An Official Definition of Autism - Research Paper Example

? AUTISM: DEMOGRAPHIC, DIAGNOSIS, & TREATMENT Introduction An official definition of autism from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), a handbook of the American Psychological Association, states that autism is a ‘qualitative impairment in social interactions’ which means that it is a form of disability where an individual is not able to interact properly, or not being able “to form peer relationships”. An autistic individual has a behavior which is “restricted, repetitive, and stereotyped” or other forms of behavior which are considered “restricted pattern of interests, or inflexible adherence to nonfunctional routines or rituals” (Myles, 2003, p. 9; “Diagnostic criteria”, 2010). Autism has several names such as Asperger or Asperger’s Syndrome (AS), high-functioning autism (HFA), autism spectrum disorder (ASD), pervasive developmental disorder (PDD), Rett’s disorder, and childhood disintegrative disorder (CDD) which is sometimes referred to as Heller’s syndrome or disintegrative “psychosis”. Asperger’s syndrome is also sometimes called autistic psychopathy. Pervasive developmental disorder not otherwise specified (PDD-NOS) sometimes termed atypical PDD or atypical autism technically refers to all these disorders, or to the entire group of conditions. All these terms have been placed under the umbrella term “autism spectrum disorder” (ASD) but different ASDs may vary in the number and intensity of the behavioral symptoms manifested. (Cecile-Kira, 2004) Asperger’s Syndrome was first reported in 1944 when Dr. Asperger wrote on his clinical findings of the children he studied who were fraught with difficulties. Many of the children could talk, some could name things in their environment, while others could count or say the alphabet and recite whole books word for word from memory. But the children had difficulty in speech communication and had other learning problems aside from their unusual behaviors. (Shore, Grandin, & Rastelli, 2006) 2. Literature Review 2.1 Diagnostic criteria Asperger’s Syndrome is distinguished from more “classic” autism, which involves language and cognitive delays, but not from “high-functioning autism,” in which individuals may have average to above-average intellectual abilities. Many individuals with ASD know words that others do not have the uncanny ability to use them correctly in sentences. Autistic children often answer questions by relying on rote memory without truly comprehending the answer. (Myles, Adreon, & Gitlitz, 2006) Autistic children fail to use eye-to-eye gaze, facial expression, or body posture and do not ask when they need comfort or affection or show such feelings. They don’t respond to people’s distress or happiness or greet people when greeting is needed. During play time, they seldom initiate interactive play. Peer friendship is not within their realm because they don’t share interests, activities, and emotions. (Rutter & Schopler, 1988, p. 19) Autistic children lack the capacity to use language for social communication. As they slowly develop their spoken language, this is not compensated for by use of gesture or mime as alternative modes of communication. They fail to respond to communication by others and do not respond when called by name. They use stereotype and repetitive and idiosyncratic language. There are abnormalities in communication pitch, stress, rate, rhythm, and intonation of speech. (Rutter & Schopler, 1988, p. 19) Autistic infants are not like the normal ones. It is also different from deaf children who lack speech because they are able to communicate by other means, but autistic children do not. Autistic adults who are able to speak fluently are likely still to show abnormalities in the flow of conversational interchanges, a formality of language, a lack of emotional expression in speech, and a lack of fantasy and imagination. (Rutter & Schopler, 1988, p. 19) 2.2 Current demographics for autism A rough estimate states that there are about 500,000 autistic individuals below 21 years old in the U.S. For every 1,000 children in the United States, there are about two to six children with autism. Most autistic children are male. An estimated 24,000 are autistic for every 4 million children born in the United States, but many of these individuals are not diagnosed until they reach school age. Behavioral symptoms for autism manifest below the age of 3. The Centers for Disease Control and Prevention has reported that for children aged 3 to 10 years, the rate of autism is 3.4 per 1000 children, higher than the rate for other sicknesses like cerebral palsy, hearing loss and visual impairment. (MED TV Health Information Brought to Life: statistics on autism: an overview, 2012) 2.3 Classification 2.3.1 Autistic Disorder or Classic Autism – is considered the most severe form of autism wherein the individual has difficulty in communicating and interacting with people. Individuals suffering from this type of autism are hypersensitive. They are supersensitive to particular sounds, colors, and textures. (Wiseman, 2009, p. 7) 2.3.2 Rett’s Disorder or Rett syndrome – occurs mostly on girls and seldom on boys. This type is rare and occurs in six to eighteen months of life. It is characterized by rapid regression in a child’s motor skills including language. (Wiseman, 2009, p. 7) 2.3.3 Childhood Disintegrative Disorder – is another rare disorder which manifests during the first two to four years of life. There is marked regression in expressive or receptive language, social skills, or motor skills. (Wiseman, 2009, p. 7) 2.3.4 Asperger’s Disorder or Asperger’s Syndrome – can be considered mild because the children with this kind of autism can have near normal means of communication but symptoms begin to show in delays in social skills. Children of this type