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right to play, right? Lovely. Uh, thank you very much. And good morning, everybody. My name is Katrina Harris, and I'm a community pediatrician, which in the UK means that my subspecialties around, uh, supporting Children with disability, and I work in, uh, one of the north London's, um, departments or north London hospitals. Um, but our clinics are based in a community which I very much so believe is the best place for disabled Children to attend If you need support from, uh, not only pediatricians, but also from the therapist. And, um, this is the model which we have in this country. And, uh, somehow, sometimes there is a little bit of confusion, because if you compare it to other countries in Europe, people believe that community pediatricians are pediatricians who are like G p single Children for a normal sort of, uh, everyday conditions, which probably 80% of Children have in this country. As community pediatricians, we sub specialize in neuro disability. And, uh, in a recent years, there have been grown, uh, wealth of experience, uh, supporting Children with, uh, one of the neuro developmental conditions, which we all known as authors and what I would like you to leave this session with is with the understanding that autism being social communication difficulties. Um, So how will you use all the modes of communication? Not only verbal, um, uh, sort of speech and that it isn't just speech and language delay because, um, sometimes parents already come to us and say, Well, if my child only could hear if my child only could speak If my child didn't have a tongue tie or whatever really other reason, then my child would not present with the difficulties than they have. Why? Like when we see a child and we're seeing that the childhood social communication difficulties, we know that the problem is much bigger. And I hope that after this hour, you sort of will have a good understanding of that. Um, I will speak a little bit about how you can diagnose the child with autism because autism is a lifelong condition. And because of that, we have to try to be as evidence based as possible. Um, we do not have a good blood test. We don't have any signs on on an MRI scan or on e g or whatever. However we use a number of tools and, um, the sort of, um, how the autism is diagnosed, Really? It a little bit depends on organization of the department and the resources. Nevertheless, we try to do it as well as we can, and then what we can do for Children with autism. And so it will be quite a practical talk about really very, very common condition. So what is autism we're talking about alters when, uh, Children have difficulties in three areas communication and social interaction. So some Children are nonverbal. Other Children can have quite a good use of, uh, spoken language. In fact, some Children have an excellent vocabulary and knowledge of it available tool, which we would call speech and language. Yet that communication is impaired because they're unable to use it for social purposes, and they don't use it for social interaction. Um, they can talk about universe or ninja Turtles. Detectives, you know, it's a sort of funny cartoons, really, with some turtles running around and so on, really, they can talk about their own interest in, uh, an hour absolute access and for whatever number of hours. And yet they're unable to tell you a simple things like, for example, that they are hungry or they are unable to ask for help. So, um, we start to think about autism because they can't use communication in a functional way. The second area, which we see, uh, such of, uh, impaired in Children with autism will be, uh, behavior and lack of flexibility of thinking. So Children with autism have a tendency to, uh, repeating themselves and, uh, being able to do thing in only one particular way or one particular way or two particular ways, but not really flexibly. And that can create a massive problem because we live in a society which is constantly changing and think about how difficult it is if you're unable to adapt to this constant change. And that is what is a massive problem, really, why they become really frustrated and incredibly anxious. Really? Because, um, uh, it is a little bit like with the use of technology. You learn to use one tool, let's say, uh, Microsoft teams and then you're stuck on the blackboard or on, uh, on another one. And then you just get very anxious and frustrated that your presentation will not, uh here and think about it, How sort of stressful it must be When Every time when you encounter any kind of situation, you expect it to be in one particular way. And actually, it's sort of changes. Really. You expect a particular bust? All right. And actually, it comes in different color shape or whatever. So this is the second area of difficulties. And then the third area, which is widely recognized nowadays, which has impaired um in Children with orders is sensory integration. Um, so how they perceive the world around through those senses and by census, I means hearing vision. Um, you know, arousal, uh, sensation in the scheme. And, uh, we know that Children with autism have a serious difficulties in that area, and that explains many of their problems. And we'll speak about it, Um, in a psychotic, um, when Children come for an assessment of autism, um, they their parents would like to see um uh, see it sort of in some sort of, uh, as a reflection in some sort of, uh, test, Really. And, um, and sort of an MRI scan is the typical way that parents want the child to be sort of assessed because obviously, when we go through the process, when we say that they are these difficulties