Autism and the Pervasive Developmental Disorders - Essay Example

Autism Introduction Autism literally means living in terms of the self. To an observer, a child in a of autism appears to be self-centered since he shows little response to the outside world. However, paradoxically, the child in such a state has little awareness of being a self. In 1960, autism was reported in 4 to 5 cases per 10,000 individuals. The prevalence of cases rose to 5 to 31 cases per 10,000 individuals in 1990 (Iovannone, Dunlap, Huber, & Kincaid, 2003). Autism and the pervasive developmental disorders (PDDs) are highly complex and variable in their clinical presentation and manifestations. For example, symptoms and characteristics change with developmental maturity and vary with the degree of associated cognitive impairment (Filipek et al., 1999a). This evolving pattern of clinical features can make the differential diagnostic process very difficult in some cases. Nonetheless, the defining feature of autism is the presence of a distinctive impairment in the nature and quality of social and communicative development (influenced by the specific biological and environmental circumstances of the individual). It is this impairment that distinguishes autism from other neuro-developmental conditions (e.g., mental retardation, developmental language disorders, and specific learning disabilities). For example, whereas mental retardation is characterized by a pervasive developmental delay, autism is characterized by a distinctive impairment in the nature of social-communicative development. The prognostic significance of this autistic social dysfunction is underscored by preliminary studies that report a negative correlation between the severity of this social impairment and treatment responsiveness, at least with regard to social and linguistic growth following intensive, behaviorally based early intervention (Ingersoll, Schreibman, & Stahmer, 2001). Additional complexity in the differential diagnosis of autism and related PDDs results from a wide range of accompanying abnormalities within cognitive, adaptive, affective, and behavioral domains of development, including mental retardation, deficits in executive functions, limitations in adaptive skills, learning disabilities, mood instability, stereotypic and self-injurious behaviors, anxiety disorders, and aggression (Hollander et al.; King, 2000). The Autism of Early Infancy: This is a normal condition. There is little awareness of the outside world as such, which is experienced in the mode of the infants bodily organs, processes and zones. A normal infant emerges from this state because of an innate disposition to recognize patterns, similarities, repetitions and continuities. These are the raw materials for such mental processes as recognition, classification, object creation and empathy. Through these processes, the child builds an inner representation of commonly agreed reality and becomes self-conscious. The study of children who have failed to emerge satisfactorily from the state of normal primary autism brings home to us the complexity and delicacy of the time-consuming process of becoming aware of the world and its objects, persons and other minds. The Autism Associated with Psychosis: When things have gone grossly wrong with these early cognitive processes we say that the child is psychotic. The degree to which he is out of touch with reality distinguishes the psychotic from the neurotic child. However, it is important to make the point that the normal healthy infant who starts life by being out of touch with reality is not psychotic. But he is autistic. Autism is a “spectrum disorder,” meaning that it manifests itself differently in each child. Like a row of dominoes, if an early aspect of development is affected in a particular case of autism, other later-emerging aspects of development will be affected too. As a result, each case of autism presents a slightly different profile of learning abilities and learning disabilities. Each learning ability and each learning disability may influence how a particular child with autism may or may not learn something the way other children without autism may learn that same thing. These autism-specific learning barriers are referred here as autistic learning disabilities. The autism-specific learning strengths are referred to as autistic learning styles. We are at a very difficult point in autism treatment. We have very good descriptions of autistic spectrum disorders. We have better and increasingly early diagnosis. We have a mandate for early treatment. We have good empirical research that describes specific symptoms and specific ways in which skill acquisition for children with autism may be deficient. We do not, however, have very much empirical, truly scientific, treatment outcome research. Testing a new treatment for autism is not as simple as testing a new drug where one group gets the new drug and the other group gets the placebo or “old” drug. Unlike a drug treatment trial, treatment for autism is not like just swallowing a pill: In an educational or behavioral treatment research study, it would be almost impossible to control