Autism Spectrum Disorder - Essay Example

The Tom Cruise and Dustin Hoffman movie, ‘Rain Man’ in which Hoffman plays a middle-aged ‘mental retard’ is the movie most people allude to when one mentions autism. However, Autism Spectrum Disorder, also known as ASD or more commonly, in lay man’s term, autism, can affect people in different degree as it can sometimes be very subtle, indiscernible, undiagnosed or quite obvious as in the movie ‘Rain Man.’ What many of us do not realize is the prevalence of ASD in countries such as Australia and the USA. In recent years, experts in education and health policymakers in Australia and even in the US were alarmed by the increasing number of people diagnosed with ASD. Some contend that this could have been brought about by the advancement in technology in the diagnosis of the incidence and some assert that those who suffer from ASD, considering the growing population are apparently rising. Whichever the explanation maybe, it is important to examine if the government institute effective policies translated to laws and decrees and offer ample aid and care to those inflicted with the disorder. This paper will critically analyze the extent of the application of these government policies as well as examine existing literatures which center on answering the needs of the ASD sufferers as well as research which provides a workable framework for the care of this population. One of the most notable books that realistically depict the life, behavior and mental functions of an ASD sufferer is Mark Haddon’s, ‘The Curious Incident of the Dog in the Nighttime,’ which portrays the life of a boy, Christopher who suffers from ASD. The account is reminiscent of Haddon’s own experience in dealing with children who are affected by the disorder. In the novel, Haddon portrays Christopher as an adolescent who faces a problem in communicating ‘emotionally’ and could not relate to the emotional and social world around him as his brain only processes logical information. Although the boy highly prodigious proficiency in math and science, his relationship with his family develops a rift as he does not understand feelings or interpret love. In fact, ASD sufferer, as the books suggests, are not capable of loving or creating deeper friendship. Christopher screams and becomes violent if touched especially by strangers (Haddon 2003). Haddon’s novel reminds me of my volunteer experience as a caregiver of children dealing with ASD. In a center for special education where young children diagnosed with ASD are taught and treated by experts and experienced instructors, I learned more about this disorder. Most ASD sufferers develop problems with nonverbal communications such as eye to eye contact and understanding facial expressions. As my job requires mainly observing, providing therapy and interviewing sufferers, I found it very difficult at first to establish friendship with the children who exhibit the condition. As strangers are dreaded, it took time for them to develop trust with others. Another problem is in starting a conversation with the ASD sufferers as most do not initiate contact or verbal contact with others around them even if they see these people everyday. The children can sometimes turn violent as they hit or bite if you come near them. Hence, understanding of the condition is a corollary to establish successful relationships with those affected which is needed for successful ‘treatment’ and improvement of their conditions. Another manifest behavior exhibited by children with ASD is their unusual focus on one task. Many develop proficient skills in the one task or activity that they spent time focusing at. As this focus can be steadfast, the result is that most of them cannot develop social skills since they have the proclivity to do things alone. Hence, treatments of the disorder center mainly on behavioral management to improve social and communications skills, speech therapy and physical therapy to improve motor skills. All these treatments utilize positive reinforcement methods. ASD or autism spectrum disorders is included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and categorized under disorders such as Aspergers Syndrome and other developmental disorders (APA 1980). The American Academy of Pediatrics defines ASD as a brain disorder that makes it difficult for sufferers to communicate with and form relationships with others. This is brought about by the inability of the brain’s various areas to work together. Those affected with autism usually experience incapacity to relate to other around them. Marked symptoms of the disorder includes a child’s delay in learning verbal skills, focused interest in one activity, repeated body rocking, atypical attachments to objects and loss of temper when routine is altered (Bergman et al 2007). The aetiology of Autism is not yet fully understood but current studies suggest that ASD could be a consequence of a child’s genetic susceptibility to various environmental factors which results to the diverse dysfunctional contact of genes and nutrients also know as Nutrigenomic Interactions. This occurs during the period of pregnancy or after birth. These interactions can impinge on the physical and bodily aspects of the fetus especially the central nervous system, the gastrointestine, the endocrine glands and even the immune system. Other aetiology of the condition points to genetic predisposition, deficiency in essential nutrients, antigens and other toxic foreign matters, and various bacterial organisms (Duff 2005). In Australia, Centrelink, the most complete resource of data on ASD and the source of National information in the country, estimates that the pervasiveness of the disorder among children 6-12 years old is 62.5 in every 10,000 (Johnson 2007). This number, however, is incomplete as the data does not include age groups beyond 12. The Australian Institute of Health and Welfare (AIHW), together with the government funded Centrelink, reports that in the years 2003-2004, diagnosed autism in Australia shows 8.5 to 15.3 in every 10,000 for children age 0-5 year olds. This is slightly higher in children of 6-12 year olds as the number of sufferers diagnosed is 12.1 to 35.7 for every 10,000. Incidences of the condition decrease at 8.3 to 17.4 in every 10,000 for children 13 to 16 year olds. This data constitutes an estimated half a million or at least 125,100 people in Australia affected by the disorder. The study encompasses all territories and states in the country with 95% confidence interval (Agresti et al 1998). Data also shows that the percentage of incidences in every state and territory in the country