and so on, then they will ask us, um, when does it come from? Obviously, it comes from of the brain is the fact that the brain doesn't sort of, uh, function properly, and then they want the test. However, in the absolutely vast majority, their MRI scan normal MRI scan is completely normal. So what we try to say is that the brains of Children with autism are wired differently. So what do we mean by that? It is about the development of synaptic, um, pathways, synaptic connections between the brains and the sort of development of specific communication pathways that is not really working properly. But obviously, once you see start to get into the neurobiology and the synaptic connections and the development of the pathways, it starts to be a little bit difficult. Then we tend to say that actually, people with autism, they are not ill. It isn't such of like a epilepsy, or it isn't like a condition that you have to treat with medication. They simply see the world from a different perspective. And really there's such a picture of a duckling which sort of looks in different direction, and it really is perfectly healthy and looks like the other Children is such a quite a nice analogy, because it sort of gives the parents a little bit more visual. Um, representation of what we're talking about when you talk about autism. So, um, sorry. Uh, so since, um, 2013, we have we're using 30 s and five criteria as diagnostic criteria. And then since 2013, I'm sorry. And maybe I hope that you can see really the whole slide, really? And that the top bar doesn't obscure a bit of the slide. But 32,013, the s employed criteria became there's, um, five criteria from this and four and that diagnostic manual of sort of classification of conditions and from a tryout. So from three areas of the difficulties, it's changed into two areas, and it's sort of inclusive. Uh, the first area where the Children have to have difficulties in order to get the diagnosis waters, um is persistent difficulties in the social use of verbal and nonverbal communication across multiple context with functional impact? Um, diagnostic criteria are very specific and they use words. But each of the word is actually really important. And I just sort of would like to really, uh, point out. So the difficulties have to be persistent. So they can't really be a little bit, uh, let's say present for one more month or two them They have to sort of, uh, be there for, you know, all the time. Really? And why is it important? Because, for example, you can have a childhood presents with the, uh, genotype similar to autistic. If they have, for example, um, epileptic and couple opathy so very, very severe abnormality associated with with epilepsy. And yet once the seizures starts to be treated, the child stops being autistic. Then they wouldn't really qualify for the diagnosis of autism. That's why we need to have the difficulties in a persistent manner. They have to be in, uh so there are sort of difficulties in the use of, uh, verbal and nonverbal communication for social purpose. And, um, why is that? We have Children who can have a very severe, uh, problems really with the speech and language so they can have a dyspraxia. And those Children do not qualify for the diagnosis of orders because they have a normal initiation of the social contact. They such, uh, engage and they can use the gestures. Or they can use of, uh, technology to sort of empower their communication. And again, sometimes the parents of Children with autism ask and to wonder whether they could sort of be referred for an assessment of augmented communication. And we tend to not to do it. Really, because we went to communication works really well for Children with several policy where they had a difficulty with the sort of, uh, speech operator shall their muscles don't work? Uh, they have a normal social interact, so they want to communicate while in Children with autism. The problem is that they don't understand the purpose of communication, and they don't necessarily have a, uh, intend to communicate in a normal way. So just giving them a device will not necessarily solve the problem. Now we need to have difficulties across multiple context. Um, and that means really, um, we know that sort of environmental factors, for example, like severe neglect in early years can create a situation that the child can look in the context of the neglecting environment like a child with autism. But for example, if they have a normal social interaction in another environment, for example, in the nursery, then obviously they will not qualify for the diagnosis of autism and then finally, functional impact. Um, we all add a little bit autistic. All of us have autistic features, and yet we wouldn't classify for the diagnosis of autism because it really has to impact on our function in society to get a diagnosis of autism. So the first criteria. Persistent difficulties in social use available and nonverbal communication across multiple context with functional impact. Big definition, lots of meaning. Now the second area which needs to be fulfilled for the diagnosis of waters according to this and five criteria is restricted. Repetitive pattern of behavior, interest or activities and sensory problems are included in that area, and we have already spoken about it and the Children with autism, they tend to prefer flavor of the sameness. They such of, uh like capacity to generalize their experiences and to learn from generalization, which is such a common way of learning in young Children. What I mean, just giving an example a very common problem in Children is a problem of eating. And if Children learn to eat in their mother's kitchen, they