Autistic spectrum disorder (ASD)

Autism spectrum disorder (ASD) - Illnesses and conditions Brain, nerves and spinal cord Autism spectrum disorder (ASD) Autism spectrum disorder (ASD) About autism Characteristics of autism Diagnosing autism Living with autism Facts and myths about autism About autism Autism spectrum disorder (ASD), usually called autism, is something youre born with. Autism means that the way you think about and experience the world is different to most people. This means you can behave differently to most people, and have different strengths and difficulties. For example, some autism characteristics (things you think, feel and do) can make it hard to express yourself in social situations, but you may also be particularly knowledgeable and passionate about topics that interest you. Read more about characteristics of autism here Autism is highly variable  the word spectrum refers to how autism is experienced differently by different people. Autism is considered a spectrum because its different for every autistic person  some autistic people might need more support than others to live the lives they want to lead. The way autism affects you can change as you grow and develop, and experience different environments. Read more about support here Talking about autism Many people who have been diagnosed with autism prefer using the term autistic to describe themselves  this is known as identity-first language (for example, Im autistic). They consider autism to be part of their identity, not a condition to be treated. For a long time people used the term person on the autism spectrum, known as person-first language (for example, Im on the autism spectrum), and some people still prefer this. In this guide, well mostly use the term autistic. If in doubt, you can always ask an autistic person what term theyd prefer. In the past, autism was broken down into several different diagnoses, including: Aspergers Syndrome autistic disorder Kanners Syndrome childhood autism atypical autism Pervasive Development Disorder Not Otherwise Specified (PDD-NOS) Because these diagnoses all had the characteristics of autism, they were removed and replaced with autism spectrum disorder (ASD), or autism for short. People also use the term autism spectrum condition (ASC). Learn more about autism from autistic people How common is autism? At least 1 in 100 people in Scotland are autistic. Currently, between 1 in 3 and 1 in 4 people diagnosed with autism are assigned female at birth (AFAB). Read more about autism and gender Autism is always present from birth, but it might not be recognised or diagnosed until adulthood. Early intervention, in the form of support for their individual needs, can be helpful for autistic children. Even if you arent diagnosed until adulthood, getting a diagnosis can be very helpful for identifying your strengths and the things you struggle with, and finding support. Read more about characteristics of autism Characteristics of autism Every autistic person is different and has different experiences. However, there are some characteristics that are common in autistic people. The way these characteristics show themselves can change with age, and also with the situation youre in. For example: the way you use language and talk might be different to most people you may use facial expressions, tone of voice, and gestures (hand and body movements) differently to most people making and maintaining friendships might be difficult for you you may be good at seeing patterns or solutions, and be good at seeing solutions to problems that other people might not you might have set ways of doing things, and find it difficult to do them differently autistic people are often very good at understanding and working with structured systems, for example languages, music, and computers you may have good attention to detail, and be good at spotting mistakes you might be passionately interested in certain things, and as a result learn a large amount about them in a short time  these interests can change throughout your life you might avoid or seek out certain sensations, like loud noises or specific textures, more than most people, and experience them more strongly there might be some foods you particularly enjoy and eat a lot of, and others that you cant be around due to their texture or smell when working on projects, you might find it difficult to think about the project as a whole  you may do a great job on your part of a group project, but struggle to imagine how it fits in with everyone elses part while autistic people can be good at paying attention to detail, you might find it difficult to leave out details that are accurate but not needed when talking to people or working on projects autistic people can be very determined and driven, and keep going with tasks or problems when other people may give up you might find youre always determined to make sure things are perfect, and sometimes forget to eat or sleep if youre working on something it can be difficult for autistic people to work in groups where there isnt clear communication about what theyre expected to do There are a number of other possible signs that a healthcare professional will look for when assessing if someone is autistic. Read more about diagnosing autism here Autism and gender At the moment, men and those assigned male at birth are diagnosed with autism more often than women and those assigned female at birth. As more healthcare professionals now know what characteristics to look for, its becoming more common for women and those assigned female at birth to receive an autism diagnosis. However, recognising autism can take longer for women and those assigned female at birth. This is because the characteristics healthcare professionals look for are the same for everyone, but women and those assigned female at birth can often show these in slightly different ways. For example, theyre more likely to mask autism  hiding autism characteristics and copying what other people without autism do  in order to fit into groups. This can make it harder to recognise that they might be autistic, and to receive a diagnosis. Autism and environment Some environments can be very difficult for autistic people, due to the way they experience and interact