Introduction
Autism is a pervasive developmental disorder that can manifest itself across a wide spectrum of severity, to different degrees. The symptoms or characteristics of autism can sometimes be easy or difficult to identify depending on the severity of the disease. Since autism is not identified with the use of a blood test and a lab report, doctors have figured out a set of characteristics. The characteristics of autism are broke down into three categories, which include: social interaction and relationships, verbal and nonverbal communication and limited interest in activity or play. Each of these three groups has their own subset of characteristics. After diagnosis, the next step a parent has to make is, deciding on potential treatments or therapies. The most common form of therapy is applied behavior analysis. ABA picks up where diagnosis leaves off, by studying of the same characteristics that were used in diagnosis and applying them to form a therapeutic curriculum for the child. Knowing what area the child is the most affected will make treatment much easier, by focusing on the areas that need the most attention to ensure the child can be functioning. After initial therapy, the parents of an autistic child may want their children to go to school. In this case, there are new programs and classes that are specially suited for children with autism.
Literature Review
Diagnosing Autism takes more fieldwork then a disorder that can be identified though certain technological or biological screenings. Essentially, screening for Autism is a behavior analysis. The Center for Disease Control suggests that parents should look for signs by recognizing the presence or absence of common milestones within the categories of social/emotional, movement, speech, hearing and vision. In 1990 the Individuals with Disabilities Education Act (IDEA) was instated, requiring states make special efforts to identify signs and symptoms of developmental delays in toddlers and infants in order to provide intervention opportunities (Council on Children with Disabilities, 2006, pg 192-193). Early identification provides adequate opportunities for treatment and growth in children, which is why these early developmental screenings are strongly enforced. Early detection will improve functioning, prepare children to enter the school system, and reduce the chances of the child needing intensive treatment throughout their lifetime. Waiting until a child misses a major milestone, such as saying their first word, is considered to be too late, resulting in more severe delays in development and create more challenges in treatment. In the 1970’s, the concept of ‘The Triad of Impairment’ (Cashin, 2009, pg 189) was titled and then adapted to methods, such as that used in the Diagnostic and Statistical Manuel of Mental Illness (DSM), for an in depth screening to focus more specifically on autism. The Triad of Impairment draws specific attention to social interaction, language used in social communication and symbolic or imaginative play. In their diagnosis, doctors identify at least six specific signs and symptoms from these headlines prior to three years old. In observing social interactions, doctors are looking for the child’s limited ability to connect to others. This may be seen in failure to make eye contact and unrelated or inappropriate body posture, facial expressions and/or hand gestures common in communication, another sign might be difficulty in developing friendships with other children. Autistic children may also seem to lack the social ability to share in the enjoyment, the interests, and the achievements of others. This may be seen in the absence of pointing out people, places, and things that someone else may enjoy. Also, regarding hindrances in social interaction, doctors are looking for a void of emotional reciprocity with others. (Lord, 2009, Diagnosis of Autism)
In observing delays in social communication, the signs and symptoms can be a lack or complete absence of spoken language. In those who are not verbally delayed, it is common to see severe difficulty in maintaining a conversation. Another sign of note is repetitive and/or idiosyncratic language and a lack of spontaneous play.
The last category that doctors observe in identifying developmental delays is symbolic and imaginative play. Doctors will be looking for preoccupation with specific parts of objects, which may result in extensive repetition or abnormal and intense focus. Repetitive movement or ‘motor mannerisms’ may also be common among those with autism. One may observe a child with autism flapping their hand or repeating a specific body movement over and over again. A final sign doctors may look for is the inability to adapt or adhere to “specific, nonfunctional routines or rituals,”(Lord, 2009, Diagnosis of Autism) often resulting in irrational outbursts and tantrums of frustration.
ABA is the most common form of therapy used when dealing with autism. ABA methods are used to support persons with autism in at least five ways: 1) to teach new skills (i.e., systematic instruction and reinforcement procedures to teach functional life skills, communication skills, or social skills), 2) to reinforce and maintain previously acquired skills, 3) to generalize behavior from one situation to another (e.g., teaching and transferring social skills to natural settings), 4) to restrict or narrow conditions under which interfering behavior occurs (i.e., modifying the learning environment; antecedent modification), and 5) to reduce interfering behaviors by discontinuing their reinforcement and reinforcing competing replacement behaviors (Longnecker, Mace, Perry, and Steege, 2007, pg. 92).
ABA is used in a home life setting, on a more basic level, focuses mainly on behavioral modification with positive reinforcement. Those programs are started as soon as possible after an autism diagnosis and are rather intense. Typically, these programs will last five days a week, 25-40 hours a week, all year round. A typical ABA program starts with an assessment of the child’s strengths and weaknesses in order to narrow down the issues needing improvement. A very common issue to begin with, in ABA therapy, is establishing eye contact, which is very difficult for many autistic children to do. From there on, therapies differ from child to child based on their age level and needs.
