been reached. </p>
<p>When we recognise anxiety, we can get action-oriented, or we can choose to soothe the anxiety. If anxiety is operating in the background unrecognised, it continues to push and gain momentum. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-moving-autism-on-tv-beyond-the-genius-stereotype-76146">Friday essay: moving autism on TV beyond the genius stereotype</a>
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<p>For people with autism, this can push to obsessions and intense interests or provide the fuel for extraordinary efforts to resist change. </p>
<p>Excess anxiety fuel may also leak into habitual motor activity, such as fiddling or motor tics, and ritualistic behaviours. Or it can push the person into behaviours and thinking that operates to filter out the noisy demands of the world, like obsessive behaviour and rituals. </p>
<p>This can turn into a cycle of increasing anxiety. Picture this scenario: a new after-school routine triggers anxiety in a young person with autism. They filter this out by becoming increasingly obsessed with gaming. It’s clear they’re not responding to the demands of the new after-school routine, so the pressure – and therefore, the anxiety – increases. So too does the filtering (gaming). As this continues, the young person is drifting further from the behaviour needed, while getting locked in to the obsession. </p>
<p>This can be compounded by not recognising the feelings and expectations of those around, prompting intense conversations and yet more anxiety. </p>
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<img alt="" src="https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224832/original/file-20180626-19404-17n5mn0.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">
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<span class="caption">Excess anxiety can cause restrictive and repetitive behaviours, which can cause social tension and more anxiety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-adult-male-autism-hands-on-695047009?src=yv9Uc0Pd-gUl0g8pgwmO9w-1-83">Steven Wright/Shutterstock</a></span>
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<h2>Supportive structures</h2>
<p><a href="https://www.omicsonline.org/open-access/conceptualization-of-a-heuristic-to-predict-increase-in-restricted-and-repetitivebehaviour-in-asd-across-the-short-to-medium-term-2165-7890-1000200.php?aid=86558">Emerging research shows</a> the chance of getting locked into these behaviours increases when routine structures of work, school and family decline. </p>
<p>As the person’s world shrinks, the space left from these externally imposed structures can be taken up with restrictive and repetitive behaviours and interests. This is when the risk of getting “locked in” to these filtering behaviours increases.</p>
<p>If anxiety levels are elevated, the externally imposed structures are down, and the person has a history of getting locked in, it’s <a href="https://www.omicsonline.org/open-access/conceptualization-of-a-heuristic-to-predict-increase-in-restricted-and-repetitivebehaviour-in-asd-across-the-short-to-medium-term-2165-7890-1000200.php?aid=86558">time to get expert intervention</a>. Specialist intervention can effectively reduce the person’s anxiety and provide a scaffold of support by increasing their structured routine.</p>
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Read more:
<a href="https://theconversation.com/autism-advocacy-and-research-misses-the-mark-if-autistic-people-are-left-out-94404">Autism advocacy and research misses the mark if autistic people are left out</a>
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<img src="https://counter.theconversation.com/content/94401/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Cashin 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>Even though people with autism are more likely to think about concrete stuff rather than abstract feelings, anxiety still exists and, if not recognised, can cause significant problems.Andrew Cashin, Professor of Nursing, School of Health and Human Sciences, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/956362018-04-25T22:44:34Z2018-04-25T22:44:34ZToronto attack: Autism does not increase risk of violence<figure><img src="https://images.theconversation.com/files/216378/original/file-20180425-175041-47c8kj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alek Minassian (second from left in this courtroom sketch) is accused of driving a van into pedestrians along a stretch of a busy Toronto street on Monday April 23, 2018.</span> <span class="attribution"><span class="source">(THE CANADIAN PRESS/Alexandra Newbould)</span></span></figcaption></figure><p>News reports have linked the van attack that killed 10 pedestrians in Toronto this week to <a href="https://www.theglobeandmail.com/canada/toronto/article-suspect-in-toronto-van-attack-described-as-socially-awkward-tech/">the possibility the alleged driver has Asperger’s syndrome</a>, a <a href="https://theconversation.com/what-happened-to-aspergers-syndrome-89836">clinical diagnosis</a> that is currently considered to be part of autism spectrum disorder (ASD). </p>
<p>Alek Minassian, who has been charged with 10 counts of murder and 13 counts of attempted murder, has been described by former classmates and acquaintances as someone with social difficulties and behavioural tics. </p>
