UK coronavirus rules relaxed for people with autism and learning disabilities

Policy updated after lawyers challenge ‘discriminatory’ lockdown measures

People with learning disabilities or autism can leave the house for exercise more than once a day and can travel outside of their local area under current lockdown measures, the government has said.

The guidance, which had previously stated that non-essential workers should only leave their homes once a day for exercise or to shop for basic necessities, was amended on Wednesday.

The updated advice reads: “If you (or a person in your care) have a specific health condition that requires you to leave the home to maintain your health – including if that involves travel beyond your local area – then you can do so.

“This could, for example, include where individuals with learning disabilities or autism require specific exercise in an open space two or three times each day – ideally in line with a care plan agreed with a medical professional.”

Although those with autism and mental health conditions are advised to limit their travel, and stay as close to their local area as possible, carers and support workers who do not live in their household can accompany them.

The change comes after lawyers from Bindmans LLP and 39 Essex Chambers were asked for help by two families with children on the autistic spectrum.

Bindmans said one of the children, whose conditions mean it was necessary for them to leave the house more than once a day for their wellbeing, was deliberately taken to a quiet location outside of their local area because of their particular needs.

The firms argued that the “inflexible policy”, which also says people should stay two metres apart from anyone outside of their household, disproportionately impacted those with certain health conditions and was “therefore unlawful and discriminatory”.

After the amendment was made to the guidance, one of the affected families said they were “delighted” they could support their son’s needs “without breaking the rules”.

A spokesperson for the Cabinet Office said the most important action the public could take during the pandemic was to stay home to prevent the spread of Covid-19.

But, it added: “We understand that this will be more difficult for some, that is why we clarified the guidance regarding the needs of those with specific health conditions such as learning disabilities or autism.”

Brain scans could identify babies most at risk of developing autism, study shows

Images revealed which infants would go on to have an autism diagnosis, raising hopes for earlier care and interventions for those affected.

Babies who are most at risk of developing autism as toddlers have been identified from brain scans in the first year of life.

The images helped doctors spot which of a group of children who were already at risk because of autism in the family would later be diagnosed with the condition.

The work raises hopes that affected children could be helped with earlier specialised care and interventions to help their social abilities before any behavioural symptoms start to appear.

Scientists studied 106 babies, all of whom had an older brother or sister with autism, and found that telltale features in brain images taken at six and 12 months revealed which infants would go on to have an autism diagnosis.

The technology is not ready to use in clinics, but researchers who took part in the study believe it lays the groundwork for a tool that can predict autism in high-risk babies before their first birthday.

“We don’t have such a tool yet, but if we did, parents of high-risk infants wouldn’t need to wait for a diagnosis of autism spectrum disorder at two, three or even four years,” said Annette Estes, a co-author on the study and director of the University of Washington in Seattle. “Researchers could start developing interventions to prevent these children from falling behind in social and communication skills,” she added.

About one in 70 children in the UK develops autism, but among those with a diagnosed sibling, the risk of the condition can rise to about one in five. The test has not been tried on children who are not at high risk.

Writing in the journal Nature, the scientists describe how they compared brain scans of high-risk babies with those from 42 low-risk children who had no siblings with autism. On each lab visit, scientists assessed the children’s behaviour and intellectual abilities.

The images, taken as the babies slept, revealed that high-risk infants who developed autism experienced a “hyperexpansion” of the brain’s surface in the first year of life. The unusual growth preceded a rise in brain volume over the following year that was linked to social difficulties the children developed.

The scientists next used a machine learning algorithm to predict from the scans and the infant’s sex which high-risk children would be diagnosed with autism at the age of two. The computer identified eight in 10 of those who developed autism. In about 3% of cases, it predicted autism that did not appear.

Antidepressants during pregnancy linked to autism

A New study, published in JAMA Pediatrics, finds a link between antidepressant use during pregnancy and an increased risk of autism in offspring.

The risk factors for autism spectrum disorder (ASD) are complex, poorly understood and potentially great in number.

Many facets have been studied, but the exact etiology of ASD is a long way from being unravelled.