really struggle with the learning to eat. For example, in the nursery, a very common problem. And yet, over the the times they observed about their Children and by copying and by sort of using their visual learning strength, they learn that they can eat not only in Mom's kitchen but also in the nursery and so on and so on. Or they sort of a stack on going to nursery the same way, etcetera, etcetera. There will be some more examples very shortly of what parents tend to tell us when they come and ask for help. So if we think about the first area a little bit more, I want to draw. Just share with you what the parents tend to tell us when we such a first meet with them and when they research of ask them about the sorry about the issues. So really, the parents come and talk about say, Well, my child doesn't communicate. My child doesn't look at people, so if they speak, if they don't speak, they don't use eye contact for communicative purpose. Our gaze, an eye contact is an incredibly powerful tool that is used by babies already from very early stages to communicate. And we are incredibly effective communicators, not only as people, just as animals, really, that using the eye contact would communicate. Children and people with autism really struggle with eye contact. The current thinking is that one should not really, uh, forced upon them. I contact because when they're forced to use eye contact when they communicate, their communication skill reduced significantly. And, um, actually, it's really difficult for them to, uh, look at people's faces and use eye contact. A parents say he does not respond to his name being cold yet he will come to a TV program when it's on. So there's absolutely nothing wrong with my child's, uh, hearing. Indeed, it is again the deficit of social interaction. She does not come to show me things, and this is the deficit of shared communication. Um, share the tension and shared communication. My child doesn't ask for help, only does things by themselves. Despite that, um, you know it can be dangerous, for example, and this is again the failure of functional communication when they can talk for hours about the topic of interest. And yet they're unable to initiate into re social interaction and ask for help. Other sorry are the sort of the infamous other sort of statements from the parents. She snatches things of other people. Um, she just take things because she doesn't know that she could ask for a toy she likes in a different way. My child can say many words, but cannot ask for simple things. What a food help. We spoke about it using, uh, really good vocabulary to, um, ex to tell about own interest, but not for functional purpose. He does not point. She repeats words she's heard on TV, so she's unable to use words spontaneously. She's unable to create, uh, communication or sentences spontaneously and yet perfectly able to repeat sentences. Children with autism tends to have a really good memory, and they memorize things extremely well. My child does not have a friend. He prefers to play alone. Um, there are several reasons. Some reasons is that perhaps it's easier to play by yourself because you're not exposed. Unpredictability of other Children. Children may not work. Want to play with the child who is such of a little bit unusual and doesn't understand social coups. So there are lots of such of aspects of that. He leads me to fridge, but I do not know what he wants from the fridge. Very tricky one because, um, that often leads to tantrums to unwanted behavior. Um, and yet they struggle to indicate what they actually want. What do parents tell us about the flexibility of thinking my child screams when we go to the supermarket? Well, maybe the child is overwhelmed by the excess of impulses, So maybe their sensory integration, um, is really impaired. They might be such of overwhelmed by the visual stimulus. You know, when you think about the supermarket, everything is shiny, a lot of colors and smells. Maybe that's child is overwhelmed by nose is high pitch, such of metallic sounds of the trolleys moved around, For example, we always have to take the same route to the nursery, so the child knows one route, and they don't understand that you can get there in different way, and that creates anxiety and really creates a problem for the child with autism. He gets upset. If we do something new again and not understanding that things can be done in a different way. He lines up the toys. Yes, he only knows one way of learning hour of playing and that is unable to explore spontaneously and in new ways. She opens and closes doors and switches the light on he flaps. Um, she's very active and cannot sit still. That often is related to sensory, um, arousal and difficulties to sort of orientate yourself. Really? He holds onto his trains wherever he goes. If you think about the constant not understanding fully that the world is changing and yet means similar things, your anxiety level is absolutely sky high and really, too will intend to hold something small because that's such of, like the object of, uh, reference. Really, Um, they at least know that sort of, uh, you know, uh, that thing gives them reassurance that there's at least something which is unchangeable and really again. Severity is based on social communication impairments and restricted repetitive patterns of behavior, and the for the diagnostic. Um uh, label you really, it really needs to have a functional impact. And what functional impact lining of the car has Children, um, fear to and Children not only fear she is, they actually are unable to explore play in any other way. And that sort of has than a much, uh, big impact on the learning and