CACHE Level 2

Certificate in Understanding
Autism

TRIAD OF IMPAIRMENTS

ASPERGER SYNDROME

UNDERSTANDING

AUTISM SPECTRUM CONDITION

PERSON-CENTRED

DIAGNOSIS

SOCIAL INTERACTION

Workbook 1
 How to use your learning materials

This course is delivered on a flexible learning basis. This means that most of your
study will take place away from your Assessor/Tutor. It helps to carefully plan your
studying so that you get the most out of your course. We have put together some
handy tips for you below.

Study Guidance

Try to plan an outline timetable of when and where you will study.
Try to complete your work in a quiet environment where you are unlikely to
be distracted.
Set realistic goals and deadlines for the various elements of your course.
Plan what you are going to study during each session, and try and achieve
this each time.
After each session, reflect on what you have achieved and plan what you hope to
complete next time.
Remember that not only do you have the support of your Assessor/Tutor, but it is
likely that your family, friends and work colleagues will also be willing to help.

Assessor/Tutor Support

Your Assessor/Tutor will be available to support and guide you through the
programme. They are experts in your area of study and are experienced in helping
many different types of learners.
They can help you to improve the standard of work you submit and will give
you useful feedback on areas in which you have excelled, as well as where
you can improve.
Remember to listen to, or read, their feedback carefully. Ask if you are unsure
about any of the feedback you receive as your Assessor/Tutor is there to help.
Make note of any tips they give. Refer to the learning materials as they contain the
information you need to complete the end-of-unit assessments.
Look out for areas in which you can improve, and set yourself an action plan to
make sure you complete the required work.
Take positive feedback on board; this demonstrates you are doing things right and
have a good understanding of the subject area.
Use the feedback to avoid repeating any mistakes you may have made.

Enjoy your studies!

2 © LCG 2020
 CACHE Level 2 Certificate in
Understanding Autism

Workbook 1
Workbook Contents

In this workbook, you will learn about autism and the theories used in diagnosing it, and
look at common misconceptions associated with autism and conditions that can co-occur.
You will learn about using a person-centred approach to support individuals with autism
and how to incorporate their preferences and needs, whilst looking at legislation and
guidance to protect and support them and the support networks available to them and
their families. You will also learn about the delays and difficulties in speech, language and
communication they can face and different communication methods and strategies to use.

Contents
This workbook contains four sections: Page
Section 1:
Introduction to autism 4
Section 2: Using a person-centred approach to support individuals
with autism 60
Section 3: Communication and social interaction in individuals
with autism 95
Section 4:
Extension activities 141

Each section has corresponding assessment questions CACHE Level 2 Certificate in

that must be completed in order to achieve this part of

Understanding Autism

Assessment 1
the programme. Learner contact details:

Name:

The assessments for this workbook can be found in: Contact address:

Postcode: Contact number:

Assessment 1 Email:

Learner declaration
I confirm that the answers in Assessment 1 were completed by me, represent my own
ideas and are my own work.
Learner signature: Assessment date:

When you have completed this workbook, you should If you need any help in completing these assessments, refer to the
relevant section within Workbook 1, or contact your Assessor/Tutor.

attempt the assessment. Your Assessor/Tutor will then

Please tick one of the boxes below to show what your status will be when you complete this course.
 EMP 1 In paid employment for 16 hours or more  GAP 1 Gap year before
per week starting HE
 EMP 2 In paid employment for less than 16 hours  EDU 1 Traineeship
per week  EDU 2 Apprenticeship

give you detailed written feedback on your progress.

 EMP 4 Self-employed for 16 hours or more per week  EDU 3 Supported Internship
 EMP 5 Self-employed for less than 16 hours per week  EDU 4 Other FE* (Full-time)
 NPE 1 Not in paid employment, looking for work and
 EDU 5 Other FE* (Part-time)
available to start work
 NPE 2 Not in paid employment, not looking for work  EDU 6 HE
and/or not available to start work (including retired)  OTH # (please state)
 VOL 1 Voluntary work ………………………………

Assessment 1 1

Upon successful completion of this qualification, learners will be awarded the

NCFE CACHE Level 2 Certificate in Understanding Autism (QRN: 601/6330/6).
This CACHE branded qualification is certified by the Awarding Organisation, NCFE.

Workbook 1 3
 Section 1: Introduction to autism

In this section, you will learn about social and communication disorders,
understanding that autism is a lifelong condition. You will become familiar with
theoretical models in identifying autism and learn about the characteristics displayed
by different individuals with autism. You will look at the guidelines for diagnosis
and why this can be difficult, including why some individuals may be reluctant to
seek diagnosis. You will learn about conditions that can co-occur with autism and
the difficulties they present. You will consider the difficulties and discrimination
that individuals with autism can face due to other people’s attitudes and lack of
understanding and how the condition is sometimes misrepresented in the media.

Social and communication disorders

Please read the following as it will help you to answer question 1.

Autism is a lifelong disability which affects how an individual communicates with, and
relates to, other people. It also affects how they make sense of the world around
them. The understanding of autism has improved since the 1940s, when it was first
identified, and as more is learned about the condition, more interventions should
become available. There is no ‘cure’ for autism but there are many things that can be
done to help individuals with autism.

The signs and symptoms associated with autism spectrum condition include:
In spoken language:
delay in speech development
monotonous or flat-sounding speech
communicating in single words, rather than sentences
frequently repeating set words and phrases

In responding to others:
may find it difficult to show and accept affection
not responding when their name is called, despite being able to hear
reacting in an unusually negative way when asked to do something

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 Section 1: Introduction to autism

In interactions with others:

can appear to have little interest in others; many adults and children are interested
in interacting with others but don’t show it in typical ways
being unaware of people’s personal space
being intolerant of others entering their personal space
not enjoying situations children usually enjoy, like parties
preferring to play alone
not making eye contact

In their behaviour:
repetitive movements, such as rocking backwards and forwards, flapping their
hands or flicking their fingers
insisting on familiar routines and becoming very anxious or upset if this is disrupted
or changed
having a strong dislike of certain foods based on the texture or colour as much as
the taste
playing with toys in a repetitive way, such as lining building blocks up rather than
building something with them

In addition to the above signs and symptoms in young children, in older children and
teenagers, the following may also develop:
avoiding the use of spoken language
using pre-learned phrases rather than making new sentences
talking ‘at’ people rather than having a two-way conversation
taking things literally and being unable to understand sarcasm, jokes, metaphorical
speech or figures of speech
failure to understand or implement social rules
being unable to adapt tone and content of their speech for different situations
having few friends and finding it difficult to form friendships
developing a very specific interest in a particular topic or subject

Workbook 1 5
 Section 1: Introduction to autism

Autism spectrum condition

Autism is not a single condition; rather, it is a spectrum of closely related conditions

with shared symptoms. The level of disability and the combination of symptoms will
vary greatly between individuals. Each individual on the spectrum has some degree of
problems with:
communication
social skills
empathy
flexible behaviour

Asperger syndrome

This is an autism spectrum condition and is characterised by:

difficulties in social interactions
a restricted range of interests
repetitive behaviour
delayed motor development (this may result in clumsiness or uncoordinated
movements)

Unlike other forms of autism spectrum condition, individuals with Asperger

syndrome do not have significant delays or difficulties in either language or cognitive
development.
There are many symptoms of Asperger syndrome, but it is unlikely that they would all
be present in any one individual. The degree at which they are present differs greatly.

Behaviours associated with Asperger syndrome include:

limited social interactions
inappropriate social interactions
repetitive speech
focusing on or discussing themselves, rather than showing an interest in others
difficulties with facial expression

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 Section 1: Introduction to autism

difficulties with non-verbal communication

avoidance of eye contact
one-sided conversation
awkward movements
unusual mannerisms
inability to understand social and emotional issues
inability to understand non-literal phrases
an obsession with very specific, unusual topics
inability to see things from someone else’s viewpoint

‘High-functioning’ autism

High-functioning autism (HFA) is at one end of the autism spectrum. This means
that the signs and symptoms are less severe than other individuals with autism.
An individual with HFA usually has average or above average intelligence. Usually,
an individual with HFA will have early language delays, unlike a child with Asperger
syndrome.
One major difference from other individuals with autism is that those with HFA and
Asperger syndrome usually want to be involved with other people; they just don’t know
how to go about it. They may have problems understanding the emotions of others
and struggle to understand facial expressions or non-verbal communication. This can
lead to them being teased and they can often feel like social outcasts which, in turn,
can lead to depression and anxiety.

Typical symptoms include:

a delay in early language development
a delay in motor skills
inability to react with others
strong reactions to textures, odours, sounds and sights
difficulties with sarcasm or non-literal use of language

Workbook 1 7
 Section 1: Introduction to autism

Did you know?

The word ‘autism’ has been used for about 100 years and comes from the
Greek word ‘autos’, meaning ‘self’. This describes the condition of autism, as the
individual is removed from social interaction, and is therefore an isolated self.
Eugen Bleuler, a Swiss psychiatrist, was one of the first people to use this term in
1911, initially using it to describe one group of symptoms of schizophrenia.
Autism and schizophrenia were linked by many researchers until the 1960s, when
it was realised that autism was a separate condition.

How autism can be considered a spectrum condition

Please read the following as it will help you to answer question 2.

Autism is a spectrum condition. This means that although all individuals with autism
will face certain difficulties, the condition will affect them in different ways. It also
refers to the differences in severity with which an individual experiences a condition.
There are some individuals with autism who can manage to live independent lives,
whilst others may have accompanying learning disabilities and may need specialist
support throughout their lifetime. Every individual on the autism spectrum has
different challenges, abilities and symptoms.

Did you know?

The National Autistic Society is the leading UK charity for people with autism
and their families. It aims to ensure that individuals with autism:
obtain the support, education and training they need
live with dignity
live as independently as possible
feel part of their community/society
are understood by all the professionals who support them
are respected for who they are

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 Section 1: Introduction to autism

Recognising that autism is a lifelong condition

Please read the following as it will help you to answer question 3.

Autism is a lifelong condition and can be mild, moderate or severe. It is not a learning
disability, but around half of individuals with autism will have learning disabilities,
and this will affect the level of support they will need throughout their lives. Some
individuals may have a ‘dual diagnosis’, meaning that they have two or more
conditions – for example, autism and Down’s syndrome. Autism spectrum condition
sometimes occurs in individuals with medical conditions such as early epilepsy, and
learning and psychiatric problems can also coexist.
It is important that parents of children with autism understand that there is no
cure, that autism is a lifelong disability and that continuing support will be needed.
It is important that parents and those working with adolescents are aware of the
difficulties and the need for long-term support as often, at this stage of life, autism
becomes particularly testing as they become more aware of their differences. This
can trigger depression or behavioural difficulties. For most people with autism, there
will be a need for continuing social support, and some will need help from mental
health professionals. Most children with autism will also need extra help at school,
sometimes at a school that specifically caters for those with autism, or from the
Special Educational Needs Coordinator (SENCO) at school, or other educational
experts. Individuals who go to college will need continuing support, including transition
support to help them make the change from school to college and university, modified
examination arrangements, guidance appointments and access to computers and
assistive technologies.
It is important to remember that children with autism become adults with autism;
it does not disappear. Adults with autism will have continuing needs for support,
including help with housing and independent or supported living, support in finding
employment and staying employed, and, in some cases, help with day-to-day tasks.
For some individuals, 24-hour support may be needed.

Workbook 1 9
 Section 1: Introduction to autism

For those adults who do need constant support, it may be possible to continue living
in the family home with parents, but some may wish to live independently. Some of
the options for adults with autism are:
Domiciliary care – this means that the adult will be supported in their own home.
Respite care – for adults living with their family, this provides a break for the
carers.
Residential care – residential services, including registered residential homes, are
available across the UK for adults with autism, providing continuity and personal
safety.
Day centres – these provide short-term respite, allowing carers some time for rest
or to do activities which are too difficult to undertake while caring for an adult with
autism; this also provides the individual with a chance to socialise and get involved
in activities which they might otherwise not be able to access.
Supported living schemes – support is always on hand from a warden.
Adult placements – adults with autism can live with a family (similar to fostering)
who agree to support them.
Supported employment – this gives adults with autism the chance to work if they
want to, providing the appropriate support.
Therapists and counsellors – might be required to provide support.

Medical support – medication may be prescribed by a doctor, or other specialist
support may be needed; for example, from a dietician.

Knowledge Activity 1: Realising that autism is a lifelong condition is

important to parents and carers, as many individuals with autism will need
additional support throughout their lives.
Describe two forms of support they may need:
1.

2.

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 Section 1: Introduction to autism

Theoretical models in relation to identifying autism

Please read the following as it will help you to answer question 4.

Kanner
Leo Kanner was a doctor from the John Hopkins University in the United States in the
1940s. He used the term autism to describe children he studied who demonstrated
withdrawn behaviour.
Kanner identified the following features of autism:
inability to relate themselves in an ordinary way to both people and situations
inability to form sentences spontaneously
the ‘insistence on sameness’ – meaning that they disliked change and different
situations
In his 1943 research paper, he looked at the evidence for the possible causes of
autism. He carried out his research by direct observation of children and looked at
the characteristics they showed relating to the condition. He felt that the children in
his study showed signs of schizophrenia, but the difference was that it was present
from birth, which suggested a biological origin. However, at this early stage of his
research, he also looked at the personality traits in the families of the children and
made a comment that there were ‘few really warm-hearted fathers and mothers’. This
suggested that the development of the children could have been affected by parental
behaviour. Later, when there had been more research, Kanner accepted the theory
that the cause of autism might have its origins in the brainstem.

Asperger
At the same time as Leo Kanner was researching, Hans Asperger, an Austrian
scientist, identified the condition now referred to as Asperger syndrome. In his
research, he stressed that difficulties with social interactions were the main identifying
feature of autism and provided a specific list of features, including:
strange use of language
obsessive interests in very narrow areas
difficulties in understanding non-verbal communication, such as facial expression
and body language
clumsiness and poor body awareness
behavioural problems
gender patterns – more males are affected than females

Workbook 1 11
 Section 1: Introduction to autism

Asperger first published his definition of the syndrome in 1944 by studying the
behaviour of four boys. He identified in these boys a pattern of behaviour and abilities
including a lack of empathy, lack of ability to make friends, one-sided conversation,
clumsy movements and an intense interest in specific topics. He noticed their ability
to talk about their special interests in detail and called them ‘little professors’.
Although this theory was said to include only four boys, a professor who knew
Asperger said he had actually studied more than 400 children during his research.

Wing and Gould

In 1979, Wing and Gould produced a model called the ‘triad of impairments’; this
was based on extensive research and clinical studies, and shows that individuals who
experience autism have core deficits in:
social interaction
communication
imagination
This model showed that the seriousness of the impairments varied considerably in
different individuals.
Information on the triad of impairments theory by Wing and Gould can be found in
more detail on pages 29-30.

Knowledge Activity 2a: Using the three models just mentioned, describe
three traits or factors that each researcher identified. One example has been
completed for you.
Kanner Asperger Wing and Gould
1 1 Clumsiness and poor 1
body awareness

2 2 2

3 3 3

Knowledge Activity 2b: Carry out your own research into the work of Kanner
and Asperger and the studies they completed, with the main findings.

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 Section 1: Introduction to autism

Did you know?

Lorna Wing was a medical doctor specialising in psychiatry and her focus
changed to childhood development disorders in 1959 when she realised that her
own daughter was displaying different traits to other young children. The work she
carried out with Judith Gould now underpins the thinking in the field of autism.
In 1962, she joined with other parents of children with autism and founded the
National Autistic Society.

Neurodiverse and Neurotypical

Please read the following as it will help you to answer question 5.

‘Neurodiverse’ refers to the diverse neurological conditions that appear as a result

of normal variations in humans. The concept of neurodiversity is that neurological
differences should be recognised and respected just like any other human variation.
These differences can include conditions such as autism, along with others like
dyspraxia, dyslexia and Tourette’s syndrome.
‘Neurotypical’ is a term often used to describe people who are not on the autism
spectrum. Neurotypicals (NTs) make up 99% of the population.

Knowledge Activity 3: ‘Neurodiverse’ or ‘Neurotypical’?

Use the correct term to describe the following:
An individual who is
not on the autism
spectrum
An individual who
is on the autism
spectrum

Workbook 1 13
 Section 1: Introduction to autism

The current guidelines for the diagnosis of autism

Please read the following as it will help you to answer question 6.

The process of diagnosis does vary and depends on the area where the individual lives.
There isn’t one standard way for an assessment to be carried out, but there are
guidelines that professionals should follow, produced by the National Institute for
Health and Care Excellence (NICE).

The Autism Act (2009)

The Autism Act led to the government producing statutory guidance for adults
with autism, called The Autism Strategy. This strategy states that local authorities
in England must have a clear pathway of diagnosis for adults, meaning that an
individual has a right to a diagnostic assessment, and their GP or local authority
should be able to inform them of how to get this assessment.

A parent who is concerned about their child should, in the first instance, visit their
GP. If the GP thinks that it is appropriate, they can refer them to a health professional
or a team that specialises in diagnosing autism and they will make a more in-depth
assessment.
Health professionals include:
psychiatrists
psychologists
paediatricians (doctors specialising in the treatment of children)
speech and language therapists
Many local health authorities have multidisciplinary teams made up of a combination
of these professionals, who work together to make assessments.

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 Section 1: Introduction to autism

Current guidelines produced by NICE

The NICE clinical guidelines advise the NHS on diagnosis and the treatment
individuals should then receive. These guidelines state that:
Local autism strategy groups should be set up with representation from child health
and mental health services, education, social care, parent/carers and the voluntary
sector.
A lead professional should be appointed to be responsible for diagnosis.
In each local area, a multidisciplinary group (autism team) should be set up and
should include a paediatrician and/or psychologist, speech and language therapist,
and clinical and/or educational psychologist, with access to other professionals if
not already in the team.
The autism team must have the skills and competencies to carry out diagnostic
assessment, communicate with those with suspected autism and sensitively share
the diagnosis with them.
The team should be able to offer information about appropriate services and support.
The team should be able to, or have access to professionals who can, carry out
diagnostic assessments for people with special circumstances, such as coexisting
conditions.
The parents’ or carers’ concerns and the concerns of young people with autism
should be taken seriously.
The team should seek advice from other professionals if necessary.
The team should know when to refer individuals to other agencies or professionals.

The difficulties of diagnosing autism

Please read the following as it will help you to answer question 7.

In most cases, parents notice the symptoms of autism when their child is two or
three years old but in some cases, mild autism is not detected until adulthood. There
are many difficulties with diagnosis, including the fact that the characteristics in girls
are different from in boys and are less noticeable, and therefore more difficult to
diagnose. Many adults in today’s society have not been diagnosed, as autism was not
well understood or recognised during their childhood; this means that there are more
children now with a formal diagnosis, as understanding, recognition and diagnosis
continue to improve.

Workbook 1 15
 Section 1: Introduction to autism

The following aspects can make a formal diagnosis difficult:

Co-occurrence
Autism presents itself differently in a wide array of settings and skill areas, but to make
the issue more difficult, it can also be accompanied by other medical or mental health
conditions. It is estimated that one third of people with autism may also have epilepsy,
while it is also possible that it may be accompanied by learning difficulties and other
conditions, including:
attention deficit hyperactivity disorder (ADHD)
depression
anxiety
learning disability
All of these conditions may be present, which may make it difficult to distinguish what
is causing the differences in the individual.

Lack of a genetic or medical test

One of the things that makes a definitive autism diagnosis difficult, even with older
individuals, is the lack of a sure genetic or medical test. So far, there has not been
a genetic marker identified that signals a confirmation of autism. All tests, therefore,
have to be subjective and can’t just be done with something like a blood test. This
means that assessments and subjective decisions have to be made to diagnose, even
though it is considered a neurological disorder.

Differential diagnosis
Autism shares many of its features with other conditions, which can make it difficult
to diagnose. Some features of autism that can be found in other conditions include:
learning disabilities
language disorders
specific developmental disorders
early onset epilepsy
Rett syndrome
neurodegenerative disorders

A child who has autism may have difficulty with speech, causing them to have social
problems, learning difficulties and communication errors.
Another child could have the same problems resulting from difficulty with speech, but
they could be caused by vocal cord malformation, for example.

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 Section 1: Introduction to autism

What is considered to be ‘normal’ development?

Although child development progresses through several critical periods where it is
‘normal’ for a child to have developed a particular skill, child development is not an
exact science. Different children develop at different rates. Therefore, by limiting the
timing of diagnosis to a very young age, there is less consideration of the normal
differences in development.
The symptoms of autism can also change over time, making some symptoms more
apparent (or less) as time goes on. Autism is a multidimensional disorder that has
many components that differ between individuals. Some may have difficulties in one
area – for example, speech – but improve greatly when given the right support. Another
individual might have relative strengths in music or drawing but have considerable
problems in maths. To make the situation more complex, many of the traits of autism
can exist in neurotypical individuals, so it is very difficult to establish what is ‘normal’ or
‘abnormal’.

