Online Course in Autism

Assignment # 1

Q1)What is this disorder,I mean Autism?

A1)Autism is a complex developmental disability that typically appears during the first three years of life.It is the result of a neurological disorder that affects the functioning of the brain. Autism and its associated behaviours have been estimated to occur in as many as 1 in 500 individuals. It is four times more prevalent in boys than girls and includes persons from all racial, ethnic, social, family income, lifestyle, and formal education level sectors.

Autism impacts the typical development of the brain in the areas of social interaction and communication skills. Children and adults with autism typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. They find it hard to communicate with others and relate to the outside world. In some cases, aggressive and/or self-injurious behaviour may be present. Persons with autism may exhibit repeated body movements (hand flapping, rocking), unusual responses to people or attachments to objects and resistance to changes in routines. Individuals may also experience sensitivities in sight, hearing, touch, smell, and taste. This is how it can be generally defined but there is an operational definition of autism based on the diagnostic criteria that defines autism as presented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, commonly referred to as the DSM-IV. The DSM-IV diagnostic criteria are generally thought to be the most widely accepted criteria used throughout the globe.
DSM-IV diagnostic criteria for autism
The DSM-IV includes autism in the more general category of "Pervasive Developmental Disorders." The five diagnostic subcategories of Pervasive Developmental Disorders given in the DSM-IV are:

Autistic Disorder
impairments in social interaction, communication, and imaginative play prior to age 3 years. Stereotyped behaviours, interests and activities.

Asperger's Disorder
impairments in social interactions and the presence of restricted interests and activities, with no clinically significant general delay in language, and testing in the range of average to above average intelligence.

Pervasive Developmental Disorder- Not Otherwise Specified
(commonly referred to as atypical autism) a diagnosis of PDD may be made when a child does not meet the criteria for a specific diagnosis, but there is a severe impairment in specified behaviours.

Rett's Disorder
a progressive disorder which, to date, has occurred only in girls. They have a period of normal development and then loss of previously acquired skills, loss of purposeful use of the hands replaced with repetitive hand movements beginning at the age of 1-4 years.

Childhood Disintegrative Disorder
characterized by normal development for at least the first 2 years, followed by significant loss of previously acquired skills. Autism is a spectrum disorder. In other words, the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviours, children and adults can exhibit any combination of the behaviours in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

DSM –iv is the diagnostic tool for autism and its as follows:

1.2
Table I – 1
DSM-IV Diagnostic Criteria for Autistic Disorder
A diagnosis of autistic disorder is made when the following criteria from A, B and C are all met.

A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3):

1) Qualitative impairment in social interaction, as manifested by at least two of the following:

  1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
  2. failure to develop peer relationships appropriate to developmental level
  3. a lack of spontaneous seeking to share enjoyment, interest, or achievements with others (e.g., by a lack of showing, bringing, or pointing out objects of interest)
  4. lack of social or emotional reciprocity

2) Qualitative impairments in communication as manifested by at least one of the following:

  1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
  2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
  3. stereotyped and repetitive use of language or idiosyncratic language
  4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

3) Restricted, repetitive, and stereotyped patterns of behavior, interest, and activities, as manifested by at least one of the following:

  1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  2. apparently inflexible adherence to specific, nonfunctional routines or rituals
  3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  4. persistent preoccupation with parts of objects
  1. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s disorder or Childhood Disintegrative Disorder.

Q2)What are its causes?

A2)Researchers from all over the world are searching for the answer to this question. They are exploring different explanations for the various forms of autism. Although a single specific cause of autism is not known, current research links autism to biological or neurological differences in the brain. In many families there appears to be a pattern of autism or related disabilities- which suggests there is a genetic basis to the disorder-although at this time no gene has been directly linked to autism. The genetic basis is believed by researchers to be highly complex, probably involving several genes in combination.

But parents must remember that autism is not a mental illness. Children with autism are not kids who mis-behave. Autism is not caused by bad parenting. There are no known psychological factors in the development of the child that have been shown to cause autism.

The most common misconception that autism is caused by "refrigerator" parents, i.e. those who do not provide their child with emotional warmth and nurturing and, in essence, reject their child. THIS IS NOT TRUE. In fact, it has been found that parents of autistic individuals are no different from the parents of normal children or children with other disorders.

It is unlikely that one specific cause of autism will be found. Instead, the prevailing opinion is that autism is actually a combination of different sub-disorders, each having its own cause or causes. It is thought that by identifying these subsets, progress might be made in determining the etiological factors influencing each. Thus, a combination of unknown biological factors are considered to cause autism. While very little is actually known, recent studies have found evidence that the autistic population exhibits a variety of neurological and biochemical abnormalities. On-going research is also investigating the influence of complications of pregnancy and birth and genetic factors. At present autism is considered a "final common pathway" because research suggests that there are several factors and conditions which may result in the syndrome.