When using the positive reinforcement technique, the children are asked questions such as, “which animal is red?” The child is only rewarded, with a cheer or high five, if they give the correct answer. If the child cannot answer the question, there are steps to show them the proper answer. The first step is telling them which animal is red. The second step is to tell them which animal is red, while pointing to the red animal. The third step is telling them which animal is red, along with bringing their hand up to and placing it on the red animal. With these steps, children can figure out the answer while the info is put into their heads, repeatedly.
ABA therapy has proven itself, time and again, to be the most effective therapy that is available to autistic children. A study done in Northern Ireland in 2004 followed 22 families who were either in a long term program group or a short term program group. The average time spent using ABA therapy for the long term group 35.5 months and 6.1 months for the short term group. All families were given questionnaires that must be filled out and returned. Almost all parents reported that ABA had helped them achieve their overall goals in areas such as independence, quality of life, skill development and maintenance, and interaction (Dillenburger, Gallagher, Keenan, and Mc Elhinney, 2004, pg. 4) This study shows that the longer a family uses and sticks with ABA, the greater chance their child has at achieving a more normal quality of life.
While ABA therapy is the most used and most effective form of treating autism, it is often hard to keep up with mentally and physically. The long hours that are usually required can take a toll on family members, especially mothers, of autistic children. Many mothers will quit their jobs and become stay-at-home mothers in order to take care of their autistic child. Once this happens, mothers also become pseudo-teachers, therapists, and doctors to their children as well. Many parents develop symptoms of depression because of all the stressors that they face in their everyday lives. It is for this reason that many primary care physicians recommend that a specialist who is trained in ABA be brought in to help the family. Also, doctors may recommend that the child attend a special school or program that focuses on ABA therapies.
Autism is a brain-based disorder that impacts a person’s ability to learn in an efficient manner (Carnahan, and Musti-Rao, 2009, pg 37). It also forces children to exhibit compulsive behavior quite frequently. Due to the fact that autistic children have a hard time expressing themselves socially they tend to become less engaged during academic instructions. Poor social skills are also a result of autism amongst children. By the children encompassing poor social skills it tends to impede their learning opportunities as well as making it nearly impossible to establish friendships with their fellow peers. Teachers who choose to educate autistic children for the most part have had experience in teaching children with social-communication needs. A majority of autistic children receive one on one attention in classroom settings because there is a greater chance for them to learn the necessary skills and techniques they need to combat their disorder. By children with autism not being able to process complex verbal information it poses as one of the core issues surrounding their ability to learn from their classroom instructors. Even though most students benefit from classroom interaction amongst the entire student body, children with autism do not have the same experience. This is why teachers are looking for new ways to promote active engagement amongst autistic students.
For this very reason interactive reading materials and music are now being used to enhance the learning ability of students with autism (Carnahan, and Musti-Rao, 2009, pg 39). The correlation between music and reading materials have been proven in resent studies to enhance children with autism ability to learn and retain pertinent information. Whenever music is incorporated with individual interests the autistic children exhibited an excessive amount of social interaction with their peers. On the other hand, whenever random music was played by the teachers as a way to promote active engagement amongst the children it was not effective at all (Carnahan, and Musti-Rao, 2009, pg 40). Teachers have also found themselves personally intervening in the way autistic children interact with one another. In the article titled Social Skills Intervention for Children with Autism During Interactive Play at a Public Elementary School the authors suggest integrated play groups and peer tutoring sessions are vital ways to promote friendship interaction amongst autistic children (Harchik, Institute, and Luiselli, 2008, pg 27). Since a majority of the autistic children attend public schools where they are constantly within the proximity of their peers, adults must be the ones to intervene and reinforce social interactions amongst them because it is has been shown they lack the proper interactional skill necessary to do it themselves.
Classroom techniques are also being implemented by teachers to enhance autistic students learning ability because the stress response in students with ASD definitely affects their ability to comprehend learning material (Lytle, and Todd, 2009, pg 40). It is a known fact that students who suffer from ASD also have anxiety disorders. Research shows that exactly 84% of autistic children suffer from an anxiety issue (Lytle, and Todd, 2009, pg 36).This being the case, individuals with ASD have heightened stress responses therefore it takes the children longer to recover from their temporary emotional outbreaks. Their high levels of stress can stem them spending more time in school and as well as natural aging. The behavioral symptoms of children with autism forces them to have anxiety attacks are repetitive movement, ritualistic or compulsive behavior, atypical attention, hypervigilance, memory impairment, sleep disturbances, and poor decision making skills (Lytle, and Todd, 2009, pg 39).
