Treatment of Autism Issues - Research Paper Example

?Treatment of Autism: Introduction: It is a developmental disorder which is encountered usually in the first three years of life and the patient lacks the skill to communicate socially. It is a condition which is caused due to abnormal biochemical changes in the brain. The exact causes of this disease remain unknown but the research is still going on to ascertain the etiology of the disease. Most of the researchers are of the view that this disease has a multi factorial etiology. Genetics of the affected child seems to play an important role in the causation of the disease. It is shown by the fact that identical or monozygotic twins have more chances to get the disease than do the dizygotic twins or the siblings. Conditions affecting the language skills are more prevalent in the family of the patient. Other chromosomal and neurological disorders are also present in the family with autism. Other factors which can also prove causative include; Diet, changes in the digestive tract, metal poisoning specifically with mercury, metabolic disorders in which the body is not able to utilize the vitamins and the minerals and hypersensitivity to some of the vaccines. There are a group of people who are of the view that mercury is a part of some of the multi dose vaccines as thimerosal so in their opinion these vaccines can cause autism but this a misperception as The American Academy of Pediatrics, and The Institute of Medicine (IOM) has agreed to the fact that all the children who are currently diagnosed as autism’s patients, vaccination is not the cause of this disease in a single case even. It should also be considered that the benefits of the vaccination outweighs the disadvantages so vaccination should not be discontinued on account of diseases like autism as most of the vaccines are single dose prescription and thimerosal is not a constituent of any of the single dose vaccine. Treatment: B. F. Skinner who was a psychologist showed that the patients who are diagnosed cases of autism can benefit maximum from participating in Applied Behavior Analysis Training which is also known as ABA training; though there are other treatment strategies also available for the management of autism patients but ABA training proves to be much superior than the other treatment modalities. The cost of using this technique as the treatment modality should be brought into consideration before initiation of the therapy. ABA Training: It is also known as Intensive Behavioral Intervention. There are differences between these two kinds of therapy but most of the parents as well as layman usually consider both of these as a form of intense treatment plan which primarily includes careful observation and studying the patient usually the affected child and the treatment mainly applies the principles of Operant Conditioning which was1st presented in the theories presented by B. F. Skinner. A study of the children affected by autism was carried out by Ivar Lovaas in 1980’s and it was evident from the results of the study that main principles of ABA can be used in a program designed to treat the patients of autistic disorders. This study showed marked improvement in the patients of autism if these techniques are used in a proper manner. There are many techniques which are currently the part of ABA management system and one of the principle techniques is Discrete Trial Teaching (DTT) which is used extensively nowadays. The main aim of this technique is to maximize the learning process in the affected children and it is useful in the development of most of the skills e.g. cognitive, social, behavioral, fine motor, play as well as it can also be used to accelerate the ability of the children to help them at times. DTT usually involves the fragmentation of the main skill into several sub skills and then each sub skill is taught to the children intensely at a time. In actual practice, repeated sessions are planned with the child and involve prompting and then the prompt is faded to make sure the successful learning of that particular skill by the child. It also uses the phenomenon of reinforcement to maintain the learned skills. One of the other principle techniques which are being employed in ABA is the use of natural environment in the teaching of the child with autism and with the development of the child; more elaborated methods of teaching are incorporated in the training program to enhance the verbal and the social skills of the affected individual. The main theme of this form of training is the use of a simple principle that we use to learn in order to fulfill the demands put on to us by the nature so in case of autism, several carefully designed demands are put in front of the child and they are repeated at frequent intervals so that the child can learn to fulfill these demands and when he does so then some sort of reward is also given to the child which help in the maintenance of the acquired skill. Principles of ABA Training: a. By increasing the behavioral skills by augmenting the social interactions and let the child performs reinforcement procedures. b. Teaching the child about new skills which may be social skills or maybe the communication skills in some places. c. Maintenance of acquired behaviors by practicing them again and again and it is usually done with the help of ability to self control as well as self monitoring of the child by himself. d. The responses which are learned by the children are stimulated and reinforced by providing these children with