What is Autistic Spectrum Disorder/Condition (ASD/C)?
The broad continuum of autism is usually referred to as autistic spectrum disorder (ASD), or autistic spectrum condition (ASC). They are really the same thing, but we tend to refer to it as a condition because it is a different way of thinking and behaving, as well as a formally classified disorder according to international diagnostic classifications.
An autistic spectrum disorder is diagnosed as a result of observation of a collection of neuro-developmental traits that seem to appear and develop in childhood. Their causes are not fully understood, although it appears to be almost certain that genetic factors are involved.
The term ‘spectrum’ is used because, while all people with autism share two main areas of difficulty, their condition affects them in different ways and to different degrees.
What is commonly referred to as Asperger’s Syndrome is also a condition on the autistic spectrum, but the label has been used less frequently by professionals in recent years, since it has been removed from the diagnostic manuals.
ASD is known as a neurodevelopmental condition and is very closely related to and can co-exist alongside other neurodevelopmental conditions, including Attention Deficit Hyperactivity Disorder (ADHD), dyslexia, dyspraxia, dyscalculia etc.
What is the prevalence of ASC?
According to government figures, autism is estimated to affect 1 in 100 people. However, the number of people identified with ASD appears to be rising, possibly reflecting increasing awareness and identification, rather than any change in the number of people affected. Seemingly, ASD affects more males than females, although this may be because of underdiagnosis in females; the ratio used to be quoted as 4:1 male:female, but the difference between male and female prevalence is narrowing.
Around half of people with autism also have a learning disability. Different people prefer different terminology and some autistic people prefer not to use the term ‘high functioning’, as functioning can mean very different things in different situations and can fluctuate with environments and demands.
What are the main symptoms of ASC?
People with ASD display traits in a number of areas:
- Social interaction and social communication, which may include:
- Difficulties imagining situations outside immediate or known events and behaviours
- Differences in using and understanding body language, facial expressions, tone of voice
- Difficulty with taking turns in a conversation
- Difficulty recognising, understanding and expressing their own emotions, as well as understanding and predicting other people’s behaviours or feelings
- Not using tact and diplomacy
All of these features could make it more difficult to fit in socially.
- Repetitive and restricted range of behaviour
- Avoidance of change where possible
- Adherence to rituals and routines
- Unusual specific interests which may amount to obsessions
- Engaging in repetitive actions or movements
- Intense interests
- Intense and highly focused interests, often from a fairly young age; these can change over time or be lifelong;
- Autistic people can become experts in their special interests and often like to share their knowledge, which can come across as excessive;
- They can become so engrossed in particular topics or activities that they neglect other aspects of their lives.
- Over- or under-sensitivities to sensory stimuli such as:
- Dislike of loud noises;
- Dislike of bright lights;
- Dislike of certain food or clothes textures;
- A reduced threshold to pain.
Research has led to these features being brought together into the two domains of :
- Social Interaction and Communication Deficits
- Repetitive/Restricted Behaviours (incorporating unusually intense or narrow interests and difficulties adapting to change) and Sensory Sensitivities
People with autism lie on the intersection of these two dimensions, meaning that they have to show sufficient features in both groups of symptoms in order to fulfil the diagnostic criteria for ASD.
It is worth noting that everyone is somewhere on the continuum, some having more autistic traits than others, but it is the degree and pattern of impairment that leads to the identification of a ‘disorder’, as it is defined according to the diagnostic manuals.
Is an assessment for ASD helpful?
- Understanding yourself better may be the most important reason to seek an evaluation. If it turns out that you meet the criteria for ASD, you will have gained a better understanding of what you do and why you do it. This translates, more directly, into greater awareness of your strengths and challenges, the problems you are likely to encounter, and the assets you have to deal with those problems.
- Although there are several traits that are typically associated with ASD, each person is unique. ASD affects everyone differently and each individual with ASD has individual strengths and weaknesses, just like everyone else, and we all benefit from knowing these.
- For many people, knowing they have ASD dispels their fear of being different. ASD is simply a different way of processing information, thinking and behaving, no better or worse than how neurotypical people behave. Knowing this often helps people to forgive themselves for the differences they have. A diagnosis heightens awareness of challenges and obstacles in a positive sense, reducing insecurities and negative self-esteem.
- Contrary to what some believe, a diagnosis of ASD, more often than not, helps improve the quality of one’s relationships. Many couples struggle with misunderstanding, miscommunication, confusion, resentment and other problems. Knowing what they are dealing with, as an outcome of an ASD diagnosis, helps improve the stresses and strains that build up when a couple doesn’t understand what they are facing.
- Many adults find that an ASD diagnosis provides a rational explanation for past behaviour that formerly appeared inexplicable. A diagnosis illuminates difficult experiences, such as difficulty understanding other people’s thoughts, feelings and actions. It helps put into context the actions of other people, including those who have been key figures in one’s development, such as parents, teachers and friends.
- A diagnosis of ASD from a professional provides peace of mind and validation, not only for those who have suspected they were different, but also for friends, family members and others who suspected the same. By identifying the source of one’s differences, the truth is revealed for all to believe. Doubt and uncertainty no longer rules.
Disadvantages of having an ASD diagnosis
- In some circumstances it may be mandatory for you to disclose your medical records, which would include a formal diagnosis. There are a few careers where autism is taken into account and these include the armed forces. Whilst it may not preclude you from joining, you would need further assessment and ultimately this could exclude you. You can check with the employer for further information.
- It may affect insurance premiums, such as health or travel insurance.