is uniform. In Western Australia over the past 20 years, the number of new diagnoses has risen twenty times and about 200 new cases have been reported ((Glasson et al 2006). Almost the same percentage of increase is noticed worldwide especially in the US (Birnbraueret al 1988; Glasson 2002). The first in-depth study of the disorder was put forward in 1943 by Kanner who initially described the condition as ‘early infantile autism’ (Wing 1993). The research, however, does not include the prevalence rate of the condition and he supposed that it was a rare occurrence. Yet, it was clear from the study that diagnostics for ASD is essential for effective treatment and intervention. Various literatures also vary in their approach in care and method of treatment of the condition but the most notable of these intervention models is Division TEACHH (Treatment and Education of Autistic and related Communication-handicapped Children). Because of its prominence, Division TEACHH, based in Chapel Hill, North Carolina, is the model used throughout the United States and Europe (Smith 1999). This early intervention program is designed to examine the strengths and weaknesses of individuals especially children with regards their visual acuity, time-tables which focus on the visual perception and time-structured routines. Proponents and experts of this method believe that the program enhances life skills that prepare sufferers to find employment in the mainstream environment and teaches them to be independent (Schopler, Brehm, Kinsbourne & Reichler, 1971;Rutter & Bartak, 1973). Current research on the viability of the TEACHH method examined the program and the educational treatment in mainstream schools in Europe and the assessment points to the effectivity of the program. When compared with the development rate of those ASD sufferers who undergo the same method, both groups exhibited improvement in visual and manual coordination (Panerai, Ferrante and Zingale 2002). Other studies such as those of Chang (2004), state that the TEACHH program reduces violence and develops social skills of children and even adults affected by the disorder. Leppert and Probst (2005) also assert the efficacy of the TEACHH method. In their study, the experts contend that the utilization of the program has decreased the stress and difficulties experienced by the teacher and further bring forward an optimistic view of their assessment of the children’s conditions. This in turn improved interaction between students and teachers. With regards the policies that the advocates of TEACHH push for in government policies and intervention, experts on the study of the method are united in their efforts for the government to allocate resources for the nationalization of early diagnosis and intervention. In the United States, the Individuals with Disabilities and Education Act, requires that children with ASD be included in the early intervention curriculum and educational program suitable for their early needs. Other policies that TEACHH promote special classrooms and environment that are well- structured. TEACHH also promote the participation of the parents, the community for interaction of the ASD sufferers and the non-disabled individuals and the workers under the government social welfare program for effective dissemination of information as well as conducting of activities in the community and in the home. Other prominent literature and research on care and policies for ASD sufferers utilizes BF Skinner’s behavioral approach (Skinner 1957). The Behavioral approach put forward by Skinner, rests on the assumptions that all learning is a form of development as all behavior is learned. Lovaas (1987), employing the theory stated that the results using Skinner’s methodology of Applied Behavioral Analysis in his project called the Young Autism Project included the utilization of rewards with his subject groups showed that 47 percent of the ASD sufferers developed normal mental and educational performance. Optimism arose on this kind of methodology but was soon criticized by researchers such as Shea (2004) who reported lower improvement percentages when the Applied Behavioral Analysis was employed. Shea later on dismissed Lovaas’ approach as ineffectual, a study supported by Smith (1999) but admitted that early intervention is essential for the development of the condition. A study conducted by Luiselli and O’Malley Cannon (2000) showed that cognitive and functional advances were made by experimental subjects after they have undergone behavioral intervention program. Marked improvements were made by an experimental group that underwent the behavioral method as compared to the control group (Eikeseth and Smith (2002). Recent literature which used the behavioral analysis methodology point to the viability of teaching language and communication skills using the behavioral approach (Goldstein 2002). The system also involved games and play activities (Kok et al. 2002) and joint attention developed by Whalen & Schreibman ( 2003). Proponents of the joint attention scheme noticed considerable improvement on the intellectual performance on their subjects. Kok (2002) on the other hand observes that play and facilitations of game activities with sufferers were reported to have increased the communicative skills of children with ASD. On the other hand, Hwang and Hughes (2000) have reevaluated 16 studies that analyze the consequences of social interactive skills on the early stages of communication ability of children with ASD. The research employs naturalistic interactive schemes that focus on imitation, positive reinforcements and time delay. Favorable developments have been reported in this scheme as it apparently improved the non-verbal and verbal proficiency, visual contact, attention span and psycho-motor ability of children with ASD. Another notable research on the area of the care and treatment for children with ASD was devised by Bondy and Frost (1994) who formulated the PECS (Picture Exchange Communication System). They have developed the ‘augmented alternative communication’ (AAC) which aimed to provide instructions on functional verbal communication schemes to children with impaired speech abilities. Children with ASD conditions are taught to ‘initiate communicative interactions’ bringing into play their preferred objects to stimulate communication. The PECS method also utilizes cards with illustrations of things, concepts and activities. The children also undergo trainings in which they learn how to classify symbols, learn how to use phrases, make comments and reply to direct inquiries. The most interesting aspect of this system is