situations that will allow them to use these responses in real environment e.g. first the children are advised to carry out certain assignment in the activity room but later on these children are asked to carry out these assignments in the real class room without the support of the teacher. e. The learning environment is modified by providing the broader and friendly environment in which the child feels free to carry out the desired activities without being feared of the punishment or any other negative behaviors. f. To minimize the possibility of the factors that can result in the interference in the learning process e.g. self injury of the child while carrying out certain activity. Strategies in ABA Training: The interventions in this form of therapy usually require the actual demonstration of the particular event that results in the occurrence or in the other case non occurrence of the behavior. There are available many tools which assist the therapist in analyzing the extent of reproducibility of different behaviors by the affected child and the resultant change in the child behavior is also noted. The evaluation of these behaviors is done in specific set ups such as schools, residence of the child or special treatment forums. Individualized experimental tools are made in order to evaluate the effectiveness of the therapy under the ABA training system. This process of assessment of the outcomes of the therapy is done by the following; a. Identification of the behaviors which result in the interference in the learning process or the factors which are causing deficit in learning some skills. b. Defining the goals and objectives which have to be achieved and timeframe should also be devised to achieve these goals. c. A methodology should be devised to measure the desired behaviors in such a way that quantitative assessment can be done about the behaviors learned by the patient. d. Baseline levels of learning of the child should be evaluated and recorded so that in future, progress made by the therapy can be evaluated by comparing with this baseline record. e. The interventions which are to be carried out should be in such a way that these should aid in teaching new skills to the child and at the same time should be effective in decreasing the intensity of interfering behaviors. f. The target behaviors which are defined at the initiation of the therapy should be measured at regular intervals so that the efficacy of the therapy can be assessed. g. Continuous evaluation should be done to assess the efficacy and the effectiveness of the therapy and also to address the deficient areas more efficiently. Concept of Reinforce and Punisher: Reinforce: It may be defined as anything which when given or present as the final consequence of a response results in an increase in the probability of the response and that particular response tends to occur more frequently due to the reinforcer; it may includes an appraisal which may be in verbal form or at sometimes it can be some reward lake a toy for the child. Punisher: In contrast to the reinforcer, punisher refers to all the consequences which will result in decreasing the probability of a particular response and these may include a disapproval by the therapist which usually in the verbal form or it can be achieved by preventing the child from some of his desired activity. It should be kept in mind that “punisher” is a technical term and it does not relate to physical abuse of the child like hitting or slapping the child. Both reinforcers and the punishers are individualized for every child and these are worked out for each child to get maximum benefit from these in shaping of a child’s behavior. All the therapies which involve behavioral modifications are somewhat similar in general but if we get more specific then there are some techniques which makes the intervention before the occurrence of the target response while others focus on the final outcome of the behavior and the intervention in made after the occurrence of the response to modify the future outcome. There are some techniques which make the child to learn different skills and adaptive behaviors. All these techniques have been used to be very useful in modifying the child’s behavior and the final outcome of these therapies is usually very fruitful as showed in different studies. Approaches in ABA Therapy: In autism there is a lack of ability in the child to learn new tasks and these children are reluctant to participate actively in their environment and whenever they are placed in a social gathering they show their lack of interest by different behaviors like crying, fidgeting, making an attempt to leave or showing their unwillingness to be present there. The ABA therapy causes a potential increase in the social communication skills of these children resulting in the increased effectiveness of the teaching at school. a. Discrete Trial Training (DTT): It consists of a continuous series of different types of lessons which are learned by the children one at a single time. Each time the child is asked to perform certain action or a certain behavior is required or requested from the child and the consequence in the form of reinforcer or punisher is given by the therapist and these consequences are individualized on the basis of children’s preferences. In the initial phase of treatment, some children only give positive response to familiar reinforcers like some food items but these food items or other such reinforcers are later replaced by rewards like appraisal or supporting the responses by gestures like kissing the child. Initially an intensive program is implemented which involves the training of about 30-40 hours per week and one task is usually stressed upon at a single time under the supervision of a trained therapist in the vicinity of the child’s home. The training of both the parents is necessary to achieve successful outcome of the program and at the end of the performance of every task, respective data is collected and once the task is performed with accuracy by the child then the other task is started but attention is given to maintain the already learned tasks. DTT can be very helpful in the behavioral modification of autistic children in making them a useful part of the community. b. Pivotal Response Therapy (PRT): It is also known as pivotal response training or pivotal response treatment; it is also a form of intervention therapy for behavior modification used in the treatment of autism. The basic principle of this theory is that there are mainly two factors which results in a change in behavior in these patients and these two are; 1. Motivation of the patient to do different tasks. 2. Ability of the patient to respond to multiple tasks. And working on these two factors can result in marked improvement in the child’s behavior PRT advocates are of the view that this disease is quite over estimated and the severity of the disease is quite less than it was thought in the beginning. The two main areas which require attention by the therapist and the family of the patient include motivation of the patient so as to initiate the performance of different acts by the child. Other factors include management of different problems by the child himself, development of feelings in the child and to use them in a positive manner and making child to respond to different stimuli at the same time. Usually child friendly playing environments are used in PRT and as a result, the patient is encouraged to take decisions, to communicate socially as well as to improve the language skills of the patient. This form of therapy is also based on the child’s choices and he is the one whose likes and dislikes decide the direction of the therapy. Parents are thought to play pivotal role in the PRT. Research is continuing on the role of PRT in the treatment of autism but established data is still not available. This form of therapy is mainly directed to improve the communication skills of the child. c. Reciprocal Imitation Training: It is a variation of PRT to teach the playing skills to the affected children, it uses the playing environment to teach the child different form of skills. This system is designed in such a way that it increased the mutual interaction between the therapist and the child while performing playing activities. As a result, there is an increase in the ability of the children to play and it is also thought to improve the social skills of the child. d. Self-Management Training (SMT): It usually supports the other form of therapies by increasing the ability of the child to take the decisions independently without much dependence on the therapist or the parents and it also results in increase level of confidence of the child. It usually involves; 1. After eliciting certain action, the child usually evaluate his success in performing that particular action by him. 2. Monitoring of one own actions. 3. Reinforcement is usually provided by the child himself The therapist teaches the child to carry out all the above mentioned actions on his own in the absence of the therapist. This is particularly useful in school going children, a study showed that before this type of training, children showed very less quantity of independent actions like playing on their own before this therapy but with the therapy involving SMT, the children’s ability to play independently and properly was markedly increased in both supervised as well as non-supervised environment. SMT is seen to increase the social communication skills of the child, decrease the negativity in the child’s behavior and it is also thought to increase the interaction of the child with the other children in his community. e. Video Modeling: This form of behavioral therapy takes the aid of video devices and the target responses are shown repeatedly on the video devices. This technique is quite effective in increasing the child’s verbal skills, response to different verbal tasks and also the skills of the child to buy something from the market. It also helps in improving the vocabulary of the child as well as child get better in understanding the feelings and at performing routine daily activities. There are two form of video modeling, one is self modeling in which the affected child does the tasks by his own and these are recorded and then edited to show the desired tasks only and the other form of modeling employs individuals other than the child himself and usually includes the siblings of the child performing the desired responses. Nowadays, video modeling is being used as a tool to increase the playing skills of the child thus in turn enhances the ability of the child to learn through interactive sessions. References: 1. Pub Med Health. Autism. 26th April. 2010. 29th April. 2011. 2. Jones, Joseph T., Psy. D. ProQuest. Applied behavior analysis as a treatment for autism: A comprehensive literature review. 2007. 29th April. 2011. 3. Autism Treatment Info. 30th April. 2011. 4. C.A.R.D. What is Applied Behavior Analysis? 30th April. 2011. 5. Raise Awareness. Applied Behavior Analysis (ABA). 30th April. 2011. Read More