Best Practices on Autism - Research Paper Example

Running head: The Best Practices Best Practices on Autism Sousan The last 4-5 decades have seen significant changed in the understanding of the plight of the people with disability. The social model of disability elaborates on the needs and requirements of the disabled population in order to provide them with requisite infrastructure and opportunities so that they can become financially independent and socially integrated. Of all the disabilities, Autism and Autistic syndrome disorders are the most complex disorders which still require extensive research for the identifying the cause and consequences of the disability. While the paper has focused on the best practices in the field but the limited diagnosis criteria and lack of emphatic treatment has greatly frustrated the parents and the scholars alike and presents a challenge for the medical fraternity as well. Introduction In the recent times, there has been extensive and wide ranging concern for issues relating to disability. The prognosis and the use of technology in the field has made tremendous advancement and the amendments in the constitutions, making special provisions to include all round welfare programs for the people with disabilities has facilitated equal participation in the socio-economic development of the country. Though the huge efforts made by the countries to facilitate and promote the participation of the people with disabilities has made significant mark, a lot more needs to be done in the field of developmental disabilities which have multifaceted and multilateral aspects that are not only complex by nature but they also need socio-psychological interventions, stretched over a period of time, involving extensive inter-personal communication. Of the various developmental disabilities, autism is significantly different and encompasses a wide set of communication problem. Clinical definition Autism and autistic spectrum disorder (ASD) can be broadly defined as neuro-developmental disorder that affects social interaction and communication. There is decided lack of responsiveness to others that is accompanied by resistance towards any type of change. Variation in incidence/ prevalence w.r.t. contextual variables like race, ethnicity, age, gender etc. The studies have shown that autism is more prominent displayed amongst the children in the age group of 4-12 (Rutter, 1970; Wiug, 1988). The various studies looking for contextual variables have found that the demographic representation of autistic children was higher in the urban areas (DSM II criteria, 1980; DSM III R criteria, 1987). The incidence of autism was higher in the immigrant population from third world countries, especially Caribbean, Asia, south America, South-east Europe (Lotter, 1967; Gillberg & Schaumann, 1982; Gillberg et al. 1987, 1991; Tanoue et al.,1988). Etiological theories Various studies have confirmed repetitive and ritualistic behaviour that gives no indication to child’s intelligence or lack of it (Kanner & Eisenberg, 1956; Rutter, 1978;). Diagnostic and Statistical Manual of Mental Disorders, better known as DSM-III criteria was developed by American Psychiatric Association in 1980 and had introduced the term ‘pervasive developmental disorder’ to identify ASD cases. Further research by Denckla (1986) and Wing and Gould (1979) had asserted that autism needs to be evaluated against the developmental age and should be independent of intelligence or any associated condition. These findings were later incorporated as DSM IIIR Criteria by American Psychiatric Association in 1987. There is no cure or treatment for ASD but various intervention practices have shown credible impact on the autistic children. Best Practices The last 4-5 decades have seen significant changed in the understanding of the plight of the people with disability. In UK and US, perception of disability has undergone a drastic transformation. Concept of disability has moved beyond the constraints of the medical terminology and has embraced a socially relevant stance keeping their all round welfare as the main objective in all their policies and plans. The social model of disability elaborates on the needs and requirements of the disabled population in order to provide them with requisite infrastructure and opportunities so that they can become financially independent and socially integrated. “It changed the centre of analysis from focusing on individual’s medical conditions to social structures, institutions, environments and attitudes” (Kwiotek). “Human competencies interact with the environment in a dynamic reciprocal relationship that shapes performance. When functional limitations exist, social participation is possible only when environmental support is present” (IOM1, 1997). The social model of disabilities which advocated the support system of the existing environment as a major enabling factor that facilitates integration, both at physical and intellectual level, was the most prominent model to define the disability as per the environmental constraints within which it exists. Terzi agrees that “the social model acts as a powerful and important reminder to face issues of inclusion as fundamental, moral issues” (2004). Indeed, the neurological science confirms the irreversibility of the process but early deduction and intervention goes a long way in rehabilitating the young ones. The following interventions and practices are used in the autism. Pharmacological therapy The autistic person/ children are prone to exhibit hyperactivity, repetitive behaviour, lack of response to social interaction, aggression or even self injury. In such cases, the use of external medication becomes necessary to protect the child or the carers. Sometimes, anxiety, depression or epilepsy further complicates the case, thus necessitating the use of pharmacological intervention. Few of these interventions are described as below. Use of Stimulants Stimulants like Amphetamines and methylphenidates are used in