Autism and Autistic Disorders - Research Proposal Example

Autism Order No. 257969 No. of pages: 9 Premium 6530 Introduction Autism is one disease no parent wants for their child because it is a severe developmental disorder that does not allow the proper growth and development of the child. In fact it retards or stunts the child’s growth physically, mentally and psychologically. Autism is a disorder that starts at birth or take place anytime within the first two and a half years of a child’s life. Most children who are autistic appear to be quite normal in appearance but engage themselves in different disturbing kind of behavior that is totally different from those of normal children. In days gone by, Autism used to be thought of as a fate that had to be accepted whether one liked it or not. But modern times have proved that Autism can be treated with a wide variety of options and the child could enjoy a very normal and happy life. Autistic cases that are much lesser in severity could be diagnosed as being a ‘Pervasive Developmental Disorder’ (PDD) or as having ‘Aspergers Syndrome.’ The children having these diseases have typically normal speech, but exhibit many "autistic" social and behavioral problems. In the past, autism was a rare - occurring disease which affected just five children per 10,000 live births. However, from the early 1990s onwards, the rate of this disease has increased exponentially around the globe with figures being as high as 60 per 10,000. The ratio of boys to girls is four to one. In 2007, the Centers for Disease Control presented a shocking report that 1 in 150 children were diagnosed as being autistic. Therefore Autism poses a major problem in our society today and calls for immediate action not only on the part of the Government but also the medical fraternity, in order to curb, if not control this escalating disease that affects millions of children around the world. The study proposes to conduct relevant research on a group of autistic children from different institutions. In order to understand autism better and render effective treatment, we need to find the genes that are involved. In two NAAR – funded studies, they had found that “candidate” genes were responsible for autism. Autism is considered to have the highest “heritability” (most genetic) and is known to be one of the most “genetically complex” diseases. The two important genes found by the NAAR studies were the Reelin Gene and the Hoxa 1 Gene. Therefore, the method we would be using in our study to find out about these genes in autistic children is called the genome screen or "linkage studies". This method would help us find the genes responsible for autistic behavior and enable us to use the right interventions for different individuals. This method is used in detecting other brain diseases such as Huntingtons Chorea and Alzheimers disease Statement of the problem Our study showed that the main core of the problem was vested in the fact, that children who are Autistic need special health care, coupled with a lot of understanding from both family and everyone they come in contact with. The main idea behind this action was to ensure that the children have a stable life and could rely on their family and feel welcomed and wanted. Having a safe and secure home with a lot of love and care provided better health outcomes than children who are deprived of it. The study also made an investigation that the right diagnosis and good treatment would go a long way in minimizing the problems faced by the child as well as the family through early interventions and systematic treatment by professionals and other social groups who serve as a backbone in the treatment of Autism. Literature Review “Autistic spectrum disorders are lifelong, complex, controversial, challenging to service providers, they can cause severe impairments and they are not uncommon.” (PHIS Report (2001, p.7) In the last ten years research in the arena of Autism has grown significantly, since knowledge on the subject has to be understood not only in the field of medicine but also among the general public. Autism which was a very rare disease has now gained momentum and is now defined as “not uncommon”. Indeed internationally figures suggest that ASD is now recognized as a major problem (Gerlai & Gerlai, 2003) demanding further research and informed intervention. Recent research has shown that Autism has impacted upon the child’s cognitive, communicative, interpersonal, sensory, imaginative, physiological, perceptual and behavioral processes. Therefore, as there is a deeper understanding of this disease, it is but inevitable that research now uses more refined diagnostic protocols, in addition to a wide range of approaches and interventions in trying to deal with Autistic children. In this climate of increased awareness of autism, history affords us the understanding that autism is not new (Frith, 1989). In a peer review study conducted by ((Eisenberg & Kanner, 1956) they found autism to be a childhood disorder. The following criteria were the result of their research. 1 "Extreme detachment from human relationships". 2 "Failure to use language for the purpose of communication". 3 "Anxiously obsessive desire for the maintenance of sameness, resulting in a marked limitation in the variety of spontaneous activity". 4 "Fascination for objects, handled with skill in fine motor movements". 