Autistic Spectrum Disorders - Literature review Example

Autism Literature review “Autistic spectrum disorders are lifelong, complex, controversial, challenging to service providers, they can cause severeimpairments and they are not uncommon” PHIS Report (2001, p.7) Autism is a type of developmental disorder that appears during the first three years of life, and “affects the brains normal development of social and communication skills” (PubMedHealth, Autism, 2010). A disorder of the neural development, it is generally characterized by impaired communication skills and flawed social interactions, and is also noticed in the restricted and repetitive behaviour of a child. Autism affects the information processing within the human brain, owing to certain modifications in the nature of the organisation and connection of the nerve cells and their synapses (Levy, Mandell, and Schultz, 2009, par. Neurobiology). It forms a part of the three recognised disorders that are banded together to form the Autism Spectrum Disorders (ASDs); the other two disorder being Asperger syndrome that shows more or less the same characteristics as Autism, but shows no impairment in the area of cognitive and language development; and Pervasive Developmental Disorder-Not Otherwise Specified (or PDD-NOS), is diagnosed, after all diagnoses tests for Autism and Asperger Syndrome have failed to meet the required criteria (Johnson, C., Scott M., and the Council on Children with Disabilities, 2007, 1183-1186). This literature review will conduct an in-depth study into the subject of autism, the learning abilities of a child with this disorder, including interventions used at schools, and the various support systems that are available, to help children with Autism. 1.1 What is autism? Autism is a form of pervasive developmental disorder (PDD), which is a disorder of the “affective contact, as an organic dysfunction of biological origin, and as a neurological or brain disorder” (Marwick, Dunlop and MacKay, 2005, 8) that impairs an individual’s functional ability to form social relations, and communicate with those around him, while also failing to respond appropriately to an environment stimuli. Individuals with this disorder show characterises that may range from being “high-functioning” ones, to those that fail to establish any sort of communication with others. The exact cause of Autism remains unknown, and is still under the purview of various ongoing scientific researches. From the previous researches conducted by different scientists there are suggestions that Autism may result from genetic mutations within the human body, but there are no clarifications, as of yet, whether this condition results from rare genetic mutations, or from the rare combinations of commonly occurring gene variants (Abrahams and Geschwind, 2008, 345).   There are also other researches that suggest that Autism may be caused by certain environmental factors, like pesticides, vaccinations in children, and heavy metals (Rutter, 2005); though the hypothesis in children’s vaccines has been strongly contended by other researchers, owing to a complete lack of any supporting scientific material (Gerber and Offit, 2009, 256-261). Kestenbaum (2008), in his research papers suggested that Autism can be observed in a child even before he is 3 years of age, though the American Psychiatric Association (2000) states that the external manifestations of Autism during infancy, especially during the child’ first two years, are very subtle and almost esoteric in nature, thus making it extremely difficult to delineate and diagnose the disorder. Autism can be identified by certain clinically characteristics that can be broadly defined as “deficits in reciprocal social behaviour, with accompanying delays in the development of language, and by the emergence of stereotypic patterns of odd behaviour...that reflects a restricted range of interests. Reciprocal social behaviour refers to the extent to which a child engages in...social interaction with others” (Constantino and Todd, 2000, 2043). Here social reciprocity includes a wide spectrum of behaviours that range from observed oddities in a child’s ‘back-and-forth actions,’ as perceived in the child’s body language, during making sounds, playing, or conversing. There may also be certain behavioural observations that may appear as obsessive or ritualistic in nature, as for example, a child instead of playing with his toys, may insist on repeatedly stacking them one on top of the other, or may insist on lining up the toys, repeatedly. Additionally, a child with Autism may have temper tantrums that cannot be controlled easily; he may also be extremely resistant to any form of changes, or over sensitive to disturbances in the sights and sounds around him. Certain symptoms of Autism may be rather subtle without any clear distinctions, as for example one may find that an Autistic “three year old child can read, but can’t play peek-a-boo” (Hayes, 2008, 3), while at times the signs may also be quite obvious, as for example, it may be seen that a “child may never utter a spoken word, but rather uses pictures or signing to be understood” (ibid). 1.2 Diagnoses of Autism From a study of its symptoms and characteristics of the disorder, it is now quite evident that the diagnoses of Autism would be more behaviour based, and not dependent on the mechanism or cause of the disorder (London, 2007, 408-9). ICD10 and DSM-IV-TR, have reported that Autism exhibits nearly 6 kinds of symptoms, of which at least two are qualitative impairments related to a child’s social interactions, one must necessarily relate to the qualitative impairment in communication, and at least one symptom must be related to the restrictive and repetitive behaviour (WHO, 2006). The American Psychiatric Association (2000), has outlined a diagnostic criteria for Autistic disorder that includes 6 or more features: (a) significant impairment observed in a large number of nonverbal behaviours, such facial expressions, gesturing in social interactions, eye to eye to gaze etc. ; (b) failure to develop relationships with the same age group, which is appropriate for a child’s development; (c) failure to seek enjoyment with other people, through shared interests and achievements; (4) deficiency in social or emotional reciprocity. As per the APA guidelines, the child must also show certain communication problems, like a delay in, or a total lack in the spoken language development, speech impairments where the child is unable to start or sustain a conversation with the others around, or uses a language that is stereotyped, repetitive, or idiosyncratic on nature, and a lack of variety in the nature of the games played by the child. The child must also show certain restricted or repetitive behavioural patterns in his interests and activities. The two most commonly used diagnoses tests for Autism are the Autism Diagnostic Interview-Revised (ADI-R) which is a form of semi-structured parent interview; and the Autism Diagnostic Observation Schedule (ADOS) for observing and interacting with a child, in order to understand the nature of his impairments. The Childhood Autism Rating Scale (CARS) is widely used by the physicians to assess the severity of Autism in children (Volkmar, and Chawarska, 2008, 19-21). A clinician first performs the basic preliminary examinations to ascertain the nature of the impairments by taking note of the child’s developmental history and also by physically examination. In a later stage, once Autism has been confirmed, genetic evaluations may be conducted, particularly when certain symptoms suggest a genetic cause to the disorder (Caronna, Milunsky, and Tager-Flusberg, 2008, 19). 1.3 Modes of interventions used for autistic children towards their educational and social integration Autism has recently gained importance in public knowledge, and has received a good deal of attention, owing to an increase in the number of reported ASD cases. “According to the National Autistic Society, over 500,000 people in the UK have an ASD. A study published in 2006 shows that as many as one in 100 children may have an ASD” (BUPA, 2010). Researches on this disorder have significantly increased in the last 5 to 10 years, and these reports show a rising rate in the number of children diagnosed as autistic each year. Such high rate of prevalence, have now changed autism, as being ‘not uncommon,’ from an earlier rating of being a low-incidence disorder, while international statistics also show that ASD as a major problem amongst children all over the world (Gerlai & Gerlai, 2003). While dealing with children with Autism, the chief objectives are treating and assisting children to lessen the social and communication related impairments, work towards having a better quality of life, decreasing the child’s functional dependence, and also helping the family cope with the distress. There is no available single form of treatment, and the therapy for Autism must necessarily be made suitable for each child’s needs and requirements (Myers, S., Johnson, C., and Council on Children with Disabilities, 2007).  The best form of treatment available for the autistic children are family support and an integrative educational system (Myers, Johnson, and Council on Children with Disabilities, 2007). Though there are available many psychosocial forms of interventions, with a certain degree of positive evidences that hint at improvements in a child and his family, however a systematic reviews of such researches have shown that the applied methodologies are generally weak in nature, with tentative clinical results, while there are almost no evidences for the effectiveness of the treatments used (Krebs, et al., 2009). Various early interventions in the form of intensive therapies, that are sustaining in nature, and other forms of special education programs along with behaviour therapies for a child, can assist in acquiring the skills necessary for self-care, social interactions and later proper adjustments at the workplace (Myers, ibid).  Various available early intervention approaches include social skills therapy, developmental model programs, applied behaviour analysis (ABA), speech and language therapy structured teaching,  that aid in acquiring social skills; while there are also various occupational therapies for adjustments in a job, later as an adult (ibid). It has been seen that interventions through the educational system is quite effective in a majority of the children with Autism. It has been seen that intensive ABA therapies, has shown good results, especially amongst the preschool children (Eikeseth, 2009), and is also quite well-established as a therapeutic model for improving the academic performances amongst the school going Autistic children (Rogers, and Vismara, 2008). The present debate centres on the issue of integrative educational system where the children with learning disabilities, like Autism, are included within a general classroom setting (Simpson, R., de Boer-Ott, S., and Smith-Myles, B., 2003). Inclusion can be summarily defined as a system where “students with the full range of abilities and disabilities receive their in-school educational services in the general education classroom with appropriate in-class support…Inclusion is based upon the presumption of starting with the norm and then making adaptations as needed, rather than focusing on the abnormal and trying to fix disabilities to make students fit into a preconceived notion of what is normal” (Ruef, 2003, 1). However, there are perceived problems in this integrative model, where the general educators are finding it exceedingly difficult to teach within an inclusive model. We find reports that state that a good percentage of the general educators feel “they did not have sufficient classroom time for inclusion efforts, that they were not prepared to teach students with disabilities, and that they might not receive the support necessary for inclusion efforts” (Kavale, 2002, 205). Thus, we find that besides providing various therapies for the child to be integrated into the present social and educational system, one of the primary measures to be adopted by the government is to arrange for appropriate training and support for the general educators, so that they are able to assist the children with various learning disabilities, including Autism, within the setting of a general classroom setting. Conclusion Autism is a form of developmental disorder that can be diagnosed as early as in a three year old child. However, one must take care that once a child is diagnosed as Autistic, the parents must go in for early intervention, so that the available support systems be started as early as possible, in order to give the child the maximum benefit as regards assistance in acquiring skills necessary for self-care, and social interactions which would help the child to integrate better into the society as he grows up. According to Kestenbaum (2008), the chief aim of any therapeutic or clinical intervention, pertaining to learning disabilities (like autism), should be to assist the child to integrate and interact well, and become a member of the normal social world. Counsellors working with autistic children should approach the child with a broader perspective, and include other service providers like psychiatrists, teachers, and other experts in the medical field. The teachers, within an inclusive model, must be well trained and given appropriate support so that they can effectively teach within an integrative classroom setting. Thus, the chief aim should be not in differentiating according to a child’s disabilities, but more towards focussing on how to integrate a child with learning disabilities with the general children in a class, and the society at large. Bibliography Abrahams, B., and Geschwind, D. 2008. Advances in autism genetics: on the threshold of a new neurobiology. Nature Reviews Genetics 9, 341-355. American Psychiatric Association, 2000. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC. BUPA, February 2010. Autistic spectrum disorders (ASDs). Retrieved from, http://www.bupa.co.uk/individuals/health-information/directory/a/autism#textBlock195193 Caronna, E., Milunsky, J., Tager-Flusberg, H., 2008. Autism spectrum disorders: clinical and research frontiers. Arch Dis Child, 93(6):518–23. Constantino, J., and Todd, R., December 2000. Genetic Structure of Reciprocal Social Behavior. Am J Psychiatry 157, 2043-2045. Eikeseth S., 2009. Outcome of comprehensive psycho-educational interventions for young children with autism. Res Dev Disabil., 30(1):158–78.  Gerber, J., and Offit, P. 2009. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis 48 (4): 456–61 Johnson, C., Scott M., and the Council on Children with Disabilities, November 2007. Identification and Evaluation of Children with Autism Spectrum Disorders. Paediatrics, Vol. 120, No. 5, 1183-1215. Kavale, K., 2002. Mainstreaming to Full Inclusion: From Orthogenesis to Pathogenesis of an Idea. International Journal of Disability, Development and Education, 49(2), 201-214. Kestenbaum, C., 2008. Autism, Asperger’s and other oddities. Thoughts about treatment approaches. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 36, 279-294. Krebs, S., Ospina, M., Karkhaneh, M., Hartling, L., Smith, V., and Clark, B., 2009. Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol. 51(2):95–104.  Levy, S., Mandell, D., Schultz, R., 2009. Autism- par. neurobiology. Retrieved from, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863325/ London, E., 2007. The role of the neurobiologist in redefining the diagnosis of autism. Brain Pathol., 17(4): 408–11. Marwick, H., Dunlop, A., and MacKay, T., 2005. Literature Review of Autism. National Centre for Autism Studies. HM Inspectorate of Education. Retrieved from, http://www.hmie.gov.uk/documents/publication/HMIE%20Literature%20Review.pdf. Myers, S., Johnson, C., and Council on Children with Disabilities, 2007. Management of children with autism spectrum disorders. Pediatrics, 120(5):1162–82. PubMedHealth, April 2010. Autism, Pervasive developmental disorder – autism. Retrieved from, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002494/ Public Health Institute of Scotland (PHIS), 2001. Autistic Spectrum Disorders, Needs Assessment Report. Glasgow: PHIS, NHS Scotland. Rogers, S., and Vismara, L., 2008. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol., 37(1):8–38.  Ruef, M. (2003). Including Students with Disabilities: Let’s Move Forward Together. Action in Teacher Education, 25(1), 1-4. Rutter M., 2005. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr., 94(1):2–15.  Simpson, R., de Boer-Ott, S., and Smith-Myles, B., 2003. Inclusion of Learners with Autism Spectrum Disorders in General Education Settings. Topics in Language Disorders, 23(2):116–133. Volkmar, F., and Chawarska, K., 2008.  Autism in infants: an update. World Psychiatry, 7(1):19–21.  WHO, 2006. Mental and behavioural disorders (F00-F99). ICD version 2007. Retrieved from, http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f84 Read More