* The National Autistic Society describes autism as “a lifelong developmental disability that affects the way a person communicates and relates to people around them”

* It’s a spectrum of disorders - although autistic people share a triad of impairments - difficulties with social interaction, communication and imagination

* It’s found in all nationalities, races and social classes, but is twice as common in males than in females

* It’s estimated that the number of diagnoses has increased tenfold over the past decade in the UK, although there is no central register, and therefore no way of measuring year-on-year trends.

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Fear of autism is, in a very real sense, a fear of the unknown. For although the lives of some 500,000 families in the UK are touched by this most baffling of disabilities, science has barely begun to understand its causes, and even diagnosis is beyond the wit of many health service professionals. For most people, the word “autism” means little beyond confused recollections of the film Rain Man. Isn’t there an autistic boy who does incredible drawings but who can’t speak? Didn’t some famous psychologist once compare autistic people to Martians? Didn’t they discover that trainspotters were autistic? Fear is mixed with fascination. But for the autistic child in school, this jumble of myth and half-truth can be one handicap too many. Which is why in this, its 40th year, the National Autistic Society (NAS) has launched an unprecedented awareness campaign. “The crucial factor missing to improve the lives of people with autism is understanding,” says the charity. For without it, autistic people “will continue to be discriminated against and victimised”.

The autistic spectrum

The NAS describes autism as “a lifelong developmental disability that affects the way a person communicates and relates to people around them”. And it points out that, while people with autism may or may not have accompanying learning disabilities, everyone with the condition shares a difficulty in making sense of the world. It’s a brave attempt to sum up in simple terms a condition that has long evaded definition, so varied are its manifestations. For while it was the “classic” cases of autism - withdrawn, uncommunicative children with bizarre, stereotyped behaviour - who first interested researchers in the 1940s, these are now seen as representing just one end of a spectrum of disorders. Researchers often speak of a “triad of impairments” which are common to people at either end of this “autistic spectrum”. They involve social interaction (difficulty with social relationships), social communication (difficulty with verbal and non-verbal communication) and imagination (difficulty in the development of imaginative play). In addition to this triad, repetitive, obsessive behaviour and a resistance to changes in routine are noticeable features. At the so-called “higher functioning” end of the spectrum, there is also a form of autism called Asperger’s syndrome, in which somebody with language skills and average or above-average intelligence is nevertheless socially impaired.

Was it ever thus?

Not only is autism found in all races, nationalities and social classes, but it has probably been present at all times in human history. Francesca Happe, a research scientist, has pointed out that “folktales can be found in almost every culture which tell stories of naive or ‘simple’ individuals with odd behaviour and a striking lack of common sense”. Such stories, be they from Russia, India or Malta, often involve somebody who takes what is said to them quite literally - a common symptom of autism. What’s more, the stories almost always centre on a man or boy, which is significant in the light of statistics which show that autism is twice as common in males than in females.

Autism gets a name

In 1943, the American child psychologist Leo Kanner wrote about a group of 11 children who shared puzzling symptoms. They looked “normal”, but they were socially unresponsive and easily upset by change, tending to echo what was said to them while restricting themselves to repetitive activities and utterances. Many reacted unnaturally to certain sounds and objects; some showed an extraordinary ability to memorise printed information. For Kanner, withdrawal was the most significant of these symptoms, which is why he labelled the condition “autism” (confusingly, the word had previously been applied to schizophrenic behaviour). But a year later an Austrian psychiatrist, Hans Asperger, described a group of children who “spoke like little adults”, yet were socially inept and physically clumsy. It is likely that both men were looking at autism, albeit at different ends of the spectrum.

What is Asperger’s?

The term Asperger’s syndrome was coined by researcher Lorna Wing in 1981 to include highly able people who, while not fitting Kanner’s stereotype, clearly have a form of autism. While the triad of impairments - social interaction, communication and imagination - are all present, they are not usually accompanied by learning disabilities, which is why many children with Asperger’s syndrome attend mainstream schools and go on to further education and employment. Such children often speak fluently, although their words can sometimes sound formal or stilted. And they often have an obsessive interest in a hobby or collecting. Usually their interest involves arranging or memorising facts about a special subject, such as train timetables or locomotive numbers, or the dimensions of cathedrals. But, with encouragement, these interests can be developed so that people with Asperger’s syndrome go on to study or work in their favourite subjects.