Stages of development vary

Diagnosis often occurs in young children and is based on what the parents say
they have observed. However, some of the key characteristics of autism do not fully
develop until later childhood. Many parents are keen for an early diagnosis of autism
for their children when the symptoms could simply be a case of late development,
which improve when they start school.

The setting of the diagnosis

Diagnosis often takes place in abnormal settings, and it is possible that this makes
children alter their behaviour. This has happened in psychology studies where
behaviour in children is altered due to adults wearing different clothes, being with
unfamiliar people or being in different rooms that are unfamiliar.

Communication barriers
Diagnoses can have unreliable methods of diagnosis. Some tests, for example, that
are used to determine how fully the child can interact, are based on the assessor’s
assumption of their intellectual ability. However, communication can often be a barrier
in these types of tests.

Workbook 1 17
 Section 1: Introduction to autism

Lack of understanding about autism

There is a lot of confusion and misunderstanding about autism, including a lack of
medical knowledge to make the right referrals. In addition, there is a lack of public
knowledge and the stigma attached to it may be very undesirable to some people;
therefore, some people may go to great lengths to avoid a diagnosis of autism. This
may be because the individual or the parent doesn’t want to believe that they have
autism.

Adults with autism

Many adults with autism have not been diagnosed as, up until recently, not much
was known about it. A formal diagnosis can be helpful, as it can help the individual
understand why they experience certain difficulties – for example, the fact that they
do not really ‘fit in’ with other people. It can also help them to deal with difficulties.
A formal diagnosis may mean that any mental health difficulties can be addressed
better, and it can help them to access services and benefits. For adults who are in
employment, a formal diagnosis means that the employer will be required by law to
make reasonable adjustments for them in the workplace. An adult who thinks they
have autism should firstly book an appointment with their GP and explain why they
think this. It is a good idea for them to take someone else with them if they find it
difficult to talk to the GP and clearly explain their reasons for wanting a diagnosis.
They should explain the difficulties they face in life, such as communication difficulties
and problems with social interaction. The GP needs to follow the NICE guideline
142 and should be aware of the statutory guidance. If the GP refuses to refer the
individual, they could ask to see a different GP at the surgery.

For more information, visit https://www.nice.org.uk/guidance/CG142

Did you know?

Factors associated with an increased likelihood of autism include:
having a sibling with autism
birth defects associated with the central nervous system, including cerebral palsy
intellectual disability
chromosomal disorders such as Down’s syndrome, muscular dystrophy and
neurofibromatosis
tuberous sclerosis

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 Section 1: Introduction to autism

The range of different diagnoses on the spectrum

Autism is a spectrum
Due to the fact that every individual with autism has their own specific traits
and characteristics, it is difficult to design a test to diagnose autism that is all-
encompassing for all individuals. These personal differences mean that to be able
to diagnose autism, specialists have to be able to accurately and reliably code an
extensive array of behaviours and observations. There are no easy, obvious, or exact
indicators. This is especially a problem at a very young age when children are only just
beginning to demonstrate their own personalities and differences. Because traits will
be present in different individuals to differing degrees, the diagnosis is difficult.
Some professionals have picked out certain traits or patterns that occur in people with
autism and named them as separate conditions, whilst others disagree that these
conditions or syndromes can actually occur on their own without the imagination
and social communication impairments that occur on the autism spectrum. Many
professionals feel that these syndromes are part of the autism spectrum.

Some of these disorders that can be named separately, but are felt by many
professionals to be part of the spectrum, include:
non-verbal learning disorder
semantic-pragmatic disorder
right hemisphere learning disorder
pathological demand avoidance

Another problem with the spectrum is that some professionals with limited experience
of autistic conditions look at a certain trait and diagnose it as the main problem,
missing the fact that the obvious and underlying difficulties are part of ‘social
impairment’ and an autism spectrum condition. Examples of conditions that may be
overlooked as being part of the spectrum include:
poor attention span
reading difficulties such as dyslexia
overactivity
Tourette’s syndrome – sudden, involuntary, jerky movements, and vocal tics
dyspraxia

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 Section 1: Introduction to autism

Did you know?

Dyspraxia is a condition affecting fine and/or gross motor coordination in children
and adults. Speech can also be affected.

Knowledge Activity 4:

Explain what is meant by co-occurrence.

Explain how this can make a formal diagnosis of autism more difficult.

Explain why the wide range of traits in the autism spectrum can cause
problems with diagnosis.

Did you know?

When a child or young person is referred to the autism team for diagnosis,
the following information is important:
reported information from parents, carers, teachers and other professionals
about signs and symptoms
prenatal and antenatal history
medical history and investigations
developmental milestones

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 Section 1: Introduction to autism

Why people might be reluctant to seek a diagnosis

Please read the following as it will help you to answer question 8.

For many individuals, there is relief when they are diagnosed with autism, as it
explains why they feel different to other people and why they struggle with some
aspects of their life. There are advantages to being formally diagnosed, as there is
then better access to support, services and benefits. Despite these advantages,
however, some individuals feel frightened of being diagnosed as they feel it will ‘label’
them and lower other people’s expectations of them.
For parents with children who have autism, the diagnosis can give them a better
understanding of their child’s individuality and bring with it much-needed support.
Other parents may feel an overwhelming sense of shock and disbelief, and become
worried about what the diagnosis means for their child’s future.
Despite the fact that a diagnosis of autism could actually help in the workplace and
protect people with autism in their jobs (under the Equality Act 2010), some feel
that it could put prospective employers off. Although many people now believe that
a diagnosis is a positive thing for school-aged children because of the educational
support it will bring about, people feel less positive about how they will be treated in
the workplace. Some even feel that they will be pushed into certain routes at college
or university, rather than being encouraged to choose courses they enjoy.

Did you know?

The Northern Ireland Assembly passed its own Autism Act in 2011. The Act
requires a strategy to be published, with the aim of ensuring that the needs
of individuals with autism, and their families, are met throughout their lives.
For more information, visit http://www.autismni.org/autism-act-(ni)-2011.html

Workbook 1 21
 Section 1: Introduction to autism

The importance of a formal diagnosis

Please read the following as it will help you to answer question 9.

Getting a diagnosis of autism can be really positive, and many individuals say that
their diagnosis has helped them to understand why they have difficulties with some
things, and also why they are particularly good at other things.
Getting a diagnosis also means that individuals with autism can get easier access to
support and benefits. The process of getting a diagnosis, however, can be difficult,
especially for adults.
Some people live with autism for their entire lives without ever getting a formal
diagnosis. Often, this is simply because autism wasn’t widely known or understood
when they were growing up.
Although some individuals may be happy with a self-diagnosis of autism, others prefer
to get a formal diagnosis.
Early intervention, especially in childhood, will improve the chances of overcoming any
developmental delays, which is another reason to get a formal diagnosis.

A formal diagnosis can be important because:

Individuals can find relief in a formal diagnosis, as it explains why they are different,
and why they face the difficulties they do.
Individuals may have previously been misdiagnosed and therefore be receiving
inappropriate treatment; being properly diagnosed can clear up these problems and
the right treatment can be sought.
Some individuals with mental health difficulties can be better treated once their
autism has been diagnosed.
It can help someone with autism gain the understanding of others, including
friends, family, teachers and colleagues – once people understand there is a
reason for the individual’s difficulties, it can be easier to empathise and offer the
appropriate support.
Individuals can find help and comfort in joining support groups and meeting other
people with autism, sharing their problems and difficulties.
Welfare benefits are easier to obtain with a formal diagnosis.
Students, if diagnosed with autism, can claim Disabled Students’ Allowance.
It can provide help and support in the workplace for individuals who feel they are
struggling in their jobs and fear losing them due to misunderstandings.
Once an individual has a formal diagnosis, they are classed as having a disability
under the Equality Act 2010, meaning that employers have a responsibility to make
‘reasonable adjustments’ for employees who need them.
22 © LCG 2020
 Section 1: Introduction to autism

Reasonable adjustments
Equality law recognises that bringing about equality for a disabled person may
mean changing the way in which their employment is structured, the removal of
physical barriers and/or providing extra support for a disabled worker.
This is the duty to make ‘reasonable adjustments’.
The duty to make reasonable adjustments aims to make sure that, as far as is
reasonable, a disabled worker has the same access to everything that is necessary
to do and keep a job as a non-disabled person.

Knowledge Activity 5: Describe three reasons for obtaining a formal

diagnosis for autism.
1.

2.

3.

Workbook 1 23
 Section 1: Introduction to autism

Facts about diagnosis

A diagnosis can help people with autism explain why they feel ‘different’ or help
a parent understand their child better.
Diagnosis can offer a gateway to identifying and accessing appropriate support
and services.
Some people live with autism for their entire lives without ever getting a formal
diagnosis.
People that don’t agree with an autism diagnosis can seek a second opinion.
Most adults with autism are diagnosed by a psychiatrist or a clinical psychologist.
34% of people with autism said they waited three years or more for a diagnosis,
according to a 2012 survey.
Autism affects adults as well as children. People with the condition can be
diagnosed at any age.
The Lorna Wing Centre was the first UK service to provide diagnostic services,
assessment and advice for people with autism.
Research by the National Autistic Society (NAS) in 2012 indicates that it may be
harder for females than males to get a diagnosis for autism.
The process of diagnosing autism can vary depending on location and the
diagnosticians/diagnostic services.

The prevalence of autism in the UK

Please read the following as it will help you to answer question 10.

The ‘prevalence’ of autism means the total number of cases of the condition in a
given population at a specific time. As there is no register or exact count kept, it is
difficult to know exact figures. According to the Adult Psychiatric Morbidity Survey
2014, the estimated prevalence of autism was 0.7% of the adult population in
England in 2014. Estimated rates of autism were higher amongst men (1.5%) than
women (0.2%). Two large-scale surveys have estimated the prevalence of childhood
autism to be around 1%, and higher in boys than girls.

Source: https://files.digital.nhs.uk/pdf/1/o/adult_psychiatric_study_ch6_web.pdf

24 © LCG 2020
 The main characteristics in individuals with autism
Please read the following as it will help you to answer question 11.

A number of characteristics are common amongst individuals with autism, and these characteristics can be used to help
recognise and diagnose the condition. These characteristics are wide-ranging and not all people with autism will have all
characteristics. Some characteristics may be present from an early age, whilst others may develop in older children and
teenagers.
Some of the main characteristics can be grouped as follows:
Spoken language Behaviour Interacting with and responding
to others
delayed speech development, such having repetitive movements, such being unaware of others’ personal
as not speaking at least 10 different as flapping their hands or rocking space
words by the age of two backwards and forwards being unusually intolerant of people
not speaking at all playing with toys in a repetitive and entering their own personal space
frequent repetition of set words and unimaginative way, such as lining little interest in interacting with other
Section 1: Introduction to autism

phrases blocks up in order of size or colour people, even people their own age
instead of using them to build
speech that sounds very monotonous something not enjoying situations that most
or flat children like, such as parties
preferring to have a familiar routine,
preferring to communicate using and getting very upset if there are not responding to their name being
single words, despite being able to changes to their normal routine called, despite having normal hearing
speak in sentences rejecting cuddles or signs of affection
insisting that everyone sits in the
preferring to avoid using spoken same place, such as at mealtimes or initiated by a parent or carer
language when watching the TV, or even at reacting unusually negatively when
speaking in pre-learned phrases, school in a classroom asked to do something by someone
rather than putting together having an obsession with the time, preferring to play alone
individual words to form new and keeping to strict times
sentences rarely using gestures such as

Workbook 1
pointing

25
26

taking longer to understand what having sensory sensitivities to things lack of facial expressions when
people are saying like loud noises and fluorescent communicating

© LCG 2020
seeming to talk ‘at’ people rather lighting avoiding eye contact
than sharing a two-way conversation 
insisting on wearing certain clothes having few close friends, despite
taking people’s speech literally and or styles of clothes and being unable attempts to form friendships
being unable to understand sarcasm, to be flexible for different occasions
not understanding how people
metaphors or figures of speech learning information such as normally interact socially, such as
timetables off by heart and repeating greeting people or saying goodbye
them
being unable to adapt the tone and
repeating words they hear, content of their speech to different
sometimes whispering them social situations – for example,
having a strong like or dislike of speaking very formally at a party with
certain foods based on the texture or other teenagers and then speaking
colour of the food as much as the to complete strangers in an
taste – for example, an individual overfamiliar way
Section 1: Introduction to autism

might decide only to eat white foods preferring to play with objects rather
developing a highly specific interest than people
in a particular subject or activity,
such as pocket watches, the Berlin
wall or a certain TV series
 Section 1: Introduction to autism

A poem about autism

Read the poem below, written by Amand Post – a parent of a child with autism. Think
about the difficulties faced by the boy and his parent.
My little boy, this love of mine,
Does not know how to say;
Please give me room for every time,
His words get in the way.
You would not know by passing by,
The struggles everyday:
But try to look him in the eye,
You’ll see it in his face.
You may not understand how hard,
Small tasks in life can be;
How difficult to speak aloud,
Or learn your ABCs.
And just because he doesn’t hug you,
Or kiss you hi and bye;
Doesn’t mean he doesn’t love you,
Please just give him time!
Through all the tantrums, fights and tears,
I look at him and see;
A little boy with tons of fears,
Who strives for normalcy.
Of course he sees he’s different,
But he just can’t see why;
Everybody’s time is spent,
Trying to make him ‘right’.
Open up your heart and mind,
And just watch quietly;
You’ll see a boy who’s really trying,
Just wants to be happy.
He’s just a scared little boy,
With every sight and sound;
I know he plays with just one toy,
And spins around and round.
I know sometimes he’ll yell and scream,
He simply cannot say;
He is not trying to be mean,
Things have to be his way.

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 Section 1: Introduction to autism

All he can say is ‘It’s not right’,

Sometimes it seems unreal;
He can’t express though try he might,
To tell you how he feels.
I know that he repeats himself,
And sometimes others too;
Believe me that does really help,
Anxiety to be removed.
So please be patient and be kind,
Love him everyday;
I know in your heart you will find,
A place for him always.
He is my special, beautiful boy,
Whom I love endlessly;
He is my gift, my love, and my joy,
He’s everything to me.

Knowledge Activity 6: From reading the poem:

1. List three difficulties faced by the boy.

2. List three traits of autism that he displays.

3. Describe the difficulties the writer faces.

4. What does the writer (the parent) ask of other people in their attitude
towards the boy?

28 © LCG 2020
 Section 1: Introduction to autism

How characteristics can vary from individual to individual

Please read the following as it will help you to answer question 12.

The characteristics of autism vary greatly from person to person. This is why Dr Lorna
Wing used the phrase ‘autism spectrum disorders’ to describe how they can vary. For
a diagnosis of autism, an individual needs to show characteristics from every point on
the triad, but severity in each area can be very different.

Impairment of social relationships

In this part of the triad, characteristics can vary, from being aloof or passive to active
but odd.

aloof – shows almost no reaction to other people

passive – will respond to attempts at interaction but won’t initiate them
active but odd – will initiate interactions with others but in an odd, repetitive
and inappropriate way

Impairment of communication

In this part of the triad, communication can vary greatly, from completely absent
speech to being able to communicate fairly well but on a limited range of topics.

absent speech or disordered speech

echolalia (repetitive speech)
reasonable communication but for a limited range of topics

Individuals who are on the autism spectrum are different from one another in various
ways. Here are some examples of the ways characteristics vary from person to person:
from severe learning disability, to normal or superior levels of intellect
from using no speech at all (mute), to using complex and correct speech
from having no reaction at all towards others, to being able to interact but in an
odd or inappropriate way
from having a special or unusual interest in a particular topic, to challenging
behaviour and even self-injuring behaviour

Workbook 1 29
 Section 1: Introduction to autism

These characteristics can also change in different circumstances, such as the

transition from young child to teenager, and then to adult. Some individuals worsen
upon leaving school, which may be due to the fact that people with autism benefit
from the structure and routine that school provides. During adolescence, some
individuals experience depression and their behaviour problems can worsen.

Impairment of imaginative thought

This can vary, from only using objects for sensation, to using toys unimaginatively and
struggling with play and imagination. Individuals with autism can copy play, such as
repeating stories that they have seen on TV or in comics, but they struggle to come
up with their own story.

use objects for sensation only

use toys unimaginatively
can’t invent an imaginary world

Repetitive behaviour

There are also different repetitive or obsessive behaviours, from repetitive body
movements like head banging or waving hands, through to having topics of special
interest which are often quite unusual.

repetitive body movements

fascination with sensory stimuli
routines involving objects
verbal routines
routines related to a special skill
having a topic of special interest

30 © LCG 2020
 Section 1: Introduction to autism

Some examples of behaviour traits

Nina is studying Hospitality and Catering at school and as one of her assessments,
she has to run an afternoon tea for 60 staff to raise money for charity. The class
has had to discuss and make their own decisions about the event, but Nina has not
joined in. One of the important decisions is that everyone will wear black trousers
or skirts and white tops, along with one of the black and white school aprons, in
order to present a professional image to customers. Nina is used to wearing her
uniform and tells the teacher she doesn’t want to wear black and white. The normal
lunchtime of 12:30 – 1:30pm will be spent serving customers at the afternoon tea.
Nina isn’t prepared to change her lunchtime and also insists on bringing her usual
packed lunch, even though lunch is being provided for the class at 2pm.

Josef likes a set routine and doesn’t like anything out of the ordinary. He insists
on sitting in the same place in the classroom and likes to be in the same
environment as much as possible. Any changes really upset him and he ends
up having a bad day. The class have been working on weather mobiles for a
geography project and there is an impressive collection of work. Before the class
go to the lesson, the teacher hangs the mobiles from the ceiling, creating an
interesting and really colourful display. As soon as Josef enters the room, he
becomes very upset and has to leave the room as he doesn’t like things hanging
from the ceiling and hates the bright colours.

Anna has a fascination with volcanoes and likes to tell everyone she meets, in
detail, about volcanoes. She collects books and any information she can and her
room is full of books and pictures on her walls. She can recite passages out of
textbooks and spends a great deal of time watching clips about volcanoes on the
Internet. She has in-depth knowledge about the number of volcanoes in the world,
where they are and how many are active, along with historical eruptions.

Workbook 1 31
32
The ‘triad of impairments’
Please read the following as it will help you to answer question 13.