whether certain parents might also naturally be doing other very helpful things, or even pursuing additional simultaneous treatments. Then, there are the problems of treatment fidelity— controlling things like whether each child in a study is getting a good teacher or therapist or a less talented one. Under those circumstances, there would be no way to know whether the parents own added treatments or the main treatment being studied was the more powerful, or even if different simultaneous treatments helped (or hindered) one another in some synergistic way. Emotionally, its another story still: First and foremost, parents will always feel they cant afford not to treat autism in their child using whatever method has the loudest rooting section at the moment. Many parents, understandably, are unwilling even to be part of studies that compare treatments, lest the treatment passed over be their childs “silver bullet.” So as a professional, what do you recommend? As a parent, what do you select? Who do you listen to? The bottom line is that the very little scientific outcome research that exists is not enough to tell us for sure what to do for each case of autism. Instead, in designing autism treatment, we must often rely on theory, which is a second, and in some ways less ideal, source of information to select and individualize treatments. A third source of information about treatment comes from the clinical experience of those who have closely studied or worked with children with autistic spectrum disorders over time, and have had an opportunity to see what has helped some improve a great deal, and others improve less. It is harder to evaluate information from clinical claims since some come from those who are very experienced with autism, but others come from “johnny-come-latelys” who feel they may have come across a remarkably effective treatment based on one or a handful of cases. In addition, with the advent of the Internet, parents, and sometimes even professionals, rely on a fourth, even less solid, source of data—personal or anecdotal reports that may be tied to no widely accepted scientific studies, little or no theory or preexisting theory, and little or no long-term clinical experience. Treatment research in autism has been dealt a really unkind blow by those only interested in a cure, a medical cure, for autism. Undoubtedly, wanting a cure is a more noble ambition than being satisfied with palliation, which is what treatments from the fields of education and psychology are all about. However, even most researchers working on “cure” research would be the first to admit that any breakthroughs are not as likely to “cure” those children now autistic as to prevent future cases. We need good solid plans to help the children who have autism now. There are some, like myself, who believe that on the path of palliation, there is much to be learned about expression of the disorder and that this knowledge will be needed to trace back to the core neurobehavioral, neurocognitive, and neurogenetic factors that shape the autistic spectrum disorders. Looking at Autism in a New Way The picture of autism treatment is further complicated by the fact that there are very different perspectives from which to view treatment: developmental, behavioral, educational, cognitive, and medical. These perspectives overlap, but each emphasizes different things. Practitioners from these different perspectives often dont understand one anothers vocabularies. It is like blind men feeling the elephant from different parts of the animal and getting very different impressions of the creature. What we will do here is cross disciplinary boundaries and integrates different perspectives by stripping away terminology that delineates and separates perspectives and instead focuses on the mechanics of what to do to carry out treatment, based on research, theory, and clinical experience. In the last 15 years, treatment for autism has mushroomed, but so has the chaos about how to carry out treatment. Parents often feel they must adopt one treatment perspective and go with it: They fear that questioning a practitioner in any way may be seen as possibly disloyal, and if they really question any aspect of their childs treatment, they may be cast out from those treatment services and their child relegated to some horribly long waiting list for alternative services that might not be as good or might not come to pass at all. Parents feel panicked once the child is diagnosed and just want to get started on treatment right away. Advice of other parents is invaluable but is just one tool that should be considered in making treatment decisions. Perspectives from experienced diagnosticians and therapists, as well as readings, should also be weighed to consider all the factors that define a child with autisms individual learning style. Autism as a Learning Disability: This conceptualization of learning weaknesses and strengths is core to the whole field of learning disabilities and to compensatory educational approaches. Using autistic learning disabilities as the organizing construct, it is possible to reconceptualize treatment for autism: The first step is