Was Rain Man accurate?

Never mind Kanner and Asperger, it was the film director Barry Levinson who made the world aware of autism. But while few have a bad word to say about Dustin Hoffman’s portrayal in 1988 of the autistic Raymond Babbitt, it can’t be stated too often that Babbitt’s autism was far from typical. He was, in fact, an autistic savant - someone who has severe developmental disabilities, but at the same time has special skills and a mind-boggling memory. It’s reckoned that one in 10 autistic people has islands of special ability, ranging from what are known as “splinter skills” - remarkable only because they occur in someone of low general ability - to the spectacular skills displayed by the likes of Babbitt, with his prodigious mathematical ability; skills that would be outstanding whoever possessed them. There are only around 25 known “prodigious savants”. One of them is Stephen Wiltshire, who has astounded the art world with his line drawings of London buildings - which he executes with barely a glance at his subject.

Is autism on the increase?

Newspapers on both sides of the Atlantic now refer matter-of-factly to an “autism epidemic”. According to US department of education data, the incidence of autism in the US has increased by 900 per cent since 1992, and last year, the Autism Research Council at Sunderland University announced that the number of cases diagnosed in the UK had increased tenfold over the past decade. A recent report by the Medical Research Council estimates that around six in every 1,000 young children have an autism spectrum disorder.

Although this estimate makes the condition more common than was previously recognised, it doesn’t necessarily indicate an increase in prevalence. Eric Fombonne, a psychiatrist from the Maudsley Hospital in London, said in New Scientist last year: “That rates in recent surveys are substantially higher than 30 years ago merely reflects the adoption of a much broader concept of autism, a recognition of autism among normally intelligent subjects and an improved identification of persons with autism.”

There is still no central register of autism cases in the UK, and therefore no way of measuring year-on-year trends. Nevertheless, David Potter, a co-author of the 1999 NAS report, acknowledges that across the professions “the feeling on the ground is that we are seeing more cases than before”.

What causes autism?

In the decade after Kanner identified it, the condition was widely blamed on “cold, intellectual parents”, and especially “refrigerator mothers” who had failed to bond with their babies. Such notions occasionally resurface. But although research is currently exploring every possible genetic and environmental avenue, an understanding of the mechanisms involved in autism seems as far off as ever. Studies of families and, in particular, twins, suggest that genetic factors play a major role, with the disorder occurring when a number of specific genes come together.

It’s possible that other factors act as a trigger, and the Autism Research Council is looking at everything from pesticides and pollution to infectious disease patterns, the use of plastics in bottles and the presence of bacteria in the intestines. Last year, it came to light that the amount of mercury used as a preservative in vaccines far exceeded safety levels. The heavy metal is one of the most toxic substances on earth, and it is known that 75 symptoms of mercury poisoning parallel those for autism. Not surprisingly, its use is to be discontinued.

Meanwhile, the measles, mumps and rubella (MMR) triple vaccine has come under particular suspicion. While mercury is not used in the MMR, other concerns have been raised regarding this injection.

Does the MMR vaccine cause autism?

In 1996, Dr Andrew Wakefield and colleagues at the Royal Free Hospital described a possible link between autism and inflammatory bowel disease. More worryingly, they went on to suggest a link between bowel disease and the persistence of the measles virus in some children who had received the MMR triple vaccine. So is the MMR to blame for the increase in autism (assuming, of course, that there is an increase)? Without reliable statistics and proper research, there can be no answers, which is why the NAS continues to call for both. In the meantime, the charity is concerned that some children, perhaps with a genetic predisposition to autism, might have an idiosyncratic response to the vaccine, particularly because a proportion of autistic children are known to have bowel problems.

Is there a cure?

When the NAS describes autism as “a lifelong developmental disability”, it is saying, in the nicest way, that there is no known cure. But every so often the headlines tell of a new drug or course of therapy that appears to work wonders for certain individuals. While many such treatments exist, sampling them might require tenacity and cash in equal measure.