experience of the world. So it's a functional restriction which such of will be needed for the diagnosis of autism. Now Children get the diagnosis of autism. Um, they need to have core features present in early childhood. So we always ask for the developmental history, and about 50% of Children will have a history of regression. Between the 1st and 2nd year of life, parents will say that the child was developing completely normally. And then something happened. And, you know, uh and then things goes badly wrong, and that's where they sort of MMR saga came into their lights. Really? Because people would say yes before the MMR, my child was normal. And after that, you know all that started in many, many cases. If you ask very detailed questions about the development, you can point out that actually, the child there baby wasn't developing normally in a way that their other Children were really And you can point out that, actually, you can trace the sort of abnormal development much further than from the sort of, uh, toddler, Uh, time. Really. But sometimes, really, it's quite tricky. And the sometimes you do think that something has happened yet we really do not know what causes the autistic big question. Yet now, frequency of the condition is really common. We say it's much higher than 1%. In fact, it might be even higher. And it's such a little bit depends on the really what population you screen. Uh, we know that Children whose mother were misusing alcohol and, um, drugs ready will have a really very high prevalence of, uh, communication disorders and autism in that group, um, can be up to 10 11%. Really? Um, that's a study from America. Ready? So, actually, the condition is really common. We just we sort of we have been sort of involved in the thinking about why is it more common? Is it on the rise? What can cause it? Really? There is no good answer really to that question. Um, one of the answers is that we are much better at detecting it and really spotting the, uh impact, and that's one of the reasons why it is on the rise now. It is a lifelong condition. You cannot grow out of autism, and because of that, firstly, you need some evidence based conditions to diagnose it. And second, you need to make the parents aware that autism changes in the sense that, uh, child is learning lots of new skills. They may be better at sort of saying things, but fundamentally they will continue having difficulties with social interaction. And, um, life becomes much more complicated. Um, and the demands of social life are much more increasing as years goes by. Already, we are learning we are more capable as subtle growth going up Children and become an adult. Nevertheless, uh, you can see very clearly that people who are diagnosed with autism as Children, they continue to have significant problems really in the area. Now, um, the impact on the function is, um, really seen across multiple settings. And we spoke about that, but something what is really, really important to remember that autism is the condition in which there is, uh, none of that. The sort of it comes from the sort of non functioning uh, nonfunctioning parts of the brain which are involved in various actions, and because of that, it is very strongly associated with other conditions, and in about 70% these conditions are not recognized. And really one of the most important conditions that needs to be mentioned here and I will mention it again, is the fact that Children with autism who have learning disability they do significantly worse in the in life as they progress than Children who have normal learning capacity. But the other sort of, uh, normal neurodevelopmental conditions that we see in the sort of Children with autism is, of course, a d. H d. We see a lot of epilepsy about 40% which is much higher than a normal population. People with the autism develop anxiety. Um, just because they don't understand what's going on. And then that all leads really to mental health problems and that obviously, all impairs their functioning. So how are we diagnosing with autism? I work in a department where we diagnose Children under the age of five, but there are many other departments were actually the cut off is between Let's say, whatever low limit to three years to 12 years because that's the age of the primary school. And then, um, in the UK there are very few departments which will have, uh, Children and young people across the sort of childhood. So until the age of 18, uh, nevertheless, really, Uh, for us, uh, who diagnosed Children at the age of five, which is probably the most common one. Uh, the referrals come from the health visiting team, from the nursery staff and from the G. P. And the referrals are directed to Social Communication Team for a multidisciplinary assessment of the developmental condition until the May present with biting, they may present with excessive behavioral tantrums that may present, really, with the sort of, you know, lack of danger awareness. I just put some slides of a girl who was such of excessive climbed er really, which sort of obviously would lead to a danger to her life etcetera, etcetera, and what happens already through the sorry through the process of assessment. So the referral comes for a multidisciplinary review of the child's difficulties. And then the nice guidelines, um, recommend very strongly that we should not go back to the single handed assessment of the difficulties so a doctor should not diagnosed of autism. Um, the assessment should be multidisciplinary at the absolute minimum. It should be, uh, medical more than that already speech and language therapist. Because in the end of the day, it's a communication, uh, disorder. And, um, in