Term Paper on Autism
In its most general sense, Autism is a heterogeneous syndrome determined by impairments in three main spheres: social interaction, language, and flexible imaginative functions. Autistic disorder is the most severe example of a group of neural development disorders also called the autism spectrum disorders (ASDs) that share the common feature of dysfunctional reciprocal social communication. The current essay briefly describes the disorder, its characteristics, potential causes, and focuses on the existing intervention methods designed to help the patients and their families to manage the crucial challenges autism issues to them. Most existing intervention methods are subject to further research and improvement, as the lack of common methodology in measuring the results of such interventions does not offer sufficient scientific evidence of their efficiency. Nonetheless, both educational interventions and medical management are widely used in handling autism today.________________________________________________________
The official definition of the disorder can be found in The Individuals with Disabilities Education Act (IDEA), according to which autism means “developmental disability significantly affecting verbal and nonverbal communication and social interaction” (U.S. Department of Education, 2010). It is generally evident before age three and it affects immensely a child's educational and communicative performance. Other characteristics often associated with autism are: engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.
The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) 1 provides standardized criteria to help diagnose Autistic Disorder: to diagnose autism, six or more items from the three categories (qualitative impairment in social interaction, qualitative impairment in communication, restricted repetitive and stereotyped patterns of behavior, interests, and activities) should be met (American Psychiatric Association, 2000, 69-70).
Autism has a strong genetic basis, though its real causes are still unknown, while the potential causes are much argued about. The list of existing theories of the potential causes of Autism includes: biological theories, psychological theories and an MMR theory. The Biological theories discuss the genetic model, although no specific gene responsible for causing an autistic disorder has been identified yet. According to Bauxbaum (2009, p. 40), “there is overwhelming evidence that ASDs are genetic disorders, but the genetic mechanisms are varied, involving both inherited and de novo changes, as well as mutations, trinucleotide repeats, CNVs, and larger chromosomal abnormalities”. Most scholars agree that autism might be caused by a complex number of overlapping reasons of different nature.
The characteristics of autism include qualitative impairment in social interaction, qualitative impairment in communication and restrictive, repetitive and stereotyped patterns of behavior, interests and activities. Qualitative impairment in social interaction includes one or more of the following: poor eye contact, poor use of gestures and facial expressions, inability to recognize the effect of their behavior on others, lack of interest in forming social relationships with peers, no participation in group activities. Qualitative impairment in communication means speech delay, taking things literally and eventual inability to interpret figurative forms of speech, poor understanding of non-verbal gestures and limited own non-verbal gestures. Restrictive, repetitive and stereotyped patterns of behavior, interests and activities might result in excessive talking on the topic of overwhelming interest, anxiety about changes and daily routine interruptions. The majority of children with classic autism have low IQ, some suffer from epileptic seizures, and some individuals are subject to self-injury.
There is no known cure, no specific treatment for the autism. Interventions are mainly tailored through focusing on the specific needs of an individual and their families. The main idea is helping children cope with difficulties caused by communicative, cognitive and behavioral differences by developing special skills and teaching their families to help them. The most popular types of intervention include: psychological education (providing support, reassurance and information for the family in order for them to understand the disorder and cope with it properly), educational placement (improving the child’s educational situation, e.g. via structured teaching use strengths and special interests of children with autism to provide necessary education), behavioral treatment (using modeling and reinforcement methods for achieving developmental goals), occupational therapy, speech and language therapy, and social skills therapy. Applied behavior analysis and treatment are well-established for improving intellectual performance and global functioning of young children.
It has also been suggested that certain diets (e.g. avoiding foods containing gluten and casein) may be helpful in dealing with certain autistic traits. However, there is still no trustworthy scientific proof and further research is needed on the issue. According to Oswald and Sonnenclar (2007), the seven most frequently prescribed classes of psychoactive drugs were antidepressants, stimulants, tranquilizers / antipsychotics, anticonvulsants, hypotensive agents, anxiolytic / sedative / hypnotics, and benzodiazepines. However, it is clear that no known medication relieves the core symptoms (social and communication impairments) of autism. Only accompanying disorders or problems may be treated more or less successfully. For example, the results of some studies published in New England Journal of Medicine in 2002 show that aggressive and self-injurious behavior may be successfully reduced with Risperidone (as cited in Bauxbaum, 2009, 41). Medications are far less successful due to the individual’s atypical reaction that is quite common for children with autistic disorder.
Autistic children are normally eligible for state Intervention programs - children must be less than 3 years of age and have a confirmed disability or established developmental delay in either physical, cognitive, communication, social-emotional, or adaptive area of development. Before implementing any intervention methods, an autistic child would normally be assessed by a specialist, who would evaluate the original situation and the original intervention, if any. Various screening tools and checklists (e.g. the Autism Behavior Checklist, and the Child Development Inventory, Modified Checklist for Autism in Toddlers, etc.) are available for the therapists to be able to evaluate the child. These documents may be helpful in evaluating the child’s overall state and ability to adapt to the existing social schemes. Therapist’s assessment also serves as a basis for the development of the individual intervention program that would serve best for the taken individual.
The cognitive-behavioral therapist’s services are necessary to help the patient diagnosed with autism. The therapist creates a system of weekly practices that will help the child gain the skills and experience needed in social environment, e.g. attention, compliance, and imitation. Most specialists turn to the applied behavior analysis practices that focus on teaching tasks one-on-one using the principles of stimulus, response and reward, based on the theories of behaviorist. The observed behavior is measured and evaluated objectively. Depending on the child’s reactions and abilities to fulfill the tasks during the therapeutic sessions and, which is more important, within the natural environment, the initial stimuli are being re-assessed and the best practices are implemented in further sessions. Such interventions are generally more successful if an individual is treated simultaneously by the family and the relevant professionals, while the developmental program is customized in a way that is most effective for this very individual, with his or her set of individual responses.
Intervention may only be less successful if an individual has a non-typical reaction to the methods of treatment – in this case the methods should be adjusted to the needs of this separate individual (possibly through enforcing his or her strengths and fields of interest). Intervention may certainly not work if an individual has been left unattended for a long time, his reactions are atypical due to additional complications of the disorder or the methods chosen are of no interest for the autistic individual. Customization is generally the best option for such problematic autistic patients. Risks are generally connected with the medical treatment as individuals atypical reaction may provoke further complications in the process of determining and treating the disorder.
The non-medications intervention effectiveness has been showing mixed results in a number of studies, though there are examples of successful recovering (some as a result of intensive behavioral interventions (Francis, 2005, 497). As for the overall success level of treating the autistic disorder it is commonly believed that the outcome greatly depends on IQ and the development of language. It is also commonly believed that intervention is beneficial for autistic patients, some form of treatment is preferable to no treatment at all, and autistic children should not be left unattended and uncared.
Autistic, a disorder of neural development, has no scientifically determined cause or treatment. It has several possible symptoms and criteria that usually develop and may be diagnosed before the age of three. The existing forms of intervention rely on families and the educational system as the main resources for treatment and care of autistic individuals. Treating such children is quite costly due to extra education and loss of economic productivity, moreover, there is no guarantee an autistic individual will be able to recover as the causes and the responses statistics is still quite vague due to lack of common methodology. However, it is generally accepted that intervention is beneficial for autistic children and their strengths might be rewarding in achieving developmental goals necessary to gain relative social stability and well-being. Further studies are necessary for defining the real reasons for the emergence of the disorder and the ways of its management and treatment.
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