parenting) autism - symptoms, causes, assessment, and treatment

7/31/2019 Parenting) Autism - Symptoms, Causes, Assessment, And Treatment

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“Autism or AutisticDisorder is a pervasivdevelopmental disordthat affects all of mentdevelopment.”

What is Autism?

Definition

Autism or Autistic Disorder is a pervasive developmental disorder that affects all of mental

development. It looks very different at different ages and certain features do not become

apparent until later. Autism is probably present at birth but is often not identified until the child

fails to develop communicative language at about 2 years of age. 70% of children with Autism

have IQ's below 70; and 11% have IQ's above 85. Those individuals who are most

developmentally delayed are usually also most autistic. As with normally developing children

no two children with Autism are alike and the differential diagnosis of such disorders as

Autism, Asperger's Syndrome, Nonverbal Learning Disability (NLD), Pervasive

Developmental Disorder (PDD), and severe communication disorder can be difficult. It is

believed by many researchers that the fundamental deficit that is seen in autistic children

is a "mind blindness" or a lack of a theory of mind or the capacity to understand that

other people think and feel the same way as they do. This deficit is believed to

contribute to the difficulty that autistic children have in imitating another person's

reactions, particularly their body movements, and particularly if the content of the

actions is affective. Several studies have also found specific deficits in autistic children's

perception and understanding of emotions.

Children with Autism have three primary distinguishing features:

· Impairments in social interaction (are not interested in peer interactions andmay show little eye-to-eye contact and lack of sharing with others).

· Impairments in communication (delays in or lack of spoken language).

· Repetitive and stereotypic behaviours, interests and activities (may show

behaviours such as hand flapping, spinning objects, and rituals).

Incidence

10 - 15 per 10,000 children are autistic and an additional 12 - 20 per 10,000 have autistic-like

features. Three boys to one girl have the disorder.

Diagnosis

The DSM-IV-TR (2000) has identified Autistic Disorder as one disorder under the wider category of Pervasive

Developmental Disorders. Under the broader category there are other disorders included such as Asperger's

Syndrome, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder (Not

Otherwise Specified). DSM-IV-TR has identified the following diagnostic criteria for the Autistic Disorder.

AUTISMSYMPTOMS, CAUSES, ASSESSMENT, AND TREATMENT



A. A total of six or more items from (1), (2), and (3) with at least two from (1), and one each from (2)and (3).

(1) qualitative impairment in social interactions, as manifested by at least two ofthe following:

(a) marked impairment in the use of multiple nonverbal behaviourssuch as eye-to-eye gaze, facialexpression, body postures, andgestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests,

or achievements with other people (e.g. by lack of showing,bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairment in communication as manifested by at leastone of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensatethrough alter native modes of communication such asgestures and mime)

(b) in individuals with adequate speech, marked impairment inthe ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic

language(d) lack of varied, spontaneous make-believe play or social

imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behaviour, interests, andactivities as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped andrestricted patterns of interest that isabnormal either in intensity orfocus

(b) apparently inflexible adherence to specific, nonfunctional routines orrituals

(c) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)

(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3years: (1) social interaction, (2) language as used in social communication, or (3) symbolic orimaginative play

C. The disturbance is not better accounted for by Rett's Disorder or Childhood DistintegrativeDisorder.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of MentalDisorders, 4th Edition, Text Revision (DSM-IV-TR) (p. 79).Washington, D.C.: American Psychiatric

Association.

AUTISMDiagnostic Criteria

“10 - 15 per 10,000children are autistic...”



“It is still not clearwhat precise deficit

underlie AutisticDisorders butresearchers have gotmuch closer tounderstanding them inthe last five years.”

It is still not clear what precise deficits underlie Autistic Disorders but researchers have got much closer

to understanding them in the last five years. This has mainly occurred because the latest research has

compared autistic children to other children with the same IQ and chronological age. Deficits appear to

be very selective and are not the same in all children with Autism.

Other Symptoms That may Be Present For Some Children

· Gross and sustained impairment of emotional relationships with people, aloofness

and/or empty symbiotic clinging.

· Apparent unawareness of their own personal identity (e.g. posturing, self-mutilation,

and failure to use "I").

· Obsessive use of and preoccupation with objects without regard to their functions.· Resistance to change in the environment and a striving to maintain sameness.

· Excessive, diminished, or unpredictable responses to sensory stimuli.

· Acute, excessive, and illogical anxiety especially precipitated by change.

· Speech may have been lost or never acquired.

· May use echolalia and certain idiosyncratic words.

· Distortion in mobility patterns such as bizarre postures or ritualistic manner

isms, strange gestures and toe walking.

· Serious retardation with possible islets of normal or near normal intelligence

and sometimes exceptional functioning in very isolated areas.

· Poor concentration, short attention span and distractibility.

· Minimal social and self help behaviours.

· May place him/herself in danger by, for example, not watching while crossing

the road.· Does not show mutual sharing of interests, activities, and emotions with others,

particularly other children.

· Does not understand the perspective of others.

· May be aggressive if frustrated or if a child comes too close to their space.

· May line up toys and not be interested in their function.

· May seem unaware of what is going on around them.

· May wander off in shopping malls and in parking lots seemingly without a sense that

they are alone.

· Mainly engages in interaction in order to get what they want.

· May "use" a person's arm in order to get what they want or to do something they cannot

do. This has been called "hand leading" and is used instead of pointing.

· Does not use the emotions of others or "social referencing" in order to decide how to act.

· Does not follow through on the requests of others because they are really not understood and

the child is doing what he wants to do.

· May enjoy physical contact with parents and other caregivers if it is when they want it.

· May not seek out comfort when upset or hurt.

· Show little desire to imitate or copy another person's behaviour.

· May show self-injurious behaviour.

AUTISMDiagnostic Criteria



Causes

Exactly what causes Autism is unknown although it is believed to be a neurological condition. Medicalconditions that could be causal are found in only about 5-10% of cases.

Genetic Component

It seems likely that a predisposition to Autism is inherited. The evidence of the heritability of Autism comes from twin and family studies. In twin studies, unusually high rates of Autism arefound in identical twins, and very low rates in fraternal or non-identical twins. Studies offamilies have indicated that 2-6% of the siblings of autistic children are also autistic, and that8% of the extended families will include another member who is autistic. Family studies alsoreveal an increased prevalence of mental retardation and cognitive difficulties in thesiblings of autistic children especially those who are mentally retarded themselves. Thissuggests that what may be inherited is not an "Autism gene" but rather a nonspecificfactor which increases the likelihood of various cognitive problems including Autism.

Neurobiological Difficulties

It is believed that Autism may be related to damage to the prefrontal cortex and limbicregion of the brain and to the connections between the two regions. The mostconsistent findings are of brain stem and cerebellum abnormalities. P.E.T. scans with

Autistic children show the location of problems to be in these areas of the brain. Adultswith this kind of brain damage, as a result of accident or stroke, display similardifficulties as autistic individuals. There is some indication that the brains of children with

Autism may have increased cell density suggesting that the cells did not get pruned backas they do in normal development. Other researchers have found that this isparticularly true within the dopamine system suggesting that there may be an excess ofdopamine which could contribute to an overactive system. Studies of glucose metabolismand blood flow have failed to reveal consistent global or regional abnormalities, althoughcorrelational studies do show some promise.

Developmental History

The developmental history of autistic children seldom reveals medical conditions that can be linkedto the disorder. However, certain other illnesses place children at risk for developing Autism. Theseare neurofibromatosis, tuberous sclerosis, and fragile X syndrome. Many children with Autism(approximately one fifth to one third) develop seizures. Most of these occur in lower functioningindividuals and usually develop in later childhood or adolescence. Many studies have shown that the

number of perinatal problems experienced by autistic children are exceptionally high including: difficultdelivery, infantile seizures, delayed breathing and neonatal convulsions. Some children appear to havenormal development earlier and only show the symptoms of Autism in the second year of life. There havebeen two explanations given for this: (1) the child did show problems earlier but they only became obviouswhen speech failed to develop and the pressure for socialization was greater, or (2) the child was born with avulnerability to acquiring the syndrome and it was triggered by a virus or other insult.

Environmental Factors

As mentioned previously in a very few cases of Autism a viral infection in a young child preceded the onset ofthe symptoms of Autism, before which there was a period of apparently normal development. There are alsosome cases where infections occurred in the mother at an early stage of pregnancy. No other links toenvironmental conditions have been found.

AUTISMCauses

“It seems likely that apredisposition to Autismis inherited.”



Development

Infancy

In general, unless there is mental retardation, the signs of Autism may not be obvious until the second year of life when languagedoes not develop normally and the child does not show any interest in playing with other children. Stereotypic behaviours may alsodevelop at this time. However, even in early infancy some signs of difficulties may be observable. See the following chart for a list ofthese signs

Early Childhood

It is usually in the second year of life that signs of Autism become most obvious and assessment is requested in order to determinethe reason or cause of the symptoms. Some of the signs that become obvious at this time are outlined below.

AUTISMDevelopment

Inactive:

· Flaccid muscle tone· Rarely cries

Or

Irritable:· Inconsolable· Only soothed when

in constant motion· Limp

Or

Motorically disorganized:· May be very active· Have poor motor

planning in reachingfor objects

Unusually sensitive tosensory stimuli

Auditory:· Appears deaf to voice

but jolts or panics atenvironmental sounds

Tactile:· Refuses food with rough

texture· Adverse reaction to

wool fabrics and labels,

etc.· Prefers smooth surfaces

Visual:· Sensitive to light· May panic at change in

illumination· Preoccupied in

observing own handand finger movements

Unresponsive:

· No social smile· Avoidance of eye

contact when held· Fleeting eye contact at a

distance· Lack of anticipatory

response to beingpicked up

· Seems not to like beingheld or hugged

· Seems content left alone

· Does not visually followthe coming and goingof primary caregiver

· Does not play peek-a-boo or patty-cake orwave bye-bye

· Fails to show normal 8-month stranger anxiety

· Does not respond tosocial bids fromcaregiver

Fails to form strongpersonal attachments

Delayed or absent coo orexpressive socialization

Failure to imitate sounds,words, or gestures

Little communication oruse of gestures

Speech delayed or showsprecocious advancesfollowed by failure to usepreviously learned words

Use eye contact wheninteracting

Does not point to objector hold up an object toshow it to caregiver

Decreased visual pursuitof objects and people

Object permanencedevelops slowly or stopsat age 2 or 3 years sochild does not developcapacity for retaining amemory of object or per-son or for searching forthem

MOTOR PERCEPTUAL SOCIAL-EMOTIONAL LANGUAGE MENTAL REPRESENTATIONAL

Signs in Infancy (first year)



Toe walking

Rocking

Head banging

Whirling without dizziness

Perseverative movementssuch as spinning orfinger posturing

Withdraws fromenvironmental stimulation

Engages in selfstimulation

Preoccupied withspinning and shiny

objects

Suddenly ceases andactivity and stares intospace. Often withhyperextension of theneck

Respond inconsistently tosounds (e.g. seems deaf)

Show unusual visualinterests (e.g.spinningobjects, "studying" objects

Moves adult's hand like atool

Insists on sameness andritualizes routines

Socialization:

· Does not respond tosocial bids· Does not smile to praise

or a smile of someoneelse

· Does not engage inreciprocal and backand forth play

· Does not imitate theactions of others

· Does not repeat actionsto get attention or toshow off for caregivers

· Does not show interestin other children orwant to play alongside

them· Does not show others aobject to show interest

Echolalia or repeatingwhat is said

Delayed echolalia unre-lated to social context

Pronoun reversals

Voice atonal, hollow andarhythmic

Does not use languageor gestures tocommunicate

Seems not to understandwhat is being said orgestured

Does not use eye contactto communicate

Play:

· No imaginative play·Little appropriate use oftoys

· Does not engage inplay sequences withtoys

· Does not play with dolls

Preoccupied withimpersonal, invariantinformation (e.g.television commercials)

May engage in repetitiveplay activities (e.g. liningup toys and opening orclosing cupboards)

MOTOR PERCEPTUAL SOCIAL-EMOTIONAL LANGUAGEMENTAL

REPRESENTATIONAL

Signs in Second and Third Year

AUTISMDevelopment

Older Children, Adolescents, and Adults

IImprovements in behaviour and compliance are usually evident after 5 years of age. The biggest change is most often a decrease insocial and emotional problems. The children become more affectionate and sociable, less resistant to change, less given to needlessfears, more aware of real dangers, and somewhat better behaved in public. However, the cognitive difficulties that are a part of thedisorder usually continue although early intervention with children with the disorder has been shown to be helpful. Long termprognosis is generally poor for children with Autism as only about 8% in most follow-up studies become employable and liveindependently. The best indicators of success in later life are having an IQ of over 85, developing speech before age 5, not havingany additional identifiable neurological difficulties, and not developing seizures in late childhood or adolescence



“To meet criteria for adiagnosis of AutisticDisorder a child mustmeet the 3 conditionsoutlined in theDSM-IV-TR.“

Diagnosis

To meet criteria for a diagnosis of Autistic Disorder a child must meet the 3 conditions outlined in theDSM-IV-TR. These are: 6 items in the areas of: impairment in social interaction, communication, or inhaving repetitive and stereotyped patterns of behaviour; or delays in social interaction, language, andsymbolic or imaginative play which are not accounted for by Rett's Disorder or Childhood DisintegrativeDisorder. Other observation schedules and questionnaires can also be used to make the diagnosis.

Although the symptoms of Autism are evident by 2 years of age or before, the differential diagnosisof Autism can still be difficult especially making a distinction between such other disorders assevere communication disorder, Pervasive Developmental Disorder, and Nonverbal LearningDisability (NLD). Testing children with Autism can be very challenging as they are usually notinterested or able to follow or imitate the examiner's instructions and demonstrations of certaintasks. Also if children have behavioural difficulties or find strange places upsetting they may refuse items that they could usually complete. For this reason it is critically important toobtain information from a variety of settings and respondents.

Assessment

Assessment needs to consider the following sources of information:· Clinical interviews with parents and teachers.· A developmental and medical history to see if there are any medical

conditions or history of medical illness that could be contributing to theproblems.

· Assessment of hearing and vision.· If it has not been done a medical examination to rule out any other disorders.

If there are soft neurological signs an examination by a neurologist would beimportant.

· Tests of developmental level are important to determine the child's level offunctioning in various areas of development. Because some children are very

difficult to test, observation of their behaviours or questionnaires completed by the parents can be essential.· Observations of the child in different settings or situations.· Observations of parent-child interactions.· Use of tests which have been developed specifically to evaluate the child for autistic

symptomatology.· Assessment for behaviour management.

Parent Interviews or Questionnaires· Parent Interview for Autism (for parents of children under 6 years of age)· Vineland Adaptive Behavior Scales· Autism Diagnostic Interview

Developmental Assessments· Diagnostic Inventory for Screening Children (D.I.S.C.)· Leiter International Performance Scale for children who are non-verbal

· Bayley Scales of Infant Development· Wechsler Intelligence Scales can be used if the child's level of development is high enough

Direct Assessments for Children with Autism· Diagnostic Checklist for Behavior-Disturbed Children· Autism Diagnostic Inventory · Autism Diagnostic Observation Schedule (ADOS)· Psychoeducational Profile for children 1 to 12 years of age who are functioning at a preschool level

Observational Scales· Autism Behavior Checklist (ABC) (completed by teachers)· Childhood Autism Rating Scale (CARS)· Checklist for Autism in Toddlers· Behavior Observation System (free play observation procedure)

AUTISMDiagnosis and Assessment



References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: American Psychiatric Association.

Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightingdale, N., Morgan, K., Auriol, D., &Charman, T. (1996). Psychological markers in the detection of autism in infancy in a largepopulation. British Journal of Psychiatry, 168, 158-163.

Cohen, D., & Volkmar, F. (Eds.)(1997). Handbook of autism and pervasive developmentaldisorder. (2nd ed.). N.Y.: John Wiley.

Kranowitz, C.S. (1998). The out-of-sync child: Recognizing and coping with sensory integration dysfunction. New York: Perigree Book.

Lord, C., & Risi, S. (2000). Diagnosis of autism spectrum disorder in young children. In A.M. Weterby & B.M.Prizant (Eds.). Autism spectrum disorders: A transactionaldevelopmental perspective (pp. 11-30). Baltimore: Paul Brookes Pub. Co.

Lord, C., Rutter, M., Divare, P.C., & Risis, P. (1999). Autism Diagnosis ObservationSchedule-WPS Edition (ADOS-WPS). Los Angeles: Western Psychological Services.

Mesibov, G.B., Adams, L.W., & Klinger, L.G. (1997). Autism understanding the disorder.New York: Plenum Press.

Rogers, S.J., & Benneto, L. (2000). Intersubjectivity in autism: The roles of imitation and

executive function. In A.M. Wetherby & B.M.Prizant (Eds.). Autism spectrum disorders: A transactional developmental perspective (pp. 79-108). Baltimore: Paul Brookes Pub. Co.

Schopler, E., Reichler, R.J., & Renner, B. R. (1986). The Childhood Autism Rating Scale (CARS)for diagnostic screening and classification of autism. New York: Irvington.

Siegel, B. (1996). The world of the autistic child: Understanding and treating autistic spectrumdisorders. New York: Oxford University Press.

Weatherby, A.M., & Prizant, B.M. (2000). Autism spectrum disorders: A transactional developmentalperspective. Vol. 9, Communication and Language Intervention Series. Baltimore: Paul Brookes Pub.Co.

Wing, L. (1998). Classification and diagnosis - Looking at the complexities involved. Communication,

15-18.

ZERO TO THREE/National Center for Clinical Infant Programs (1994). Diagnostic classification 0 -3 diagnos-tic classification of mental health and developmental disorders of infancy and early childhood. Arlington, VA:

ZERO TO THREE.

AUTISMReferences



“Applied Behaviour Analysis (ABA) is basedon the view that autismis a neurologicaldisorder which causes anumber of deficits inbehavioural responses.

TREATMENT

Definition

Autism or Autistic Disorder is a pervasive developmental disorder that affects all of mentaldevelopment. For further information on the diagnosis of Autism refer to the sections on“Symptoms, Causes and Assessment”. Children with Autism have three primary distinguishingfeatures:

· Impairment in social interactions.· Impairment in communication.· Repetitive and stereotypic behaviours, interests, and activities.

Treatment for children with Autism may be one or more of the following and may vary depending on the intellectual capacity of the child. Treatments that may be used include:

· Applied behaviour analysis (ABA)· Sensory integration therapy · Auditory integration therapy · Interactive approaches· Music therapy · Music interaction therapy · Using megavitamins· Medication· Teaching the child to mind-read

These forms of treatment are briefly described below and comments made on theireffectiveness.

Applied Behaviour Analysis (ABA)

Applied Behaviour Analysis (ABA) is based on the view that autism is a neurological disorderwhich causes a number of deficits in behavioural responses. Using Skinnarian operantconditioning the approach aims to increase adaptive behaviour (such as eye contact, language,self help skills) and decrease inappropriate behaviour (such as stereotypic behaviours andaggression). It works through reinforcement, punishment, shaping, fading, generalizing, extinction,etc. of the child's behaviour so he learns what is expected of him. Behaviours are broken down intosmall steps, and each step is taught (usually on one-to-one) by giving the child consistent cues that arefaded out as soon as possible, so the child learns to respond to similar cues in the natural environment.

In order to enhance motivation, teaching sessions are made as much fun as possible and tangiblereinforcements are used such as toys or Smarties. The reinforcers are presented at a fast rate initially andthen faded to intermittent reinforcement in order to sustain the behaviour. As the sessions progress thetangible reinforcements are gradually replaced by social reinforcers such as praise. Parents are included inthe treatment so it can be carried over into the home and school ensuring that children will be consistently reinforced and will be able to able to use their new skills in different settings. Of all the interventions used with

Autism research has shown it to be the most effective, especially for young children. It has been shown to resultin integration into normal classrooms and to normal functioning for some children.

AUTISMTREATMENT



“Children with Autismhave difficulty processistimulation from theenvironment thatcontributes to their oveor under-arousal by normal stimulation in tenvironment.”

Sensory Integration Therapy

Children with Autism have difficulty processing stimulation from the environment that contributes to theirover- or under-arousal by normal stimulation in the environment. This can explain the hypersensitivitiesor sensory defensiveness to touch, loud noises, bright lights, and certain food textures that are oftenfound with these children. These contribute to their ritualistic and stereotypic behaviours such asbody-rocking and spinning objects. It may also explain some of their withdrawal from closeness tohuman contact that children with Autism display although it is not believed to be the primary explanation. Sensory integration is a one-to-one therapy usually administered by an occupationaltherapist, that involves body massaging, swinging from a hammock, rocking, jumping onbouncy surfaces, climbing and crawling on special apparatus, or spinning on special chairs.

Another related approach that is used with children who show extreme sensory defensiveness

has been to apply rapid and firm pressure to the arms, hands, back, legs, and feet with anon-scratching brush with many bristles. A special brush is used which is a plastic surgicalscrub brush. The brushing is followed by gentle joint compression to the shoulders,elbows, wrists, hips, knees, ankles, and sometimes fingers and feet. It needs to berepeated frequently throughout the day. Clear evidence for the effectiveness of thetreatment is lacking although studies by its originator A. Jean Ayres suggest that it canreduce certain behaviours and increase some positive behaviours.

Auditory Integration Therapy

Auditory Integration Therapy (AI) assumes that sensitivity to sounds causes aggressionand impairs the Autistic child's interactions with others. The purpose of the therapy is toreduce this sensitivity so that their learning and especially their language will improve. Itis hoped that by reducing auditory sensitivity, behaviour and learning, especially of

language will improve. The therapy is conducted over about 2 weeks and the child spends10 hours over the 2 weeks listening to music played through a machine that filters outfrequencies to which they are sensitive. During this time it is suggested that all othertreatment be discontinued. No scientific studies have been conducted although parentreports have indicated that children who receive the treatment have a reduced rate ofbehaviour problems and understand language better than children who received a placebo.

Interactive Approaches

Stanley Greenspan and Serena Weider are the most well known advocates of using play to increasethe functioning capacity and interactions of children with Autism. Children with Autism have littleappropriate use of play objects and usually do not engage in pretend play. The treatment (called FloorTime) can take place in a room with toys that can be used to stimulate imaginative play including cars,animals, dolls, doll furniture, trains, etc. It can also be used throughout the day when the child is doing

something he is interested in. The child's parent is usually included in the session and is encouraged by thetherapist to carry out the following:

1. Follow the lead of the child in whatever they are doing with the play and make it interactive. Theinteraction should not be interrupted as long as the child is enjoying it and wants to continue.

2. Treat all the child's behaviour as if it is intentional and purposeful even though it may seem randomand purposeless (e.g. the child is just picking up and dropping objects or may run around aimlessly).

3. If the child is requesting something, indicating you do not know what he means will help extend the

AUTISMTREATMENT



“Because children wi Autism enjoy music somuch it has been founto be useful to integrateboth play and music.”

4. Face the child and make sure that their actions are differentiated from your own and sometimes put your hand over the child's to help them do something instead of encouraging the childto lead with his hand over yours.