have normal to above normal intelligence. (Wiseman, 2009, p. 8) 2.3.5 Pervasive Development Disorder – Not Otherwise Specified (PDD-NOS) 2.4 Case study The first case study on Asperger was conducted by a psychiatry doctor named Asperger on a boy named Fritz V. It happened in the 1930s. Fritz V. was born in 1933 and was referred by his school. From the earliest age, the boy never did what he was told and always did the opposite. He was always restless and fidgety and tended to grab everything within reach. Fritz was never able to become integrated into a group of playing children. He never got on with other children and, in fact, was not interested in them. He was very aggressive, and was thrown out of kindergarten after only a few days. He had attacked other children, walked nonchalantly about in class and tried to demolish the coat-racks. He had no real love for anybody but occasionally had fits of affection. Fritz did not respect anybody. Fritz’s family was of good descent. The mother stemmed from the family of one of the greatest Austrian poets. The mother herself was very similar to the boy. (Asperger, 2008) When Fritz talked, he did not enter into the sort of eye contact which would normally be fundamental to conversation. He darted short ‘peripheral’ looks and glanced at both people and objects only fleetingly. His voice was high and thin and sounded far away. Fritz’s relations with the outside world were extremely limited. This was displayed through his posture, eye gaze, voice and speech. In the ward, he stood out from the rest of the group. He remained an outsider and never took much notice of the world around him. Fritz’s emotions were indeed hard to comprehend. It was almost impossible to know what would make him laugh or jump up and down with happiness, and what would make him angry and aggressive. It was clear from the start that Fritz could not be taught in a class. Fritz’s writing was atrocious; orthography was difficult. He used to write the whole sentence in one go, without separating words. He was able to spell correctly when forced to be careful. However, he made the silliest mistakes when left to his own devices. Learning to read, in particular sounding out words, proceeded with moderate difficulties. Upon the teaching of Dr. Asperger, Fritz improved and even got good grades in his examination. (Asperger, 2008 ) 2.5 Current research in regards to autism treatment Research on autism has shown that this sickness has neurobiological causes. It means autism is a sickness in the nervous system, the causes of which are genetic, metabolic or biological in nature. Research has also seen that it is a behavioural condition caused by biological factors. Diagnosis states that it is a dysfunction of the gastrointestinal tract, or it could also be in the immune system, or it could be genetic in nature. But experts find it as a purely biological disorder caused by genetic factors, exposure to chemicals or toxins, or failure of some bodily systems. (Wiseman, 2009, p. 6) 2.5.1 Current Treatment The Doman-Delacato patterning treatment involves exercises aimed at forming or correcting neurological organisation that has been damaged or never developed. This was created by Doman and Delacato (The Institute for the Achievement of Human Potential [IAHP]). (Myles, Swanson, Holverstott, & Duncan, 2007) The intervention is based on the belief that the development of a child reflects that of human evolution, for example crawling, creeping, crude walking, and mature walking. Most disabilities are false labels, each representing only different symptoms of brain damage. Children with disabilities are referred to as brain-injured children. The therapy instituted by IAHP was done on children, regardless of their brain injury, and with the goal that children could attain intellectual, physical and social excellence. (Myles et al., 2007) 2.5.2 The hidden curriculum The hidden curriculum refers to the set of rules or guidelines that are often not directly taught but are assumed to be known. The hidden curriculum contains items that impact social interactions, school performance, and sometimes safety. Idioms, metaphors, slang, or things most people understand through observation within the group or social entity, are some of the hidden curriculum. Body language can be a hidden curriculum. Each group or social entity has some hidden curriculum. When someone says “get off of my back” with an accompanying body language, the speaker just wants to be left alone, but to a child with autism or AS, that will be a different thing. Miles et al (2006, p. 26) recommend this simplification of language technique in communicating with children with ASD: Students with ASD have difficulties with systematic problem solving. Living out is a strategy that facilitates problem solving and helps students understand their environment and be successful. The classroom exercise can be done by stating it aloud because it helps the students put together what the teacher and others are doing as well as the why and the how. Students with ASD are often distracted by nonessential information and are unsure which details are important to be attentive about. Living out loud helps the student stay on task and understand the salient pieces in a given situation. (Myles et al, 2006) 2.5.3 Teaching communication skills The teaching process is very important for children with ASD, and this also depends on the quality of the teaching method and how the teacher is experienced and equipped on teaching communication skills on children with ASD. Some teaching strategies rely on pictures, physical prompts, and direct modelling rather than verbal explanation. Children younger than eight years old and with verbal IQ well below average will benefit from this strategy. But for older children and those with good receptive language ability, social