These symptoms have forced teachers to employ new strategies to reduce stress levels amongst autistic children. Teachers suggest a change in scenery is imperative when it comes to stress reduction amongst autistic children. Eliminating unnecessary classroom distractions such as colorful materials, bright fluorescent lights, and crowed shelves can be the difference between a calm autistic child or a stressed out autistic child. Providing the children with ways of coping with their disorder can provide them with different forms of relaxation. Activities that are forms of stress relievers for autistic children are tai chi, stretching, exercising, swinging, bouncing, work breaks, and listening to music (Lytle, and Todd, 2009, pg 40). When these children have specific routines they follow on a daily bases they are at more ease throughout the day because they know what to expect day in and day out.
Personal Reflection
While reading these scholarly articles it is obvious that the process of diagnosing autism it is quite difficult because there are no neurological tests that can be done to determine if a child is indeed autistic. This leads us to think there is a chance that medical officials are indeed over diagnosing children who they suspect to be autistic because they exhibit certain characteristics they believe are not fitting for a child. In reality, when people think about the supposed symptoms of autistic children, nothing seems peculiar about them. All children progress at different rates while they are in the infant stage of their life. So, quite naturally, there will be kids that are more advanced than others but we cannot use their accelerated development as a catalyst when examining all children who might suffer from autism.
Another important fact to point out is children at times tend to be energetic and they can also become very shy or timid depending on how comfortable they are in a particular setting. This does not mean they lack sufficient communicational skills, it simply means they do not feel comfortable enough in their current surroundings to behave with some type of poise. Since Children are very impressionable, they tend to conform to whatever environment they might be in. So, of course, if a child was being screened by a doctor to see if he or she is indeed autistic they would appear to be shy and very soft spoken because they do not know the intentions of the doctor. Children tend to act a certain way amongst their peers because they can sense the connection between them and that is the fact they are kids. That is not the case when it comes to children and adults, especially ones they view as strangers. A lot of stereotypical attitudes are attributed to autistic children. This is mainly due to doctor’s ability to diagnosis these children. Parents of autistic children tend to hold their doctors ability to diagnosis their child’s illness to a higher standard because they are supposed to be experts in that field. William Arney and Bernard Bergan article discusses this type of behavior. This article also talks about how the practice of medicine has changed from the nineteenth century to the twentieth century. During the nineteenth century some of the leading medical officials felt it was necessary to dehumanize individuals while they were trying to diagnose their illness. Medical officials during this time also went as far as shunning people who they deemed as chronic and handicapped patients because they felt there was no appropriate place for them in society (Arney, and Bergen, 1983). With medical discourse changing now in the twentieth century autistic children are not subject to the same ideological views as the doctors during the nineteenth century. Doctors, for the most part, now consider every possible factor when diagnosing a patient’s illness. They now use common sense and some form of morals and ethical guidelines when it comes to diagnosing patients.
When it comes to the new classroom techniques being implemented to ensure autistic children some form of stability in their daily lives it is important to understand what works best for each individual child. Since a majority of the teachers and therapists have prior experience with autistic children, they should know how to locate their triggers so they will not cause them to have any emotional episodes that can cause their condition to worsen. The fact that teachers were able to incorporate music and interactive reading materials into their curriculum to promote active engagement amongst their students is definitely a huge stride in the right direction. Children tend to always gravitate towards any type of educational endeavors when there is a musical foundation in place. This is quite evident in educational programs suited for children such as Sesame Street, Barney, and Dora the Explorer. With this research, music can help bridge the gap between poor social and communication skills between autistic children. The first step to identifying a particular problem with some ones position on a particular topic is to first understand their work from an analytical standpoint.
Problem Addressed
As recognized throughout the semester, greater understanding and education on a topic is critical to development, growth, progress and change. If we do not understand or are truly aware of the problem, there is no hope for discovering a new, better and more effective way of doing things. In gaining greater insight into the world of autism, we recognize that in order for our communities, schools, medical centers, and society as a whole to be more equipped to effectively treat the autistic population and support their families, we need to become more knowledgeable on the topic. Fortunately, great strides have been made recently in raising awareness through increased media attention. What’s interesting is that this movement has been spurred though the passionate involvement of parents, which has given birth to numerous organizations, support groups, programs, information networks, etc. In light of the increased awareness, schools have gradually become more equipped and willing to meet the needs of those who require special attention. There is always room for improvement. Often, schools will make claims to be accommodating, but fail to meet quality standards. The state could, in coordination with other preventative measure, set up a board of people to inspect schools and institutions to insure that they are meeting the needs of all children to the best of their ability. Another concern regarding the effects of autism is the strain that is placed on the families. It seems that because of our society’s individualistic nature, parents are often left to tackle autism and it’s constant challenges on their own. Even though support groups and online networks have been developed, I believe that our communities could do more to provide support for families who are living with a child that requires infinitely more attention than a child without Autism. With high numbers of children diagnosed with an Autism Spectrum Disorder, it may be beneficial to start up community co-ops for these families, where the families can connect, and the children can be in a learning environment with other kids who experience the same challenges. If institutions set up training programs or awareness interventions for their communities, then possibly a collective sensitivity with arise, creating enhanced community support. In various interviews and personal accounts, I heard moms talk about how they felt like people looked down on them for having a child who would have intense, irrational outbursts in public, or who would display abnormal behaviors (Autism Speaks, 2007). If communities had a better understanding of Autism, there would be more support for families and most likely, more success in providing the best care for their children when there is a release for the vast amount of associated stress.