This current study looks in depth at Canadian births, antidepressantuse and their influence on ASD. The results might be considered controversial and are guaranteed to spark debate.

Antidepressant use during pregnancy is already a bone of contention and has been discussed and researched at length. This latest study adds an extra dimension to the conversation.

The question of whether to prescribe antidepressants during pregnancy is a difficult one. There are inferred risks to the unborn child, however, if the prescription is stopped, there are risks for the mother.

As many as 1 in 10 pregnant mothers in the US take antidepressants at some point during the course of their pregnancy.

This high level of prevalence, plus the fact that depression appears to be on the rise, has sparked further research into the implications.

Studies into antidepressant use and pregnancy have so far unearthed a number of associated risks; these include an increased chance of spontaneous abortion, major congenital malformations, premature birth, lower birth weight and pregnancy-inducedhypertension.

Other studies have, with various levels of confidence, found links between antidepressant use during pregnancy and a risk of persistent pulmonary hypertension and the possibility of neonatal withdrawal symptoms.

The latest research, led by Prof. Anick Bérard from the University of Montreal and CHU Sainte-Justine children’s hospital, adds ASD to this list.

Use of SSRIs significantly linked to increased ASD risk

In short, people with ASD learn, interact, communicate and behave in subtly different ways to the rest of the population.

Each case of ASD is different; some children with ASD may need an incredible amount of support. Other ASD individuals could not be picked out from a crowd, but in certain circumstances, they might struggle to understand or integrate with society.

Because ASD has only been described relatively recently, and the official diagnostic criteria are still in flux, no one knows whether the incidence of ASD is growing, or whether modern parents and clinicians are simply better at spotting it.

Prof. Bérard’s study used data from the Quebec Pregnancy Cohort. In total, 145,456 conceptions leading to live births were collated and followed up for 10 years.

For the first time, the investigators took note of not only antidepressant use, but also they marked which trimester the drugs were taken in and, importantly, the class of antidepressants being taken.

The high quality of the Quebec Pregnancy Cohort’s data allowed for close control of potentially confounding variables. The team had access to factors including the mother’s socioeconomic standing, family history of autism, history of depression, previous births and age at conception.

Autism – are we any closer to explaining the enigma?

Autism is a developmental disorder characterised by impairments in social interaction and both verbal and non-verbal communication, along with restricted, repetitive or stereotyped behaviour. Following more than a quarter of a century of extensive research from psychologists, are we any closer to explaining the enigma? Has stretching the diagnostic boundaries helped or hindered scientific and practical progress? A critical step in ‘solving the puzzle’ of autism is to consider the myths and realities surrounding autism, both for those living with it and their relatives. This issue gathers a variety of perspectives from those people and from leading researchers in the field.

At this time about 25 years ago I was nervously awaiting readers’ reactions to my book. Having been persuaded to go with the title Autism – Explaining the Enigma, I knew for certain that I hadn’t explained it. I had laboured on it for years and years, and most of the time I felt ‘Who am I to even try and write such a book?’ The main antidote for this feeling came from fellow psychologist John Morton, who egged me on from draft to draft with words like ‘you have something to say, so say it’.

In those days, books on autism were a rarity, and people were just beginning to ask what autism was. The film Rain Man, starring Dustin Hoffman and Tom Cruise, was a milestone in the rise of public awareness of autism. I remember how difficult it was for bookshops to decide which of their sections was suitable for the book. Mostly, it was placed with psychiatry texts, and ironically Frith was placed next to Freud. I would have much preferred to be placed with books on experimental psychology, because I believe that psychology provides the space where the enigma might eventually be solved. I could not imagine then that there would be a time when books on autism fill their own section, and when there would be this special issue of The Psychologist.