5. Use surprise and novelty to capture the child's attention and interest so the child is compelled torespond such as using a musical box or a jack-in-the-box.

6. Pursue the child until he responds and keep trying new approaches to get interaction.7. Use tickling, peek-a-boo, and rhymes such as This Little Piggy, Ring Around the Rosy and

help the child join in the actions. Add new meanings to stereotypic play and add pretendhuman figures such as having the lined up cars or the train which is going round andround to pick up people and talk about the people in the train or lining up waiting forthe bus or train.

8. If the child becomes upset empathize with the feelings but do not give up on the

interactions.9. Use every opportunity to expand on pretend play such as, for example, offering

pretend cups of tea or pretend keys to open doors.

Music therapy

Many children with Autism enjoy music and often enjoy dancing to it and will "sing"along with the words. This allows the child a medium for non-verbal self-expressionand can provide a channel for communication. It can also be used to form the basisfor enjoyable interactions and a relationship.

Music Interaction Therapy

Because children with Autism enjoy music so much it has been found to be useful to

integrate both play and music. A music therapist or a musician scaffolds the interactionbetween the child and his parent(s). Children who cannot speak and do not engage ininteractions with their parents are provided with prolonged exposure to preverbal play patterns supported by the music. Through lap play, dancing together, tapping to the music,and joint attention supported by the music the social or interactional skills and timing skillsimportant for language are developed.

Using Megavitamins

Megavitamins have also been used as well as different types of restricted diets such as gluten freeand restricting certain food such as sugar, milk, eggs, and chocolate. Some researchers have claimedthat the vitamins B-6 and magnesium have positive effects but there is little evidence that theseapproaches are helpful.

Medication

Because Autism is a neurobiological disorder researchers have been studying the effects of medication on thedisorder. As yet, medications have been used to treat some of the symptoms of autism such as disruptivebehaviours, aggression, and stereotypic behaviours but have not been able to increase adaptive behaviourssuch as language and imagination. Some medications that have been used include antipsychotics (such asrisperidone), ritalin, and anti-depressants but they have had mixed results and some have had adverse sideeffects. Anti-depressants (particularly Selective Serotonin Reuptake Inhibitors, (SSRIs)) have been found to behelpful for children with high anxiety and sensitivity to various stimuli to calm them and reduce negativebehaviours. SSRIs have also shown some benefit both in terms of reducing unwanted behaviour as well as inincreasing prosocial behaviours. However, studies have involved small numbers of children and have not beendouble blind placebo controlled studies.

AUTISMTREATMENT



“Children with Autismhave deficits or have not

developed a theory ofmind or the capacity for

"mind-reading" and this isseen as at the basis ofmany of their difficultieswith socialization, pretendplay, communication, andunderstanding theemotions of anotherperson that relate to theirbeliefs.”

Teaching the Child to Mind-R ead

Children with Autism have deficits or have not developed a theory of mind or the capacity for"mind-reading" and this is seen as at the basis of many of their difficulties with socialization, pretendplay, communication, and understanding the emotions of another person that relate to their beliefs.This deficit can lead to insensitivity to other people's feelings, difficulty with making friends by readingtheir interests and intentions, and can lead to more elaborate difficulties such as problems withrealizing they are being deceived. The program Teaching Children to Mind-Read was developedby Howlin, Baron-Cohen, and Hadwin and research has shown that the method has beensuccessful in teaching children with Autism to learn specific mental state concepts and that theimprovements were maintained long after the intervention ended. The program provides thematerial that can be used to teach. It involves three types of learning: (1) teaching the child

about emotions from recognizing facial expressions in photos such as happy, sad, mad,and afraid up to being able to recognize what a person would be feeling from a sequenceof pictures, (2) teaching the child about perspective-taking and how people see thingsdifferently both visually and on the basis of knowledge that they have, and (3) teachingchildren to pretend play at increasingly complex levels.