- If you intend to migrate to another country in the future, it may make obtaining a visa more challenging.
- Unfortunately, there is still stigma attached to autism. Whilst there has been a significant movement within the neurodivergent community to help support and educate people, there is still some way to go. Some people remain ignorant, and discrimination is still possible.
- There is a risk of diagnostic overshadowing, i.e. if, in the future, you develop a comorbidity such as anxiety, rather than anxiety being treated, all symptoms might be misattributed to the autism diagnosis.
- Autism assessments can take time and can be stressful for the person involved. They are often multilevel assessments and can involve various steps, some of which may feel uncomfortable.
- Whilst a diagnosis may open up some sources of support, it does not necessarily mean that a person will receive much more than before they were officially diagnosed. It can be dependent on what is available locally and access may still require further steps and evaluations.
- A person may feel anger at the fact that their diagnosis was missed for so long, that nobody else realised they were autistic and that they had been struggling with sensory and social experiences. This can be a difficult experience post diagnosis.
- If you do not receive confirmation of the diagnosis that you have been seeking, this can be very challenging and upsetting for some people. You must consider how you will feel if you do not receive a diagnosis.
- Sometimes people’s sense of identity is affected negatively by a formal diagnosis of autism. Depression, confusion, loss of self-confidence, shame, anger and feelings of failure are some of the reactions that can occur. For most people these are understandable feelings and will hopefully ease with help, support and positive awareness and acceptance.
Who can make a diagnosis?
Diagnosing ASD requires considerable training and expertise as it may be difficult to distinguish from a mental illness or numerous other conditions, whose features may look similar. Primary Care clinicians such as GPs are generally not trained to diagnose children and adults with ASD, and hence specialised diagnostic services are required.
At Psychiatry-UK we have a number of psychiatrists, psychologists, nurses, and occupational therapists who specialise in this field.
Is ASC associated with any other conditions?
Many people with ASD also suffer from a number of coexisting mental and physical health disorders, the treatment of which may be complicated by this comorbidity. A number of psychosocial interventions can be used to target these conditions, for example, Cognitive-Behavioural Therapies have been used to treat depression, anxiety or OCD in individuals with ASD. When coexisting conditions such as depression, anxiety or ADHD are successfully treated, most people’s ASD should become easier to manage.
Autism and ADHD
Although the main components of ADHD and ASD are different, they can share some of the same symptoms, which at times causes diagnostic challenges. People can be diagnosed with both, and it does appear that being diagnosed with either ASD or ADHD increases the likelihood of that person being diagnosed with the other. However, the two are separate conditions.
What is the treatment for ASD?
Following a diagnosis of ASD, there are a number of treatment options that will be recommended, all delivered by therapists with expertise in this condition:
- A Psychosocial Needs Assessment will identify your specific needs around social interaction/communication/rigid behaviour/sensory sensitivities/daily living activities
- Life skills coaching for ASD
- Cognitive Behavioural Therapy for depression/anxiety/OCD
- Family therapy
- Parental coaching
- Employment/education advice
However, many local areas unfortunately do not have such facilities for treatment under the NHS, given that they are still in the early stages of development. For this reason, we advise that you might like to check with the National Autistic Society for information about charities/other organisations with such services in your local area. Otherwise, accessing private services would be another option.
Please note that there are no specific medications for people with ASD, but rather for associated conditions (depression, anxiety, OCD, ADHD, alcohol or drug misuse)
I think I have ASD – Is it too late to have an assessment after a certain age?
It is never too late to get a diagnosis. A diagnosis can help increase understanding (yours and others’), and help you to work on any areas within your life that you find challenging. Learning about ASD, and understanding any potential problems you might be experiencing as a result of having the condition, can help you at any age and any stage in life.
What is the National Strategy for people with autism?
Several government and research papers, such as ‘Fulfilling and Rewarding Lives’ and ‘Supporting People with Autism through Adulthood’ set out aims in the following main areas:
- Increasing understanding, awareness and facilitating diagnosis of ASD
- Improving access for adults with ASD to the services and support they need to thrive within the community
- Helping adults with ASD obtain work or study opportunities, by means of reasonable adjustments to the workplace or college/university.
Psychiatry-UK and ASD assessments
ASD assessments conducted by professionals at Psychiatry-UK involve filling in three ASD Pre-assessment Questionnaires as standard practice (RAADS, Self Report ASD Questionnaire and Informant Report ASD Questionnaire) in advance of the assessment, followed by an online interview or consultation, which will take one hour. In complex cases, when further exploration is necessary, an additional meeting can be arranged either with the patient, an informant, or both. In some cases, further tests might be recommended in order to elucidate the diagnosis. Any further meetings and tests will attract additional fees which the assessing Consultant psychiatrist will discuss, if relevant, at the end of the first consultation.
At Psychiatry-UK we have a large team of professionals offering ASD assessments. The team meets weekly to discuss cases and update on developments in the ASD field.
It is advisable that prior to asking for an ASD assessment you take an AQ10 screening test. If the score is lower than 6/10, the likelihood of a diagnosis of ASD is lower; therefore we do not recommend you have an assessment, unless you would like to have the diagnosis of ASD ruled out.
References, Further Reading and Websites
- The National Strategy for Autistic People, Children and Young People 2021 to 2026 | Local Government Association
- NHS England » National framework and operational guidance for autism assessment services 2023
- The National Autistic Society: http://www.autism.org.uk
- Tony Attwood: https://tonyattwood.com.au/
- Work place adjustments: