Middle Childhood

Middle Childhood (6 to 12 years of age) are the first years of formal schooling. For some children it is a time for particular vulnerability due to a number of factors as they develop socially, culturally, cognitively, emotionally and physically (Charlesworth et al., 2011). Examples of development in this population include developing fine and gross motor skills advance (physical); ability to solve problems using logical strategies (cognitive); viewing themselves as belonging to a category (cultural); identify and articulate emotions (emotional); develop peer groups (social) (Charlesworth et al., 2011). However, there are numerous challenges children may experience during middle childhood that can affect their development socially, culturally, cognitively, emotionally and physically. These include family conflict, poverty, chronic health problems, family violence, disability, and diagnoses that were not identified in early childhood (Charlesworth et al., 2011). In addition, challenges from early childhood such as poor birth weight may affect a child’s development in later years, particularly if issues are not identified prior to beginning school (Charlesworth et al., 2011).

Autism Spectrum Disorder 

Teachers are a key person in these children’s lives so it is not unexpected that they are often the ones who identify issues with a student’s development whether it is cognitive or behavioural. Teachers work with children with different abilities and have also studied child development, which is why if an issue is not picked up in early childhood, it will often be identified when formal schooling begins, which is sometimes as early as four years of age in the preparatory year. One condition that is often overlooked, particularly for girls, is autism spectrum disorder (ASD), with more males identified in the earlier stages of childhood (Hull et al., 2020). Children who are diagnosed with an autism spectrum disorder have deficits in key areas of social communication and interaction and restricted, repetitive behaviours (Geldard et al., 2019).  The Diagnostical and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013b) is the main guide that health professionals such as paediatricians, psychologists and psychiatrists use for determining whether a person presenting with a specific cluster of autism traits meets the ASD criteria. As there is no definitive biological test for determining autism, a process is followed that involves a number of tests and observations by multiple stakeholders, such as parents, teachers, speech therapists and occupational therapists, to assist medical professionals with making a diagnosis (Stansfield, 2020). A diagnosis of ASD is now assigned a severity specifier of level 1, 2 or 3, depending on the support required; however, this does not align with the severity of social communication difficulties or repetitive behaviours but to the amount of support an individual requires (APA, 2013b).

There are many autism assessment tools available to clinicians, which is why Australian guidelines were developed to improve consistency of the diagnostic process of ASD in Australia (Whitehouse et al., 2018). The journey to a diagnosis involves a holistic process and at the middle childhood level where children are in their first formal years of school, teachers, Guidance Officers and other school staff are an integral part of the diagnostic process (Stansfield, 2020).

Evidence of Symptoms 

Due to pathologising traits and stigmatism, today’s knowledge and understanding of autism is still in its infancy and appears some way off from understanding and acceptance of this different way of thinking (Stansfield, 2020). As there is no definitive biological test for determining autism, a process is followed that involves a number of tests and observations by multiple stakeholders, including guidance officers, parents, teachers, speech therapists and occupational therapists, to assist medical professionals with making an accurate diagnosis (Stansfield, 2020). It is common for individuals diagnosed with ASD to also have one or more co-morbidities such as anxiety and depression, which may add complexities to the diagnostic proccess (Geldard et al., 2019).

Prior to a diagnosis, it is a common occurrence for a teacher in the lower primary school years who realises when they need to have potentially a difficult conversation with the parent about their child when they observe known autism traits (Stansfield, 2020). The teacher would have observed the student during classtime and play time and noted that the student’s development is different to their peers. There are numerous checklists available that may assist teachers in documenting behaviours in class. Table 1 displays the common traits of autism that may be observed in lower primary school in the target population. A child will not have all of the traits but these are traits that may identify the need for a referral.

Table 1

Common observable traits of autism in 6 -12 year old children at school

Note. Adapted from The Spectrum (2022)

The cluster of deficit-based traits for ASD  identified in the DSM-5 are oriented toward males (Ranson & Byrne, 2014), leaving girls undiagnosed or misdiagnosed when their collective autistic traits are misinterpreted and categorised under a mental illness rather than autism (Carpenter et al., 2019). Table 2 displays traits from personal and lived experiences, rather than formal diagnostic tools such as the DSM-5 manual (Craft, 2012; The Little Black Duck, 2018; Marshall, 2013; Hayden, 2020). Many of these traits in Table 2, males can also exhibit.

Table 2

Autism traits pertaining to female students

It is imperative for teachers, particularly in lower primary school to have up to date professional development on autism and its presenting traits to fast-track the referral process for an earlier diagnosis (Stansfield, 2020). An earlier diagnosis means earlier intervention leading to better student outcomes.

Impact on the Individual and Interactions

There are a number of ways that autism impact a young student’s daily life. These include and are not limited to anxiety, resistance to change, difficulty forming friends, transitioning between classrooms or tasks, and bullying (Autism Tasmania, 2022)

Anxiety and stress, particularly from academic, social and environmental factors, impact the school experiences of autistic children (Adams et al., 2019). This anxiety about school can lead to school refusal. Familiar environments are also preferred, which is why a predictable routine often found at school, is helpful when transitioning between classes and tasks (Autism Tasmania, 2022). Changes, particularly at short notice can increase anxiety leading to meltdowns (Stansfield, 2020). Playing independently either on one’s own or parallel playing often means there is little opportunity to develop social skills to form friendships. Playing on one’s own also increases the likelihood of being bullied, however, in lower primary school, this may not be noticed due to misunderstanding social cues (Stansfield, 2020).

Challenging behaviours and the added pressure on parents around a child’s diagnosis contributes to higher rates of separation and divorce rates (Hartley et al., 2010). A study in the Unites States by Freedman et al. (2012) showed that autistic children are at higher risk of parents divorcing compared to their peers. The added stress of intervention and understanding a child who is ‘different’ does add a layer of stress to the parenting role.

Suggested Interventions

There are interventions that can take place both at school and externally to the school. When a Guidance Officer (GO) receives a referral and the student is suspected as having many autistic traits but does not have a diagnosis on file, reports from observations and testing can be used to assist the GO to decide on the appropriate testing tool to utilise dependent on the presenting behaviours. Although a GO cannot diagnose, their reporting is an important part of the autism diagnostic journey by gathering information for the paediatrician. These assessment results can also assist the teacher in the classroom for not only curriculum implementation but also how the learning will occur.

When a student already has an autism diagnosis, GOs can interpret the reports and assist teachers in implementing strategies suggested in reports such as an Occupational Therapy report. GOs can support the families and teacher by working through the assessment results, the report findings and choosing appropriate teaching and learning strategies for the autistic student. This may involve sitting in with parents and teachers at Individual Education Plan (IEP) meetings and assisting with goal setting and interpretation of assessment results. This collaborative approach can be helpful for the follow up process.

Although the diagnostic process is deficit based to receive an ASD diagnosis, it is imperative that school staff such as the classroom and GO also take a strengths-based approach to the intervention (Stansfield, 2021). Teachers need ongoing PD on autism to understand how autistic students, particularly girls, present in the classroom and recognise the need for a referral so that these students receive support and intervention in the early years (Stansfield, 2020).