5 "Good cognitive potentialities". In another study, about 74 clinical case records that were written by Asperger and his team Hippler and Klicpera (2003) conclude that today’s ICD 10 (World Health Organization, 1993) and DSM 1V (American Psychiatric Association, 1994) criteria for Asperger syndrome (AS) do not quite fit for the individuals described by Asperger and his team. They feel that motor and social clumsiness and speech and communication ‘deviances’ (p.300) should be taken into account in future discussion of diagnostic criteria in order to differentiate between Autism and Asperger’s syndrome, (AS) based on the mixture of symptoms that are regarded as common in autism and AS. The study suggested that autism and AS cannot be accurately distinguished from one another except in the case of “classic” or Kanner’s autism where the differences could be found in the intellectual function. The present concept of Autism is very broad in the sense that it covers a wide range of differences and functional disabilities. Autism could also exist along with learning or other developmental disorders which could include psychological as well as physical disabilities. Considering this wide range it covers, it is termed as “autism spectrum disorders” or “autism spectrum.” In his study, Wing proposed to categorize this spectrum of autistic disorders, which he termed as ‘Triad of Impairment’, coined by Wing and Gould (1979), describes the three key areas and the wide range of behaviors which are affected in children afflicted with ASD. Autism is defined using behavioral descriptions since there are no specific biological markers clearly known. Due to such overlapping conditions, changes take place in individuals over a period of time, “the range of severity and the ways in which education, ability and temperament can modify individual presentation, the behavioral descriptions are very wide.” (Hill & Frith, 2003). Other findings in the study were the changes that occurred according to the age. It was also found that those affected by ASD had an increased sensitivity to visual, aural, taste, touch, and smell stimulation. Christopher Gillberg gives us a clearer picture by defining these main three areas of difficulty in ASD as reciprocal social interaction, reciprocal verbal and non-verbal communication in addition to imagination and behaviour. Those individuals who wee diagnosed with Asperger’s syndrome shared difficulty on the basis of the triad of impairment. However, they usually attended regular mainstream school, but their problems should in no way be underestimated, though they may seem quite subtle when comparing them to children having “classic autism.” While their academic abilities in certain areas of special interest could be of excellent standard, the difficulties faced by them could impact on their day – to – day ordinary activites. Hence it becomes all the more difficult for children with ASD to integrate and react to people they come into contact with, because they would not be able to understand the gap between their abilities and their social interactions caused by ASD. According to (Bauminger, 2003) ‘These individuals often experience difficulties making friends and can experience loneliness and frustration as a result.’ Therefore, the debate involving the diagnostic characteristics of Asperger syndrome continues. Leekam et al. (2000) found that of 200 individuals with autistic spectrum disorders, all met ICD-10 criteria for autism, whereas only 1% met the criteria for Asperger disorder. However, 45% fulfilled Gillberg’s criteria for AS. Again, the difference was because of the ICD-10 requirement for the regular normal development of language skills, cognitive skills, curiosity and skills involving self-help, before a diagnosis of Asperger syndrome was made. ‘The mainstream consensus, however, is that AS is not quantitatively or qualitatively different from autism and forms part of the spectrum of autistic disorders.’ (PHIS, 2001) Hypothesis Statement A follow up program was conducted to see and find out about the progress of children who were suffering from ASD during the study with Kanner (1971). It was found that both siblings and family had a great impact on the progress of the individual. A review was taken to find the essential differences in the outcomes between autism and Asperger Syndrome. Of the eleven individuals used for his study, one of them was Donald who was aged 5 at the time of the study. Kanner (1971) conducted a follow up program of 28 years and found that his subject Donald had showed remarkable improvement over the years. In the beginning Donald had made stereotyped movements with his hands in the air, shook his head from side to side while humming. He disregarded people completely and pushed away or threw objects that could not spin. At the age of eleven there was remarkable improvement largely due to the couple who undertook to care for him. They gave him full support by giving him opportunities and space for development and also made him attend a country school where he made good progress. The next follow up program was when Donald was a bachelor 36 years of age. By then he had had got a degree in 1958 and worked as a teller at a local bank. Though Don was not completely normal, yet the progress was more than was asked for and he was able to take care well of himself as he had adjusted wonderfully to his disability. Therefore, progress is certain for children affected by autism especially with new diagnostic trends and approaches available in our present day society. Research Design The research study is going to be based on examining autistic children through interviews and questionnaires for parents. Children would be divided into groups according to the severity of the disease before initiating them into a clear cut program. A thorough physical examination would be conducted on the autistic children and urine samples would be taken to investigate the type of genes present. According to the results obtained the diets of the children would be changed. Serotonin levels would be checked because autistic children are known to have high serotonin levels in the blood. The program would involve systematic teaching – learning processes in