© LCG 2020
A study of children living in South London was carried out by Lorna Wing and Judith Gould in 1979. From the total
population of children under 15 (35,000), all children known to the social, educational and health services (914) were
screened. Children were selected from the group if they had severe learning difficulties and/or if they showed one of
the following:
social impairment verbal and non-verbal language impairment repetitive/stereotyped activities
The ‘triad of impairments’ is a theory that shows that individuals who have autism will share three main areas of difficulty.
These are difficulty with social communication, difficulty with social interaction and difficulty with social imagination.
Now, we will look at the triad of impairments in more detail.
Social impairment Verbal and non-verbal language Impairment of thinking and
impairment behaviour (repetitive/stereotyped
activities)
Section 1: Introduction to autism

A person with classic autism Individuals with severe autism may Social imagination allows us to
may appear withdrawn, aloof or never develop any speech, whilst those understand and predict other people’s
uninterested in the people they meet with Asperger syndrome may speak behaviour, make sense of abstract
and have difficulties around social fluently, using full sentences. For all ideas, and imagine situations outside
relationships. Their ability to develop people on the spectrum, it is the ability our immediate daily routine. Difficulties
friendships is generally very limited. to use their communication skills that with social imagination mean that
People with Asperger syndrome also is impaired. Individuals may experience people with autism find it hard to:
have these difficulties, but are often difficulties in any of the following: imagine the world from someone
more aware that they have difficulties. processing language and else’s perspective and understand
They may want to make friends and be interpreting facial expressions, body that other people may have different
a part of society but are awkward or language or tone of voice thoughts and feelings from their
clumsy in social situations. own
interpret other people’s thoughts,
feelings and actions
 Some of the things you might understanding figures of speech or predict what will happen next, or
notice are: metaphors. Their literal what could happen next
avoiding eye contact (because they understanding means that they will understand the concept of danger –
cannot process the information think you mean exactly what you for example, that running onto a
overload of speech, facial say. Therefore, they would find busy road poses a threat to them
expression and body language) metaphors such as ‘she bit my head
off’ confusing and even frightening. engage in interpersonal or
standing too close when talking to Sarcasm and humour are often imaginative play, unless it is
someone – unaware of personal beyond them something they have copied – in
space which case, they often pursue this
following long or complicated rigidly and repetitively
not realising when the person they sentences, and they might only be
are talking to is cross or tired able to follow one simple instruction prepare for change and plan for
laughing or speaking at at a time. Therefore, communication the future
inappropriate times in school or the workplace is often cope in new or unfamiliar situations
an area of difficulty for individuals
showing no interest in other
with Asperger syndrome, even
people’s opinions or interests
though they appear to have good
Section 1: Introduction to autism

These behaviours are often taken as a verbal skills

sign of rudeness, which further affects
explaining how they feel
their ability to socialise.
repeating the last word of your
sentence when asked a question.
Others may say things more than
once – echolalia

Workbook 1
33
 Section 1: Introduction to autism

The screening involved a group of 132 children who attended special schools, and
who ranged from 2 to 18 years. The children were observed and given medical and
psychological tests and their carers were interviewed using a schedule devised by
the researchers.
The group was divided, on the basis of social behaviour, into 58 children with
appropriate social interaction and 74 socially impaired subjects. The groups did
not differ in age, but more males were seen in the socially impaired group.
This important work by Lorna Wing gave rise to the concept of the triad of impairments.

ts: A u ti s m
e n
irm
a
p
im
of

Social Social
Triad

relationships communication
Autism
Spectrum
Condition

Rigidity of
thought,
behaviour and
play (social
understanding)

34 © LCG 2018
 Section 1: Introduction to autism

Impairments of social interaction

The aloof group The passive group The active but odd The over-formal,
(this is the most (this is the least group (children of stilted group
common type of common group) this group make (seen in later life,
social impairment) active approaches this behaviour is
to others but common in the
make that contact most able person
in strange ways) with autism)
behaving as if the child paying no excessively polite
other people accepts social attention to the and formal
don’t exist approaches other party have a good level
little or no eye may meet the poor eye contact, of language
contact made gaze of others although try very hard
no response may become sometimes may to stick to the
when spoken to involved as a stare too long rules of social
faces empty passive part of may hug or interaction
of expression, a game shake hands without really
except for too hard understanding
extreme joy, them
anger or distress
no response to
cuddling
if something is
wanted, carers’
hands may be
pulled towards
the object
may respond
to rough and
tumble play well
but when this
stops, return to
aloof pattern
seem to ‘be
in a world of
their own’

Workbook 1 35
 Section 1: Introduction to autism

Impairments of communication

Using speech
Common speech problems include:
repeating words spoken to them (echolalia)
asking for things by repeating a phrase they associate
with the action, e.g. ‘Do you want a cup of tea?’ instead
of ‘I want a cup of tea’
missing linking words out of sentences, such as ‘in’, ‘on’,
‘because’ and ‘under’. So, for example, a child may say
‘go car shop’, missing out the joining words
explaining in greater detail than is necessary
long replies to questions, spoken as if learned from a
book

Understanding speech
Just as speech varies, so does understanding of speech. Even in more severe cases,
most people with autism understand some speech. Difficulties can arise in certain
situations:

Different objects that have the same name can be confusing, such as bowl (washing
up bowl or eating bowl)
Words that sound the same cause confusion, such as ‘meet’ and ‘meat’.
Literal interpretation can cause problems, such as phrases like ‘it’s raining cats and
dogs’ or ‘have you lost your tongue?’ being taken literally.
Humour can be difficult for a person with autism, especially if it relies on a play
on words.

Tone and voice control

There are a number of characteristics relating to the way speech is made which can
be found in a person with autism. These include:
problems with volume – sometimes too loud, often too quiet
the voice may sound mechanical or monotonous
enunciation of words can be over-emphasised
a foreign or different accent is sometimes used

36
 Section 1: Introduction to autism

Using and understanding non-verbal communication

Speech is only one of a variety of ways in which we communicate; all sorts of gestures
accompany speech, and these include eye movements, arm and hand movements,
posture changes and facial gestures. People who do not have autism but have an
impairment in, say, speech are able to use other ways of communicating, but people
with autism have an impairment in communication, which goes beyond just speech.
An individual with autism is unlikely to develop additional communication skills and
whilst some of the more severely impaired can learn some manual sign language,
they will not use it spontaneously.

Impairment of thinking and behaving

One of the key characteristics of autism is the inability to play or engage in
imaginative activities. So, a toy truck becomes a play thing only in as much as the
spinning of a wheel provides stimulation. Some more able people with autism develop
a sequence of events which appear to be play, but on close observation, it is seen
that the sequence is often repeated over and over again.
The lack of imaginative play leads to limited or no understanding of other people’s
emotions, so people with autism find it difficult to share happiness or sorrow with
others.
Many people with autism find their pleasure in special interests.

Repetitive stereotyped activities

Many people with autism display stereotyped activities, including:
tasting or smelling objects
feeling or tapping different surfaces
listening to mechanical noises such as washing machines
switching lights on and off repeatedly
spinning objects
head banging
These behaviours often continue into adulthood.

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 Section 1: Introduction to autism

More complex stereotyped behaviours include:

placing objects in long lines that they do not want moved
extensive bedtime routines
the family having to sit in exactly the same places at mealtimes
attachment to strange objects such as pieces of string or leaves
collecting strange objects such as tins of polish
in more able people with autism, fascination with the weather, timetables, train
numbers, etc. may be found
Many of these don’t carry on into adulthood, although a fascination with numbers and
sequences can sometimes continue.

Other features
Lorna Wing noted a number of additional features which, in themselves, are not
universal and not critical for diagnosis, including:
stereotyped movements like finger flapping, arm waving, jumping, head rolling and
walking on tiptoes
abnormal gait and posture where the individual may not swing his/her arms properly
when walking, may hold their hands out when walking or may bend their fingers or
arms in unusual ways
the individual with autism may have difficulties with physical education and games,
especially with team sports

Responses to sensory stimuli

People with autism may react to sounds and visual stimuli in unusual ways:
A person with autism might not react to a very loud noise but will respond to a
favourite theme tune; many people with autism find loud noise or background noise
difficult to deal with.
Some children with autism can display unusual abilities to move and find objects in
near darkness.
Some individuals with autism may show distress when exposed to very bright lights.
Sensitivities to smell, taste and certain textures are quite common.
People with autism can display indifference to pain.
Feeding difficulties can occur as children develop strong dislikes to certain foods
due to taste, texture or colour – for example, only wanting to eat green foods.

38 © LCG 2020
 Section 1: Introduction to autism

Inappropriate behaviour
Behaviour that others may find challenging is common in children with autism.
Examples include:
confusion and fear of unfamiliar or changing circumstances
restlessness, destructive and aggressive behaviour
screaming in public
meltdowns
people with autism generally will not lie, so if they consider someone to be ugly or
dislike their new haircut or dress, they will probably tell them

Positive and negative points of the ‘triad of impairments’

Please read the following as it will help you to answer question 14.

The triad of impairments was a theory based on research by Wing and Gould in 1979
and brought all previous research together.
The model of identification by Wing and Gould included:
social impairment
verbal and non-verbal language impairment
repetitive/stereotyped activities

The previous use of the ‘triad’, with three areas of impairment, is now often reduced
to two, known as a ‘dyad’.
The dyad of impairments identifies difficulties in two main areas:
social communication
restricted, repetitive patterns of behaviour, interests
or activities – including sensory difficulties

A positive point of the triad of impairments is that there are more underlying
impairments identified, and this is why some people are critical of the ‘dyad’, feeling
that some people may not be diagnosed.

Workbook 1 39
 Section 1: Introduction to autism

Negative points of the triad of impairments theory include:

It does not include sensory behaviours, and in the dyad of impairments, these
are included.
It focuses on giving a name to the condition rather than identifying all the needs
of the individual.
It does not identify how much support, and in what areas, an individual needs.

It is thought by some that the discovery of a biomarker for autism will show the
causes of autism and also allow earlier and better methods for diagnosis and
therefore intervention. Examples of proposed biomarkers for autism include gene
expression profile, eye movement, brain function, brain size and structure, head size,
proteomic profile and metabolomic profile. There is still a lot of discussion around the
use of biomarkers and some people are against it.
Diagnosing autism in adults in comparison to children is difficult, mainly because the
condition has remained undiagnosed until later in life, and a range of assessments is
needed for diagnosis and support. A screening test for adults has been designed to
check for autism based on a questionnaire with a scoring system.
The questionnaire is completed by a GP or other health professional and some
examples of the questions include:
Does the person seem to understand the feelings of others?
Does the person seek the company of others?
Does the person have an intense attachment to objects?

Did you know?

A biomarker is an indicator of a biological state and needs to be a measurable
factor associated with the condition. Biomarkers can be measured using various
samples, including urine, blood and saliva. Biomarkers can be used to identify
risk factors associated with a condition and some can be used to improve early
detection of a condition. They can also be used to improve diagnosis and provide
personalised treatments so that people get the right type of support. The hope
is that biomarkers for autism will be identified and used, rather than diagnosing
simply through behaviour and communication, as currently happens.

40 © LCG 2020
 Section 1: Introduction to autism

In the latest diagnostic manual used in Europe (ICD-11) the term Aspergers has been
removed and is incorporated into a single diagnosis of ‘autism spectrum disorder’.
This mirrors the diagnostic manual in the US, the DSM-5.

For more information on the changes visit https://www.autism.org.uk

Conditions that can co-occur with autism

Please read the following as it will help you to answer questions 15 and 16.

Autism is strongly associated with a number of coexisting conditions, and recent

studies have shown that around 70% of individuals with autism also meet the criteria
in diagnostic tests for at least one other psychiatric disorder that is causing further
psychosocial disfunctioning. Intellectual disability (an IQ below 70) occurs in around
50% of young people with autism.

Mental health difficulties

Anyone can experience the symptoms of a mental health difficulty, not just individuals
with autism; it can be genetic or brought about by extremes of emotional stress, for
example. A symptom of mental illness can be thoughts or feelings that are difficult to
deal with, or that prevent a person from getting on with life as usual. In severe cases,
individuals may think about self-injuring, or may actually injure themselves, if they are
finding life situations too difficult to deal with.
Mental health difficulties affect an individual’s thoughts and feelings and change how
they view the world. Some feelings associated with mental health difficulties are:
anxiety
hopelessness
low self-esteem
sadness
These feelings affect an individual’s mental well-being and stop their
ability to carry on with normal life. At a point where these feelings become
more intense, occur over a long period of time, or affect the way a person
normally lives, a doctor may make a diagnosis of a ‘mental health problem’.
In some cases, the problems are only temporary and the individual can
recover. In other cases, individuals can experience severe and enduring
mental health difficulties which may require long-term treatment.

Workbook 1 41
 Section 1: Introduction to autism

Learning disability
Individuals with autism can have different ‘degrees’ of learning disability and this can
affect all aspects of their lives, such as studying at school, learning how to wash
themselves or cooking a meal. Some individuals are able to live fairly independently;
some may need some support to live on their own; and others will require lifelong,
specialist support.
People with a diagnosis of Asperger syndrome do not usually have accompanying
learning disabilities but may still have specific learning difficulties, such as dyslexia, or
other related conditions, such as ADHD or epilepsy.
There is often confusion between learning disabilities and mental health difficulties.
Having a learning disability is not the same as having a mental health issue such as
depression or psychosis. Anyone can be affected by mental health difficulties at any
time in their life and, in many cases, these can be overcome with treatment. People
with learning disabilities are at risk of developing mental health issues during their life
and should receive the treatment they need.
‘Learning disability’ is the term that the Department of Health and Social Care use
within their policy and practice documents.

In Valuing People (2001), they describe a ‘learning disability’ as a:

significantly reduced ability to understand new or complex information in order to
learn new skills
reduced ability to cope independently, which starts before adulthood with lasting
effects on development

42 © LCG 2020
 Section 1: Introduction to autism

Other conditions that can co-occur with autism

Autism is very often diagnosed alongside other conditions, such as dyslexia, dyspraxia,
attention deficit hyperactivity disorder (ADHD) and epilepsy.
Therefore, it is important to support individuals with more than one condition in a way
that meets all their needs, and to understand that the difficulties caused by autism
are distinct from those caused by the related condition.
Co-occurring conditions Concerns that can arise from these
conditions
Dyspraxia • An individual’s coordination
Dyspraxia is an immaturity in the way the difficulties may affect participation
brain processes information, resulting and functioning of everyday life skills
in messages not being properly or fully in education, work and employment.
transmitted. This affects the planning of • Children may struggle with activities
what to do and how to do it and leads like washing and dressing, writing,
to problems of perception, language and typing, riding a bike and playing.
thought. • As an adult, many individuals struggle
Dyspraxia sometimes runs in families. with learning new skills at home, in
There may be an overlap with related education and work, such as driving
conditions such as dyslexia and autism a car and DIY.
spectrum conditions. • There may be a range of co-occurring
Individuals with autism often have difficulties which can also have
difficulty with fine and gross motor serious negative impacts on daily
coordination and may also be given a life, including social and emotional
formal diagnosis of dyspraxia. difficulties as well as problems with
Like with autism, individuals with time management, planning and
dyspraxia may be over- or under-sensitive personal organisation.
to certain sensory stimuli like textures, • The difficulties may affect an adult’s
light and sound. education or employment experience.
• Many individuals experience
difficulties with memory, perception
and processing.
• The problems in planning, organising
and carrying out movements in the
right order causes great difficulty
in everyday situations, for example
cooking a meal, making a bed or
writing and drawing.
• Dyspraxia can affect articulation and
speech, perception and thought.

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 Section 1: Introduction to autism

Epilepsy The diagnosis of epilepsy is based

Epilepsy is a condition causing seizures mainly on the description of the seizure
or loss of consciousness and is the that an eyewitness can give the
second most common neurological neurologist.
condition in the UK. Coming to terms with a new diagnosis
It results from an upset in the brain’s can be very difficult and can lead to
chemistry, meaning that the messages stress and depression.
that travel between nerve cells become Sometimes the physical changes in the
scrambled. Therefore the activity of brain immediately after a seizure cause
neurons is disturbed, which causes a anxiety.
seizure or loss of consciousness. The seizures can cause injuries and
Individuals with autism who also have even death - individuals with epilepsy
epilepsy experience different types are also at risk of sudden unexplained
of seizure. Types of seizures found in death (SUDEP) with 600 dying each
someone with autism include: year in the UK from this.
infantile spasms Epilepsy medicine can cause side
infantile convulsions effects such as anxiety or depression.

atonic seizures Individuals can find it very difficult to

adjust to the changes in their lives,
minor motor seizures such as having their driving licences
absence epilepsy (petit mal) taken away.
complex partial seizures Memory can sometimes be affected by
seizures, some epilepsy medicines and
generalised tonic-clonic seizures
by damage to the brain that has
(grand mal)
caused the epilepsy. Memory problems
can have a big impact on an
individual’s everyday life; affecting
work, education, and the ability to cope
with everyday situations.

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 Section 1: Introduction to autism

Attention deficit hyperactivity It is difficult to diagnose, as many

disorder (ADHD) children with autism show signs of
ADHD is a condition that makes an inattention and hyperactivity when they
individual inattentive, impulsive and start school.
hyperactive. An increasing number of Children with ADHD are unlikely to see
children are diagnosed as having both an improvement in their symptoms with
ADHD and autism, and many people age, without medication or therapy.
are confused about the links between A diagnosis of ADHD can only be made
the two. if signs of the condition are seen before
Not everyone with ADHD is hyperactive; the age of seven and the child has had
there is a subtype where there is no the symptoms for at least six months.
difficulty with hyperactivity. Symptoms need to be seen across both
home and school environments.
The most widely known drug used to
treat ADHD is Ritalin, which acts to
reduce electrical activity in the brain,
which in turn reduces hyperactivity.
Some people, however, don’t agree with
the use of Ritalin, feeling it is used to
prevent families and schools from
having to address the real issues/provide
the right support and education.
The condition leads individuals to seem
as if they are misbehaving, but really
they can’t control it. This occurs often
as a result of stress, not because they
want to be naughty. This can be very
difficult for parents to cope with,
especially in public. Although a lot of
children grow out of the hyperactive
aspect of ADHD, issues with
concentration can continue.
Some individuals are particularly
sensitive to sensory stimuli like textures,
lights and sounds; these factors can
therefore be very distracting to
individuals with ADHD.
Medication to treat ADHD can reduce
the appetite, which influences behaviour
and sleep patterns.

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 Section 1: Introduction to autism

Knowledge Activity 7: Carry out your own research into dyslexia and the
concerns that can arise from the condition. Give five key concerns:
1.

2.

3.

4.

5.

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How attitudes and lack of understanding can compound

the difficulties of individuals with autism
Please read the following as it will help you to answer question 17.

False and often negative perceptions about autism are commonplace, and this lack
of understanding can make it difficult for people on the autism spectrum to have
their condition recognised and to access the support they need. Many people do
not understand the condition, and in some cases people may not realise that an
individual is autistic, as it is an ‘invisible’ disability which may not be immediately
obvious. This can cause many problems for individuals with autism, who may be
judged for their behaviour or treated differently due to a lack of understanding. For
example:
• There is a misconception that individuals with autism do not want to mix and that
they prefer their own company; this can lead to them feeling isolated and alone
as people don’t make the effort to interact with them.
• People may not understand the difficulties with social interaction they face,
and may be uncomfortable communicating with them. For example, individuals
with autism may not understand social norms regarding personal space and
appropriate topics of conversation; this can lead to them being socially excluded.
• A misconception is that individuals with autism do not feel emotions; this could
lead to people being insensitive towards them.
• If people do not understand the condition and the fact that they may display
behaviour that challenges, they may view them as rude and argumentative and
may try to avoid them.
• Due to difficulties with social interaction or the fact they display behaviour that
challenges, they may struggle to access services and facilities.
• Individuals may experience bullying and abuse because they are perceived as
being ‘different’ because people don’t understand their needs.
• People may make judgements about them that affect their opportunities, for
example in employment.
• People may mistake autism for being a
mental health condition or may assume that
individuals have a learning disability, which
may not be the case. This could cause
individuals to be treated differently, and not in
accordance with their needs.

Workbook 1 47
 Section 1: Introduction to autism

Think about some of these responses from people or organisations towards people
with autism and how this could impact on individuals with autism and their family.

Christina won’t be able Leave the classroom

now; I told you if Sorry, you’re
to join the rest of the going to have to
class on the theatre you interrupted leave the library if
trip; last time she kept again you would you can’t keep your
shouting out and spoiled have to leave. voice down.
it for everyone else.

If he won’t eat the If you can’t tell me clearly

meal provided, you’ll what the problem is, you’ll
have to find another have to leave without being
nursery for him; we I’m sorry, we can’t invite attended to; there are other
can’t tolerate fussy Caillin to the birthday people who are waiting for
eaters. party; the other children appointments and you’re
don’t like it when he wasting our time.
whispers to himself.

Did you know?

From the 1960s and throughout the 1970s, research into treatments for
autism included interventions such as electric shock, LSD and behavioural
change techniques. From the 1980s, the role of behavioural therapy and highly
controlled learning environments became the main treatments for autism and
related conditions. Today, behavioural therapy and language therapy are the main
techniques used.

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How autism can be misrepresented in the media

Please read the following as it will help you to answer question 18.

There is a lack of accurate information about autism in the media, and it is felt by
many that the difficulties faced by those with autism are under-reported; this results
in a lack of understanding of the condition amongst the general public. This, in turn,
can lead to misinformation and intolerance.
Many newspapers and magazines are only interested in stories that will make money,
and therefore often they focus on either tragedy or ‘feel-good’ stories. Some people
feel that autism is not often dealt with in the media as it does not present a
‘feel-good’ factor and tends to frighten people, or make them feel uneasy. Often,
when autism is dealt with, the media tends to sensationalise it or show only the
stories which show the severe complications that can result from autism.
In the past, inaccurate discussions in the media have led to more ignorance and
intolerance, with people making comments such as:

‘he hasn’t got ‘lazy parents just

autism; he’s want an excuse as
just stupid’ to why their child is
‘he’s just badly behaved’
lazy’
‘it’s not autism;
it’s poor
parenting’

In other cases, the media have taken an event and heavily published the autistic
traits of an individual - a good example being Anders Behring Breivik, the Norwegian
gunman who killed 77 people in 2011. Newspaper articles focused very much on
the psychiatrist’s statement that he more than likely had Asperger syndrome and
comments that this ‘left him incapable of empathy or real friendship’. This kind of
reporting can have a profound impact on perceptions, prejudices and barriers for
people with autism as it leaves people frightened and suspicious. This can lead to
increased stigma, prejudice, bigotry and discrimination for those with disabilities.

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 Section 1: Introduction to autism

Even though a study in 1991 found that there was no increased tendency to violence
from individuals with Asperger syndrome - even finding that violence in those with
the condition was lower, proportionally, than the total population - the media has
frequently connected being autistic with increased violence and criminal behaviour.
Parents of autistic children and individuals with autism have often expressed concerns
that stories in the media are written to create pity from the reader, or even fear, and
that there are so many negative stereotypes given.
Some negative comments about people with autism include:

Autism is an Autism It’s a

epidemic Autism wrecks lives meaningless
causes life
divorce
Autism steals Why are
children autistic people
SO loud?
He just Autistic people
needs a are a drain on
good slap society

Some films and TV programmes feature autistic people and

these too can formulate set ideas in people’s minds. For
example, in 1988, Dustin Hoffman won the Best Actor Oscar for
his performance in a film titled ‘Rain Man’, playing someone with
autism. Before this film, many people had never heard of autism.
The film, and subsequent news stories about real children with
autism, focused on the autistic ‘super’ ability to memorise whole
books, rapidly solve difficult mathematical equations or play a
concerto with absolutely no musical training.
Rain Man’s popularity shaped many people’s perceptions of autism for many years,
and some people feel this did the condition harm and could even have resulted in
autism being misdiagnosed.