with the world. Every autistic person finds different things difficult, but common examples are: social situations with no timetable or clear rules on things like who speaks when  for example, parties and nights out busy environments like concerts, supermarkets, and school playgrounds, where there might be a lot of different loud noises at once Many environments allow autistic people to feel more comfortable and be themselves. When autistic people are in an environment with people who understand their individual needs and characteristics, theyre likely to: feel more relaxed perform better at tasks find it easier to learn use less time and energy trying to fit in with their environment Because every autistic person is different, it can take time to understand how you experience different environments. It may also take time to find the environments that suit your needs, and to learn which ones to avoid. If theres an autistic person in your life, its important to ask them what theyd prefer and if theres anything you can do to make a new environment more comfortable for them. If youre the parent or caregiver of an autistic child, you can ask how they felt in situations, or look for signs that theyre uncomfortable during or after being in different environments. Autistic children are often able to communicate best with those closest to them about what they enjoy and dont enjoy. Read more about finding the right environment Diagnosing autism The signs of autism can be different depending on the person and how old they are. Because autism is present from birth, it can usually be diagnosed in childhood. However, it may only be recognised later in life. Understanding of autism has grown over time, so more people are now being diagnosed when theyre older if the signs werent recognised when they were children. These are signs of autism that health professionals look for when making a diagnosis, but an autistic person may not have all of these signs. For example, delayed speech (learning to speak later than most children), or a child not speaking at all, can be a sign of autism. However, many autistic children talk at the same age a child without autism would. Its also possible that these signs are there, but they arent caused by autism. If you think you or your child might be autistic, talk to your GP or health visitor. Signs of autism in children The signs of autism can change as children grow  babies and toddlers show different signs of autism than children aged 4 and older. Babies and toddlers Signs of autism in babies and toddlers can include a number of things that affect different parts of their life and behaviour. Talking and showing emotions Autistic babies and toddlers might: start talking later than most children seem less aware of others around them  for example, they might not respond to their name being called make repetitive movements when excited or upset  for example flapping their hands, rocking back and forth, or making the same noise repeatedly Autistic babies and toddlers might not: smile back when you smile at them point to show when they want something point to show you something they find interesting share when theyre feeling happy  for example, they might be having fun playing, but they might not turn around and smile at you Playing Autistic babies and toddlers might: spend a long time setting up toys in a certain way, and set them up the same way every time enjoy lining toys up in order, or watching parts of them move Autistic babies and toddlers might not: seem interested in playing with other children their age seem to use their toys to make up stories or pretend  they might also start pretend play at a later age than most children Sensory (sights, smells, sounds, touch, and tastes) Autistic babies and toddlers might: react strongly to sounds, smells, touch, tastes, or things they can see  for example, if they like the way a stuffed toy feels, they want to spend a lot of time stroking the toy become upset if given something to eat or drink thats new to them eat a limited range of foods Children aged 4 and up As children grow and experience different environments, such as nursery and school, the characteristics of autism can appear differently. Communicating Autistic children might: speak differently to most children  for example, they might use an unusual accent, talk slowly or quickly compared to others, speak in a flat tone that doesnt change, or use a sing-song voice use longer or more complicated words than most children, even in relaxed situations struggle to ask other people questions about themselves find it hard to keep a conversation going Relationships Autistic children might: show a great deal of enthusiasm for talking about subjects that interest them, but experience significant difficulty when talking about other peoples interests find it difficult to make and keep friends want to play with other children, but find it hard to ask if they can join in have 1 or 2 good friends that they spend a lot of time with spend free time, such as school break times, by themselves find it hard to tell the difference between someone being friendly or joking and someone trying to bully them or hurt their feelings get on better with adults than other children their age get on better with children who are younger or older than them spend time with a group of children, but find it hard to join in with other childrens play, and so spend a lot of time on the edge of the group have friends at school, but show little to no interest in seeing them outside of school Different situations and routine Autistic children might: accidentally make social mistakes, for example correcting a teacher about classroom rules find some social situations, like parties or busy places, overwhelming and difficult to cope with be passive around other children or adults, agreeing to everything and doing everything people ask often tell others what to do, including while playing struggle with social situations with no timetable or clear rules, such as free play or school break times find it difficult to cope with changes to their routine, especially if the change is unexpected  for example, having a different teacher for a day or having plans change due to bad weather Sensory (sights, smells, sounds, touch, and