autistic children who exhibit ADHD or are inattentive for long period of time (Gringras, 2000). Use of Antipsychotic Antipsychotic agents like haloperidol, dopaminergic-blocking agent, risperidon etc. are effective in controlling hyperactivity, obsessive compulsive behavior, tantrums and self injury, though they have side effects like drowsiness, weight gain, drooling etc. (Campbell et al., 1997; McCracken et al., 2002). Use of Anti-depressants Previous research had shown that certain anti-depressant drugs like Cipramil was effective in calming down violent behaviour but the recent US study has shown that risk of prescribing the drug outweigh the benefits to the autistic person (Nursing times, 2009). Use of Mood stabilizers Hollander, Phillips and Yeh (2003) have found that Anticonvulsants and lithium have relative effect in controlling aggression and mood swings. TEACCH Method Treatment and Education of Autistic and Related Communication Handicapped Children or TEACCH is the most popular intervention that involves the carer and parents so as to teach various tasks to the child. The method is based on the understanding of the cognitive reality of the autistic child and the predictive behavioral pattern. The method was developed by Dr Eric Schopler of the Department of Psychiatry, University of North Carolina School of Medicine, USA in 1966. The major objective of the TEACCH is to promote autonomy for autistic children at all levels of functioning, depending upon the severity or degree of autism. The methodology comprises of diagnosis, parents training, skill development and communication techniques to the autistic child through structural predictability model which uses cues and symbols. It is especially relevant in the mild autism (Ozonoff & Cathcart, 1998) PECS Method Picture Exchange Communication System was developed by Andrew Bondy and Lori Frost. It is an augmentative training package for teaching functional communication to children and adolescent with autism (Walker, 1978). The autistic is taught communication through desired pictures and gestures. No verbal prompts are used. The main goal of PECS intervention technique is to teach verbal and non verbal communication to autistic children who have hitherto not shown an evidence of social responsiveness. Gluten and Casein Free Diet (GFCF) This is a major breakthrough and involves dietary regulation to control aggression, hyperactivity and self injury. Gluten and Casein Free Diet primarily provides the essential protein diet to the autistic children and adults in the form which is easily digestible because studies have found abnormal peptide complement in the urine of the autistic persons. The GFCF has shown positive results and helps in controlling aggression, irritability and hyperactivity amongst the autistic children and adults. Floortime Method This method takes cognizance of the nervous responses of the autistic children through special kind of play that is led by the children themselves and the therapist follows in a manner that encourages the children to exploit their abilities within the defined parameters of the degree of autism. The play-way methodology of intervention is highly successful even in the moderate to severe cases of autism. Since the therapist adopts himself according to the lead of the child, the child becomes interested and will have fun. This would lead to responses like eye contact, smiles and laugh thus giving special meaning to the whole interaction and intervention process. The learning relationship development is highly relevant for the development of nervous responses of the autistic child. Area of future research Autism and Autistic syndrome disorders are the most complex disorders which still require extensive research for the identifying the cause and consequences of the disability. The limited diagnosis criteria and lack of emphatic treatment has greatly frustrated the parents and the scholars alike. The external behavioural patterns of aggression and violence leading to self injury are factors that certain medical intervention has been able to control to some extent. But there is urgent need to find effective treatment and prevention methodology to give relief to the patient. There is an urgent need for a systematic review of the current research on AAC intervention and natural speech production to guide evidence-based decision making in initiating AAC (Schlosser & Raghavendra, 2004). While there have been many studies that focused on improving linguistic, technical, and strategic competence, there is a scarcity of research on socio-relational competence. In order to enhance the participation of the persons affected with autism at the various level of functional development, it is imperative that their socio-relational competencies be developed to the extent that they may start participation in the socio-economic development of the society. Indeed, it would not go amiss if one must also looks at the complementary and alternative medicine which could be more effective in the treatment of the autism. Conclusion ‘Recognizing that people with disabilities are important contributors to society and that allocating resources to their rehabilitation is an investment’ (WHA58.23). The governments are keen to promote policies and create facilitators so that disabled people become differently abled persons and contribute positively towards national growth. One can conclude that autism is the most scientifically complex disability encompassing a number of variations that not only confound the ordinary people but present a challenge for the medical fraternity as well for the psychologists and social scientists alike who are left with the task to, not only unravel the mysteries of the nervous system but also to evolve ways and means to cope with the socio-psychological affect of the disability. Reference American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington: APA American Psychiatric Association (1987). 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