Due to the way autism is portrayed in films and on TV, most people believe autistic
people fall into one of two categories:
being in a world of their own, not speaking and making repetitive movements
being super smart and managing in society but having difficulty socialising
As we have discussed, autism is complex and individual, and the above stereotyping
only goes further in aiding misconceptions.

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Knowledge Activity 8: Firstly, research some of the images portrayed

by films and TV shows of individuals with autism on the Internet.
Examples you could look at include:
Christian Wolff from ‘The Accountant’
Sheldon Cooper from ‘The Big Bang Theory’
Brick Heck from ‘The Middle’
Choose two portrayals and explain how these might cause problems for people
with autism.
1. Example:

Problems that may be caused:

2. Example:

Problems that may be caused:

Did you know?

34% of children with autism say that the worst thing about being at school
is being picked on.
17% have been suspended from school, of which 48% have been suspended
three or more times and 4% have been permanently excluded from one or more
school.

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 Section 1: Introduction to autism

How discrimination against individuals with autism can

occur inadvertently in society
Please read the following as it will help you to answer question 19.

As we saw earlier, some people fear a diagnosis of autism because they feel they
will be judged by this ‘label’ and not the person they are, or their actions. Having
autism isn’t something that individuals should be made to feel ashamed of. It’s not
something that should be used to discriminate against people, and individuals should
not feel they have to keep it private for fear of how they will be viewed by society.
The stigma of autism does exist however, and often non-autistic (neurotypical)
people don’t realize that they are treating an individual negatively because of their
autism label. If neurotypical people keep this stigma in mind when they interact with
individuals with autism, they are less likely to fuel it.
Individuals with autism may come across discrimination in education, employment
and in seeking services, such as healthcare or benefits, often due to their problems in
communicating and the fact that many people do not understand these differences
or how to deal with them.
Many employers fail to realise the part individuals with autism can play within their
organisation – many have very valuable skills which can be applied in the workplace.
Individuals can face problems gaining employment due to the issues they face in
communicating and how they may come across in an interview. In the workplace
they may face discrimination due to lack of understanding; for example, they may
be socially excluded or struggle to remain in employment if employers fail to make
reasonable adjustments.

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Knowledge Activity 9: The following scenarios show how people may be

inadvertently discriminated against in everyday life. Think about the following
individuals and their situations. What are the problems that they may face, due
to lack of understanding or knowledge from neurotypical people?
Individual Scenario Problem faced
Alex has Asperger Alex has started to disrupt
syndrome and has some of his lessons at
above average school, as he is getting
intelligence. bored. This is particularly
He struggles to a problem in English, as
communicate with he has read the novel they
others. are covering in class very
quickly. He starts disrupting
the class and ripping pages
out of his book, fidgeting
and speaking out loud. His
mum explains to the teacher
that he is bored as he reads
very quickly, and asks if he
can be moved into a higher
set. The teacher has limited
knowledge of Asperger
syndrome but knows he is
on the autism spectrum.
She tells his mum she can’t
move him up as he is not
clever enough, adding that
this is demonstrated by his
behaviour.

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 Section 1: Introduction to autism

Aleema, a mother Because Abi, who has

of two, takes her autism, is not allowed to
children, one with have the green sandals she
autism, to buy new really wants and has to have
school shoes before sensible black school shoes,
the start of the new she starts to scream and
term. cry. Other customers start to
look and talk about them,
and eventually the shop
assistant asks them to leave
the shop, as it is putting
other customers off. She
says that they can only allow
well-behaved children into
the store.

Reuben has recently As Reuben has decided he

started at pre-school will only eat red, yellow and
three days a week, orange foods, the manager
to prepare for school. contacts his parents to
He has a very narrow say that they can’t accept
range of foods that fussy eaters as it makes
he will eat. the lunch period too difficult
for staff to manage. They
ask them to find alternative
arrangements within one
week.

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An example of discrimination against autism

A large well-known organisation was fined for discrimination against a girl with
autism after employees at a store refused to allow a family member to accompany
an autistic girl into a fitting room.
The judge ruled that the retailer had discriminated against the 14-year-old girl, who
suffered mental anguish as a result of the incident.
A psychologist who interviewed the autistic girl said she reported feeling bad,
scared and nervous. The girl told the psychologist, “It’s all my fault. I hate autism;
I am a misfit.”
The girl had been shopping for school clothes with her 17-year-old sister at the
store and her sister requested that she accompany her into the fitting room, telling
the assistant that her sister has a disability and couldn’t be left alone.
The assistant told the sister that their store policy stated that only one person was
allowed in the fitting room at a time. He refused to let the sister accompany the
autistic girl, even when the sister provided information about the girl’s disability.
When the girl’s mother arrived and questioned the assistant about the policy,
she explained that her 17-year-old daughter was a carer and asked that she be
allowed to accompany the autistic girl into the fitting room. This request was still
refused and the mother asked to file an official complaint about the incident, but
was offered no assistance in doing so.

Discrimination in schools

Children with autism can face discrimination at school, as they sometimes require
extra support with day-to-day activities such as:
using speech (e.g. communicating with others, understanding what others are saying)
memory or ability to concentrate, learn or understand
manual dexterity (e.g. holding a pen, pencil or book, using tools in design and
technology, playing a musical instrument, throwing and catching a ball)
physical coordination (such as taking part in games and physical education)
mobility (moving around, getting to/from school, moving about the school and/or
going on school visits)
ability to lift, carry or move everyday objects (e.g. carrying a full school bag)
dealing with noisy dining rooms and navigating busy corridors
An example of how discrimination might occur within a school setting could be a
teacher shouting at a pupil for not carrying out an instruction because, as part of their
autism, they have language difficulties and have misunderstood what has been asked,
or need more time to process the instruction.
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 Section 1: Introduction to autism

Terms relating to discrimination in the context of schools

Direct discrimination
Direct discrimination is when a school treats a disabled pupil less favourably than
a non-disabled pupil.

Indirect discrimination
Indirect discrimination might happen when a school has a policy or rule that puts
disabled pupils at a disadvantage. An example might be a school having a rule
that all pupils must be able to make their own way to and from after school clubs
independently.
Schools also have a duty to make ‘reasonable adjustments’ for disabled pupils
– in effect, making an exception to the rule if the rule would put the disabled pupil
at a disadvantage.

Discrimination arising from disability

Discrimination arising from disability might happen when a school treats a disabled
pupil unfavourably because of something that is related to their disability. An
example is a school refusing to allow a pupil with attention deficit hyperactivity
disorder (ADHD) on a visit to the theatre, as the pupil has attention difficulties
and could disrupt the performance.

Harassment
Harassment occurs when a member of staff engages in unwanted conduct
that either:
violates the pupil’s dignity
creates an intimidating, hostile, degrading, humiliating or offensive environment
for a pupil

Less favourable treatment

To establish whether there has been ‘less favourable’ treatment, the school must
compare how it has treated other pupils, or would have treated them in a similar
situation. Even though a pupil may have been treated less favourably than other
pupils, the discrimination may not be illegal if it was justified in the circumstances.

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Case study
Marissa has autism which includes sensory difficulties, and she becomes very anxious
when the fire alarm goes off in school. Instead of following the evacuation procedure,
she stands with her hands over her ears and does not move. The teacher tells her
to leave the building, but Marissa is frozen to the spot. The teacher starts to shout
at her and eventually she lashes out at the teacher. Marissa is excluded for two days
for assaulting the teacher. The school claims that the treatment was justified to keep
order and discipline in the school and that the incident was serious enough to justify
the exclusion.

What should have been done to provide ‘reasonable adjustment’?

When the fire alarm sounded, there could have been reasonable adjustments
made to prevent the incident happening. For example:
1) Staff at the school should be trained about autism and provided with strategies
to avoid these difficulties.
2) Marissa needs to be given training for social situations and strategies for coping
when the fire alarm is raised.

Informing schools of autism, and confidentiality

The Equality Act 2010 says that if a school treats a pupil less favourably, or fails to
make reasonable adjustments, it is not discrimination if they did not know about the
disability and could not reasonably be expected to know that the pupil was disabled.
Schools therefore do need to know if a pupil has autism and the exact nature
of the autism. Schools are expected to take steps to find out if a pupil has a
disability and will need to know how to apply reasonable adjustments and specific
arrangements. If a school has not been told about a child’s disability and a claim
is made against them for disability discrimination, they may be able to defend their
actions, or inaction, because they didn’t know.
Parents, or the pupils, can ask the school to keep the nature or existence of the
disability confidential. This request though could limit what the school can do by
way of making reasonable adjustments.

Did you know?

Only 15% of adults with autism in the UK are in full-time paid employment.
Out of adults with autism, 70% feel that they are not getting the help that they
need from social services and said that with more support they would feel less
isolated.

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 Section 1: Introduction to autism

Discrimination against adults with autism

It is against the law to discriminate against an individual with autism in the workplace,
in education, when renting or buying property and when providing any goods, services
or facilities.
Some examples of discrimination are:
harassing an individual with autism, for example by making jokes about their
disability
victimising an individual who has decided to take legal action because they have
been discriminated against
not taking the necessary steps to make sure disabled individuals can access goods,
facilities and services – this applies whether or not the goods, facilities or services
are paid for or free
excluding an individual with autism from activities, for example recreational
activities in a care home

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Summary

In this section, you have learned about:

what is meant by autism
how autism can be considered as a spectrum condition
theories in relation to identifying autism
how autism is diagnosed and the current guidelines for diagnosis
the prevalence of autism
the main characteristics found in individuals with autism
conditions that commonly co-occur with autism
common misconceptions about autism
how discrimination may occur against individuals with autism

Workbook 1 59
 Section 2: Using a person-centred approach to support
individuals with autism

In this section, you will learn about current legislation and guidance that protects
people with autism, and how their rights can be promoted. You will look at the
importance of treating those with autism as individuals, providing person-centred
support, and consider how to incorporate the individual’s needs and preferences when
providing support. You will think about how compassionate, non-judgemental support
can be provided and also look at working with individuals’ strengths and abilities to
enable them to achieve their full potential. You will also learn about the need for
confidentiality when working with individuals with autism.

Current legislation and guidance

Please read the following as it will help you to answer questions 20 and 21.

There are a number of laws that protect people with autism. It is important to
remember that autism is a disabling condition and that individuals with autism may
also have a learning disability.

Autism

The Autism Act 2009 was the first law ever relating to a specific condition, with the aim
of providing services for diagnosis and meeting needs, increasing awareness of autism,
helping adults into work and improving access to services. It was published to ensure
that the adult autism strategy was implemented properly and did two key things:
1. It put a duty on the government to produce a strategy for adults with autism (this
was published in March 2010).
2. It put a duty on the government to produce statutory guidance for local councils
and local health authorities on implementing the adult autism strategy by the
end of 2010. (New statutory guidance was published in 2015 which replaced the
2010 version.)

The guidance produced informs local authorities, NHS bodies and NHS Foundation
Trusts what actions should be taken to meet the needs of individuals with autism
living in their area. It states that local authorities and the NHS:
should provide autism awareness training for all staff
must provide specialist autism training for key staff, such as GPs and community
care assessors
can’t refuse a community care assessment for adults with autism based solely on IQ

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individuals with autism

must appoint an autism lead specialist in their area

must develop a clear pathway to diagnosis and assessment for adults with autism
must commission services based on adequate population data

Local councils and local health bodies have a legal duty to implement it because it
is statutory guidance. The 2015 guidance provides a lot more information than the
2010 version. It provides information and guidance on:
reasonable adjustments
equality
how to support people with autism and complex needs
employment
preventative support and safeguarding
criminal justice

Equality and disability rights

A definition of disability is ‘a physical or mental impairment that has a substantial and

long-term effect on day-to-day activities.’
The Equality Act 2010 had a significant impact on people with learning disabilities
by giving them protection against discrimination on the grounds of disability. This law
combined the Disability Discrimination Acts of 1995 and 2005, and covers:
 ducation
E
Disabled people must have the same rights and educational opportunities as others
and not be discriminated against because of their disabilities.
 mployment
E
Disabled people must be treated fairly in applying for jobs, and once in employment
they must be given the same opportunities. Employers must make reasonable
adjustments to allow the employee to work.

Goods and services
Providers of goods and services must not treat individuals with disabilities less
favourably or offer goods of a lower standard or poorer service than they would for
non-disabled people.
Assessment
The Act highlights the need for assessment of autism, as a range of benefits and
services can be put in place.

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 Section 2: Using a person-centred approach to support
individuals with autism

Special educational needs

The Special Educational Needs and Disability Act 2001 was designed to strengthen
the rights of children and young people with disabilities and special educational needs
(SEND) to be educated in mainstream schools.
The Act is accompanied by the Special Educational Needs and Disability (SEND) code
of practice (released in 2014 and updated in 2015). The code of practice states that
all children with special educational needs should usually:
be educated alongside other children in ordinary schools

have access to a broad, balanced and relevant education which includes the
National Curriculum
For more information about the SEND code of practice, visit https://www.gov.uk/
government/publications/send-code-of-practice-0-to-25.

With regards to statementing, the Act requires that ‘a statement should specify clearly
the provision necessary to meet the needs of the child. It should detail appropriate
provision to meet each specified need and quantify provision as necessary’. Also,
it requires that ‘LEAs must make decisions about which actions and provision are
appropriate for which pupils on an individual basis. This can only be done by a careful
assessment of the pupils’ difficulties and consideration of the educational setting in
which they may be educated’.
Every school has a Special Educational Needs Coordinator (SENCo) who is responsible
for coordinating help for children with SEND.

The main provisions of Part 1 of the Act are as follows:

 LEA can only refuse a child with SEND a mainstream place if it can demonstrate
An
that no reasonable steps could be taken to safeguard the ‘efficient education of
other children’.

Schools must inform parents if they make any special educational provision for
their child.
Schools, as well as parents, can request a statutory assessment.
Parents and young people should be included when a statement is being amended.
LEAs must set up and advertise Parent Partnership services.
The SEND Tribunal can set time limits for implementing its decisions.

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individuals with autism

Part 2 of the Act applies to disability discrimination law for the provision of services by
all education providers. The main provisions in terms of disability discrimination are:

Schools must not treat disabled pupils less favourably than non-disabled pupils
(without justification).
Schools must make reasonable adjustments to accommodate disabled pupils.

LEAs must plan to increase environment access, curriculum access and access to
information for disabled pupils.
The duties apply even if they do not currently have disabled pupils.
The Children and Families Act 2014 made changes to SEND statements and these
are now Education, Health and Care (EHC) plans. This brought about some key
changes affecting young people in education or training up to the age of 25, rather
than 16. Parents and young people with autism have the option of a personal budget
to buy specialist support when a care plan is issued.

Mental capacity and best interests

A definition of mental capacity is ‘acting on, making, communicating, understanding

and remembering decisions’.
The Mental Capacity Act (MCA) 2005 states that if an individual lacks the mental
capacity to make their own decisions, then whoever does make decisions for them, or
takes any action on that person’s behalf, must do this in the person’s best interests.
The person who has to make their decisions is referred to as the ‘decision-maker’ and
is usually the carer responsible for the day-to-day care; this could include care staff,
relatives or friends, or a professional such as a doctor, nurse or social worker where
decisions about treatment, care arrangements or accommodation have to be made.
If an individual appoints someone (called an ‘attorney’) by making a lasting power of
attorney (LPA) or an enduring power of attorney (EPA – predecessors to LPAs) to make
decisions on their behalf, then that attorney must make decisions in the person’s best
interests.
The decisions that may have to be made on the individual’s behalf include:
decisions about the individual’s property
financial matters
their healthcare, including serious medical conditions
social care
living arrangements

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individuals with autism

The law states what ‘best interests’ are and what must be taken into account:
 not make assumptions about someone’s best interests merely on the basis of
Do
the person’s age or appearance, condition or any aspect of their behaviour.
Consider all the relevant circumstances relating to the decision in question.

Consider whether the person is likely to regain capacity (for example, after receiving
medical treatment). If so, can the decision or act wait until then?

Involve the person as fully as possible in the decision that is being made on
their behalf.

Consider the individual’s past and present wishes and feelings (especially if they
have been written down).

Consider any beliefs and values (for example, religious, cultural or moral) that
would be likely to influence the decision in question, and any other relevant factors.

Advocacy

Advocacy means to speak on behalf of another person. This means that if an

individual cannot speak for themselves, and have control over their own life, they may
need someone to act as an advocate for them.
The Care Act 2014 recognises that if individuals cannot speak for themselves and
make decisions about their care and support, and have no family to help them, the
local authority has a responsibility to arrange for an independent advocate to work
with them.
The Mental Capacity Act 2005 is designed to protect the rights of individuals who do
not have the capacity to make their own decisions. Under this act, an Independent
Mental Capacity Advocate represents them, and it is their responsibility to learn as
much as possible about the individual so that they can act in their best interests.

How laws and guidance support individuals with autism

These laws and guidance can provide support to individuals with autism as they:
• provide protection against discrimination due to their disability – in terms of
education, employment and goods and service provision
• protect their rights - for example, in cases where they are unable to speak for
themselves
• look after their best interests and state what is required of those who make
decisions on their behalf

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• put a duty on the government to make provision for them in terms of healthcare
and support
Inform healthcare services about necessary provision

The Care Act 2014

This is a law about the care and support people receive, and also includes support
for carers. It sets out the responsibilities of local authorities as:
1. Promotion of individual well-being
2. Prevention of an individual’s care and support needs from becoming
more serious
3. Promotion of integrated care and support with health services
4. Provision of information and advice
5. Promotion of diversity and quality in provision of services
6. Cooperating with its relevant partners, such as other local councils,
the NHS and police
7. Cooperating in specific cases with other local authorities and their
relevant partners
It states that the local authority must assess the needs of individuals who need
care and support. This assessment must involve the individual and their carers or
others who have an interest in their welfare. They must also assess the needs of
carers who provide or intend to provide care to a person.

Knowledge Activity 10: Think about the situations encountered by individuals

with autism spectrum condition. State which legislation makes some provision to
support them.
Individual Legislation providing support
Charlotte is unable to make her own
decisions or speak for herself on important
issues like her living accommodation and
healthcare.
Patrick has behaviour that challenges
as part of his condition, and the local
secondary school that is only a 10-minute
walk away from home says they are unable
to accept him. The reason they give is that
they have a very strict behaviour code that
Patrick will be unable to adhere to.

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Karim has been successful in gaining

employment in an office and is responsible
for filing and placing orders, which he
is good at. However, when he becomes
frustrated with tasks he often shouts out
loudly and bangs his fist down on furniture.
The manager says he is disturbing and
upsetting other staff, and if it continues he
will have no choice but to dismiss him.

Did you know?

The Trades Union Congress (TUC) launched its first ever guide to autism in
2014. This document, ‘Autism in the workplace’ is for union representatives
and workers, and provides information such as:
advice on how to support staff with autism
the facts around the condition
how to make reasonable adjustments for workers with autism

how to help workers with autism make plans for potential problems before they
arise

Person-centred support
Please read the following as it will help you to answer question 22.

A person-centred approach means ensuring that the support given to an individual

with autism is personalised, and done in the way that the person wants and needs it
to be carried out. This involves finding out what people want, identifying the support
they need, and taking steps to help them get it.
A person-centred approach involves ‘co-production’, which means that individuals
are more involved in making decisions about the services they receive. Under this
approach, individuals can work collaboratively with professionals such as doctors and
psychologists to choose the best healthcare options for them. This helps to put the
support needs of the individual first, as well as enabling the individual to take more
control and ownership over their own life and future.
A person-centred approach is a ‘live’ care plan and includes what is important to
the individual now and in the future, and what support they need. This care plan is
constantly reviewed.

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For individuals who have learning disabilities, it is important to provide them with
information in a way they understand, so they are able to make informed choices, i.e.
a process of choosing from options based on accurate information and knowledge.
This might mean information has to be presented in plain, straightforward language
and also using symbols and pictures if it helps. Ideally, the individual should be
involved in these decisions from the earliest possible stage. The aim of a person-
centred approach is to put the individual in control of the services they want; if they
find a particular service does not meet their needs, then they should be free to look
for alternatives. The approach should ensure that the individual’s needs are met; they
shouldn’t simply be expected to fit in with an existing routine/service.

In delivering person-centred support, it is important to:


see the positive things about the individual and celebrate/value every person for
who they are
 yourself in the individual’s shoes and have a good understanding of how they
put
see the world
 aware of the difficulties individuals with autism have regarding different
be
environments, due to sensory processing.
understand the need for the individual to feel safe and relaxed
try to alleviate any anxieties the individual might have
respect the individual’s need for structure and routines
understand that autism affects each person differently
work closely with the individual and their families
listen to the individual’s wishes for how they want to live their life
use communication methods and strategies that the individual understands

Did you know?