that it is compatible with TEACHH. What we can glean from the aforementioned literature on ASD is that, most of these methodologies offer observable and considerable evidence of positive results. Although experts cannot establish an opinion that identifies the program on early intervention as the most viable, it is apparent that early intervention and diagnosis is essential to the development and alleviation of the conditions of ASD sufferers. Another notable system that arose from all these intervention, treatment and care scheme for children and adults with ASD is the utilization of playful environment which endows children with ASD the opportunity for interactive and shared activities which in turn could develop their ability to cope with rigors of the mainstream social life (Jordan 2004). Advocates of TEACHH, the behavioral approach and PECS, however, share common goals and argue that policies of the government must extend to its education department to provide training for special instructors. Proponents of these programs on early intervention also recommend that consultations with the major stakeholders such as individuals with ASD and their families, service providers, caregivers and experts and professionals in the academe be made regularly so as to come up with workable government plans and policies. Another area of policy concern is the lack of funding source for research and data information which are essential for the understanding of and solution formulation for the disorder. Early intervention and identification of the condition must also be a part of the government initiative as private diagnosis of ASD is very costly and research mostly shows that those who are afflicted mainly come from middle income to low income families. Experts must also identify the gaps, problems and state’s role on early intervention and identification as well as determine successful and existing models which the state can utilize as in its welfare system. The institutionalization of this role will allow families and parents to be informed on how to access and navigate effective care and government services for children with ASD as the disorder is most pronounced in countries such as Australia. As ASD has alarmingly increased, it has also heightened the concern of the general public, health service providers and other experts on the disorder. The absence of a compelling wide-scale data is another cause of alarm as the rates in percentage and incidences of the disorder remain unknown and funding for research and wider scale data gathering remains scanty and limited. Experts on ASD mainly utilize non-Australian data in order to understand local information about the disease (Williams et al 2005a). Centrelink, the federally funded organization which provide information on ASD is one of the institutions that push for the creation of national standards with regards ASD. A new federal funding program was also initiated this year by Prime Minister John Howard dubbed Helping the Children with Autism Program. The program is managed by Autism Spectrum Disorder Advisory Group (ASDAG) for the federal Department of Housing, Families, Community Services & Indigenous Affairs (FaHCSIA), the main policymaker of the federal government on issues regarding ASD. Last year, the government announced that they would allocate about 190 million dollar in order to aid children with ASD. The measure will be funded through Medicare services which will cover the cost of early diagnosis and intervention for approximately 15,000 families and special educators. This policy has been criticized as families question the government’s delay in coming up with a policy after begging the government for support and funding for many decades. Moreover, experts have seen a gap on this initiative as those who suffer from mild autism will not be covered by the program. Yet, representatives from the government including the National Disability Services contend that the plan is a firm foundation for the government’s resolve to alleviate the lives of ASD sufferers and their families as the scheme would see to it that early intervention centers, training schemes and subsidies for families with children affected by ASD would be set up (Williams 2008). Report by the Autism Advisory Board, a government funded organization have brought forth proposals for the federal government. One of these is the government provisions of a much easier access to fast and less costly diagnoses as the government bureaucracy created barriers in timely access to diagnosis and treatment. The board states that the waiting time for families lasted up to 24 months around the country making it especially difficult for families in rural areas to access affordable diagnosis. The board questions deliberate action of federal multidisciplinary teams who are provided funds to offer these services. Experts also suggests that early intervention to pre-schoolers with ASD must be afforded urgently particularly to families who reside in rural and remote areas. Recommendations also include trained instructors on ASD inflicted children even in public primary schools all over the country. As most schools in Australia accept children even with ASD, it is recommended that schools have access to highly trained instructors who could deal with the children. The board contends that this option must be made available to families. The improvement of data collection on ASD and its prevalence in Australia is also a main concern. National collection of data which will serve as a foundation for future research and policies, better treatments and intervention must likewise be effected (Williams 2008). Although there a small gaps in the government policies and slight systematic setbacks on the intervention and aid set up by the government, these are considered minor issues as the government has shown efforts to aid families whose children suffer from ASD. The framework and the sets of action that the Australian government undertook do not depart from the method and system recommended by existing literatures and research. The focus on early intervention and early diagnosis as well as treatment, adapted and embraced by the federal government is quite laudable. On the other hand, for early intervention and treatment to be efficacious, the government must provide specific, clear and workable system in order to avoid delays in diagnosis as well as to immediately provide for the needs of the family with ASD inflicted children. What is equally laudable is the government’s creation of agencies that deal with ASD in every state and territory. 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