Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) refers to a triad of impairments encompassing differences in social interaction, social communication, social imagination, and difficulties in adjusting behavioural repertoire. Other common features include sensory differences, which are now becoming acknowledged as a core component, as well as dietary and sleep difficulties. ASD affects people across the whole range of intellectual ability—from individuals with associated severe ID through to highly skilled engineers and academics; however, each person affected experiences difficulties understanding the world and impaired social functioning due to underlying common core cognitive difficulties, namely lack of Theory of Mind, resulting in empathy difficulties, lack of Central Coherence, making it ‘difficult to see the wood for the trees’ and difficulties with Executive Functioning. Genetic factors play an important role in causation, likely coupled with an early environmental insult. ASD is more common in people with ID, with around one third of those with moderate to severe ID able to be diagnosed; epilepsy is another common association. Comorbidity is common, including neurodevelopmental disorders (e.g. ADHD), psychiatric disorders (e.g. mood and anxiety disorders), and challenging behaviour, all requiring recognition in their own right. Management of the core condition primarily focuses on appropriate social and education/employment support along with awareness training for those supporting the person, with medication reserved for associated conditions such as management of mood. Capacity and risk issues arising from difficulties understanding the world, predicting consequences of actions and accepting the need for support also need addressing. Effective management of associated difficulties such as sleep disturbance can be equally vital for quality of life.