The Kingwood Trust is a charity set up in 1994 by a couple who have a son
with autism. It is a specialist support provider working with 50 people with
autism, especially those with complex needs, who mostly live in their own
homes in Oxfordshire and neighbouring counties.

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Knowledge Activity 11: Think about the following scenarios and, adopting a
person-centred approach, think of a solution for each individual.
Individual A solution, considering the
individual’s needs and preferences
Roy has a job in a canteen, which he
loves. After the lunch shift, the canteen
staff leave the area and have a break in
the restroom so that a specialist cleaning
team can come and perform a deep
clean. Roy becomes stressed and upset
at having to leave the canteen and join
the others; this is affecting his job.
Evita needs regular medical attention at
a hospital three miles away from home.
Having to make the journey makes her
very anxious and she adopts self-injuring
behaviour.
Franco lives in sheltered accommodation
and there are regular checks on the
premises by maintenance staff and
the health and safety officer. He
feels unsafe when people enter his
living accommodation and it brings
on behaviour that others may find
challenging. This can then cause
problems with the staff and other
residents.

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Treating those with autism as individuals

Please read the following as it will help you to answer question 23.

As autism is a spectrum condition, there are many different characteristics that

may be present, and individuals on the autism spectrum face many problems and
challenges every day. Each individual with autism is a unique individual, with unique
needs and abilities. Therefore, in treating and supporting individuals with autism there
is no ‘one size fits all’ treatment. The most effective interventions are tailored to meet
the unique characteristics of each individual.
Some individuals might have difficulties communicating with people or socialising;
they might also have other conditions such as epilepsy or learning disabilities which
bring about additional problems.
Some individuals may require interventions to tackle the core symptoms of autism,
such as serious problems with communication, whilst others may need interventions
to address other issues such as self-injuring behaviour and anxiety. Different
interventions will have differing levels of success in different individuals and it is not
possible to treat everyone in the same way.

Knowledge Activity 12: At Green Acres secondary school there are 4 year
8 pupils with autism. They are all 13 years old, but present different traits.
These very different characteristics show how important it is to treat people
with autism as individuals, as their needs differ so much. Consider how their
needs could be supported.
Pupil How they could be supported
Eva chooses not to speak, and
therefore it is difficult for teachers to
check her understanding of topics and
tasks. She becomes very anxious and
stressed in noisy environments and
covers her ears with her hands, refusing
to participate in class activities.
Elliot finds it difficult to communicate
appropriately with others. He has been
over-familiar with staff and other adults
and has been in trouble for being
cheeky and rude. When he speaks to
other pupils however, he adopts a very
formal manner and is frequently made
fun of.

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Alec finds it difficult to cope with

changes to his daily routine and lately
there have been a lot of different
activities going on, including sports
day, two day trips and a special cross-
curricular study day. He has become
very upset and has started refusing to
go to school.
Danny finds it difficult to sit still and
often gets in trouble in lessons for
fidgeting, getting out of his seat and
disturbing the rest of the class. When
he becomes frustrated, he sometimes
damages other pupils’ work or the
displays in the classroom, and pupils
have started to act in quite a hostile
way towards him.

Providing support that is compassionate and non-judgemental

Please read the following as it will help you to answer question 24.

Compassionate – ‘feeling or showing empathy and concern for others’

Non-judgemental – ‘having an attitude or approach that is open and not
incorporating a judgment one way or the other’

Providing compassionate support means that professionals and volunteers working

with people with autism need to show concern and understanding for the individuals,
as well as their families and friends. Individuals and their families need to be able
to spend time where they can freely discuss questions, concerns and feelings. This
should allow time for self-reflection for those caring for people with autism. Providing
a compassionate approach is essential in helping individuals and their families stay
healthy emotionally. People need to be able to see life and the daily struggles of the
individual from their point of view; understanding how they see the world is important
in trying to provide any help, support or therapies. It is also important to believe in
the individual and let them see this, in order to help them through the barriers they
face. Compassionate support must enable individuals to identify their needs, and in a
communication channel of their choice. This also may take into account the use of an
advocate, linking into the Mental Capacity Act 2005 (as mentioned on page 64).

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Providing non-judgemental support means that people do not judge individuals with
autism for their behaviour and do not judge parents or families for the way they
have brought them up, or the way that they deal with their behaviours. This will also
help parents to adopt a positive and optimistic attitude towards their children. It is
important to understand that individuals with autism have significant educational,
social communication and behavioural needs. It is also important to acknowledge that
parents and families have the right to support and respect. The Equality Act 2010
aims to ensure that every individual, regardless of particular characteristics, such as
disability, has an equal opportunity to make the most of their lives and talents.
In providing compassionate and non-judgemental support, the principle of well-
being, as described by the Care Act 2014, should be promoted, which embraces the
following considerations:

Personal
Suitability of living dignity,
accommodation including
respect

Control by the
individual over Physical and
day-to-day life, mental health
including care and and emotional
support and how well-being
it is provided

Well-being

Domestic,
Protection
family and
from neglect
personal
and abuse
relationships

Participation
in work, Social and
education, economic well-
training or being
recreation

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Working with adults with autism in a care or residential setting

Staff who work with adults with autism in a care or residential setting should:
Work in partnership with the adult and also with their family/partner/carer where
appropriate.
Make sure they are easily identifiable to the people they are supporting, for
example by a name badge, and be consistent in their appearance (even a different
style of dress can unsettle some individuals).
Be approachable and explain their role clearly, using the individual’s name when
addressing them.
Build trust, for example by making sure they are always on time and don’t miss
pre-agreed visits or appointments.

Make sure that communication is appropriate for the individual so they understand
what they are being told, and consider additional aids for those with a language,
learning or hearing disability.
Offer care and support in a respectful manner and build a trusting and supportive
relationship with the individual.
Be aware of the fact that some individuals do not like making eye contact, and
think about how best to communicate with them without making them feel
uncomfortable.
Think about the pace of conversation, making sure that they do not give
‘information overload’ as this can cause anxiety.
Make sure that the individual feels that events are well planned and that they know
what will be happening and when.
Understand how autism can impact on the individual’s social, personal, education
and working life.
Understand how the social and physical environment can impact on an adult with
autism and provide a suitable environment for activities and meetings, taking into
account sensory issues such as lighting and noise.
Show sensitivity to issues of sexuality and someone’s need to develop personal and
sexual relationships.
Be aware of how problems with social and personal interaction and communication
can lead to problems such as misunderstandings and exploitation.
Support the individual in taking an active part in decisions about their care.
Aim to provide and maintain continuity of individual relationships, where possible.

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Consider the use of a trained advocate for the individual if appropriate.

Be observant and look for unusual likes and dislikes about issues such as food and
physical exercise, and be aware of how these could lead to physical health problems.
Support referral to a GP or other health professional if necessary.

Did you know?

Housing Options is a charity that provides housing advice to people with
learning disabilities. They estimate that the current shortage of housing for adults
with autism in the UK is in excess of 10,000 homes. The Supporting People
programme offers vulnerable people the opportunity to improve their quality of life
by providing high-quality and housing-related services which enable them to live
with greater independence.

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Promoting the rights of individuals with autism

Please read the following as it will help you to answer question 25.

Individuals with autism are often misunderstood and this can lead to them being
excluded from society and discriminated against. Often, their access and support
needs are not properly understood and this can lead to needs being unmet. Many
people with autism feel that they are not accepted or appreciated as equal members
of society. Many individuals with autism are unable to access the support they need,
which leaves them isolated and vulnerable. This lack of appropriate support can result
in deterioration in an individual’s mental health.
Key rights that need to be considered for individuals with autism include:
• independence
• individuality
• making their own choices
• fair and equal treatment
• respect
• dignity

There are several organisations that work to promote the rights of individuals with
autism, and this can be done by:
• opposing the stereotyping of people with autism and working to promote positive
images and the correct information about the condition in the media
• working to involve people with autism in the planning of public sector provision
(i.e. services provided by the government such as healthcare, housing and
benefits)
• aiming to involve people with autism in the development and delivery of autism
awareness training
• campaigning for independent living for people with autism and working for social
inclusion
• increasing the public’s awareness of ‘neurodiversity’
• increasing awareness of autism amongst the public and professionals, and
reducing stigma associated with all autistic spectrum conditions
• working with local authorities and other services to ensure that appropriate
support services are in place and that there is equal opportunity for individuals
with autism to be included and to participate in society
• working to improve educational provision for those with autism, including the
provision of vocational training and skills development

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• working for the provision of life skills and social development skills for individuals
with autism in order to facilitate their full and equal participation in education and
as members of their community
The National Autistic Society launched the ‘Think Differently About Autism’ campaign
to help improve public awareness and understanding of autism. This involved
producing information materials for schools and workplaces to help them to become
more ‘autism friendly’. It also includes information on consulting with people with
autism. It aims to encourage people to think differently and act positively to bring an
end to discrimination, intolerance and common misconceptions.
The government, both at local and central level, also has an important role to play
in changing people’s attitudes, raising awareness and promoting the rights of people
with autism. The UN Convention on the Rights of Persons with disabilities puts a duty
on governments to:
act to raise awareness and understanding of autism
act to tackle discrimination towards those with autism
ensure adequate training for those who come into contact with autistic individuals

Did you know?

There are a number of organisations that aim to promote the rights of those
with autism.
Autism UK is a research charity which aims to:
promote civil and human rights of autistic individuals
raise awareness of autism and related conditions
improve services, facilities and conditions for autistic people

encourage the involvement of autistic people in the design of services used by
autistic people
campaign for the enforcement of legislation and guidance relating to autism
establish support locally and regionally for autistic individuals

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Knowledge Activity 13: Ella is 30 and, due to the death of her mother, has
recently moved to her own accommodation. She does not work, due to
difficulties associated with her diagnosis of autism, and needs to claim benefits.
She also lives with a learning disability and is unable to fill out the forms needed to
apply for benefits. She finds it very difficult to communicate in person and avoids
going in to organisations where she would have to speak to someone she doesn’t
know.
1. What could the possible impact be on Ella in this situation?

2. How can the work by organisations that campaign for and promote the
rights of those with autism help in such situations?

3. What support does Ella need?

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Incorporating preferences and needs of individuals

when providing support
Please read the following as it will help you to answer question 26.

It is important to consider the preferences and needs of individuals with autism when
providing any type of support, and this is part of the person-centred approach that we
have already looked at.
Individuals will have preferences on many aspects of their life, including where they
study or work, where they live and who with, the type of healthcare they receive and
the social activities they take part in.
Sometimes, the preferences of the individual and their needs will not be the same, and
there may be conflict when trying to support them. It is important to try and match their
preferences and needs as much as possible when providing support and coming up with
solutions to important issues such as housing, education and employment. Sometimes,
individuals may need to be redirected to other options, where their preferences can’t
completely be accommodated. It may be possible in some situations to provide a
different option or activity to suit the individual’s preferences.

The needs of individuals can include:

skills training
social opportunities, such as social clubs and trips out
employment support, such as help with applications, CVs and interviews
housing support and housing provision
independent living support and training
school to work training and preparation
work-based learning
support accessing work
support sustaining a job
speech and language therapy
specialist help for those involved in the criminal justice system
personal mentoring
education and careers advice and support
transition planning and support
emotional regulation
work experience

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The Autism Educational Trust have put forward a ‘Person-Centred Planning Toolkit’
produced by Alice Stobart which includes five key features of Person-Centred Planning
(PCP). This states that:
the individual is at the centre of the planning process

planning should reflect what is important to the individual now and in the future,
and consider the support they require
family, friends, carers and partners are involved in the planning process
 plan helps the individual to be included in the community and supports the
the
community to include the individual
the plan is ongoing and needs to be reviewed and amended as required

Some examples of how preferences and needs can be incorporated when providing
support:
Individual Preferences Needs
Chongan wants to go Chongan doesn’t want To help Chongan to live
to university to study a to choose a different independently, he could
course; however, it is course and wants to live be provided with some
not offered at his local independently near to the skills training to help with
university. He therefore has university. his organisation and basic
to either choose a different cooking and household
course, or live away from management.
home. He could be provided with
Chongan needs support help for the transition,
in many everyday tasks preparing him for the
such as cooking. He also changes he will experience.
struggles with organisation Chongan could also be
and finds new situations provided with a mentor to
stressful. visit him in his home and
help with any problems he
may face.

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Suzy has a job in a Suzy likes the job she Suzy could be provided
busy office and she has does and doesn’t want with social skills support
experienced problems to transfer to another to help her communicate
at work as she finds it department. She wants to more effectively with
difficult to communicate get on with her colleagues other people. She could
with colleagues. Others and longs to fit in and be join a local support group
sometimes feel that she included in social events, that provides social
is rude to them but she but doesn’t know how to opportunities, including
doesn’t mean to be. After resolve the situation. day trips, evening visits to
a number of problems, the cinema and bowling
the manager suggests that complex and a range of
she transfer to another workshops including craft
department where she activities and sports.
would be able to work
independently with little
contact with others.
Ian is unemployed; he has Ian wants to find work and Work experience could be
never had a job and is wants to get on with other arranged for Ian, along
struggling to find work due people. He feels isolated with some work-based
to his lack of experience. at home, as he has little skills sessions to improve
He finds it difficult to contact with people. his chances of securing
deal with new situations, employment. He could be
and meeting new people provided with some training
makes him anxious. on job applications, such
as CV and letter writing.
Some support with social
skills would be useful and
a mentor could be provided
to help him prepare for
new situations and meeting
new people.

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Knowledge Activity 14: Martyn has completed a two-year course in

Hospitality and Catering and wants to be a chef in a hotel. Martyn has difficulty
working under pressure and cannot cope with lots of noise. He becomes very
anxious if people shout, as he thinks they are angry with him.
The college helped Martyn find work experience in a small cafe within a care
home complex for the elderly, where he enjoyed preparing simple snacks in a
relaxed environment, working with two other people. Martyn is now applying for
full-time positions and is adamant he wants to work as a chef at Cedar Lodge
Hotel, a very busy city centre hotel.
Martyn likes routine and is very good at repeating the same task many times
over, to the same standard. He is very good at timekeeping and is well organised.
He is neat, tidy and likes to complete everything to a good standard; he takes
pride in tasks he carries out.
1. Why is a job as a chef in a busy hotel kitchen not necessarily the right
choice for Martyn?

2. Is there anything that could be done to help him achieve his preferred job?

3. Is there any other position in a hotel that might suit Martyn better?

4. How could you help Martyn explore other choices, to suit his personal
needs, rather than just his preferences?

Did you know?

Learners with autism often experience significant barriers in accessing further
education (FE). In a busy mainstream college, learners with autism need a
quiet area they can use when they feel anxious. Support staff need a good
understanding of autism so that they can respond appropriately to their needs.

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Working with individuals’ strengths and abilities to enable

them to achieve their full potential
Please read the following as it will help you to answer question 27.

Each individual with autism is unique and some of those on the autism spectrum
have exceptional or unusual abilities, skills and strengths. About 40% have average to
above average intellectual abilities. It has been estimated that 25% of individuals with
autism are non-verbal but learn to communicate using other means.
Realising that a student, for example, has a particular skill might create an
opportunity to form a connection with them or motivate them. They could be helped
to use their particular strength to overcome difficulties that they have in other areas.
Certain abilities and strengths mean that individuals are suited to particular types
of employment and could lead to job opportunities. It is important to be aware of
individuals’ skills and abilities in order to help them achieve their full potential.
Identifying individual strengths is the basis for moving
forward and supporting individuals with autism.

Some examples of strengths or special abilities that

individuals with autism may have include:
artistic ability
musical ability
excellent visual skills
good long-term memory
good memory for detail
good memory for rote facts (maths facts, statistics, train timetables etc.)
good ICT skills
ability to retain and understand concrete concepts, sequences, patterns and rules
good mathematical skills
problem-solving skills
an intense concentration or focus, particularly in a subject or activity they really like
good at spelling
honesty
loyalty
logic
little concern for what others think of them

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thinking outside the box and providing solutions others may not see
showing non-judgemental listening
direct communication
able to memorise incredible amounts of information
extreme adherence to rules and routines
attention to detail
Some of the above abilities and strengths can actually be seen as
problems or challenges when looked at from another perspective.

Think about these different perspectives:

Strengths or abilities Challenges
As Jeff does not see an emotional As Jeff lacks emotional connection with
viewpoint and sees everything in black others, he is not sympathetic towards
and white, he is very logical and helpful their problems and this often comes
with decision-making in situations where across as cold and unkind. This makes it
emotions of neurotypical people can get in difficult for people to form relationships
the way. He can see the problem clearly with him and he tends to be socially
and without any emotional connection. isolated, having few friends.
Janine is not concerned with what others As Janine is not concerned with what
think of her and doesn’t feel the need others think of her, she makes no effort
to be popular or try and win favour with to fit in socially and doesn’t make
anyone. This makes her good at her job, conversation with anyone. She often
which requires an independent approach comes across as rude and indifferent
showing no favouritism to any employee. and as a consequence ends up even
more isolated.
Altan has a particular interest in ICT Altan spends all his spare time on
and is very talented. He spends all this particular area of interest, at the
his spare time studying the area and expense of everything else. He has
working on new skills. He is doing well little knowledge of other subjects and
in ICT at school, getting good grades for is struggling as he only wants to spend
assignments and will do very well in the time on computer-related activities. He
final qualification. also has very little knowledge of everyday
practical situations, like preparing a meal
and self-care.

It is important to look at difficulties and challenges that individuals with autism have
and see if they can also act as strengths, which could be turned into qualifications,
college courses or jobs.

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‘Fulfilling and rewarding lives’ – the strategy for adults with autism in England – was
the government’s vision for transforming the lives of, and outcomes for, adults with
autism, which started in 2010 and was reviewed in 2013. Although the new strategy
‘Think Autism’ was published in 2014, it states that all the existing recommendations
and duties from the 2010 strategy still apply to local authorities and the NHS. These
recommendations mean that adults with autism:
are able to choose where they live
receive support to live independently
have the same rights as everyone else
are safe from discrimination and hate crime
have their health needs properly met
are able to have relationships and social networks
can live in a society where people understand and respect their differences, and
these differences are accommodated
have the same opportunities for education as everyone else
have a right to receive an assessment of need from social services
are able to receive support to get a job and stay in work

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Knowledge Activity 15: Think about the following skills and try to think of
a job that the individual would excel in:
Skill, strength or special ability Suitable jobs or roles
Maggie likes routine and structure, she
has excellent time-keeping and can stick
to tight schedules. She shows extreme
adherence to rules and schedules and
excellent attention to detail. She is very
good at repeating the same task over
and over again, to an identical standard.
Bingwen is very logical and able to
think outside the box; he has excellent
problem-solving skills and mathematical
skills. He has excellent memory for times,
schedules and number facts.
Enzo does not get involved with
emotional facts and thinks things
through logically and clearly. He is good
at listening to people without making a
judgement.

Did you know?

From statistics based on population samples, it is estimated that of those
individuals with autism:
85% are not in full-time employment
66% do not work at all
60% have to rely on their families for financial support
33% have no income at all
40% of children with autism suffer from bullying at school
70% of people with autism experience mental ill health in childhood
about 75% have no friends or have difficulty making friends
72% would like to spend more time in the company of other people
only 14% live independently

over 70% of those who do live independently have experienced bullying
or harassment

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The contribution of informal networks in supporting

individuals with autism and their families
Please read the following as it will help you to answer question 28.

Support for individuals and their families is very important in dealing with the
difficulties autism can pose. Support can be formal or informal.

Support

Formal Informal
Nursery or Preschool Grandparents

Early intervention centres Siblings

Medical centres/hospital Other family members

Schools Friends

Advocates Neighbours

Local and state government Colleagues

departments
Religious communities
Home support or respite care
Carers

Other professionals

Members of the public

Education programmes

The media and Internet

Autism support, representative

and rights organisations (eg.
Ambitious about Autism and
National Autistic Society)

Parent support groups

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Parents of children with autism rate family as one of their top three sources of
support. Friends and family are key elements in an informal support network. In
establishing an informal support network, it is important that people understand
what autism means and how it affects the individual and their behaviour. They need
the basic information about autism, but also about how best to communicate with
the individual, their likes and dislikes. People will react differently and some may
take longer than others to fully understand the situation, before they can really offer
support.

There are various ways people in informal support networks can help the individual
and their family, for example:

offering to go shopping with the family so they can help out with siblings if there is
any behaviour which others may find challenging

offering to babysit so that parents can have some time to rest, or spend with other
children who are not getting enough time or attention

simply being prepared to listen when either the individual or their family need
someone to talk to
cooking a meal or helping with jobs, just to provide a bit of respite for the family
joining in family activities to help out

accompanying parents to appointments or school reviews, just for some moral
support
taking a stressed and busy parent out for a coffee, just to give them a break

helping with special interests of the individual and helping to provide activities to
allow them to study and research what they are interested in

taking the individual out to improve their social life and encourage more contact
with others

Often, children can have a special relationship with their grandparents, who can be
an important and invaluable source of support. They can help support the child’s
development, providing both social and emotional support by spending time with them
and listening to their worries or special interests. They could attend therapy sessions
and parents’ evenings to learn more about their grandchild and what they need.
Grandparents are often a useful source of childcare and will look after children for a
day, or have them stay over, giving parents a much-needed rest. Some grandparents
will be able to help with household tasks or even with finances, for example extra
classes or expensive activities.