Almost as soon as I had finished the Enigma book, I became hopelessly attracted to Asperger syndrome. With time I met an increasing number of unusual adults with a provisional diagnosis of autism, who amazed me because they were far more able to converse than the now grown-up children whom I had first seen when I started doing research on autism in the 1960s. What struck me was their ability to provide insightful observations about their experiences. That opened up completely new possibilities to investigate the autistic mind. Adults like this had been mentioned by Hans Asperger in his landmark paper from 1944. I set about translating this paper and got in touch with other researchers who were similarly struck by these individuals, and the result was a book on autism and Asperger syndrome. I never anticipated how dramatic the impact of the concept of Asperger syndrome would be in the brief history of autism. Many psychologists and psychiatrists had only just become aware of autism, and now they had to embrace a whole autism spectrum (Wing, 1996). I believe the impact is still felt even if the label Asperger syndrome no longer appears in the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association.

One of the positive effects of the interest in Asperger syndrome is that we now know that autism can occur at all levels of intellectual ability, including very superior levels. On the negative side, this makes us sometimes forget that about half the cases diagnosed with an autism spectrum disorder suffer also from a marked degree of intellectual disability.

It is this substantial group that presents the most challenging behaviour and the most difficult problems of management. However, problems in managing life cannot be blamed on intellectual disability. Instead they are the consequence of the profound social communication problems that are at the core of autism. In a truly epic study that reported a 40-year follow-up of 45 autistic individuals with an IQ >70, Howlin and colleagues (2013) found that 83 per cent were unable to live independently. Here is a plea for psychologists to take up their cause.

Now I stick my neck out to mention another unforeseen side-effect of stretching the diagnostic boundaries. With more lenient criteria and heightened awareness of autism, the diagnostic process will inevitably produce false positives. Thus, there are individuals with problems in social relationships and other features that are reminiscent of autism, who have either claimed or been given the label Asperger syndrome, but actually belong to a different category. Sadly, this category is as yet undefined and may even be part of neurotypical individual variation.

Meanwhile these people have changed the perception of what the syndrome is like. This perception is currently geared to emphasise the continuity between neurotypical and autistic development. While I like the idea of neurodiversity, I am not so sure that this necessarily means that there are only quantitative differences between people. The argument is also geared to deny that the nature of autism can be explained by cognitive deficits. I find this problematic – but, given that I have thought and written about cognitive deficits in autism all my life, I would say that, wouldn’t I?

My deliberately provocative suggestion is to reconsider the mildest of the mild cases of Asperger syndromes. Perhaps these individuals should be classified as having ‘autistic-like personalities’ rather than an autism spectrum disorder. Everyone agrees that there is an enormous variety in all our individual experience and histories, just as there is in our personalities and temperaments. Not everyone is an extravert and happy only with other people. Some display little emotional warmth and some are narcissists that do not care very much about others and often don’t pay much attention to other people. There are also perfectly neurotypical tendencies that tend to make life difficult: pursuing a specialised interest, being obsessive, enjoying strict routines, dithering over decision, and so on. It seems to me entirely plausible that combinations of these social and non-social features can occur in one and the same person and can then present an autistic-like picture. Human social relationships are extremely complex,  and failure is common. It is very desirable to be able to explain such difficulties without blame for the individual. They are indeed often outside the individual’s control. This is true for many medical conditions. Now if autism is a medical condition it can provide a ‘no-blame’ explanation. This would explain why perfectly neurotypical people like the idea that they – or one of their neurotypical friends – may be a ‘little bit autistic’.

However, there is a conundrum. If you follow the argument above, these individuals do not have a medical condition. They may feel different from other people, but aren’t we all different and don’t we all have our problems?

And this is how I understand the campaign for neurodiversity. It would make perfect sense, for some people, to argue for abandoning the idea of autism as a separate and pathological condition. After all, these individuals do not suffer from any ‘condition’, and it is indeed wrong to say that they have cognitive or emotional ‘deficits’. They just have problems that might be a little bit worse than those of many other people. However, although I am entirely on the side of the neurodiversity campaign, I draw a line at including the whole of the autism spectrum. I am very well aware that this argument is still running and that it will take a lot of discussion and also empirical research to find out whether the line I want to draw can really be drawn.