And while some do appear to help some individuals with autism, others clearly make no difference at all. Among the more promising are the Lovaas method and “daily life therapy”, both developed in the US but now available in the UK. Lovaas involves intensive behavioural training by therapists and parents, starting at the age of five, ideally at 42 months. A number of groups advocate a dietary approach, using vitamin and other supplements with varying degrees of success. Meanwhile, controversy rages over the effectiveness or otherwise of a hormone called secretin. As yet unlicensed for human use, secretin has been administered in a number of high-profile cases and shown to be effective. Some trials have shown it to be useless, however, and it may be that, in common with most “treatments” for autism, it works only in cases of a certain type.

How can teachers help?

While autism is usually spotted before a child reaches school age, it’s not unknown for a child to reach primary or even secondary school before their disability is identified. Teachers can play a vital role in spotting the characteristics as early as possible. Look out for difficulty with communicating and relating to others, inability to play imaginatively or think in abstract ways, and an insistence on keeping to set routines or following elaborate rituals. If you suspect a child might have autism (they would need to exhibit all three of the above tendencies), talk to your school’s special needs adviser or your special education needs co-ordinator.

If autism is diagnosed, the local education authority will decide whether the child should go to a special school. Should they stay in mainstream education, responsibility for their development will lie for the most part with you and your school’s special needs co-ordinator and learning support assistants, and it will be necessary to adapt your teaching accordingly. Speak to other members of staff and ensure that they understand the child’s behaviour. And you may wish to prepare other children for the fact that one of their classmates may act strangely, perhaps arranging for the child to have a special “buddy” to explain jokes and games, and to keep a look out for bullying and teasing. Try to identify the child’s abilities and build on them, and keep in touch with parents and carers. Help the child to mix and work with a sympathetic partner or a group. Emphasise the social aspects of activities and encourage partner games. Break times and lunchtimes can be particularly difficult (a child with Asperger’s syndrome will often prefer to be alone or with one other person), and it might be useful to structure breaktimes for an autistic child. Always be aware that a child might take what you say quite literally, so avoid sarcasm, metaphor or exaggeration.

Continually check that the child is listening and understanding. Use visual aids when teaching a subject that requires abstract thinking. Avoid distractions, such as extra noise or movement. Allow the child extra time to complete tasks if they need it (for exams such as GCSEs, you can apply to the examining board for extra time, while an amanuensis can be used in SATS). Some autistic children have difficulty with tasks requiring good co-ordination, such as using a pencil or catching a ball. Above all, avoid unnecessary change. If change of routine is unavoidable, then warn the child beforehand, and bear in mind that autistic children simply cannot cope with too much change.

CASE STUDY:MMR

I’m not a parent, but the recent furore over the MMR vaccination has left me preoccupied. I eat beef, lamb, and eggs. I like to think that I approach health controversies with a large dose of cynicism, and were I in the position of having a child to be vaccinated in any other situation, I think that I would probably go ahead. But not with MMR. Working in education, you get used to the alarmist headlines, but I’ve taken these ones seriously. I’m not affected by scaremongers. But I am terrified of autism, and I wonder if I’m the only one.

There must be few professionals working in special needs who have not encountered a child somewhere along the autistic spectrum. Increased inclusion, along with rising numbers of children who have been diagnosed, has led to increased awareness, if not understanding, of the condition. A good way of testing what’s current in educational thinking is to look at the topics of in-service training days; when the latest brochures land on my desk, more than a few of them are tackling the issue of autism.

Parents are becoming more vocal, and my mainstream secondary school and LEA are looking for ways of meeting these needs. I have had many valuable encounters with autistic children, but the condition scares me. The unreachable nature of these students, their obsessions, the ruthless force of their logic, and the pent-up nature of their intelligence are aspects that I deal with as a professional, but wonder how the parents handle it day in, day out. Our progress through life is based on our ability to form and maintain relationships, so what happens when this aspect of development is denied to both the child and their family?

These are private feelings, but they sit uncomfortably with my work and views on promoting inclusion, and I don’t know what to make of them. Every child is special, and their individuality should be cherished, but when I meet the parents of autistic children, I feel a sense of awe and pity. What does the future hold for their child? What prospects do they have of seeing their children gain maturity and independence? How do they negotiate the maze of special needs guidance, the lack of specialist provision, public ignorance, and the need to do the best they can for him or her? How do you forge a bond with a child who must inspire frustration and rage, as well as love?

As a teacher, I can deal with whatever my working life brings me, but as a prospective parent, I don’t think that I could cope with this condition in a child of mine.

The writer is a special needs co-ordinator in the north of England