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Think about how the following support helps the individual or their family and how it
contributes to the quality of their life:
The situation Support
Jim has autism and displays behaviour Elsa, Rita’s sister, works part-time at the
that others may find challenging. He farm ten minutes away from Rita. She has
becomes anxious very easily and his some free time at weekends and evenings
parents, Rita and Lee, struggle to and she offers to take Jim twice a week to
cope with his behaviour once this the farm to spend time with the animals –
happens. His two siblings spend a lot Saturday afternoon and one evening a week.
of time entertaining themselves, while On Saturday afternoon, Lee takes the other
Rita and Lee spend time with Jim. Jim two children swimming and then shopping
loves animals, and while he is reading whilst Rita catches up on household chores,
about animals, watching them on TV and when they return they have a meal
or visiting places with animals, he is together. The children get more attention and
happy and is less anxious. Jim is calmer and happier when he returns
early evening.
Since his parents died, Naseefa has Naseefa’s brother and his wife live 15
been living on his own. He doesn’t minutes away and they have two teenage
like to communicate with people and children. Between them, they make sure
avoids shopping if he can, which leads that whenever there is a visit to Naseefa’s
to lack of food in the house and poor house due, they arrange a time when they
hygiene. He also becomes anxious if can be there with Naseefa, arriving before
anyone has to visit the house, such as the time to talk through what will happen in
to read the meter or service the boiler. order to reduce his stress.
They have a rota, and each visit Naseefa
once a week to take him to the shops to
help him overcome his difficulties talking to
other people. This ensures he has the food
and household goods needed to stay in good
health.
Gloria has a ten-year-old daughter, Alice and Les are a retired couple living a
April, who displays very difficult few doors away. Alice used to work in a
behaviour. Holding down a full-time bakery. The couple decide that to give Gloria
job and looking after April on her own some respite, Alice will have April at the
often leave her feeling exhausted. house three times a week to bake and help
April loves to bake and is very talented her develop her skills. One of the evenings,
in the kitchen; she is very precise Les will drive Gloria to the large supermarket
and artistic and can make some very in town to allow her to do her weekly
complex cakes. Gloria rarely has time shop without the stress of behaviour that
to spend baking with April and really challenges from April. This leaves Gloria with
struggles with the behaviour that a couple of nights free, one for catching up
results when she is bored or isn’t with jobs at home and the other to go out
allowed to do what she wants. and meet a friend for a break and a chat.
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Did you know?

The National Autistic Society offers advice and support groups for the families
of individuals with autism, including grandparents, as it can be helpful to speak to
other grandparents who are in the same position. The organisation feels that it is
useful to seek support from others and read personal accounts written by those
with autism or their families. They also state that it is important to see things from
the individual’s perspective.

Knowledge Activity 16: Think about how informal support could help the
following people:
1. David has two sons – Daniel, who has autism, and Matthew, who is
neurotypical. He frequently has to go to pick Daniel up at school if there
has been a problem and he is distressed. This makes it difficult for him
to pick up Matthew from primary school. He also struggles to get to the
shops, especially if he has Daniel with him.

2. Anais is a single mother who doesn’t work and she is at home all the
time with her three-year-old son who has autism. She struggles with his
demanding behaviour and feels very isolated.

3. Millie has a teenage daughter, Abbie, who is studying for her GCSEs,
and also seven-year-old Adam who has autism. He is very noisy and is
obsessed with fire engine, ambulance and police sirens and mimics these
sounds constantly. Abbie is becoming more and more stressed that she
cannot get any peace and quiet for studying, and this is putting tension on
the relationship between Millie and Abbie.

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The importance of working in partnership with the

individual and others
Please read the following as it will help you to answer question 29.

It is important for community professionals to develop understanding and competency,

working with a range of agencies so that they can respond appropriately to the needs
of individuals with autism and their families and carers. Areas with professionals
working in partnership with the individual and others include:

health service practitioners (for example, GPs, psychiatric nurses and occupational
therapists)
social care (for example, social workers, community teams and assessors)

further education (for example, lecturers, learning mentors and learning support
staff)

employment (for example, disability employment advisors, careers advisors,
employers)
the criminal justice system (for example, police officers and prison officers)

It is important to work in partnership with the individual, as this is all part of a person-
centred approach and recognising those with autism as individuals. This is essential in
finding out what they need, want and prefer; for example, what type of healthcare they
want or what sort of living accommodation or arrangements they prefer.
In recognising what an individual needs, wants and prefers, it is important to keep in
mind informed consent and capacity of mind.

As well as working closely with the individuals themselves, it will often be necessary to
liaise with a wide range of other people, such as:
• family
• carers
• friends
• healthcare professionals
• care workers
• advocates
• social workers

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It is important to work in partnership with these other people, as it can:


help in developing ideas, such as appropriate ways of dealing with situations, or
how to provide the necessary services
 useful to share skills and knowledge; for example, schools may need the expert
be
knowledge and assessment from a child psychologist

help to share resources between different organisations; for example, one school in
an area may be able to provide suitable space and activities for an afternoon each
week for children with autism from surrounding schools
help to develop relationships with different audiences

help to add another dimension; a professional from a different field may be able to
complement the work of another
enable people to share their experiences and difficulties and talk through strategies
for dealing with issues such as behaviour that challenges

provide a venue; if a physical venue is needed, another organisation may be able
to provide it, and may be able to help with hosting the event - such as a local clinic
providing a room to host support meetings for families and carers

provide an essential insight into a certain area, as other professionals may have
certain skills and expertise that others lack

help in reaching new audiences; for example, an organisation wanting to promote
positive images of autism may benefit from other organisations that already have
access to target audiences

help reach more people; for example, contacts with other organisations such as
schools, colleges and support groups could help a health centre organise and run
a larger event

help to strengthen relationships by introducing them to new people, new ideas and
new support contacts

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Difficulties faced by adults with autism when there is a lack of

partnership with frontline services

Many adults with autism face difficulties when dealing with staff from services such as
healthcare and benefits advisors, as there is a lack of understanding of the condition.
Many staff acknowledge that their understanding of autism is limited, and this means
that they might not communicate in an appropriate way and fail to adapt their own
behaviour or the services offered to meet the needs of adults with autism. Through
agencies working together and the provision of autism awareness training, adults
with autism will have more chance of receiving the care, support and services they
need. Many adults with autism have lost trust in public services, and a barrier to them
accessing what they need has been created. Some examples of the problems that
may occur are:
employment advisors recommending only a certain type of job, as they feel they
are unsuitable for the type of job they have expressed an interest in
staff refusing to deal with adults with autism, as they think they are just being
deliberately rude and difficult
a patient with autism being treated under general anaesthetic to treat simple
conditions, because they won’t keep still
police officers and others in the criminal justice system being ‘heavy-handed’ in
their response to adults with autism, as they do not understand their problems with
communication
a social worker referring an adult with autism to the wrong type of support group,
as they do not have enough understanding of the exact condition
Staff in these services can gain a better understanding of autism by working in
partnership with other agencies. This can help them to realise the difficulties faced
by individuals and know how to adapt their communication, services and facilities in
order to ensure the adults with autism receive the services they are entitled to

Did you know?

Almost half of adults with autism over the age of 25 still live in the family home,
and more than half are dependent on their parents for financial support. This
is a cause of concern for many family carers because they worry about who
will look after their dependents in the future. Many adults with autism are not
able to access the specialist support they need to enable them to live more
independently.

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The principles of confidentiality when supporting

individuals with autism
Please read the following as it will help you to answer question 30.

Confidentiality is an important issue and any organisation that deals with individuals
with autism must, in most cases, maintain confidentiality. There are some situations
where this may not be possible, which may cause a dilemma for healthcare and other
professionals.
An individual has a right to privacy, and needs to feel trust and confidence in any
organisation they deal with. The individual has the right to expect that any information
given to an organisation will only be used for the purpose that it was given and
shouldn’t be passed on to any other organisation without their consent.
Anything that is said to a health professional should be regarded as confidential,
as should any discussions about individuals that take place in meetings.
All records kept about individuals are confidential and must comply with the General
Data Protection Regulation. Records can only be passed on to another organisation
with the individual’s consent and all records should be kept locked up, or on a
computer system with limited access.
If an individual is being referred to another organisation, they should give permission
for the referral and for their information to be shared with the referral agency.

The General Data Protection Regulation (GDPR) is European legislation that works
alongside the UK’s data protection legislation.
The GDPR sets out six main principles. These are that personal data is:
• processed lawfully, fairly and in a transparent manner in relation to individuals
• collected for specified, explicit and legitimate purposes
• adequate, relevant and limited to what is necessary
• accurate and up to date
• kept in a form which permits identification of individuals for no longer than is
necessary
• processed in a manner that ensures appropriate security of the personal data

(From Article 5 of the GDPR. Further information on GDPR can be found on the
Information Commissioner’s Office website at www.ico.org.uk)

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There are certain situations where a health professional may feel that maintaining
confidentiality is a problem; for example, if it means putting life at risk or being privy
to criminal behaviour. If this situation arises, the following process should be followed:

If the professional feels that there is a problem in

maintaining confidentiality, he/she should in the
first instance discuss it with the individual to see if
it can be resolved

If the situation can’t be resolved, the professional

should discuss it with their line manager

In rare cases, the line manager may decide that

confidentiality needs to be broken

The situation should be discussed with the

individual and they should be kept informed at each
stage of what is happening

Each organisation will have a policy in place covering confidentiality and data
protection and set procedures that staff have to follow. All staff must be fully aware
of the organisation’s policies and procedures.
The following points are important to maintain confidentiality and data protection:

Policies and procedures must be in place within all organisations dealing with
individuals with autism.

The staff must be made aware of these policies and procedures and know exactly
how to implement them; regular training and information sharing is needed to
maintain this.

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The individual must be informed of how their details will be stored.


The individual must be informed of whether any of the information they provide
will be shared with anyone outside the organisation, or whether it may be used for
statistical information.

The professional or advisor needs to be clear if a client does not want their
information to be shared.

The professional/advisor must keep information given confidential; individuals
should be aware of this.

Professionals/advisors should reassure clients during interactions that anything
discussed will remain confidential (this applies unless there is a concern about the
client’s safety).
If there is a breach of confidentiality, the individual’s trust will be lost and could
result in the organisation being taken to court, as breaching confidentiality and data
protection is against the law.
There are certain situations where confidentiality may be broken, for example in the
case of child protection.

Did you know?

Under the General Data Protection Regulation, health data is considered to be
‘special category data’ because it is very personal data. Whilst there is provision
for this more sensitive data to be shared (with consent) for the provision of
healthcare, organisations must be careful about sharing data for other reasons
without a proper lawful basis. The Information Commissioner’s Office (ICO) can
take criminal action against organisations that fail to comply.

Summary

In this section, you have learned about:

the legislation and guidance to support individuals with autism
how individuals can be supported
how the rights of individuals with autism can be promoted
how to incorporate the preferences and needs of individuals when providing support
the importance of working with an individual’s strengths and abilities
how informal networks can provide support for individuals and their families

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individuals with autism

In this section, you will learn about the process required to communicate, and
how speech and language development may be delayed or affected in people
with autism. You will look at different forms of communication and the difficulties
faced in communicating verbally. You will also learn about how social development
may be affected and the difficulties those with autism face in social interaction.
You will consider the links between social development and speech and language
development, and how both can be supported.

The processes required to communicate

Please read the following as it will help you to answer question 31.

Being able to communicate is the most important skill needed in life. Almost everything
we do involves communication:
• everyday tasks such as ordering food and drink
• buying goods and services
• getting the care we need
• getting from place to place
• learning at school
• sorting out problems
• making friends
• having fun

Communication involves a number of key processes, including:

• cognitive: the interpretation and processing of language
• social: the use of language to connect with others
• physical: the mechanics or articulation of speech

‘Cognitive learning’ is a system of mental responses that helps learning and makes
learning quicker through memory. Ineffective processes can result in learning difficulties
that can manifest in speech and language problems. These processes rely on positive
personal factors, appropriate behaviour and a supportive environment. Learning can
be affected by previous experience and how the individual has been supported. These
factors can also affect the development of speech and language.

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Speech and language skills are essential to academic success and learning. Language
is the basis of communication, and learning takes place through the process of
communication. The ability to communicate with peers and adults in the educational
setting is essential for a student to succeed in school, and this continues throughout
life, also impacting upon employment. Some theories suggest that the ability to
communicate is what makes us human. Communication is much more than academic
and career success; it is central to our ‘being’.
Reading, writing, gesturing, listening and speaking are all forms of language.
Children with communication disorders often do not perform as well as others who
can communicate effectively. They are more likely to:
have difficulty reading
struggle to understand and express language
misunderstand social cues
avoid attending school
have difficulty with tests and exams

Speech

Speech production is the process by which:

Spoken words are selected to

be produced

Phonetics are formulated

Words are articulated by the motor

system in the vocal apparatus

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Speech production can be spontaneous, where an individual forms the words of a

conversation; or reactive, where they name a picture, read aloud, or carry out vocal
imitation, such as in speech repetition.
Speech production is not the same as language production, as language doesn’t have
to be vocal; it could be made up from signs or symbols, for example.

Language

Language is the basis of communication. Forms of language include:

reading
writing
listening
speaking
gesturing

Problems in language development can lead to difficulty in learning to listen, speak,

read or write. Problems can occur in the production, comprehension and awareness
of language sounds, syllables, words, sentences and conversation. Individuals with
reading and writing problems may also have trouble using language to communicate,
think and learn.
Receptive language means understanding words and sentences that are used.
As children develop, their ability to understand the language that they experience
also develops.
Receptive language development is the foundation for all language and
communication skills.

Supporting receptive language skills:

get the attention of the individual you are speaking to first, before asking a
question or giving information
begin an instruction by using the individual’s name
keep instructions or information short
don’t use complex verbal instructions or information; keep it short and simple
use positive instructions and minimise the use of ‘don’t’ and ‘stop’ – let the
individual know exactly what you want them to do
provide ‘waiting time’, wait for a response and don’t immediately repeat the
instruction or question

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Expressive language is the use of words and sentences in agreed structures and
forms. This also develops in stages: children become increasingly able to use their
language and communication to convey their own thoughts, feelings and needs. When
they are older, most children will be able to fully express themselves and make their
needs and feelings understood.

Did you know?

A study has shown that severe language delays early in the life of a child with
autism can be overcome, especially if the child exhibits non-verbal intelligence.
The study looked at speech delays in children with autism and found that 70%
of children who were unable to string words together to form even very simple
phrases by the age of 4 went on to do so by the age of 8. Some even achieved
fluent speech.

How speech and language development may be delayed

or affected
Please read the following as it will help you to answer question 32.

Not every individual with autism will have a speech and language problem, and
communication skills vary from person to person, depending on their social
development and their intellectual ability. The word ‘autism’ comes from the Greek
word ‘autos’, meaning ‘self’. Often, those with autism are self-absorbed and appear
to be in a world of their own, being unable to communicate and interact successfully
with others. Individuals with autism often have difficulty developing language
skills and understanding what others say to them. They may also have difficulties
communicating non-verbally such as:
making eye contact
use of facial expressions
hand gestures
body language
varying their vocal tones

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Here are some patterns of language use often found in individuals with an autistic
spectrum condition:
Rigid or repetitive language

Often, individuals with autism say things in a conversation that have no meaning or
are out of context. For example, some individuals repeat words that they have heard
over and over again, a condition known as echolalia.

Echolalia

Immediate Delayed
echolalia echolalia

The individual repeats The individual repeats

words someone has just words heard at an
said to them earlier time

Some individuals speak in an unusual way, for example:

using robotic-like speech
using a high-pitched voice
using a sing-song voice
using a strange accent
always starting off a conversation with the same phrase

Uneven language development

As children, many people with autism do develop some language skills, but not to
a normal level and progress tends to be uneven. Some have an especially strong
vocabulary in an area of special interest and develop this very quickly. Some are able
to read words quite early on but don’t actually understand what they are reading.
Many don’t respond to the speech of others and often don’t respond when their own
name is called.

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Narrow interests

As some children develop areas of special interest, they may be able to deliver
in-depth monologues about that topic, but may not be able to hold a two-way
conversation about it.

Did you know?

There is evidence from several studies carried out that there is a link between
Speech Language and Communication Needs (SLCN) and emotional and
behavioural problems. It has been shown that children with an early diagnosis
of language or communication difficulties are more likely to have behavioural
difficulties than those without problems. These problems can increase with age.
Studies investigating children with identified behaviour difficulties found that 75%
of them had significant language difficulties.

Different forms of communication used by individuals

with autism
Please read the following as it will help you to answer question 33.

Communication is all about people exchanging messages, and for communication to

be successful people must be able to understand the meaning of these messages
and take part themselves.
Some individuals with autism will be able to use and understand verbal
communication, whilst others may be able to repeat set words and phrases but not
understand them (known as echolalia) and some individuals may be completely
non-verbal. For individuals who have difficulties with speech, have limited speech,
or physically can’t speak, communication can be very challenging, and other ways
of communicating have to be used. However, for individuals who have difficulty with
using speech, other ways to communicate could include signing, use of symbols,
gestures, written communication and Voice Ouput Communication Aids (VOCAs).
One term used when defining what kinds of additional help some children and
young people need is Augmentative and Alternative Communication (AAC). This is
used to describe the different ways of communicating, either to support speaking
(augmentative) or instead of speaking (alternative).

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There are two main types of AAC system:

Unaided communication Aided communication
Unaided communication means methods Aided communication can be ‘low-tech’
that don’t use additional equipment. or ‘high-tech’ and refers to methods
They use what the individual already has which involve additional equipment, such
available to them – their hands, body as a picture or symbol chart or book, a
and face. These methods include body talking computer or a VOCA.
language and facial expression, pointing
and signing.
High-tech aids need batteries to work and cover a variety of AAC systems. These
make use of whatever physical movement the user can control, which could be their
hands, feet, head or eyes. High-tech aids allow the individual to make choices and
create messages using pictures, symbols, words or letters that can be linked to an
electronic voice.
Low-tech aids are those that don’t need batteries to work, such as picture or symbol
books or boards.

Use of symbols for communication support

Symbols are all around us, such as road signs which help us drive safely, food labels
to help us choose what to eat and on computers and mobile phones to help us select
the programme we want to use. Symbols can also be used by people who find speech
difficult, to help them communicate effectively.
Symbols that help individuals to communicate can:
be arranged on communication boards
be displayed on a computer screen
be found in communication books

The individual can choose the symbol they need to indicate what they want to
communicate. Sometimes a symbol has the word written underneath it, which
helps if the ‘listener’ is not familiar with all the symbols. There are many different
symbol systems in use around the UK, but they all aim to support an individual’s
communication using picture format.
As each symbol system has different features, it is important to choose the right
one for the user.

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Think what these symbols could be used to show:

Knowledge Activity 17: Symbols are all around us and we come across lots
every day. Give an example for each of the following to show how symbols
are used and why they are important:
Situation How the symbol is used Why the symbol is important
When buying or
choosing food

When driving
or cycling

When using a
mobile phone
or electrical
appliance

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Signing

Signing is when individuals use their hands to make different hand movements,
facial expressions and space to communicate. It can help some individuals
understand what is being said to them. Signing can be used alongside or instead of
speech.

For this to be effective, everyone has to learn what signs mean and learn to make
signs themselves. There are different signing systems used in the UK; below is an
example of some of the signs used in British Sign Language.

Hello Goodbye Morning

Afternoon Night Thanks/Please

How are you? Good

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Body language and facial expressions

Many people add meaning to what they are saying through using body language and
facial expressions such as:
smiling
frowning
raising their eyebrows
winking
shaking or nodding their head
gestures like waving goodbye

For individuals who find speech difficult or have limited or no speech, facial expression
and gestures can be a very important way to help them get their message across to
others.
Some individuals with physical impairments can find facial expression and gestures
difficult and may have their own unique ways to express what they say; for example,
‘no’ might be looking down, whilst looking up will represent ‘yes’. In individuals without
language and learning disability, behaviour can be the main form of communication;
for example, an adult hitting their head when distressed or in pain, or a child starting
to pinch themselves when they become bored.
The listener needs to take time to find out what the individual’s preferred method is,
and also be consistent with the method they use.

