Autism spectrum disorder (autism) is a neurological developmental disorder which often presents and manifests in early childhood, affecting the ability of the individual to learn, behave, communicate and interact with their social surroundings. In the United Kingdom, it is estimated that there at least 700,000 individuals with autism, which is an estimated prevalence of around 1 in 100 people. The differences in perception and understanding of the world, social surroundings and their sense of selves is different to individuals without autism disorders, and this often leads to feelings of isolation and misunderstanding from those around them. Clinical psychologists aid in the diagnosis of autism which in turn may lead to greater access to services and support, and help families come to terms with behavioural, social or cognitive difficulties which affect the individual.
Autism spectrum disorders have long been diagnosed in the literature in psychology manuals and journals, yet often given specific names depending on the aspect of cognitive or social functioning which was affected. In 2019, the term autism spectrum disorders (ASD) is a catch all term for these other conditions which may have been reclassified or taken out of use. In younger individuals, developmental issues such as difficulty in social situations, social isolation, persistent patterns of behaviour, resistance to changes in routine and extreme interest in topics/hobbies are often the first identified symptoms of the condition.
Clinical psychologists are involved in the diagnosis of autism, often through a skilled and careful evaluation of clinical history, behavioural patterns and even interviews with family members and friends to ascertain valuable qualitative information about the individual’s interests, hobbies, behaviours and intolerances. The diagnosis of autism in childhood can prove difficult, particularly in younger individuals who have not developed the capacity for speech and autonomy, but may express symptoms of social and developmental difficulty. Some sources suggest it may take up to 3-4 years to definitively diagnose autism as it may take some time to exclude other conditions and gather enough qualitative evidence to make a diagnosis. Although there is thought to be a genetic and environmental component, there are no clinical biomarkers or blood tests available to point towards diagnosis.
The diagnosis of autism by clinical psychologists is often performed with special types of interviewing to ascertain the individual’s perspective of the world, their cognitive capacity and their perspectives on social functioning. Other interviews with supplementary information of caregivers, parents, teachers and friends may be used to ask more direct questions around the interests and abilities of the individual academically and socially. In patients with more cognitive disability, tests of language, speech and articulation may be used, but these all take place in environments which are more conducive to the individual feeling as relaxed and comfortable as possible as to not exacerbate any symptoms they may present. Once thorough examination and a large amount of qualitative data has been obtained, the role of the clinical psychologists is to evaluate the individuals social, cognitive and behavioural strengths, as well as highlight areas which, with intervention, may help in their overall quality of life.
Although autism is a lifelong condition, individuals who receive early interventions, support and therapies often have a much better outcome in the earlier stages of learning and social functioning development. The use of cognitive behavioural therapies and autism-specific therapies such as applied-behaviour analysis can aid in identifying and reducing the prevalence of adverse behaviours by empowering and encouraging the individual to interact more with their healthy, positive behaviours. Often, a key aspect of therapy for autistic individuals is the advocacy to find activities which aid in personal development and provide ambition – these often arise as musical, academic, artistic or environmental passions which can provide life changing influences to individuals with autism. Individuals who are diagnosed at a younger age may also be given ‘floor time’ therapy, whereby the individual’s caregivers and parents are encouraged to interact and play, whilst prompting the individual with increasingly complex commands and requests. The initiation of therapies in an environment that is familiar and comfortable to the individual has a large impact on how well the support therapies work, and empowering the individual with close family members aids in social processing. Parents who interact with floor time therapy often gain a better understanding of their child’s behaviour and actions, and may improve their ability to see the world from their child’s perspective, gaining a better outlook on their child’s behaviour. Once a diagnosis has been made through a clinical psychologist, referrals to other secondary and tertiary caregivers occurs through schools, support groups and counsellors who can be invaluable lifelines to families, carers and individuals who know or suffer with autism.
Autism is a highly individual condition that affects individuals in a variety of ways, and as such the approach to therapies is often tailored to the individual. For example, one individual may have a propensity towards social anxiety in situations, therefore their therapy may be aimed more around counselling and behavioural therapy to address the distress and anxious thinking. Likewise, other non-therapeutic directed activities such as hobbies and personal time will empower the individual and may give confidence around social interactions to build their resilience and social ‘wealth’. Other individuals may have certain behaviours around sleep, food and self-care which might be approached in a different way by giving small exposure to these behaviours and monitoring the individual’s response with the family members involved. Indeed, the therapies for the individual are almost as important to the families of the individual who may require counselling and support to provide them with emotional and social resources by which to support their child or family member with autism.
The role of clinical psychologists in the treatment of autism is fundamental to getting a diagnosis and being signposted to best areas of support for the individual and family members. The therapeutic options are often centred around social and behavioural therapies through counselling and other specific techniques. A fundamental part of therapy for autistic individuals is the uptake of activities, hobbies and passions which may serve as an outlet for them and their families when coping with difficult issues. Getting a diagnosis is fundamental to the treatment and support of the individual, and allowing the individual to lead a happy, fulfilling life alongside their family and loved ones.