our team, we have access to speech and language therapist, clinical psychologist and occupational therapist and pediatricians. And usually it's a group of two or three people who are involved in the diagnostic process when the child is, um, accepted for an assessment. Unfortunately, um, universally, across the UK, there is a far too long waiting time for an assessment of, uh, several several months and even more than a year in many places. And then when it comes to religious, the assessment, um, by preference and observation of the child should happen at home and in the nursery environment. But through covid, it has all been modified to completing quite detailed questioners that really, um, describe child's functioning and really help the parents to sort of categorize their difficulties. Because some parents are not necessarily good historians. They would just tell you a lot about really what difficulties they experience. But That doesn't necessarily mean that it's such a particularly helpful for you who wants to sort of concludes really, and really see whether the child fulfill criteria of the SM five and a sort of diagnostic schedule already. And then once you have completed the questioners or seen the child in the in the in the nursery or at home, then you invite the child and the parents to clinic for an assessment. And once the assessment is completed, then a feedback to the parents is given and the assessment concludes, uh, whatever tool the team is using, plus a medical assessment. Um, and the medical assessment completed by the developmental pediatrician, uh, tries to look for underlying causes for the picture, you see, but also for any kind of really other medical problems that the child may have, really, And whether they're medical neurological, uh, you know, uh, coordination disorder, A. D. G. Etcetera, etcetera. Now, the gold standard for the assessment of autism is a dose autistic diagnostic observation schedule. Um, our team tends are very lucky, and we're able to use an A dose, which is a structured, play based assessment, Uh, during which, uh, there are at least one or two observers who will sort of score really the, uh, the schedule really and what it is. It is the set. It's about 10 different play activities, which really concentrate on assessing child social responses during specific play activities. So we look at the child's eye contact. We look at the child's facial expressions during these sorts of assessment and how well the child using these facial expressions expressions to, um, uh, communicate whatever is happening. And you know whether it's the the fear or anxiety or annoyance or happiness or whatever, Already. But you would be surprised how flat, Um, on the, uh, facial expressions many young Children are. We look at the repetitive behaviors, we look at the modern mannerism, and they don't need to be just the classical flapping. Children tends to do also really strange things, really, which they used to regulate themselves. Is that over excited? If they're anxious that they tend to do these sort of, uh, mannerism complex mannerism to sort of find their way to regulate themselves, we look at their creativity. We look at the, uh, imaginative play, etcetera. We look at whether how they in involving the social interaction. You would be surprised you have a very skilled professional who knows exactly how to play the game, to get the child engage, really. And some Children will do everything to remove themselves from that communication by simply sort of showing their back. Radiologist, you know, whatever, really. So it is a very powerful tool for the parents to watch, because through that watching that tool, they can see very clearly where their child's has difficulties. We also use that tool to point out to the child's strength already, because many Children have very specific strength and they these strengths can be used to support them in their earth therapeutic work afterwards. Now I said that at the autism is a lifelong condition and because of that, it's really important that we such of, uh, use standardized information and that standardized information has to be either through observing the child through parental interviews, but also through such of gathering information about any other concerning feature that the child's functioning has and some teams are not really able to such of apply a does not because they cannot train but due to resources are due to convenience, etcetera and there are many, many other standardized ways of screening Children and supporting your diagnostic process. Some of the known ones are ADR autistic diagnostic interviews, uh, revised Execute social Communication questioner, which are two questioners filled in by parents and teachers. And they have to reach specific thresholds. Three d. I interview for the diagnosis by assessment of autism spectrum disorder. I mean, there are many, many of them and then sort of people 10 to use them to support the sort of diagnostic observation diagnostic criteria. Yet what's powerful about a dose is the fact that you can not only gather the information, but also you can see it. And you can also show it to the parents while the observation happens. And then what happens later, after there's such of the assessment, we give the parents post diagnostic feedback. One of these sorts of important facts is to really cancel the parents that it is not their fault that the child has autism because all parents feel guilty. We know nowadays there is a 70 or more genes associated with the condition. We know that, uh, autism Ramsey families so called, So we always ask about the history of neurodevelopmental conditions, really. But