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Knowledge Activity 18: We all use different ways of communicating to help

support messages we want to get across to others.
Think about a symbol or gesture that might be used in the following situations:
1. Trying to see if someone wants a drink while in a very noisy environment

2. Giving someone directions in the street

3. Trying to get the bill in a busy restaurant

4. Asking if someone is OK

Written messages

Providing the individual can spell, the use of the alphabet in a chart
or keyboard can be useful in helping them to communicate. They
can spell out messages for others to read using pen and paper,
a laptop, keyboard or mobile phone.

Voice Output Communication Aids (VOCAs)

VOCAs include a wide range of devices that are designed to help individuals who are
unable to speak. A VOCA produces spoken words to help the user get their message
across to others. Some devices store words or phrases which allow the user to put
messages together which are then spoken out by the device. There are many different
types of VOCAs available so it is important to seek independent professional advice to
ensure that the individual gets the right device to meet their needs.

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Difficulties faced by individuals with autism in

communicating verbally
Please read the following as it will help you to answer question 34.

Some people with autism never develop verbal language skills and have to use
gestured communication, such as sign language. Others may be able to communicate
using symbols, where pictures are used to help the individual communicate their
thoughts and feelings.

Processing verbal information

When an individual struggles to make sense of information taken in, it is sometimes

referred to as an auditory processing disorder. This is different to a hearing problem,
as it does not mean they are hard of hearing. Difficulties with auditory processing do
not affect what is heard by the ear, but rather how the information is interpreted, or
processed by the brain. Difficulties can occur when the individual tries to process a
sound, either to hear and understand the signal or when trying to form a response.
An auditory processing disorder can interfere with speech and language. It can affect
all areas of learning, especially reading and spelling. As a lot of learning in schools
and colleges relies on being able to process verbal information, individuals who
struggle to process information can have serious problems understanding lessons and
therefore progressing. This has a knock-on effect throughout their life, including their
chances of employment.

Individuals may have problems with:

Auditory discrimination – the ability to recognise differences in sounds, such as the
ability to identify words and sounds that are similar and those which are different.
Auditory memory – the ability to store and recall information which is given verbally,
meaning an individual may not be able to follow instructions given verbally or may
struggle to recall information given out verbally.
Auditory sequencing – the ability to remember or reconstruct the order of items in a
list, or the order of sounds in a word or syllable, meaning the individual may struggle
to spell words as the letters may be in the wrong order.
Auditory blending – the process of putting together sounds to form words.
Phonological awareness – the understanding that language is made up of individual
sounds which are put together to form the words we write and speak, meaning the
individual may have difficulty reading, writing and understanding spoken words.

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Signs of information processing difficulties in children:

having problems ‘holding’ information
slow to follow verbal instructions
needing things repeating
misunderstanding instructions
completely missing instructions
failing to remember instructions
often feeling overloaded with class or homework tasks
may be slow copying information
having problems knowing where to start a task, appearing disorganised
failing to respond appropriately to quick verbal exchanges and conversations, and
therefore struggling to form relationships with peers

Interpreting verbal information

Individuals with autism can struggle to interpret verbal communication because:

they often have a very literal understanding of language
they often don’t understand jokes or sarcasm
they can struggle with inferred meaning
they can have difficulty in taking a turn in a conversation
they don’t fully understand and use volume, intonation, tone and pitch
they often have very repetitive conversations
conversations may be based mainly around their own special interest
they may have conversations out of context

Quite often, an individual with autism can take up to ten seconds or more to process
one comment made to them, or an instruction given. When communicating with
them, people need to think about the time needed for a response, and may need
to repeat the question or instruction or even rephrase it. Visual cues can be used to
provide additional support, which will aid understanding and provide processing time
after the words have been spoken.

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It is important to help individuals communicate as it:

Helps people
live an
independent
Enables
Helps life
people to
people gain
express their
employment
feelings

Enables Enables
people to be
The importance people
involved in
to ask
decisions about of providing questions
their future
support for
communication
difficulties
Enables Enables
people to people
participate in
school and to say what
play they need

Helps
people develop Helps people
relationships feel good about
with familiy and themselves
friends

Did you know?

Children with autism may experience one or more of the following areas of difficulty:
Speech sound disorders – difficulty in pronouncing sounds.
L anguage disorders – difficulty in understanding what they hear and difficulty
expressing themselves using words.
Cognitive-communication disorders – difficulty with perception, memory,
awareness, reasoning, judgement, intellect and imagination.
Stuttering disorders – interruption of the flow of speech including hesitation,
repetition or prolongation of sounds and words.
Voice disorders – where volume is too loud or too soft.

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Think about how the following comments could cause confusion to an individual with
autism, and how this could also impact on them socially and make it difficult to take
part in conversations.

I have my doubts I’m staying

I don’t want you
about whether there single in future;
having anything
will be a wedding; I think I’ve had my
else to do with
he’s getting cold feet. heart broken.
him; he’s a
shady character.
Wow, that’s
really cool! Don’t shoot the
Let’s not get messenger; it’s nothing
involved in any to do with me! I was
I’ve had a hard day mud-slinging! just told to pass the
at work today; it’s
message on.
been like flogging
a dead horse.

Knowledge Activity 19: Matthew is 15 years old and studying his GCSEs at
school. He is studying Food and Nutrition and carries out practical work every
week. Matthew rarely speaks, especially in front of groups of people. When the
teacher takes the register, she asks each member of the class to state what they
are making, along with with their reasons for the choice, and the safety rules
they need to follow. Matthew won’t join in, and the teacher feels that this could
be dangerous in a practical situation, as she can’t check what he is doing and
whether he understands the safety rules.
What could be done to help Matthew communicate the information the teacher
wants, without him becoming anxious?

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How social development may be delayed or affected

Please read the following as it will help you to answer question 35.

Typically, babies are very social and show this early in life in their reactions to people.
Consider the differences in neurotypical and neurodiverse infants:
Neurotypical infants: Neurodiverse infants:
gaze at people, making eye contact do not show interest in faces
smile seem indifferent to people
grasp at fingers, faces and hair lack eye contact
some appear very calm and cry less as
they don’t seek attention from parents

Lack of empathy

Individuals with autism lack the ability to see things from another person’s
perspective. A typical five-year-old shows an insight into other people’s feelings and
intentions based on cues such as gestures and facial expressions. They often lack
these interpretation skills, leaving them unable to predict or understand other people’s
actions or intentions.

Autism, friendships and affection

Many children with autism experience social exclusion during their school-age years,
seeming not to ‘fit in’. As a response to this, some invent imaginary friends, worlds or
scenarios. Making friends in real life and maintaining friendships often proves to be
very difficult for individuals with autism.
They often seem to prefer being alone and may either resist attention altogether or
just passively accept hugs and cuddling without reciprocation. Some children rarely
look for comfort from others, or respond to parents’ displays of anger or affection in a
non-typical way.

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Difficulties with social interaction

Please read the following as it will help you to answer question 36.

Individuals with autism find it difficult to interact with others socially. They often do not
make eye contact and tend not to look at people, and they may be socially inhibited
and seem disinterested in the social world. Even when they do focus on people, they
have difficulty interpreting what they see and hear. For this reason, many individuals
with autism experience social isolation and have difficulty making and keeping friends.
Often they do not respond to non-verbal communication such as body language,
gestures and facial expressions, which makes it difficult to get on with other people.
They can find it difficult to understand and express their needs, as they are often
unable to interpret and understand the needs of others, making it difficult to share
interests and activities with people. Some, who have delayed speech and struggle to
communicate, may withdraw into repetitive play on their own and avoid interaction.
This then continues into adulthood, leading to social isolation.

Some problems individuals may have with social interaction include:

• low rates of social initiation among peers
• low rate of response to others
• showing little non-verbal communication
• gesturing and emotional expression are often absent
• paying less attention to others’ emotional displays
• showing less empathy or shared emotion
• difficulties with social imagination (e.g. struggling to join in with imaginative
games and seeing things very literally

The difficulties individuals face with social interaction can be seen in a variety of ways:
• difficulties making friends
• difficulties maintaining friendships and relationships
• limited use of non-verbal communication
• lack of shared enjoyment or activities with others

As many individuals with autism have behaviour difficulties, this can often prevent
them from becoming involved socially with other people, and they may be excluded
from activities because of this. It is common for children with autism to:
• struggle to regulate their behaviour
• cry and have verbal outbursts
• adopt self-injurious behaviour which seems inappropriate and without cause
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• prefer consistent routines and environments

• react negatively to changes in their surroundings
Some individuals can gradually learn to control their behaviour and cope with difficult
situations, such as life changes, in other ways. This will require education and training
to enable them to make these changes.
Previous experiences can also affect social development and can affect emotional
coping, behaviour and practising skills.

Did you know?

A study by Sigman and her colleagues found that children with autism were less
responsive to adults who pretended to injure themselves. They spent less time
looking at the injured adult and were rated as showing less empathy than either
typically developing children or children with Down’s syndrome. Sigman concluded
from the study that children with autism show a lack of social attention.

Knowledge Activity 20: Think about the information above, about the social
difficulties faced by individuals with autism, and the facts below.
Only 15% of adults with autism in the UK are in full-time paid employment,
and only 9% are in part-time employment.
26% of graduates with autism are unemployed; this is the highest rate of any
disability group.
37% of adults with autism have never had a paid job.
1. Suggest at least two reasons why people with autism may struggle to
gain employment.

2. Suggest two reasons why people with autism might struggle to hold down
a job.

3. What could be done in the workplace to help individuals with autism to ‘fit
in’?

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The links between social development and speech and

language development
Please read the following as it will help you to answer question 37.

Studies into typically developing children show a link between social development and
speech and language development. Once a child starts to explore their environment,
they are exposed to new stimuli, which can enhance their language development. A
child needs to be interested in socialising and communicating with others in order
to be an effective communicator. Therefore, difficulties with social interaction can
seriously hinder the development of language.
The development of language is very important for socialisation as it allows a child to
communicate with other people and it also allows adults to reason with the child and
make it clear what type of behaviour is expected. Children start to feel less frustrated
when their language develops, as they can ask for things and explain how they
feel. Therefore, if language development is delayed there are more difficulties with
behaviour and social problems.

Did you know?

Research has shown that good communication skills are often described as an
essential characteristic in job specifications, even though the role may not require
the applicant to communicate. This makes job applications and interviews very
challenging for many individuals with autism and often discourages them from
applying for jobs.

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Methods that can be used when communicating with an

individual with autism
Please read the following as it will help you to answer question 38.

Many people find it difficult to communicate and interact with individuals with autism,
and most people with autism will have problems interacting with others. Communication
does not have to involve spoken language, and other forms of communication need
to be established. To choose a suitable method of communication, it is important to
look at how a child communicates, looking at their strengths, and if they don’t use any
speech then gestures could be successful.
Some individuals with autism use echolalia, which is the repetition of other people’s
words. When a child uses echolalia, it can indicate that they do not understand
the word, but it is a positive sign as this can suggest an interest in communication.
Echolalia can also be pleasing for the individual, either in literal terms of enjoying
the way it sounds or feels, or because it makes the individual feel safe.
Communicating successfully with individuals with autism relies on knowing how they
communicate and why they communicate. There are two main types of communication:

Communication

Pre-intentional communication
This is when the individual says Intentional communication
something without intending This is when the individual says
to, or without having any effect something to give a message
on other people. An example to someone else, for example
is a child crying as a result of asking for something or
hunger, but not intending to ask protesting about something.
an adult for food.

It can be very difficult for individuals to make the step from pre-intentional
communication to intentional communication, because they need to realise that their
actions do have an effect on others, and they are often socially unaware.
There is a wide variation in terms of intentional communication; less able individuals
may communicate only to get the things they want, or to get things they don’t want
removed, whilst others communicate for other reasons, such as asking questions,
making comments or observations, or to be sociable.

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When choosing a method to communicate with an individual with autism, people

can consider:

Written
messages

Signing Gestures

Forms of
communication
Body
Symbols
language

Use of Facial
pictures expression

There are various ways to support communication and encourage individuals to

communicate with others:
use the person’s name at the start of a conversation so they know you are talking
to them
use their special interest to engage them and motivate them to take part
make sure they are paying attention before speaking to them
provide time for them to respond, as it takes longer for someone with autism to
process the information
use visual supports like symbols and pictures to help them process what is being
said to them more easily
speak clearly and use short sentences; if too much
information is given, they can be overloaded and unable
to take in any more information
when possible, avoid questions such as ‘why’, ‘where’
and ‘when’, as they can be difficult to cope with
keep questions short

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only ask necessary questions to reduce the decision-making needed

ask specific questions, and don’t ask open-ended questions; it may also be a good
idea to provide options rather than expecting them to think of options themselves
consider the environment carefully, as it can affect the amount of information they
can take in, such as a very noisy or crowded place
use role play to show them appropriate social interaction
expand on what they say; for example, if they say ‘cat’, reply ‘yes, a black cat’

In a group setting, it is important that teachers, teaching assistants and other

professionals consider effective communication:
consider how activities are presented
take account of each child’s unique needs
think about the size of a group – too large a group may not be good for children
who struggle to concentrate and pay attention
check that the child can hear
enable the child to see the book being read at story time
check that the child is paying attention
check that they are not being distracted by others
provide a quiet environment for good listening, not where furniture is being moved
or dinner plates are being cleared up for example
choose a suitable story, not one that is too complicated

Did you know?

There is a great variation in the age and rate at which children acquire spoken
language. Generally, a child would be expected to have said their first words by
around the age of 18 months, and if a child has not spoken by this time, most
health boards would suggest referral to speech and language therapy. The majority
of ‘late talking’ children go on to develop age-appropriate language skills without
specialist help. As a general rule, children who have still not attempted to use
spoken language after the age of two should be considered for referral to speech
and language therapy. Time should be allowed for children to settle into new
settings such as pre-school, so that they can develop the confidence needed to
demonstrate their skills.

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Knowledge Activity 21: Think about communicating with an individual who

becomes very anxious about new events or situations. What events do you
think the following symbols are preparing the individual for?
1.

2.

3.

Strategies used to support communication and social

interaction
Please read the following as it will help you to answer question 39.

It is important to remember the triad of impairments that we saw in section 1 when

thinking about how to support communication and social interaction, as these three
areas of impairment will affect how the individual communicates, on a one-to-one
basis and socially.

Individuals with autism will experience difficulties in:

Social interaction – difficulties with social relationships; for example, they may
appear aloof and indifferent to others.
Social communication – difficulties with verbal and non-verbal communication;
for example, they may not fully understand the meaning of common gestures,
facial expressions or tone of voice.
Social imagination – difficulty in the development of interpersonal play and
imagination; for example, they often have a limited range of imaginative activities,
copy play or pursue activities rigidly and repetitively.

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individuals with autism

Children with autism can learn these skills, but will need specific teaching, as they
often find it difficult to learn by watching their peers and tend to miss opportunities
to practise their social and communication skills. Situations and social skills often
need breaking down and explaining, and time needs to be allowed to practise these
skills. The time spent practising will allow them to understand the situation and
absorb the information at their own rate. A suitable time needs to be found to teach
skills; sometimes it may be appropriate to teach skills as the opportunity comes
along, whilst for others it may be more effective to choose a set, weekly routine. It is
important not to choose periods of high stress, and to make sure the individual knows
what is going to happen during the session. It also needs to be a suitable time of day
when you have the individual’s attention, not when they want to be somewhere else
or taking part in an activity or watching a favourite TV programme.
Even if an individual with autism learns appropriate responses in a particular situation,
they will need support to transfer these skills to other situations, no matter how
similar. Teaching opportunities therefore should be as naturalistic as possible.

Individuals may need support to develop the following skills:

Conversation Understanding Friendship Dealing with Play skills
skills emotions skills conflict
greeting reading facial knowing what anger observational
people expressions a friend is management skills
joining in a reading body choosing self-regulation sharing
conversation language appropriate being self- joining in play
listening skills being aware friends assertive taking turns
ending a of own body recognising ability to ask compromising
conversation language true friends for help conflict
taking turns being aware ability to ability to walk resolution
in a of own voice share a away from
– voice friend coping with
conversation stressful ‘no’
talking about intonation, ability to deal situations
pitch, speed, with peer dealing with
set topics not being losing
body language, pressure aggressive
giving people having a large reciprocal play
personal emotional dealing with
space bullying ending play
vocabulary
e.g. not just
happy/sad
anger
management
and self-
regulation skills)

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In typically developing children, the skills just mentioned will start to develop early on
and continue developing over a number of years. They generally happen without much
direct teaching, as they begin to explore the environment and use trial and error to work
things out. Usually, by watching other children, they try to imitate them and join in with
play and social interactions. Children with autism do not appear to develop these skills
naturally, and their difficulties can then continue into adolescence and adulthood.
The following strategies can be useful in supporting communication and social
interaction:
Social stories™

Social stories are a trademarked term owned by Carol Gray, an Australian speech and
language therapist. They are short stories about a particular event or situation which
help the individual know what to expect from a certain situation. They are useful in
helping them cope with transition and change in their life or events coming up that
they might find stressful. The story prepares them and shows them what to expect
and helps to reduce anxiety. They can also be used to explain how other people
may behave or respond to certain situations or how to control their behaviour. Using
social stories can help to provide more structure for the individual and will therefore
reduce anxiety. Social stories can also be illustrated, which is useful because many
individuals with autism like visual aids.

Picture Exchange Communication System (PECS)

This is a system of augmentative communication (to support speaking) and alternative

communication (instead of speaking) often used with children with autism. It uses
picture symbols to aid speech development.

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Comic strip conversations

This is the use of visual representations like symbols and stick figure drawings in
different colours. It helps the individual to see different elements of a conversation
visually and makes concepts easier to understand.

Comic strip conversation Compliment conversation

TEACCH

This is a system that helps to prepare individuals with autism to live or work more
effectively at home, at school and in the community. The emphasis is on helping
people with autism and their families live together more effectively by reducing or
removing ‘autistic behaviours’.
It stands for Treatment and Education of Autistic and related Communication
handicapped Children, and it aims to:
encourage parents to work with professionals so that the techniques taught can be
continued at home
improve individuals’ skills through education and by modifying the environment
provide individualised treatment based on an assessment of the individual’s abilities
identify skills and focus on them to enhance skills
provide structured teaching, as children with autism often benefit from a more
structured environment
provide generalist training for professionals who work with individuals, who
understand the whole person, rather than specialists such as speech therapists
and psychologists who only focus on certain areas

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Makaton

This is a language programme that uses signs and symbols to support speech and
help individuals to communicate.

Music cues

Music therapy can help people who don’t communicate or interact well. New skills
can be paired with a musical cue; once the skill is learned, the person no longer
needs the music cue.

Arranging social activities

As individuals with autism can find it difficult to make and maintain friendships. It is
important to provide support in finding social activities and situations that they can
participate in and help them to practise preparing for it. This could be local community
resources, like a local chess or gardening club, or a specially organised social group
for people with autism. Many areas have their own social groups to support those with
autism to engage more socially, for example arranging day trips where individuals have
to communicate or group/team activities like bowling or quiz nights.

Use of technology

Speech generating devices to replace speech are available, along with some other
forms of technology, such as headphones to cancel out noise and games to help
children improve communication and skills.

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Supporting individuals to communicate in social situations

Communicating in social situations requires the individual to have a fair understanding

of emotions, facial expressions and body language. There are a range of strategies
that can be employed by families and carers or schools and support groups to help
them do this:
Digital cameras and video recorders could be used to show the individual their own
facial expressions and body language to help with awareness.
Charades, miming and role play can be used to demonstrate positive and negative
body language.
Magazines could be used to find images of positive and negative body language
and different facial expressions.
Symbols could be used to show different facial expressions, as many individuals
with autism are only aware of a limited range, such as sad, happy or angry. A wider
range of facial expressions needs to be understood, such as surprised, confused,
worried, frightened and thoughtful.

Commercially available programmes

There is a wide range of commercially produced programmes

available that parents or carers and social groups can use to
support individuals with social communication and behaviour issues.
The CAT-kit:
Cognitive affective training (CAT) is a set of visual aids that allow
an autistic individual to show charts and drawings of how they are
affected, or how they are feeling. For example, a timetable of the
day can be given to the individual and they can use this to show how they have been
feeling during the day, and the intensity of the feeling can then be measured on the
diagram. A picture of the body can be used to show where pains or feelings are, and
these can be connected to emotions and behaviour, helping to better control their
behaviour through self-awareness.


DO-WATCH-LISTEN-SAY: Social communication intervention for children
with autism
This is a detailed assessment and intervention guide which helps to identify a child’s
abilities and skills, which can then be targeted for intervention. Activity sheets are
provided, with intervention activities to improve skills in play, group skills, social skills
and social communication.

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Talkabout – A social communication skills package

This is an assessment tool that looks at the social skills of an individual. It provides a
visual summary of the individual’s verbal, non-verbal and assertiveness skills. This can
then be used to plan intervention.