tastes) Autistic children might: react strongly to sounds, smells, touch, tastes, or things they can see  for example, being unable to cope with seams in their socks or the noises in supermarkets find certain sounds, smells, feelings or tastes particularly calming or enjoyable  for example, coloured lights or being tucked tightly into bed make repetitive movements when excited or upset  for example flapping their hands, rocking back and forth, or making the same noise repeatedly Signs of autism in teenagers and adults The characteristics of autism can affect you differently as you get older  you may also recognise some of the signs of autism in children in yourself as an adult. Many people are diagnosed with autism as teenagers or adults based on noticing that they think and behave differently from most other people. Signs of autism in teenagers As you age and experience different environments, you might notice different signs of autism. Communicating As an autistic teenager, you might: find it hard to be understood in conversations, find it hard to work out when to talk in conversations  you might never get to say what you want to say, or find yourself talking over other people find it easier to communicate with other autistic people be able to talk for a long time about the subjects that particularly interest you show a great deal of enthusiasm for talking about subjects that interest you, but experience significant difficulty when trying to talk about other peoples interests be able to answer other peoples questions, but struggle to know what questions to ask or how to answer when someone tells you something about themselves find other people say you use a lot of long words, or use longer or more complicated words than most people often use the same phrases when youre talking struggle with hidden meanings when other people are talking to you  it might be difficult for you to understand a hint, or notice when someone is flirting with you find people can take the wrong meaning from your words or behaviour  for example, if you make a lot of eye contact, they might think youre flirting with them Behaviour and different situations As an autistic teenager, you might: find eye contact uncomfortable, or struggle to know how much eye contact to use do well when youre in your routine, but find it difficult when routines change  changes might make you feel anxious, make it hard to concentrate, or mean you have to work harder on things itd normally be easy to do struggle to imagine things that you havent experienced before  for example, if youre going to a party for the first time, it might be hard for you to imagine what will happen and what youll be expected to do find yourself making social mistakes without realising why  for example, during conversations you might not realise there are things other people would rather not talk about, or dont think are important to talk about Learning and hobbies As an autistic teenager, you might: have a lot of knowledge on particular topics, and spend a lot of time learning about them and telling others about them have a hobby you feel very passionate about and spend a lot of time on find it hard to start a new activity but get very focused on it once you get started  you might be able to focus on it better than most people find it difficult to stop doing an activity youre very focused on, even if you need to move on to something else  you might forget to eat or sleep Emotions and relationships As an autistic teenager, you might: spend a lot of time being careful to avoid making social mistakes, or trying to make sure you dont accidentally hurt anyones feelings find that other people struggle to understand your feelings from your face or tone of voice find that your friends are often older or younger than you find that your friends tend to be autistic people have to ask people to explain idioms (phrases that say one thing, when theyre actually talking about something else), for example: well cross that bridge when we come to it, which means well talk about that problem later have a clear idea of right and wrong, and strong views on issues that are important to you  you might struggle to understand exceptions to rules, or grey areas find a lot of people dont understand your sense of humour, and you might not understand why their jokes are funny be trusting, and find people can often take advantage of you find it hard to work out when someone is being unkind Sensory (sights, smells, sounds, touch, and tastes) As an autistic teenager, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch  for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like gyms have a strong positive reaction to sounds, smells, sights, and things you can touch  for example, enjoying flashing, multi-coloured lights in nightclubs or how loud the music is at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming  for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Signs of autism in adults As you age and experience different environments, life events, and circumstances, you might notice different signs of autism. You might also have developed coping strategies for environments you find difficult, changing the way you manage them. Work and education As an autistic adult, you might: find it more difficult than most people to communicate in interviews  for example, talking about your skills  which can make it hard to get a job find it more difficult than most people to keep a job  you may be good at your work, but it might be hard to have good relationships with colleagues and managers have a lot of knowledge or feel very passionate about a subject thats useful for your work or studies find it difficult or frustrating when rules or ways of doing things dont make sense to you find it more difficult than most people would to work on a project or task that has unclear instructions for how to complete it Relationships and being social As an autistic adult, you might: find socialising hard work  when others seem to have a lot of energy after meeting a group of friends, for example, you might feel exhausted have had relationships with friends or partners end because you couldnt understand how each other thought, behaved, and communicated find dating challenging prefer to be alone during breaks