we also know that there are some environmental factors which may contribute to that. And what I mean by that, I already mentioned that Children of, uh, mother's misusing drugs and alcohol have much higher. Um uh, prevalence of the condition. Really? Um, we also know that your Children who suffer from severe child abuse and neglect in early time and the yes, um, take a social deprivation they can develop with the phenotype, which looks very much like autistic. But, um, how well the child will do in their life depends not so much on orders but on the child's learning capacity. Because 50% of Children qualify for the diagnosis of intellectual disability. Having like you less than 70 in young Children under seven, we don't really do cognitive assessments. Um, and we don't estimate like you, but we can see very clearly if there is a severe developmental delay, really, and and such of us, are we such a feed that back? But, uh, I think it would be really good if such of many Children, particularly those diagnosed a bit later. We're also supported with the cognitive assessment and assessment of their learning ability. Really, because it would be very helpful while advising for school and education. Now you can sort of think what is the pediatrician's role, and that obviously depends on the medical needs of the child. I mentioned that let's see which is really common. But not only so many Children's official constipation from sleep, which, apart from behavioral aspect, may such of also have problems with the delayed, uh, initiation of sleep phase, which is so well, so easily treated with the melatonin. Many Children through their restricted diet to develop peka lots of mental health problems. Many Children suffer from sleep problems because of obstructive sleep apnea's etcetera, etcetera. So in the end of the day, there is a lot of what pediatrician can add apart from taking developmental history and the area of difficulties. One of the big areas of difficulties, which is sort of directly relates to, um, impaired communication is behavioral challenges, and you just have to ask yourself the question. Why is it because the child is sort of sensory overloaded and they can't tolerate whatever is going on? Is it that they are sort of anxious and scared of communication? Or is it just simply that they don't want the sort of constant change and the variety? But whatever happens with the behavior, you can deal with the behavior without asking a big question, why and then the context of the sort of, uh, autism spectrum condition. Uh, we tend to share the parents the model of the iceberg, and the reason for that is that you know the iceberg. The what you see about the water is only a third of the problem. Two thirds of the problems are two. Sorry, two third of the eyes are actually hidden under water, and you can see them. So when you think about the behavioral problem, like pushes Children obsessed with specific such of toys, not tolerating change so that the behavior you see. But in order to understand it, you really have to unpack all that. What is not seen on the such of service. And you really have to think, How does it relate to the difficulty that Children with autism spectrum condition had? Parents tend to understand it really well. It's a really very good model to sort of draw for them and to help them to understand it. So I hope that by now you just get it more and more that actually autism is not a disease. You can't give them a tablet which will solve the problem. You can't cure it. But you have to understand people and try to support them because they cannot really such of, uh, work without sort of this help and support. So let's think about what you can do to help and what sort of intervention you can apply. We try to help parents understand the diagnosis and we organize a lot of workshops, really for the parents, parents information session and so on, Just simply to understand the difficulties and really think about the practical stuff strategies, we try to, um, support the parents in the understanding of importance of consistency and really that the less changes, the most most consistent, the easier it will be. And for that purpose, you need good communication between staff and parents. Now, many parents really ask for therapy and unfortunately, within their sort of restricted the resource of NHS, we really can provide very little therapy. Most of the therapist really, uh, within the NHS, they're only able to, uh, provide some guidance, um, once because they feel that the child is with the parents 24 hours a day and the parents have to know how to tackle this situation. Um, and then the parents have to sort of keep going and sort of, uh, sort of work on consistency with the such of educational settings, Really? So that the child has the same approach, Really? Wherever they go. Um, some parents still insist on therapy, and they privately funded, but that is just really supporting the parents in their constant work with the child. Now, I'm trying to play for you this little video, which I recorded of a colleague of mine, Lydia, who ran this play groups with the parents with, um Excuse me, Doctor, I don't think you shared the audio the use of little cause. All right. Uh, sorry. I'm just trying to think I'm from this. How do I go? Okay, so let's just go into that. Just a very quick comment on that video. Why? I like it because it just shows how, uh, my colleague Lydia is supporting the parents to, uh, teach the Children, Uh, the importance of communication. Um, they say what they want. They get a crisp, really, and that sort of motivates them to communicate, because teaching them a motivation is one of the fundamental