<p>It’s not the first time alleged perpetrators of violent acts have been linked to autism.</p>
<p>Coverage of school shootings at <a href="https://www.independent.co.uk/news/world/americas/sandy-hook-massacre-adam-lanza-paedophilia-fbi-files-mass-shooting-newtown-elementary-school-a8018566.html">Sandy Hook</a> and <a href="https://www.cnn.com/2018/02/16/us/shooter-profile-invs/index.html">Parkland</a> in the United States similarly linked these acts of deadly violence to potential diagnoses of autism.</p>
<p>Autism advocates have been quick to respond — <a href="https://www.thestar.com/news/gta/2018/04/24/autism-not-associated-with-violence-advocates-say.html">autism does not typically cause violence</a> or motivate an individual to drive a van into pedestrians on a crowded city street. </p>
<p>So what does the science say? Are those with ASD more prone to violence and, if so, what precautions should be taken? </p>
<h2>Reduced risk of violence</h2>
<p>The straightforward and scientifically supported answer to the question is unequivocally that <em>no</em>, individuals with ASD are <em>not</em> prone to violence any more than any other individual in society. </p>
<p>On the surface, the link may appear to be warranted. There is a belief that, in addition to <a href="https://autismcanada.org/about-autism/characteristics/">core social communication and other behavioural difficulties</a>, <a href="https://link.springer.com/article/10.1023%2FB%3AJADD.0000022607.19833.00">individuals with ASD also present with limited or non-existent empathy towards others</a> that may lead to a propensity for violence. </p>
<p>But one of the <a href="https://www.jaacap.com/article/S0890-8567(17)30150-8/fulltext">most rigorous studies to date</a> on this topic has shown that, in fact, individuals with ASD are <em>less</em> likely to engage in violent acts. </p>
<p>This study, which examined almost 300,000 individuals in Sweden, explored psychiatric diagnoses, gender, age, and many other variables in the context of violent crime. Overall, 4.4 per cent of individuals with ASD in this large sample were convicted of violent crime in contrast to 2.6 per cent of individuals without ASD. This increased risk of 40 per cent would seem to suggest autism as an influential factor. </p>
<p>However, once co-occurring conditions were accounted for, the rate of violent acts by those with only ASD was less than the group without ASD. </p>
<p>And, importantly, the evidence indicates that having ASD actually <em>reduced</em> the risk of violence. </p>
<p>In essence, it is not having a form of autism that contributes to an individual’s propensity for violent acts; rather, other psychiatric conditions such as <a href="https://www.psychologytoday.com/us/conditions/conduct-disorder">conduct disorder</a> and/or adverse childhood experiences appear to be much stronger factors. </p>
<p>Other researchers have investigated this topic and <a href="https://www.mdedge.com/psychiatry/article/77690/neurology/violent-behavior-autism-spectrum-disorder-it-fact-or-fiction">arrived at similar conclusions</a>.</p>
<h2>Media fear-mongering</h2>
<p>So, what should we take from this? First, journalists should be more aware of their power to influence public perceptions of those with mental health challenges. </p>
<p>They should be clear on what ASD is before asserting that it had any role to play in the atrocities of late. </p>
<p>Second, focusing the narrative around a single potential causal factor for violent acts simplifies what is, inherently, a complex issue. Perpetrators of violence do not commit their acts because of any one single factor. To state that Asperger’s syndrome may cause an individual to behave in this manner is false at best, and very harmful to a large number of individuals.</p>
<p>Third, and most importantly, the public should be better informed about the array of amazing and unique individuals who have ASD. </p>
<p>As almost any individual with autism, their family, or people that support them will tell you, it does not contribute to propensity for violence; however, people with autism are often victims of it. </p>
<p>Researchers and clinicians struggle to provide this information to the public in an effective manner. There are significant efforts to improve society’s understanding of those with ASD — such as <a href="https://autismcanada.org/get-involved/national-autism-awareness/">World Autism Awareness Day</a> and many local, provincial, and national events to educate society about ASD — many of which have proven to be effective. </p>
<p>We now have to progress towards society’s acceptance of those with autism. This will involve learning about ASD and how we can all work and live together to our mutual benefit, without a climate of fear-mongering or inaccurate information. </p>
<p>If we can achieve that, we will all be better off.</p><img src="https://counter.theconversation.com/content/95636/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>The evidence indicates that having autism spectrum disorder actually reduces the risk of violence.Adam McCrimmon, Associate Professor of Educational Studies in School Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.