skills training strategies can include explanations of why to act in certain ways along with the more concrete strategies that rely on pictures, physical prompts, and direct modelling. (Baker, 2003) 2.5.4 Incidental Teaching Another type of teaching is incidental teaching. This is different from discreet trial which is a structured one. Incidental training teaches the child about a social situation as it is occurring, and the goal is to teach social cues, rules, other’s feelings and perceptions that are all part of the social situation. The process involves explaining to the child what is happening in a social situation through words or visual aids. The child can be coached and praised. This can be pointed out during actual situations, for example when a child with autism gets hurt when accidentally bumped by somebody in the hallway. This can be explained to the child why the bump was accidental, so that he will not get angry. The other person’s intentions can be explained, while a hidden social cue is pointed out. The child can respond more appropriately in such a situation. (Baker, 2003, p. 30) 2.5.5 Social Skill Picture Stories Another method of teaching children with ASD is the presentation of Social Skill Picture Stories. These are mini-books that depict, step by step, children demonstrating various social skills. Each skill is presented like a cartoon strip, presenting digital pictures of actual children combined with text and cartoon bubbles, telling what the children are saying or thinking as they engage in the social skills. There are explanations in the pictures which present some correct, and some not correct, ways to act. The explanations are very important for the understanding of the child with ASD. (Baker, 2003, p. 32) The instructor can present the different skills accompanied by pictures to illustrate each skill step. The instructor can go through each page of a particular skill and then repeat the process to allow the student to grasp the message and relate what is happening in the picture. The instructor can ask the following questions: “What is happening in the picture? What is the first step? How is he feeling? What is he saying? What happens next?” (Baker, 2003, p. 33) There are various ways to set up the Social Skill Pictures. First a skill has to be targeted, along with the accompanying perceptions and verbalizations; then the skill steps and pictures to be presented will have to be mapped out. The students can be used as models for the photographs. Pictures can be taken with a digital camera and then uploaded into a computer. The next step would be to import the pictures into a Microsoft Power Point Presentation. Bubbles and texts can be handwritten or typed onto coloured paper, and pasted on the pictures. The students can participate in the cutting, pasting and assembling of the skills. The sequencing of the skill in the proper order can be made into a game to enhance the understanding of the individual steps. (Baker, 2003, p. 32) 2.5.6 Cognitive Picture Rehearsal This kind of social skills training utilizes cartoon-like drawings on index cards combined with positive reinforcement principles (Groden & Lavasseur, 1995; Baker, 2003). This is also known as Cognitive Picture Rehearsal that includes drawings or pictures of three components: the antecedents to a problem situation, the targeted desired behaviour, and a positive reinforcer. The process involves displaying the picture on index cards, while on the top of each card is a brief explanation describing the desired sequence of events. The sequence of cards is repeatedly shown to the children so that they themselves can repeat what is happening in each picture. The sequence is reviewed just before the child enters the potentially problematic situation. Example of a Cognitive Picture Rehearsal SOURCE: Condensed from Social skills training for children and adolescents with Asperger syndrome and social communication problems (Baker, 2003, p. 33). 2.5.7 Social Stories Social Stories is a concept developed by Carol Gray and colleagues (Gray et al, 1993; Baker, 2003). These are stories written in the first person and focused on the students’ understanding of what is happening or problematic situations. First, a child’s understanding of a situation is developed; a story then flows, leading to the whys and other underlying facts of the situation. Baker (2003) cites a 13-year-old who frequently got into fights at lunchtime because he believed that other students were really teasing him. This belief was developed when he sensed that several boys at the other side of the cafeteria were laughing. The boy would give them “the finger”, and soon a fight would start. An investigation or observation was conducted and it was found out that the other boys were laughing but not at the child with ASD. The boys were far away, about 50 feet and were not looking at him. So it was a case of wrong perception. After this exercise, the boy realized his mistake: that the other boys were not looking or laughing at him. 2.5.8 Structured Learning Structured Learning refers to the strategies of Goldstein and colleagues in their “Skillstreaming” series (McGinnis & Goldstein, 1997; Baker, 2003), an excellent resource for social skills training that articulates skill steps for numerous skills. This consists of four teaching components: Didactic instruction – this involves the instructor – who maybe the teacher, aide, or parent – who will explain the steps of a particular skill, often with the skill steps written on a poster or black board as a visual aid. The key to this approach, or any other approach that relies partially on verbal and written instruction, is to engage the child’s attention. Modelling the skill steps – When the skill steps have been explained, the next step is to model them for the students, and then ask them to carry them out. In this portion of the exercise, the facilitator needs a situation to act as co-actors. Role-playing the skill – The student is asked to act out the skill steps in the right order. The instructor can participate but not directly, so he can act as a coach to help the students through the skill steps. Again the observers in the role-play are given instructions to see if each step in the role-play is done correctly or not. Practicing in and outside the group – The student has to indicate with whom he or she will practice and when. The instructor can tell the students that if they return the assignment sheet and indicate how they practiced the skill, they can receive a bonus prize at the next session (Baker, 2003). 