Developmental Social-Pragmatic (DPS) Approaches To Teaching Communication

Developmental Social-Pragmatic (DPS) approaches emphasize the importance offocusing on the child's natural attempts for communication and use more naturalactivities and events as contexts to support the child's development of socialcommunications. In other words they do not rely on scheduled activities or programssuch as the ABA approach to enhance the behaviour. Developed by Prizant, Wetherby,and Rydell, the approaches use interactive-facilitative strategies to carry out the therapy

and focus on aspects of both verbal and nonverbal behaviour. The interactive approachdescribed above is similar in the principles that underlie the approaches. In summary theDPS approach uses the following:

· Enhances spontaneous communication within a flexible schedule and variedinteresting activities.

· Builds on multimodal communicative repertoires including speech, gestures, andalternative communication methods.

· Encourages turn taking and reciprocity in interactions.· Encourages the child interacting in a number of social groups.· Uses gestures and visual supports to help the child make sense of the communication rather

than breaking down the tasks into small pieces.· Emotional expression and affect sharing are seen as crucial to the interactive and learning

process.

· The intervention starts from the developmental level that the child is at, sometimes starting fromprespeech, or echolalia, and moving to more creative levels of language.

· Attempts are made to have the child seek out assistance in order to calm down and types of activity are provided that can help them to regulate the emotions.

Augmentative Communication

Some children with Autism will not be learn to speak and will need to use augmentative and alternativecommunication supports. Some of the common forms of augmentative communication devices are: use ofpictorial or written schedules to assist the child to understand the school schedule, teaching children manualsigns that they can use to communicate certain needs, and the use of voice-output computer programs. Thesedevices can all allow the child to communicate and to be communicated with.

AUTISMTREATMENT



As well, treatmentneeds to be given asearly as possible and tobe intense to besuccessful.

Summary and Conclusions

With so many treatments available choosing which type of treatment would benefit an individual child canbe very confusing and frustrating for parents who are often looking for a cure for their child. There are,however, some guidelines that can be used in making decisions:

· Treatments should start as early as possible and treatment received between 2 and 4 yearscan improve a child's skills considerably.

· Treatment needs to be different for different children depending on their IQ level (whichcan range from below 50 to 120 and above), whether aggressive behaviour and otherstereotypic behaviour is a problem, whether the child has language, and their levelof socialization and their capacity for warm interactions with other children. It is,

therefore, important that the child has a thorough assessment in order to determine the most appropriate treatment combination.

· Treatment may need to be intense to begin with to get the gains that may bepossible and many improvements have occurred when treatment has beenintense.

· All teaching in the various therapies needs to be broken down into smallsteps, so that complex skills are acquired gradually, as a sequence of separatecomponents (see ABA and improving mind reading especially).

· Teaching needs to pay attention to the child's interests and to build on them(e.g. if a child loves trains use them as a subject to teach other words, math,and reading).

· Having a structured classroom to help contain the child's anxiety and nervoussystem arousal can be very helpful.

· Sensory integration therapy and use of exercise as a release is an important

component of treatment.· Using visual cues to reinforce learning as well as routines that the child follows

(e.g. have the child look at pictures of the stages of having a bath before they have one).

· Avoiding using long strings of verbal information as the child will probably not beable to follow it.

· Skills need to be reinforced by rewards but when the child finds the intervention fun andpleasurable the influence of the rewards can be further enhanced.

· Teaching needs to begin at the level the child is at and not a level that would be expectedgiven the child's age. However, for children with higher levels of functioning,individualizedrather than pre-packaged teaching methods need to be applied.

· Family support is crucial to help parents deal with the demands of providing treatment.

In conclusion it is important to: use a combination of various treatment strategies including approaches

that build a relationship with the child and enhance parent's relating with their child and behaviouralapproaches. As well, treatment needs to be given as early as possible and to be intense to be successful.

Author:Sarah Landy Ph.D., Developmental Psychologist

We recognize and thank the Government of Ontario for its generous financial support of this publication.

AUTISMSummary and Conclusions



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parenting) autism - symptoms, causes, assessment, and treatment

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