But here is the line I would like to draw: people with autism really have a very different mind and different brain. To me this has always been what attracted me most to autism. It is very rare and a precious gift to get a glimpse into another mind that operates on different assumptions and with different premises. However, there need to be other voices in this discussion. Should we believe only in continua and quantitative differences, or by contrast, in categorical and qualitative differences? This is an enigma that is tantalisingly hard to resolve. I know which side I am on, but I am prepared to change my mind if the weight of the evidence convinces me.

Are we getting any closer to solving the puzzle? A critical step in this journey is to bust myths that have accumulated and to listen to voices from all parts of the community and from all those who are directly touched by autism. Myths and truths about autism have been intertwined in the many representations of autism in literature and film and our attitudes are often conflicted. We like to see autism as an interesting personality variant with potential for creative genius. This is what films and fiction mostly portray. We can also see that autism can be a terrible obstacle to living an ordinary life. We find it easy to be sympathetic to young children with autism, but often hard in relation to some adults, let alone old people. If the voices of people with autism are also heard they will give an important counterbalance to researchers’ and professionals’ pronouncements. Only by putting together many different viewpoints will we eventually know what autism is really like.

The sheer quantity of publications and its presence on many dedicated web pages confirms that autism research has thrived in the last 25 years. It has flourished in particular in the UK, and some of our most talented psychologists are represented in this issue. It is thrilling to me to think that the UK still has a head start in the psychology of autism.

Uta Frith is Emeritus Professor at University College London


Young children with autism are more trusting than other children

Young children with autism have difficultly deliberately deceiving other people, now a new study has shown that they are also more trusting than their neurotypical peers. These two characteristics may be related to the same underlying cause – namely, difficulty representing the mental states of others (known as “Theory of Mind”), although more research is needed to demonstrate this.

Li Yi and her colleagues tested 22 children with autistic spectrum disorder (ASD; average age 7), 27 neurotypical age-matched controls, and 26 IQ-matched neurotypical controls (average age 6). The children chose which of three boxes to look in for the reward of a sticker. When an adult stranger first looked in the boxes and indicated which box the sticker would be found, nearly all the children with autism looked in that box. By contrast only just over half the age-matched and IQ-matched neurotypical controls did so.

In another condition, the children hid the sticker in one of the boxes while one of the researchers was out of the room. On returning, this researcher pointed to an incorrect box as the location of the sticker. Again, the children chose which box to look in for the reward. This time the children with autism, just like the neurotypical controls, nearly always looked in the correct box (where they themselves had placed the sticker). This shows that their trust is not unqualified. It is specifically when they lack knowledge themselves that they are more trusting of other people.

Yi and her team said “to the best of our knowledge, our findings are the first to report ASD children’s trusting tendency during the early years.” They advised that more research is needed to explore the reasons for autistic children’s high levels of trust. Apart from problems with Theory of Mind, other possible reasons include a tendency to forget previous instances of adults lying; or conversely, perhaps they tend to experience encounters with more trustworthy adults than neurotypical children do. Another avenue for future research, Yi’s team said, is to look for ways to teach children with autism not to be excessively trusting.

Yi L, Pan J, Fan Y, Zou X, Wang X, and Lee K (2013). Children with autism spectrum disorder are more trusting than typically developing children. Journal of experimental child psychology, 116 (3), 755-61 PMID: 23810631

Children with autism miss non-verbal cues

Non-verbal clues may be missed by autistic children when listening to what adults have to say to them. This is the suggestion of new research published in the journal Developmental Science and presented at the British Science Association, which found looking away might result in young people with autism not catching certain aspects of a conversation, BBC News reports.

Investigators from Durham and Northumbria Universities discovered that people will often look away from others when thinking, but focus on their face when talking to them. It was put forward that this may be one reason why children with autism sometimes have difficulty when it comes to social interaction.

Lead author of the report Debbie Riby, a member of the British Psychological Society, said: “One of the really important things for teachers to be aware of is that we shouldn’t expect children to keep looking at us when they’re trying to think.”

She added this should be taken into account not only by those teaching a child with autism, but also typically developing pupils and those with Williams syndrome.