The Social Access Theory talks about how often times people who want specific services and treatment are unable to receive them because of lack of opportunities, funds, insurance, education, a powerful advocate, etc. Unfortunately, not all parents who have a child with Autism have the means or access to gain proper and critical support. With the uncertainty of additional training given to future teachers on dealing with children who have autism, a greater universal understanding of how ABA therapy works and specific and unique struggles and tendencies of children with Autism, would produce positive and formative results. If all schools worked effectively with children who have special needs and equipped them to meet the same or higher standards than their parents prescribe, there’s potential for a new level of progress. Encouraging efficacy in children with special needs is only possible if the teachers are confident and equipped to walk along side those in a spectrum.
Conclusion
With the advancements that have been made with autism, it is much easier to diagnose sooner, rather than later. Knowing what degree of autism your child has, can help the parents decide what form of treatment is needed. Since many breakthroughs have been made with various treatments and therapy, the potential stigma of having autism has lessened. Parents will begin to see results with the therapy and feel satisfied from watching the minds of their child grow. It is crucial that this growth is further stimulated, placing responsibility on the education system to redily embrace those with autism. Fortunately, the curriculum has been adjusted, according to the new findings about autism, to be the most beneficial to the student. By creating an enviornment mute of distractions, and having materials that are specially suited for the autistic, it is possible for many schools to cater to the unique needs of autistic children and develop special programs for them. It is only a matter of time before new studies lead to advancements in treatments and new teaching styles. Thanks to the further understanding of autism, families with autistic children can hope for a ‘normal’ life spent with them.
References
Carnahan, C. & Musti-Rao, S. 2009. “Promoting Active Engagement in Small Group Learning Experiences for Students with Autism and Significant Learning Needs.” Education and Treatment of Children 32(1): 37-61.
Lytle, R, & Todd, T. 2009. “Stress and the student with autism spectrum disorders.” Strategies for Stress Reduction and Enhanced Learning 4(41): 36-42.
Schwichtenberg, A., & Poehlmann, J. (2007). “Applied behavior analysis: does intervention intensity relate to family stressors and maternal well being?” Journal of Intellectual Disability Research 51(8): 598-605.
Steege, M.W., Mace, F., Longenecker, H., & Perry, L. (2007). “Applied behavior analysis: beyond discrete trial teaching.” Psychology in the Schools 44(1): 91-99
Dillenburger, K., Mc Elhinney, M., Keenan, M., & Gallagher, S. (2004). “Parent education and home-based behavior analytic intervention: an examination of parents' perception of outcome.” Journal of Intellectual & Developmental Disability Research 29(2): 119-130.
Harchik, A.E., Institute, M., & Luiselli, J.K. (2008). “Social skills intervention for children with autismduring interactive play at a public elementary school.” Education and Treatment of Children 31(1): 27-37.
Arney, W.R.A., & Bergen, B.J. (1983). “The Anomaly, the chronic patient and the play of medical power.” Sociology of Health and Illness 5(1): 1-24.
Dryden-Edward, R, MD. (2007) "Autism." MedicineNet. Retrieved November 20, 2009 (http://www.medicinenet.com/autism/article.htm)
Lord, Catherine. "Autism Speaks, Diagnosis of Autism." Autism Speaks, Home Page. N.p., n.d. Web. 22 Nov. 2009. <http://www.autismspeaks.org/diagnosis/index.php#DSM-IV>.
Cashin, Andrew, and Philip Barker. "The Triad of Impairment in Autism Revisited." Journal of Child and Adolescent Psychiatric Nursing 22.4 (2009): 189 - 193.
Committee on Children with Disabilities. "Developmental Surveillance and Screening of Infants and Young Children." Pediatrics 108.1 (2006): 192-196. AAP Policy. Web. 22 Nov. 2009.
Autism Speaks. (2007, August 29). Autism Every Day – 7 minute version [Video file]. Retrieved from http://www.youtube.com/watch?v=FDMMwG7RrFQ
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