Autistic spectrum disorder

• The diagnosis of autism is a long and often distressing process for parents and carers. It is important to understand that some children may not be diagnosed initially and may be reassessed at some point in the future.
• The way in which each child grows up and is affected by autism varies greatly – some children may have significant care and learning needs from a young age, while others will learn themselves how to cope and mask some of their traits.
• It is important that parents and carers are supported through the process and that the child is enabled to reach their full potential.

Autism is a developmental disability in which affected people perceive and interact with the world in a different way to others. It is a lifelong condition and there are around 700,000 autistic people in the UK (approximately one in every 100 people). It affects people from any culture equally, but it is slightly more prevalent in men than women.

Autism is not an illness or disease that can be cured and each individual is affected in different ways. As such, it is defined as a ‘spectrum’ condition. All autistic people share certain difficulties, which affect each person in different ways. Some autistic people also have learning disabilities, mental health issues or other conditions, and require thorough assessments to identify their individual support needs.

Not everyone with autism will need support to engage with everyday life. Many can enjoy day-to-day personal interactions and have a healthy independent life.

There are many benefits for parents in obtaining a formal diagnosis of autism for their child. It allows the child to reach their potential by ensuring all caregivers have a better understanding of the child's specific needs. It can also help to identify which children may need one-to-one support on a daily basis and which children can cope in nursery and school with minor adjustments.

A diagnosis is usually undertaken by a multidisciplinary team due to the fact that the autistic spectrum is vast, and the characteristics vary greatly from child to child. Health professionals should consider referring a child for an autistic assessment if there are developmental concerns, as described in the symptoms section below.

1. Language delay or a change in speech development by age 2 years, for example:

• Fewer than 10 words by 2 years
• Regression or loss of speech
• The presence of non-speech, such as vocalisations
• Odd or flat tone to their speech
• Frequent repetition of set words or phrases
• They continue to refer to themselves as ‘you’ or ‘he/she’ beyond three years
• They do not respond or have a delayed response to their own name
• They have a tendency to use single words even when capable of using sentences.

2. Their awareness of the people around them changes or does not develop, for example:

• They have a reduced or lack of a social smile
• They demonstrate avoidant behaviours when requests are made of them by others
• They tend to reject cuddles given by caregivers (they may initiate them themselves)
• They have a reduced or lack of awareness of personal space and

The exact cause of autism is unknown and research is ongoing. Some research has suggested that there is likely to be a combination of genetic and environmental factors. Autism has no association with a child's upbringing, their social circumstances and is not something that can be prevented.

There is no cure for autism. However, thorough assessments by a multidisciplinary team will enable children or adults with autism to reach their potential. It will also help carers and those around them to understand their needs and make adjustments that will help to reduce anxiety and allow a fulfilling day-to-day life (National Autistic Society, 2019). 

NICE has highlighted some factors that are associated with an increased prevalence of autism which nurses should be aware of:

• A sibling with autism
• Birth defects associated with central nervous system malformation and/or dysfunction, including cerebral palsy
• Gestational age less than 35 weeks
• Parental schizophrenia-like psychosis or