2.5.9 Applied Behaviour Analysis Applied Behaviour Analysis is an approach to changing behaviours that uses procedures based on scientifically established principles of learning; it involves a considerable amount of monitoring of the intervention programs, collecting data about the behaviours that we hope to change, and ongoing evaluation of the effectiveness of the intervention procedures. (Kearney, 2008) ABA is practicable to children with ASD. In ABA, the behaviours we target for change are behaviours that can have real-life applications for the children with ASD. One example of Applied Behaviour Analysis is the Discreet Trial Training (DTT). The “discrete trial” refers to a small unit in which an adult, such as the child’s teacher, provides a discriminate stimulus, then followed by the child response and the reinforcement of the response immediately following the child’s response (Naoi, 2009). 2.5.10 The Discreet Trial Training Most children with ASD have good receptive language ability and would not generally need such structured an approach as discrete trial methodology. But the strategy is extremely helpful for children with limited receptive language ability. The children can be helped by teaching basic words so that they can later respond to verbal instructions and questions. It can also help students attend to a task when they do not respond to verbal instructions to pay attention. (Baker, 2003, p. 34) Other important benefits from discreet trial technique include helping students maintain eye contact, and to identify objects, actions, or adjectives. For example, consider a child with autism who does not understand how to respond to instructions like “walk over to the big ball and give it to your teacher.” The child might go through a series of discrete trials to learn the meaning of words like “big,” “ball,” “teacher,” and “walk.” This exercise in teaching communication skills on the child with autism is said to be highly structured and depends on the teacher or trainer cueing the child. Baker (2003) said that it does not typically foster spontaneous social interaction, but it can help in building prerequisite language and attention in preparation for other kinds of training that may facilitate greater social interaction. 3. Conclusion Due to their need for structure and predictability, most children on the autism spectrum find it helpful to have a visual concept of what their day, week, or even vacation will be like. In addition to ensuring that the day runs smoothly, the predictability of schedules and other visual supports can help prevent emotional outbursts and meltdowns by relieving anxiety associated with not knowing what is going to happen next. 4. Recommendations Children with ASD need a lot of understanding in their social re-orientation and integration in order to live a normal and fulfilled life. Most of the types of Autism Spectrum Disorder that we have discussed in this paper point to autism as a disability rather than a mental disorder. We want to point out that children with ASD can be taught the necessary social skills and classroom lessons, normally and formally as we could, only if the teacher or parents of the children learn and understand the children’s situation. Understanding and patience in teaching social skills to children with ASD are some of the key points. One way is to first ‘teach’ the teacher the ABCs of ABA; this means the first lessons of Applied Behavior Analysis, and one of these ABCs is the Discreet Trial Training as previously discussed. We can teach a lot of social skills to children with ASD. It just takes our time and effort to learn first how to do it before we teach them how to learn. Then children with ASD can have a fulfilling life along with ‘normal’ people like us. There have been many programs for the effective teaching and learning methods for children with autism. But these programs have to be continuously improved, remodeled, or reprogrammed because teaching children with autism is a complex and continuous process. The population children with autism increase every now and then, and we have to face the fact that they are part of humanity. We have to properly deal with them and provide them the necessary love, care, nourishment, education, and all the necessary things in life in order for them to grow as normally as they could. References Asperger, H. (2008). The case of Fritz V (with annotations from Uta Frith). In J. Rausch, M. E. Johnson, M. F. Casanova (Eds.), Asperger’s disorder. New York: Informa Healthcare USA. Baker, J. E. (Ed.) (2003). Social skills training for children and adolescents with Asperger Syndrome and social-communication problems. Kansas: Autism Asperger. MED TV Health Information Brought to Life: statistics on autism: an overview. (2012). Retrieved from http://autism.emedtv.com/autism/autism.html Myles, B. S., Swanson, T. C., Holverstott, J., and Duncan, M. M. (2007). Autism spectrum disorder: A handbook for parents and professionals (Volume 2: P-Z). CT: Greenwood. Myles, B. S., Adreon, D., and Gitlitz, D. (2006). 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