aspects of autism. It also creates a really opportunity for the parents to socialize because they are really very lonely. Children don't tolerate normal such of social settings, and then they can take their Children to normal playgrounds. Well, this way they create friends for life. Really? So what else we do? Really, we do. Some sensory integration works is because whether they're individual or group sessions, we try to understand from them sensors, their difficulties and how to such of support them so that they don't get over, weren't and how to help them to regulate themselves. One of the big problems is the problem of the Children being orally sensitive to taste textures, and that creates a massive sort of, uh, food restrictions at, uh, iron deficiency on any etcetera we create. We also have their sleep workshops because sleep is already another big problem, and then behavioural workshops a lot to sort of keep going because I've got a few more slight and we only have 5, 10 minutes. So what works. We sort of try to teach the parents that structure and predictability is so important because these Children, they cannot generalize. They cannot live with these such of unpredictability. And if you provide structure your reduce anxiety, the behavior is better. Visual prompts are encouraged. Um, too Children with autism because they have, uh, sort of underdeveloped to the such of speech and language communication pathway. They tend to have overdeveloped, really other pathways, and they are fantastic visual learners. Therefore, having a visual timetables, rules and anything that they can see tends to help really, their behavior. Now one of the most important aspects of really helping really to prevent really unwanted behavior is to develop the language and communication, uh, and to support the communication. And in many Children with autism, we recommend packs really, which is a picture exchange communication system, and we speak about it very shortly. And then we asked them to extend Children's play to model imaginative play because many Children with autism, they're very good at copying. However, they haven't got the capacity to create, um, spontaneously new ways of play. So instead of already just learning the sort of trains we just try to teach them how to do something else with the sort of with a toy. Uh, sorry. It's such of the good, the work up in small groups, really, because it helps to learn, turn taking, share ing waiting, etcetera and again and again to reduce the anxiety. Think about structure and routine, but also about giving, warning and cut downs. You know, before your Children have problems with transition from one activity to another from moving from the classroom to play room. So then you just teach them that if you show 54321 and then it's time to go, it's much easier for there for the Children with autism to understand that there will be a change happening now. Um, we also really think about the, uh, encouraging the parents to think about the environment about the labeling and sort of, you know, trying to, uh, putting temptations out of reach, etcetera. They're just really very practical things, which you don't necessarily always think about the yourself. And then one of the very important aspect is just to think about really creating a space for quiet time. Because Children with autism tend to have difficulties with regulating themselves as they get very easily overwhelmed and in order to help them to calm down and not to go into outburst of these such of, uh, emotions. If they are sort of directed to quite a little tent or space just for themselves, that tends to help them with this process. Now, um, parents are asked, what strategies have you tried and what has helped your Children's needs? Because it is the parents who are the experts. And they can sort of teach other parents and ask professionals how to manage these difficulties because they're exactly the same in old Children. And as I mentioned that the most important strategy is to find a way to communicate with your child and to give your child to express themselves what they want, really. And in order to use that, um, we tend to teach people to use picture exchange, communication system and what is what a. Y packs because it teaches initiation. As you saw in the video, it teaches foundation of the communication. If you do something, I respond to it. So like she was saying, the Children repeat more and I give you what you want, ready to reduce frustration? Because when the child gets what they want, they don't a sort of behave in frustration, way to increase their choices again to prevent unwanted behavior. Now, what are the benefits of? It's very universal, just lots of pictures. It teaches. Spontaneous communication is visual, so it works on the strength what the Children have. It has a clear structure, just like the language. It's inexpensive, and people can sort of draw their own pictures to use photographs, so it empowers the parents to help their child. This is an example of the visual timetable impacts from the nursery. So the child knows that they come and they have first the circle time. After that, they will be allowed to go outside and climbed on the climbing frame. Then there is a little bit of playtime again. After playtime, they have to tidy up the toys. Then it's time for the toilet. You have to wash your hands after the toilet, you get some lunch. It's time to go home, and it is very clear for the child to know We all want to know what's going to happen to our day and that is no different for Children with autism. Now we've been talking about the Children's needs, but there are many Children with autism. Have strength. I'm not