What is the ‘Triad of Impairment’?

Today my paediatrician told me that she thinks my son could have autism.  I have heard of the condition before but have no experience with it at all.  When she tried to explain it to me she mentioned the triad of impairment.  Does anyone know what this is exactly because I got really confused?

Autism is a lifelong developmental disability affecting how someone communicates and interacts with other people.  In England around 1 in every 100 children has autism and it is more common in boys than girls.

Autism is also known as Autistic Spectrum Disorder (ASD) because the symptoms of autism vary a great deal along a spectrum from mild to severe.  However, people with autism will all share some similar characteristics.  The ‘Triad of Impairment’ is used to describe the main features all people with autism have difficulty with to some degree.

Social interaction:

  • Behaves as if others do not exist, treating people as objects
  • Can be unresponsive to peoples voices/attempts at communication
  • Finds making friends/building relationships difficult
  • Struggles to manage unstructured parts of the day

Communication and Language:

  • Difficulty with both the processing and understanding of verbal information
  • Difficulty understanding jokes/sarcasm/literal interpretation, social language, body language and paralinguistic features (intonation, stress, tone of voice)

Imagination/Rigidity of thinking:

  • Likes things to be routine and structured
  • Obsessively follows rituals
  • Can have impaired imaginative play (especially with others)
  • Lack of empathy for others
  • Has a poor awareness of danger (thinking forward/what can happen)

All people with autism will show difficulties in these areas but to varying degrees.  Alongside this triad some people with autism can have many different features accompanying their autism, for example;

  • Learning disability
  • Mental health problems. 
  • Sensory sensitivity: either hyper-sensitive (e.g. dislike of loud noises or touch) or hyposensitive (will seek out sensation e.g. putting things in their mouths or enjoys vibrations)

The severity of the condition will determine how it affects someone’s life.  Some people with severe/low functioning autism with associated learning disability will be completely dependent on other people in all areas of their life and may be unable to communicate with people around them.  However, others with less severe/high functioning autism are likely to be able to integrate into society and be quite independent.

A commonly known from of high functioning autism is Asperger’s Syndrome (AS).  People with AS often have average or above-average intelligence and will have fewer problems with their speech.  However, they will still find it difficult to understand and process language and will need support in learning how to manage social situations.

The road to a formal diagnosis can be a very long, confusing process and can be difficult for parents to cope with.  Here at Integrated Treatment Services we can help to make this process easier by offering support, advice and answering any questions you might have (as I am sure you will have plenty!).  We aim to see your child for assessment within a week of referral or we can work alongside any NHS sessions you may organise, liaising closely with the NHS therapist to keep your child’s therapy consistent and effective.

You can contact one of the team at I.T.S by calling 0845 838 2921 where a specialist speech and language therapist can talk you through how we can help.  Alternatively, if you have a quick question about autism or would like to suggest another topic to be covered in an article you can email: info@integratedtreatments.co.uk or simply click ‘Ask us a Question’.


July 2013


Laura Oldakowska

Speech and Language Therapist



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