at work find it difficult to make small talk  meaning conversation about day-to-day things such as the weather  or understand the reasons for making small talk enjoy spending time with other people, but find activities that dont have clear rules or a schedule  for example, going to parties or nightclubs  difficult because you arent sure what to do prefer meeting up with people to do structured activities, like cooking or taking part in a shared hobby or interest Hobbies and skills As an autistic adult, you might: have a lot of detailed knowledge about a particular topic or hobby and feel very passionate about it find that the hobbies or topics youre particularly passionate about have changed several times in your life Communication and emotions As an autistic adult, you might: find other people often misunderstand you, or seem upset by things you say even if you dont mean to upset them find it hard to understand why people around you see a situation one way, and not the way you understand it find change more difficult than most people do  things that disrupt your daily routine, like changes to your job or going on holiday, can make you feel stressed and anxious Sensory (sights, smells, sounds, touch, and tastes) As an autistic adult, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch  for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like busy buses or trains have a strong positive reaction to sounds, smells, sights, and things you can touch  for example, enjoying lying under a weighted blanket, or the loudness of the music at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming  for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Autistic traits and diagnosis Autistic traits  meaning things that autistic people often do, think, and feel  are often shared by people who dont have autism too. This doesnt mean that everyone is a little bit autistic, or that autistic people dont need support. To be diagnosed with autism, a person has to have a lot of autistic traits from birth, and those traits need to have a big effect on their life. In order to be diagnosed with autism, those traits must cause what a healthcare professional would call clinically significant difficulties in their day-to-day life. This means that they have difficulties with day-to-day life due to their autistic traits and need to use their own ways of overcoming those difficulties, or the people in their life need to help them to overcome them, or both. Being in a supportive environment makes a big difference to an autistic persons wellbeing and quality of life. Learn more about how autism is diagnosed Other health conditions People who have these conditions can be more likely to also have autism: developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disability muscular dystrophy Downs syndrome cerebral palsy epilepsy neurofibromatosis  a number of genetic conditions that cause tumours to grow along the nerves (the main types are neurofibromatosis type 1 and neurofibromatosis type 2) rare genetic conditions, including fragile X syndrome, tuberous sclerosis and Rett syndrome Causes of autism The exact cause of autism is unknown, but researchers think its at least partly genetic  that autism can run in the family. However, autism can also develop when theres no family history. Theres no way to predict whether a child will be autistic, even if one or both of their parents are autistic. More research is being done to find out which genes cause autism  its thought to be caused by more than one. Living with autism Like everyone else, autistic people can be happy and healthy in the right environment  however, the right environment for an autistic person can be different to the right environment for a non-autistic person. Autism doesnt mean that a person will need additional support to work, have relationships, or enjoy hobbies. However, many autistic people do need additional understanding or support to overcome the challenges caused by having autistic characteristics in a society where most people dont have them. Therapies for autistic people Theres no cure for autism, and most autistic people wouldnt want to be cured even if it was possible. Many autistic people feel autism is part of their identity, and not something to be cured or treated. Related conditions Because of the difficulties they can experience, autistic people may need treatment or support for other conditions, including: low mood anxiety sleep problems Psychological therapies like cognitive behavioural therapy (CBT) are often used to treat depression, anxiety, and sleep problems, both in people who have autism and people who dont. Psychological therapies can help to manage conditions linked with autism, like anxiety, but psychological therapies arent a treatment for autism itself. Therapy techniques might need to be adapted to work for an autistic person. Challenges in daily living Depending on whats offered by your NHS board and local organisations, there are therapies to help overcome the challenges that autistic people can experience. Possible therapies include: help with communicating, both for autistic people and the people in their lives groups for autistic people to share experiences and advice sensory assessments and support with an occupational therapist to help find ways of managing and improving your environment and how you experience the world training courses for loved ones, to help them understand autism and offer the best possible support Finding the right therapies Interventions that aim to train out behaviours (like repetitive movements, for example) or force autistic people to behave like non-autistic people are unethical and often harmful. However, many autistic people can benefit from support in learning skills to overcome some of the difficulties they experience  this is different to forcing someone to change their behaviour. For example, an autistic adult might want to learn extra social skills to improve their relationships at work, or a therapist may work with a child and parent to help them to develop their communication skills. These therapies dont aim to change a persons autism, but to give them skills they can use. If youre an autistic adult, the decision to have therapies for things like social skills should be