order to enrich the child’s life and make them adjust to their environment around them. Besides the regular program, follow up programs by experts would be conducted to understand about the progress the child has made. Research Methods According to Morris, ‘disabled children experience a tolerance of patterns of care that would not be accepted for non- disabled children’. (Morris, 1995, 1998a, 1998b) Methods or approaches differ from one another. However, a structured education setting, behavioral approaches that shape and modify children’s behavior, and other developmental and interactive approaches, which aim to develop and nurture social and communicative processes through naturalistic interaction, and cognitive approaches, which aim to teach the child through co-construction of shared meanings seems to be the best way to treat this disease. The following are the methods that would be used to examine and treat children with autism. Physical examination The participant’s caretakers would be briefed on how the research was to be conducted and after they consent a physical examination of the children would be carried out. Blood and urine tests would be carried out and the levels of sugar, urea, serotonin and genes would be assessed and recorded. This examination would help to provide the answers as to how far the disease has progressed. Based on these results the child receives specialized treatment from different professionals. Structured Educational Setting Division TEACCH (Treatment and Education of Autistic and Communication Handicapped Children) is considered to be a global approach that is based upon close collaboration between parents and professionals, while making use of structured and regular intervention, adaptations to the environment in addition to alternative communication training, to minimize the problems faced by children and adults with autism and accommodate and develop their strengths (Schopler et al., 1980). A variety of studies continue reporting on the effectiveness of a structured environment for people affected by autism. For example, positive outcomes are reported from applying a structured intervention to a high functioning autistic adult (Chang, 2004) where use of routines, scheduling, and establishing rules and expectations helped to reduce children’s violent behaviour and improve their social interaction. Despite methodological difficulties in systematically evaluating this approach, Jordan (2004) draws out the strengths of structured teaching through visual aids and reducing stress through environmental adaptations. Behavioral Approaches This approach is based on the theory of Skinner (1957) which says that all behavior is learned and learning is development. In this approach, it is possible to modify behavioral responses by making use of operant conditioning and associative learning. Using this method of Applied Behavioral Analysis during his Young Autism Project comprising of a group of subjects and involving the use of rewards and aversives, the results showed that 47% of the children had achieved normal intellectual and educational functioning. The results of its effectiveness gave rise to a great deal of optimism about the effectiveness of this particular approach, but the methodology used has since been much criticized (Schopler, Short & Mesibov, 1989; Gresham & MacMillan, 1998; Shea, 2004). The two methods mentioned above have been highly successful in the treatment of children and adults with autism. Though these methods have both advantages as well as some drawbacks they have been found to be quite successful in the treatment and progress of the patients. Though the progress is long drawn out and gradual, yet it has been found to be remarkable in bringing about changes in the lives of these people and thereby helping to enhance their lives to a great extent. References Asperger, H. (1944) ‘Autistic psychopathy’ in childhood. In U. Frith (ed) (pp.37-92) Autism and Asperger syndrome. Cambridge: Cambridge University Press. Chang, B.H. (2004) Applying a structured intervention to a high-functioning autistic adolescent. Hu Li Za Zhi, 51(2):104-10. Frith, U. (1989) Autism: explaining the enigma. Oxford: Basil Blackwell. Gerlai, J. & Gerlai, R. (2003) Autism: a large unmet medical need and a complex research problem. Physiology & Behavior, 79, 461– 470. Gresham. E M., & MacMillan. D. L. (1998) Early intervention project: can its claims be substantiated and its effects replicated? Journal of Autism and Developmental Disorders, 28(1), 5-13. Hippler and, K. & Klicpera, C. (2003) A retrospective analysis of the clinical case records of ‘autistic psychopaths’ diagnosed by Hans Asperger and his team at the University Children’s hospital, Vienna. Philosophical Transactions of the Royal Society.London. B, 358, 291– 301. Jordan, R. (2004) Meeting the needs of children with autism in the early years. New South Wales Autism Society. Sydney. Leekam, S., Libby, S., Wing, L., Gould, J. & Gillberg, C. (2001) Comparison of ICD-10 and Gillberg’s criteria for Asperger syndrome. Autism, 4(1):11-28. Morris, J. (1998b) Still Missing? Volume2. Disabled Children and the Children Act, London, The Who Cares? Trust. Vol. 8, pp. 91 – 108 Schopler. E., Reichler. R.J., & Lansing, M. (1980) Individualized assessment and treatment for autistic and developmentally disabled children, Vol. 2: Teaching strategies for parents and professional. Austin, TX: Pro-Ed. Schopler, E., Short, A., & Mesibov, G.B. (1989) Relation of behavioral treatment to "normal functioning": Comment on Lovaas, Journal of Consulting and Clinical Psychology, 57, 162-164. Shea, Victoria (2004) A perspective on the research literature related to early intensive behavioral intervention (Lovaas) for young children with autism What is Autism? www.autism.com/autism/index.htm Read More