Supporting communication

Some of the strategies previously discussed, to aid social interaction, also aid
communication, such as comic strips and social stories. An individual who struggles to
communicate verbally may need alternative strategies to support their communication,
such as the use of visual supports.
Visual supports
Many people with autism are visual learners, so providing information in a visual way
can support their communication, language development and their ability to process
information. By being better at communicating, they will have more chance of making
improvements in the way they interact socially with others.
Using visual supports can:
reduce anxiety
improve the individual’s understanding
provide routine and structure
encourage the individual to become more independent
provide more opportunity for them to interact with others

Visual supports include:

photographs
pictures
line drawings
miniature models of real objects
real objects, such as an item of clothing or food wrappers

Areas where the use of visual support may help people with autism include:
timetables/schedules
making choices
sequencing

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individuals with autism

transition and changes

starting and finishing activities
introducing new activities or situations
giving instructions/reminders
understanding emotions and expressions
sharing information
praising positive behaviour
reducing behaviour that challenges
encouraging social skills
finding people and places
safety
structuring the environment
independent living skills

Visual supports may be useful for people with autism to describe how they are feeling;
for example, they could have a thermometer, speedometer or ladder to show their
range of emotions and how they change throughout the day. For some individuals,
however, they can be too abstract.

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Other strategies to support communication include:

Provide the individual with a reason to communicate; don’t just give them everything
they want so they don’t need to communicate. Try to create situations where they
need to communicate in order to get what they want, such as asking them to
choose an activity from a short list, or asking direct questions about any areas of
special interest.
Try to give more time for activities, such as routine everyday tasks like eating,
washing and dressing. If rushed, they will not have the time to think about what is
happening, but if they have more time they can engage more in tasks and will be
more encouraged to talk about things.
Encourage them to do things with others, rather than being on their own, as this will
help them to communicate with others and interact socially. If they are playing with
an object on their own, the parent or carer can join in with them, as this will
encourage communication and develop interaction skills.

Knowledge Activity 22: Mikey is starting at secondary school soon and is very
anxious about the changes in his life. He loves routine and likes to know what he
will be doing every day, but at secondary school there are lots of different activities
and he will study different subjects every day. There are also a lot of extra activities
that he will be encouraged to take part in to help him improve his social interaction
and communication, such as a board game club, homework club and team games.
Many of these extra activities take place after school or at lunch time, and he is
worried about being in the right place at the right time for all these activities.

7am 8am 9am 10am 11am 12pm 1pm 2pm

3pm 4pm 5pm 6pm 7pm 8pm 9pm 10pm

How could the visual timetable above help Mikey in his transition to
secondary school?

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What other supports could be used to help him make the big change without
experiencing too much anxiety and stress?

Did you know?

Communication Matters is a charity aiming to help people of all ages who
would benefit from AAC, regardless of their condition or geographical location.
Members of the organisation include people who use Augmentative and Alternative
Communication, their families, support workers, professionals and the manufacturers
of communication systems. The organisation has skills, knowledge and expertise in
the area of AAC and aims to achieve its aims through a number of activities:
training events, including an annual conference
study days
free roadshows
a research programme
various resources and publications including a journal, e-news and an e-library,
discussion forums, local networks, and a website

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Knowledge Activity 23: What would be the most useful strategy for the
following individuals?
1. Ryan is starting college in September and has to make a considerable
journey to the city centre. At school he was always driven there and dropped
off just outside the school gates. He will have to take a bus and a tram, and
this is making him very anxious. How could Ryan be aided to overcome this
difficult transition and face the daily journey he has to make?

2. Danielle has started a new job and works in a warehouse, it is very big
with lots of tools that she has to be able to find to make orders up for
customers. She is having difficulty remembering where everything is kept and
struggles with some of the names of the tools. How could she be supported
in her job?

3. Rahul has been successful in securing the apprenticeship he wanted at a

local engineering firm. He is finding it difficult to fit in socially, as he spent
most of his time alone at school. He has trouble keeping up with the quick
conversations, jokes and banter between his colleagues but doesn’t want to
become isolated, as he felt very lonely at school. How could Rahul be helped
to improve his social skills so he can make friends?

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Adapting communication to meet the needs and

preferences of each individual
Please read the following as it will help you to answer question 40.

Communication is the giving and receiving of information, and because it is the

foundation of what we do in everyday life, it is important to find appropriate ways of
communicating with individuals with autism. It is essential to think carefully about
the individual and their needs and preferences, as everyone is different; we all think
differently and communicate in different ways. We give many messages to the people
we communicate with, not just in what we say but in how we say it, and what we are
doing as we speak. Many individuals will be motivated to communicate by what they
need or want, whilst others may want to share things and ask questions.
When choosing and adapting our communication: we need to observe the individual’s
reactions and learn what their normal behaviour and reactions are. It is important to
think about how they are feeling when communicating with them, and whether they
are comfortable, happy, sad, anxious, stressed etc.
If an individual feels stressed and appears uncomfortable with eye contact, for
example, it may be better to sit at the side of them to reduce their anxiety, so that
they do not feel the pressure of having to make eye contact.
By using appropriate communication skills, you can provide better support to the
individual, enabling them to make their own choices and make them feel respected
and valued and in control.

Quite often, there is a need to adapt our communication style to meet the needs
of individuals and use aids to help them enhance their communication. If there is a
barrier to communication, such as lack of speech, lack of understanding or difficult
behaviour, it is important to identify the barrier, and then work out how best to
overcome it. For some individuals, body language can be useful in communicating
when they can’t express themselves clearly using words. Individuals can also display
different types of behaviour that challenges such as:
moving back and forth
moving away from the person talking to them
swearing
using repetitive phrases, out of context
keeping silent

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individuals with autism

Here are some points to consider when adapting communication:

what is the purpose of the communication, what do you need to know, or what
information do you need to give the individual?
how long do they need to process the information and give a response?
what is their ability to listen? You may need to keep conversations and
instructions short
can they take a joke, or do they become confused and take things very literally?
be intentional with language; use words they understand and can connect with
be intentional with body language
make good eye contact, unless this makes them feel uncomfortable
allow them enough personal space; some individuals feels uncomfortable when too
close to others
watch their feedback; if they seem uncomfortable, think about the environment;
they need to be in a place they feel comfortable in
calm them down if they are anxious; don’t feel the need to ‘chit chat’ to fill silences
find visuals like illustrations, flash cards or photographs if they struggle with speech
slow speech down if necessary
use visual timetables or calendars to show things that are going to happen
keep background noise down

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 Section 3: Communication and social interaction in
individuals with autism

Think about how the calendar with symbols below communicates which events are
going to be taking place and when.

JULY 2020
MON TUE WED THU FRI SAT SUN
1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

Did you know?

Research by Rice and Wilcox, looking at the delays in language development,
found:
Failure to understand verbal instructions given by adults can often be
interpreted as misbehaviour
Because a lot of teaching in schools takes place through verbal description
and instruction, children who don’t understand are unable to store or use the
information
Children with language delay or impairment have limited resources for
demonstrating knowledge and explaining their reasoning
Language ability is a key factor in the ability to make friends with other children

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 Section 3: Communication and social interaction in
individuals with autism

Creating a constructive environment to aid communication

and social interaction
Please read the following as it will help you to answer question 41.

The sensory environment is an important consideration when supporting individuals

with autism with communication and social interaction, as many individuals have
sensory differences (especially hypersensitivity) involving at least one of the senses.
In order to make them feel comfortable, and therefore more likely to communicate
and interact, it is important to realise their individual needs and preferences regarding
their environment.

Lighting
Lighting that is too harsh, or pulsating (for example a fluorescent light) can
make some individuals tire more quickly, and they will be less alert and likely to
communicate or interact. It can also lead to decreased eye contact and shorter
concentration spans.

Sound
Background music and noise such as traffic, wind, TV and nearby conversations can
be distracting and will result in reduced concentration. When individuals are affected
by sound, they are likely to be less interactive with less focus, and make less eye
contact. In order to communicate and interact with them, it is best to reduce noise
and make sure that appliances like the dishwasher aren’t going to provide background
noise or any sudden beeping noises that might bring communication to an end.
Some individuals are so sensitive to sound that they will become anxious and
distressed, maybe crying, having meltdowns or covering their ears.

Colour
Some individuals will pay more attention to certain colours. This can distract them
from communicating, as they will pay more attention to the coloured object that they
are attracted to. For example, if a wall is painted in colours that attract them, it would
be a good idea to change the wall colour so they pay more attention to other things,
rather than the walls. However, when you want attention from them, this can be
helped by wearing the colours that attract them.

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individuals with autism

Visual distractions
Too much visual information can be distracting, so if a room is highly decorated
with pictures, symbols, characters, nursery rhymes and moving toys, it can distract
attention. It can decrease eye contact with other people, as the environment is
competing with people for the individual’s attention.

Negative associations
Quite often in a house, there are lots of objects that shouldn’t be touched or played
with, and lots of things they are expected not to do.
Think about how an individual with autism might feel if the following were said very
often:

You must
No, don’t never do
do that! that again!
Don’t go
in there!
Leave that
alone!
What have I
told you about No, don’t touch;
picking that up! it’s dangerous!

For some individuals, who tend to withdraw, they will tend to play and explore less,
which in turn will hinder their progress in communicating and interacting further.
Others, who are interested by strong reactions from parents or carers, may repeat
these unwanted behaviours in order to get a reaction.
Both of these reactions are undesirable, so it is important to think about how this can
be avoided. Locking delicate, expensive or dangerous items away for a short time can
help to avoid this negative situation.

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individuals with autism

Creating a constructive environment to aid communication and

social interaction

If possible, a dedicated room should be provided where the child or individual can
focus, so there is a place to work together on social interaction and communication.
This should be a place where they are able to concentrate on activities and the
person they are working with.
Some things to consider include:
no distractions to draw their attention away
use comfortable lighting
too small a room may mean insufficient space for activities and games like role play
for a small child, a room that is too large might not create a focused environment
high shelves should be fitted so distractions like toys can be moved out of eyeline
when concentration is needed
have plain wallpaper
use light, neutral colours
have a table and chair, at the right height for them
cover distracting views of the outside with a window covering that still lets enough
light in
have a bathroom nearby if possible, so that trips to the toilet don’t take too much
time out of activities
make sure that the environment created is comfortable for the parents/carers too
so they are relaxed and not tense
have everything needed to hand in the room before starting activities, including
food, drink, books and toys. This means you do not have to leave the room and
disrupt activities
choose furnishings and floorings to create a calm atmosphere; patterned flooring
can be confusing and lead to anxiety
some people can be affected by smells, such as chemicals or perfumes that other
people wouldn’t notice; think about the use of any substances if smells do appear
to affect the individual
in other areas of the house, or in school settings, cupboards and drawers can be
labelled to help them learn words

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individuals with autism

In the home, it is important to consider the environment, but also the atmosphere
that is provided for individuals with autism; for example, is the home a happy one,
and is it a relaxed atmosphere or stressed? Are the other people in the home likely
to create a feeling of warmth and security, or will the individual be made to feel more
uncomfortable and stressed? In creating the right kind of atmosphere, people need
to consider:
making sure that they are in good physical, mental and emotional health; if not,
this could adversely affect the individual
making sure that they are in control emotionally, as this will have a positive effect
on the rest of the household
getting support and help from others, so they can spend quality time with the
individual and give time to supporting them with communication and interaction
minimising the time the individual spends with people who are tense and will make
them feel uncomfortable

SPELL framework

The SPELL framework should also be considered when creating an environment and
atmosphere. This is a framework that aims to recognise and therefore cater for the
unique and individual needs of each child or adult, and it provides planning and
intervention for individuals with autism. It stands for:
STRUCTURE
POSITIVE
EMPATHY
LOW AROUSAL
LINKS

Structure
Structure is recognised as very important for individuals with autism, as it makes the
world seem like a safer and more predictable place to them. It can increase their own
independence and decision-making ability by reducing the extent to which they are
dependent on others. This involves adapting the environment and providing a process,
so that they know what is expected of them and what is going to happen.

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individuals with autism

Positive approaches and interventions

Expectations are set that are high but realistic; this means that careful assessment
of the individual is needed, which should focus on their strengths and needs, their
own level of functioning and the amount and type of support they will require. The aim
is to build self-esteem and self-confidence by building on their strengths, interests
and abilities.

Empathy
This means seeing the world from the point of view of the individual, to find out how
they see their world, what motivates them and what might distress or frighten them.

Low arousal
The environment provided needs to be calm and ordered so that anxiety is reduced
and concentration maximised. There should be as little distraction as possible; any
noise, clutter, harsh lighting and other distracting stimuli may cause them to be
overloaded.

Links
Strong links between the different parts of the individual’s life are beneficial, for
example between parents and teachers. This reduces the possibility of confusion and
misunderstanding or fragmented approaches.

Did you know?

A study by Emmons and Anderson suggested creating a ‘sensory bag’
containing a selection of sensory items that could be carried around from place
to place, would help the child to manage their anxiety or sensory overload. They
suggested that a sensory bag should contain:
stress balls
a whistle
an unbreakable mirror, for them to view their own emotions
two footprints that can be placed on the floor to jump on
scented lotions

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 Section 3: Communication and social interaction in
individuals with autism

The role of specialists in supporting communication and

social interaction
Please read the following as it will help you to answer question 42.

Screening, assessment and treatment of communication, social and behavioural

problems may involve cooperative efforts with the following specialists:
Speech and language therapist (SLT)

SLTs work with diagnostic and educational evaluation teams to provide comprehensive
language, communication and speech assessments for individuals with autism.
Therapy for individuals with speech and language disorders may be provided in
individual or small group sessions, in classrooms when teaming with teachers, or
in a consultation with teachers and parents.
Their role includes:
forming plans for support for alternative methods of communication for those
who do not use any spoken language, for example sign language or augmentative
devices.
building on receptive and expressive language skills for those with developing
language.
working on the more subtle aspects of conversation with those with high verbal
skills; looking at the more subtle aspects of pragmatics and conversational
reciprocity will be the focus.

Psychiatrist

Psychiatrists are involved in the diagnosis of autism and can offer follow-up treatment
and interventions and may also be involved in ensuring that programmes of
medication are developed and maintained. They are usually only involved when there
are cases of serious co-occurring mental health difficulties.

Paediatrician

Paediatricians are experts in the health and development of children, especially those
with developmental disorders, and are often involved in the diagnosis of autism,
along with other professionals. They are often involved in follow-up treatment and
interventions.

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individuals with autism

Clinical psychologist

Clinical psychologists focus on behaviour and how it affects the individual; they will
often produce a behaviour management plan. They are also involved in the diagnosis
of autism, along with other specialists.

Doctors

The GP is often the first point of contact and can

refer the individual to other professionals, such as a
paediatrician or a psychiatrist.
Doctors can prescribe medication for the treatment
of specific autism-related symptoms, such as
anxiety, depression or obsessive-compulsive disorder.
Antipsychotic medications can be used to treat severe
behavioural problems. Medication used to treat people
with attention deficit disorder can be used effectively to
help decrease impulsivity and hyperactivity.

Counsellors and therapists

Individuals with autism often experience anxiety when they have to cope with changes
and uncertainty in life, and can also experience depression and behaviour difficulties.
Counsellors can help situations like this by talking through issues. Some are trained in
cognitive behavioural therapy (CBT), which can help to change the way that individuals
think about themselves and other people, with the aim of helping them to function
better in day-to-day life.
They can also apply behavioural or educational interventions using highly structured
and intensive training sessions to help individuals develop social interaction and
communication skills.
Family counselling for the parents and siblings of individuals with autism often helps
families cope with the challenges of living with someone with the condition.

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individuals with autism

Educational psychologist

Educational psychologists carry out assessments and look at the learning profiles and
needs of children and young people with autism, using an educational setting such as
a school or college. They offer expert advice to teachers, parents and the individual to
improve their chances in education.

Social worker or care manager

Social workers and care managers assess the care needs of individuals with autism,
and their families. They also arrange services, such as healthcare and homecare, to
meet those needs.

Behaviour support team

This is a team that supports families with children who have autism who show
behaviour that challenges. They plan and introduce behaviour management
programmes. A child and their family can be referred to the team (if available) by a
GP, social worker or school.

Outreach worker

An outreach worker helps the individual to access opportunities and activities outside
their home, such as education, sport or hobbies.

Occupational therapist

Occupational therapists assess the difficulties that individuals have with day-to-day
activities and help them to overcome these difficulties, promoting independence.
Activities which they might be able to assess and provide support on include:
dressing
washing and personal hygiene
swallowing and eating
feeding
mobility issues
138 © LCG 2020
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individuals with autism

driving
rest and sleep
education or employment
play – taking part and exploring play
social participation
shopping
meal preparation
house cleaning and maintenance

Knowledge Activity 24: Consider the following scenario and name three
professionals who you think should have been involved with Timothy and state
the role they could have played.
Timothy is eight and was diagnosed with autism at the age of four. His parents
first noticed that he did not connect with them or his siblings when he was one,
failing to make eye contact and seeming disinterested in his environment. Once he
started at nursery school, his behaviour became very challenging and he started to
show aggression to other children.
His spoken language was limited and by the time he went to school at nearly
five, he still couldn’t communicate effectively. This made him frustrated and his
behaviour continued to worsen.
Professional Role played
1

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 Section 3: Communication and social interaction in
individuals with autism

Did you know?

Behaviour that challenges in children with autism includes biting and self-injurious
behaviour.
Biting can be due to communication difficulties, frustration, distress, feeling pain,
or an attempt to gain sensory input.
Self-injurious behaviour includes head banging, eye gouging, hand or arm biting,
hair pulling, face or head slapping and skin picking, scratching or pinching.

Summary

In this section, you have learned about:

the processes required to communicate using speech and language
how speech and language development may be delayed in individuals with autism
different forms of communication that can be used
difficulties individuals may have with communication
how social interaction may vary in individuals with autism
strategies used to support communication and social interaction

140 © LCG 2020

 Section 4: Extension activities

Further your knowledge and understanding of the topics in this workbook by

completing the following extension activities.
Introduction to autism

Extension Activity 1: The government published a new statutory adult autism

strategy in March 2015, which replaced existing guidance from 2010. Visit
www.gov.uk to find out about the guidance and give five requirements of the
guidance for the provision, care and support for individuals with autism.
1.

2.

3.

4.

5.

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 Section 4: Extension activities

Extension Activity 2: Mr Clayton, a year 5 teacher, was very disappointed

when he marked the history project the class had been working on since the
beginning of term. When he gave back the projects, he told them that he had
expected a higher standard of work. He said “Pull your socks up, class!”. Jason,
a boy with autism, leaned down and pulled up his socks. Explain the problem with
what Mr Clayton said.

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 Section 4: Extension activities

Extension Activity 3: Using examples of individuals that you know, by talking

to other people with experience of working with individuals with autism, or by
Internet research, identify the behaviour and needs of three individuals.
Individual and their behaviour Needs of the individual

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 Section 4: Extension activities

Using a person-centred approach to support individuals with autism

Extension Activity 4: To extend your understanding of the laws and

guidelines that aim to help people with disabilities, carry out research into
Valuing People (2001) and Valuing People Now (2009). Make notes on what these
policies did to improve life for adults with learning disabilities.

144 © LCG 2020

 Section 4: Extension activities

Extension Activity 5: Using an example of someone you work with or know

who has autism, think about the most important support networks in their life
and describe the problems they experience as part of the condition and the
support needed.

Workbook 1 145
 Section 4: Extension activities

Extension Activity 6: Find out about the support available in your local
authority for people with autism.

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 Section 4: Extension activities

Communication and social interaction in individuals with autism

Extension Activity 7: Carry out your own research into social stories and
how they can help individuals plan for stressful events or things that frighten
them. Think about the following scenario:
Eric is 16 and his older sister, Deborah, is getting married in a month. Eric is
very fond of Deborah and although she wants him at her wedding, some members
of the family think he should not attend. The problem is, when he becomes
stressed and anxious by having to make a long journey or meeting large groups of
people, Eric’s behaviour can be very challenging. Family members are worried that
he will spoil the wedding and won’t be able to control his behaviour. How could a
story help to prepare Eric for the journey and the wedding and help him to control
his behaviour?
Write your own story, or produce a story board, to provide support for Eric.

Workbook 1 147
 Section 4: Extension activities

Extension Activity 8: Listen out for some conversations that include sarcasm
or metaphors that a person with autism might find difficult to understand.
Describe each conversation and explain the difficulties someone with autism
might have with it, and how this could make it difficult for them to join in socially
with other people.

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Section 4: Extension activities

Extension Activity 9: Design your own symbols for communicating with

a child who doesn’t speak, so you can:
a) Ask the following questions
Do you want to play in the garden?
Would you like to go swimming today?
Would you like me to read you a story?
Do you want a drink?
Which method of transport do you prefer to use to get to the museum?
b) Give them the following information
It’s time to go to bed now
You need to have a wash now
We are going to the beach today
That behaviour isn’t appropriate
Well done, that’s great!

Well done!
You have now completed Workbook 1 and should
attempt the assessments. If you require any help or
guidance, please contact your Assessor/Tutor.

Workbook 1 149
 Please use these pages for additional notes

150 © LCG 2020

Please use these pages for additional notes

Workbook 1 151
 NETWORKS AND SUPPORT

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