CHAPTER 6: CONCLUSIONS AND RECOMMENDATIONS
2.8 TRIAD OF AUTISM
2.8.3 Imagination and behaviour
then at the age of 2 - 6 years, they begin to echo what they hear from other people.
While neurotypical children use their echoed language for communicative purposes, some children with autism continue echoing for months, or even years, sometimes even for life. This phenomenon of the continuous repeating of words and sentences, often in a whisper,is known as Palilalia. This may also continue for years, or for life.
Between the ages of 7 - 12, children with autism develop communicative speech at varying degrees and quality. Their spoken language can be formal, literal and delivered in monotone with unusual qualities of voice, pitch and volume, making the spoken language qualitatively different from normal speech. This means that a child who was once mute and almost completely non-communicative may become very talkative. However, their comprehension of spoken language may still not be sufficient (Peeters and Gillberg, 1999). During pre-adolescence and adolescence, the language development of 1 in 6 to 1 in 4 children with autism deteriorates. During adulthood,the individual's social impairment determines his/her communicative skills (Peeters and Gillberg, 1999).
(Beyer and Gammeltoft, 2000; Sicile-Kira, 2003; Emmons and Anderson2005;
Dumortier, 2007). Sharing in the imagination of others and creating joint play scenarios is difficult for individuals with autism as imagination means going beyond the literal, and they will therefore settle for stereotypical and limited patterns of behaviour they have learned by heart. However, having difficulty in creating something exclusively from their imagination does not mean they cannot 'imagine' within their own narrow play routines, or be gifted in the visual, musical or even language arts (Jordan and Jones, 1999; Peeters and Gillberg, 1999; Blackburn, 2007a).
2.8.3.2 Difficult behaviour and emotional problems
As mentioned above, due to a restricted imagination, children with autism have peculiar behaviours leading to an overall restriction of behavioural repertoire (Peeters and Gillberg, 1999;Sicile-Kira, 2003). Itis this limited repertoire of behaviours and interests,and not only the quality of these behaviours,that is typical of autism. Some children do share common types of behaviours,but it also depends on the individual's personality, level of intellectual and linguistic functioning, and the intervention provided. Such behaviours, however, can change over time (Furneaux and Roberts,
1977; Peeters and Gillberg,1999; Jordan, 2001).
Children with autism are mostly resistant to change, and insist on repetition of the same daily routines,for example,get home from school, eat, watch television,bath, then go to bed. If their routine changes, it could cause temper tantrums. Some children have routines of their own such as placing of toys in a line,jumping a few times before entering a room and so on. Theycould also become attached to a certain object: a specific toy,and refuse to part with it,or a child may become a collector of objects for example, sticks. Resistance to change can apply to food as well, as the child may refuse to eat certain foods at school,only eat them at home,be scared to try new food,or will only eat certain plain foods for example,plain pasta or rice without any sauce (Kanner, 1943; Wing, 1980; Sicile-Kira, 2003; Emmons and Anderson, 2005;Dumortier,2007).
Fearing harmless things such as balloons, vacuum cleaners, or riding on a bus, is common. They may also be unaware of real dangers due to a lack of understanding danger and its possible consequences (Wing, 1980; Sicile-Kira, 2003; Blackburn, 2007b).
Unusual body movement is one of the most noticeable behaviours of a child with autism. Hand flapping, twisting or spinning of objects in front of their faces, jumping up and down, facial grimaces, walking on tiptoe, spinning around without becoming dizzy, and so on, are the most common behaviours when the child is excited (Wing, 1980; Wicks-Nelson and Israel, 1984; Blackburn, 2007a). Furthermore,it is possible for children with autism to change.certain behaviours as they get older and more mature. This depends on the child's personality, which determines the way he reacts to his autism (Furneaux and Roberts, 1977; Wing, 1980; Peeters and Gillberg, 1999;
Jordan, 2001). Individuals with ASD who are non-verbal, rely on behaviours to communicate with others. Many of these behaviours are avoidance behaviours, and they often cannot help what they are doing and are not just being difficult (Sicile- Kira, 2003; Blackburn, 2007b).
2.8.3.3 Imagination and behaviour impairment from birth to adulthood in autistic disorder
Different or unusual behaviours are evident in some children with autism from the first year of life and often manifest when they have difficulties understanding the social world, and experiencing the world the same way as other babies do. They also struggle with joint attention. Furthermore, they do not relate to their own image, nor to that of an adult. This is concerning because being able to compare feelings and experiences with others is important for the development of imagination in the child (Beyer and Gammeltoft, 2000).
At the age of about 18 months, children with autism do not use parallel play and have difficulties in identifying meaningful social activity. They copy play sequences and make them identical each time they play. If change occurs, such children may experience anxiety or confusion (Beyer and Gammeltoft, 2000). By the age of 18
months children have the ability to create separate worlds,the ordinary world and a fantasy world that runs parallel with it. By the age of 24 months,they still engage in make-believe play. Children with autism however, do not always understand the make-believe, fantasy world (Peeters and Gillberg, 1999; Beyer and Gammeltoft, 2000). A child with autism,at the age of 18 - 24 months,is still discovering reality.
The child may have great difficulty understanding that a toy car and a real car both represent a car. This requires cognitive effort,which better-functioning children with autism manage better to understand (Peeters and Gillberg,1999).
It is common for individuals with autism to develop unusual body movements e.g.
hand flapping,before their first birthday. The continuous repetition of a word or a sound, or even a sentence in a highly stereotyped fashion, may develop. This is difficult to distinguish from a vocal tic.Itis also possible for individuals with autism to develop behaviours that are self-destructive, like face hitting, eye poking, head crashing,wrist biting and thigh slapping (Peeters and Gillberg, 1999; APA,2000).
There have been cases where individuals with autism presented no unusual behaviours until the ages of about 2 or 3 years, and then had a period of moderately severebehaviours lasting from 1 to 3 years. Some unusual behaviours are permanent, others may be temporary, developing patterns of interest after the ages of 4 or 5, collecting things e.g.,sticks; memorising specific information e.g.,names,developing a fascination for visual and auditory aspects of objects, e.g. listening to a specific sound or looking at something specific e.g.shiny paper (Peeters and Gillberg, 1999;
APA, 2000). This elaboration indicates that individuals with autism experience difficulties in three areas of development, that is, social, communication and imagination, which are known as the 'triad of impairment'. However, these are not the only aspects that these individuals have to deal with. They also have to deal with other related conditions as discussed below.