talking about the sort of, uh, extra special abilities I'm talking about, sort of normal or sort of, uh, strength, which we all have. So there are visual learners. They have egg, excellent memory. And then you have a good attention for detail. Uh, they're compliant with the rules providing that they're clear and unchanging. They found very close connections with the immediate family. They don't lie because they don't understand why they should lie. And they can learn alphabet songs, numbers, sometimes much earlier than their peers. And a very small percentage of Children has an area of special interest, but they are really very, very small now. I put a picture of many people who either, um, would have been diagnosed with autism if they lived in 20 century or they actually had the diagnoses because their behavior has been known. Um too be really difficult. And yet they achieved an awful lot. Um, just to point out the possibility of the strength and really thinking that actually, they, you know, there is a space in the world for all of us. Now we're heading towards the end very quickly. Lorna Wing, psychologist professor of psychology in 1996. 3rd, those of us who live and work with Children and adults with autistic disorders have to try to enter their wealth since they cannot find their way into ours. We need to learn to comprehend and empathize with autistic experiences in in order to find a way to help each individual to cope with the system of social rules that are so alien to them. If you think about autism as a disability, uh, and and not it's a little bit like, you know, you would never ask people who cannot see to appreciate the picture. People with autism struggle with, uh, with the sort of automat understanding of constantly changing rules. And if you develop really understanding of that, then it's such of It makes you really empathetic and supportive, and you help the people to function in our world. So the final thought is that each shot is an individual. They have a lot of strength, but they also have a need, and that's why they come always to us, so thank you. Now this page shows you a couple of links to the YouTube videos. The first one top one is to the trailer of an amazing film called The Rain Man from the nineties, which such of describes a relationship between the brother and the man, Uh, statement who had autism. And it really was fundamental from understanding of what many people in the general public of the condition. The second YouTube link is to a person whose life now a rail person who's a very successful media person who talks about his autism. And I think they're really good because they sort of, uh, show you how successful you can be despite being at the same time, significant impact. I sort of give the link to the nice guidelines because they really we not only tell us what we should do and how we should assess the condition, but also, uh, what can be done for Children and water is such of evidence based. And then one of my favorite books. Ready, which talks about the boy teenage boy, the curious incident of the dog in the middle of the night and three li people in England know the book because they can to do it for the A G. Ccs. So thank you very much for listening. Um, I think there's some questions in the chart. Let me have a quick look. Really? If there's anything for me, thank you very much, Doctor. There's no questions in the chart as far as I've seen. Uh, but if everyone, um, if you could stay on for a few more minutes to do the feedback, please, everyone, Um, again, it's very important for us to keep going. Uh, please ask a question, if that's all right. Yes. Yeah. Um, so one of my colleagues, uh, told me that, um, I do have some sort of, um, symptoms over. I'm 35 years old. He said I should really go and get tested for to see if I am in the spectrum. Uh, myself. I don't think I am in the spectrum, but he has got a lot of experience. Um, with adults that they get diagnosed quite late. Um, what is the process, Doctor? I've spoken to my g p and I think they refer you to a site. Is it psychologist or psychiatrist? For your first assessment. And there are departments under, uh, sort of, uh, mental health. Really, each area will have a department where you can direct yourself to assessing, Um uh yourself autism. I think it's actually very important that you want to do it yourself because you need to understand why you're doing it is that is going to have help you to understand yourself and help you to function more, you know, efficiently or better or whatever. Then that's fine. But as I said, autism is not the disease. You're not going to die from not having it diagnosed, really. And it's not like diabetes that if you don't take insulin, then sort of you are not going to die. Really? So I think that what happens sometimes is that Children, when the Children are assessed, really because they have clearly functional difficulties, then the parents recognizing themselves, and then they ask how they can be such of, uh, diagnosed and they direct themselves to adult services. But I wouldn't necessarily go through the diagnosis just because somebody else recommends it. No, that's great. Thanks so much. Um, thank you again, Doctor. We are eight minutes over the time, so I'll give everyone another minute to do the feedback. Sorry. I think we started quite late. Really? But because I was trying to keep time. Really? But I'm very sorry. That's where I was. No worries. No worries. No. Sorry. No, I didn't mean that. Yeah. Anyway, thank you very much for listening. And if you have any questions, then sort of, uh, they can be directed to me and I will try to answer them. Yeah, Thanks a lot. Thank you.