yours. If you have an autistic child, any therapy they have should be with the aim of meeting their needs. Learn about avoiding harmful and unhelpful therapies for autism Autism and your environment Sometimes, when a situation is too much to cope with due to sensory input (things you see, hear, feel, smell or taste), or being asked to do things that cause stress or distress, an autistic person can become overwhelmed. Meltdowns and shutdowns When an autistic person becomes overwhelmed and isnt able to use or benefit from their coping strategies, they might have meltdowns or shutdowns. Its important, for parents of autistic children in particular, to be aware that a meltdown isnt a tantrum. A tantrum is something that a child can control, and tantrums often happen because a child wants something. A meltdown or shutdown isnt something an autistic person can control, and its caused by being overwhelmed. During a meltdown, an autistic person might try to make themselves feel less overwhelmed. This can include doing things like: trying to get away from people  for example by running away or hiding trying to get people away from them  for example by shouting, screaming, hitting, or acting aggressively During a shutdown, an autistic person might try to block everything out  for example by not responding to anything or anyone around them. Read more about meltdowns Challenging behaviour Like everyone else, autistic people can display challenging behaviour if theyre in the wrong environment. While it can be challenging for the people around them, this behaviour is often a result of distress or frustration, particularly if an autistic person has difficulty with communicating. Behaviour that challenges others is usually a way for someone to get their needs met when they dont have any other way to do so. Its not bad behaviour, or intended to cause harm. This kind of behaviour is most common in children, or people who find it hard to communicate their needs  for example, people with a learning disability. If youre autistic, effective communication about your needs, and finding ways to have those needs met, can be helpful in reducing the distress that can lead to behaviour that challenges. If someone in your life is autistic, or youre the parent or caregiver of an autistic child, finding the right strategies for supporting their needs is important and helpful, and can be done if theres effective support for everyone involved. Behaviour that challenges can also be caused by: trying to meet sensory needs  for example, wanting to do something because it feels nice, like rubbing soaps and creams all over themselves and the walls wanting something  for example, being hungry or wanting to play with a toy needing assistance or attention  for example, because theyre bored or want help with a project at school trying to escape an environment or the people around them, but doing so in a way that can be dangerous or harmful, such as running into the road Behaviour that people can find challenging includes: being destructive  breaking things, for example being disruptive  making noise in class or throwing things, for example self-harm aggression Help is available for anyone experiencing distress that might result in behaviour that challenges. Finding support can help you identify the reasons behind this behaviour and find other ways of communicating and meeting needs. Contact your GP or the healthcare professional who usually supports you for advice. Getting the right environment Environment is important to quality of life for autistic people. There are ways you can adapt (change) and improve your environment to make it as comfortable and supportive as possible for you or your child. The social model of disability is a way of looking at the world that treats the difficulties people with disabilities have as being caused by barriers in society, rather than just the disabilities themselves. These barriers can be physical  for example, buildings not having accessible toilets. Barriers can also be caused by peoples attitudes  for example, many people will assume someone is lying because they dont make eye contact while talking. The social model of disability can be a helpful way of considering the difficulties someone faces, and how to adapt their environment so it works for them. Learn more about the social model of disability Autism is covered by the Equality Act (2010), which means that schools and employers are required to make reasonable adjustments to ensure autistic people are comfortable in their environment and able to learn or work. Learn more about the Equality Act (2010) Common changes to an environment that can help autistic people include: sensory changes  for example, being given a quiet space to work, being able to use sensory toys like fidget spinners, or being allowed to make noises while working communication changes  for example, using email or apps to communicate, using very clear language, allowing additional time to ask questions, or using visual communication such as photos or pictures as well as written words routine  keeping to a regular routine and giving warning of any changes as far in advance as possible Every autistic person is likely to benefit from different changes  the best way to find the right ones is to ask an autistic person, or in the case of a child, their parents or caregivers. Learn more about autism from autistic people Facts and myths about autism There are many incorrect beliefs about autism, particularly the causes of autism or the best ways to overcome the challenges often faced by autistic people. Causes These things do not cause autism: bad parenting vaccines, or any ingredients in vaccines trauma or distress at a young age diet infections Fake treatments Theres no cure for autism, but many people incorrectly believe there are ways to cure it, or to change the way autistic people experience and interact with the world. Some fake treatments are dangerous  even the ones that arent dangerous are unethical, and none of them are helpful. Harmful and dangerous fake treatments include: any treatment that aims to train out autistic behaviour like forcing someone to stop making repetitive movements any treatment that aims to train autistic people to do things that cause them distress