to inventory a particular childs autistic learning disabilities. The second step is to examine existing treatment strategies and treatment programs and systematically ask what each has to offer in the way of compensation with respect to a specific autistic learning disability. The third step is to put the first two steps together—taking the list of treatments that may be relevant to a particular childs specific profile of autistic learning disabilities and then figuring out how, within this childs matrix of abilities and disabilities, to select treatment components that will address each weakness using strategies that utilize the childs relative strengths. In this way, a very specific set of treatment needs can be formulated and a very individualized treatment plan developed (Gerlach, 1996). Reconceptualizing autism as a learning disability syndrome is intended to help break disciplinary barriers. Sometimes parts of the behavioral model for treating autism will be used, sometimes not. Sometimes, a more educational model will fit, sometimes a more social-developmental model. By philosophically adhering to just one treatment or another you will surely treat some, maybe even most, symptoms in a particular case of autism. However, each child should be treated for all his or her symptoms of autism, and this systematic approach, reconceptualizing each symptom as a learning disability, assures that each sign is addressed. The Holy Grail: The best of everything: the best treatment, the best teachers, the best medicines—as much as is needed, as early as possible—still may not yield all the hoped for results when it comes to autism treatment. Parents need to know this as they start seeking treatments. They need to be reminded of it as treatment proceeds. Part of any treatments success is recognizing what the child has accomplished. Parents also need to learn when to give their childs teacher a pat on the back when a job has been done well, even if there is still work to do. Likewise, parents sometimes need a pat on the back from teachers; it is parents who reinforce and round out what is learned in school and treatment. Finally, parents need to pat one another on the back once in a while; autism treatment is a Sisyphean struggle. It can help to remind one another how the cup is half full, not half empty (Newport, 2002). There will always be things that the child brings to his own treatment: A big part of treatment response is the result of which treatments are given. However, another part of the treatment response is what the child brings to the table: his innate capacities. Both parents and teachers need to be able to recognize and respect the child when he is working as hard as he can and accomplishing as much as he can. Both teachers and parents need to learn how to recognize when a child is doing his best. We all want the child to learn more but also to be happy, not perpetually anxious or stressed. In the last 25 years, there has been tremendous progress in how children with autism are treated. A number of methods for teaching children with autism have been devised, tested, and used. But, parents and teachers often become mired in controversy about what should be done—which method to use, how closely the teaching must adhere to the principles of the original method, where teaching should take place, how individualized the instruction should be, how much instruction there should be, who should teach, which peers belong or dont belong in the childs classroom, and so on. Conclusion Every child is educationally and biologically unique and will need something slightly different. The challenge is to understand the range of differences that make up what are called the autistic spectrum disorders and then to understand the individual differences that can be described in terms of slightly different profiles of strengths and weaknesses. The design of truly individual treatment plans that exploit strengths and compensate for weaknesses begins with a detailed understanding of how learning is different for children with autism than for those without autism and how learning is different among different children with autism. Reference: Filipek, P. A., Accardo, P. J., Baranek, G. T, Cook, E. H., Jr., Dawson, G., Gordon, B., et al. (1999a). The screening and diagnosis of autistic spectrum disorders. Journal of Autism & Developmental Disorders, 29(6), 439–484. Hollander, E., Dolgoff-Kaspar, R, Cartwright, C., Rawitt, R, & Novotny, S. (2001). An open trial of divalproex sodium in autism spectrum disorders. Journal of Clinical Psychiatry, 62(7) , 530–534. Ingersoll, B., Schreibman, L., & Stahmer, A. (2001). Brief report: Differential treatment outcomes for children with autistic spectrum disorder based on level of peer social avoidance. Journal of Autism & Developmental Disorders, 31(3) , 343–349. Iovannone, R., Dunlap, G., Huber, H., & Kincaid, D. (2003). Effective educational practices for students with autism spectrum disorders. Focus on autism & other developmental disabilities, 18(3), 150-166. Newport, Jerry, 2002. Autism-Aspergers & sexuality : puberty and beyond Gerlach, Elizabeth K. 1996. Autism treatment guide. Read More