Pregnancy and/or Birth:

There are a variety of pre-, peri- and postnatal conditions that may cause brain dysfunction which may possibly be associated with autism. These include maternal rubella or illness, Rh incompatibility, untreated phenylketonuria, anoxia at birth, and infantile seizures. Research findings, while suggesting a connection, have failed to substantiate any direct causal effects.

Genetic Factors:

Although research has failed to find a specific gene marker for autism, findings of familial studies and the greater prevalence in males than females strongly suggest a possible genetic involvement. Among identical twins both are afflicted with autism in about 82-86% of cases. The rate among fraternal twins is 25%. The syndrome of autism has been found to be more common in the siblings of a child with the disorder than in the general population. That is, if parents have one child with autism, they have an increased chance of having another child with the same disorder (i.e., the rate of autism amongst siblings is approximately 2%). In 7 to 10 percent of the autistic population, a syndrome called Fragile X has been identified, involving a break or weakness in the formation of the X chromosome. The correlation between Fragile X syndrome and autism has not been proven.

Neurological Influences:

For many years neurological factors have been surmised to influence the etiology of autism as indicated by the occurrence of other central nervous system disorders in association with autism. Unfortunately, the exact nature of the potential contribution of such factors has remained elusive.

Biochemical Influences:

Much of the research in this area has involved the study of the neural transmitter serotonin. Studies have indicated that the level of blood serotonin in autistic individuals remains high despite normal maturational decreases throughout childhood. It has been suggested that this failure to show a maturational decrease in blood serotonin levels is related to an immature neurologic system in the autistic population. As with other areas of etiological research, conclusive evidence remains elusive.

Sometimes there are other conditions also associated with autism like mental retardation and epilepsy ..

Q3) What are its symptoms?

A3)Parents have to be very careful as the characteristics of this disorder vary so much, that a child should be evaluated by a multidisciplinary team which may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or another professionals knowledgeable about autism. Diagnosis is difficult for a practitioner with limited training or exposure to autism. And is sometimes misdiagnosed by well-meaning professionals. Difficulties in the recognition and acknowledgment of autism often lead to a lack of services to meet the complex needs of individuals with autism.

Children within the ASD often appear relatively normal in their development until the age of 24-30 months, when parents may notice delays in language, play or social interaction. Any of the following delays, by themselves, would not result in a diagnosis of an ASD. Autism is a combination of several developmental challenges.

According to the National Institute of Mental Health, these are some of the red flags for autism that parents should look for even in very yound children.

Possible Indicators of Autism Spectrum Disorders

  • Does not babble, point, or make meaningful gestures by 1 year of age
  • Does not speak one word by 16 months
  • Does not combine two words by 2 years
  • Does not respond to name
  • Poor eye contact
  • Doesn't seem to know how to play with toys
  • Excessively lines up toys or other objects
  • Is attached to one particular toy or object
  • Doesn't smile
  • At times seems to be hearing impaired

Generally children with autism show symptoms of deficit and excessive behaviours in the following areas.

Communication: language develops slowly or not at all; uses words without attaching the usual meaning to them; communicates with gestures instead of words; short attention span;

Social Interaction:
spends time alone rather than with others; shows little interest in making friends; less responsive to social cues such as eye contact or smiles;

Sensory Impairment:
may have sensitivities in the areas of sight, hearing, touch, smell, and taste to a greater or lesser degree;

Play:
lack of spontaneous or imaginative play; may not imitate others' actions; may not initiate pretend games;

Behaviours:
may be overactive or very passive; throws tantrums for no apparent reason; may show an obsessive interest in a single item, idea, activity or person; apparent lack of common sense; may show aggression to others or self; often has difficulty with changes in routine.

Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. There are great differences among people with autism. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions.

The person may have difficulty initiating and/or maintaining a conversation, or keeping a conversation going. Communication is often described as talking at others (for example, monologue on a favorite subject that continues despite attempts of others to interject comments). People with autism process and respond to information in unique ways.

Like other children, they respond to their environment in both positive and negative ways. Autism may affect their range of responses and make it more difficult to control how their bodies and minds react. Sometimes visual, motor, and/or processing problems make it difficult to maintain eye contact with others.

Some individuals with autism use peripheral vision rather than looking directly at others. Sometimes the touch or closeness of others may be painful to a person with autism, resulting in withdrawal even from family members. Anxiety, fear and confusion may result from being unable to "make sense" of the world in a routine way.

Q4)Whether autistic child can lead a normal life as others?

With appropriate treatment, some behaviours associated with autism may change or diminish over time. The communication and social deficits continue in some form throughout life, but difficulties in other areas may fade or change with age, education, or level of stress. Often, the person begins to use skills in natural situations and to participate in a broader range of interests and activities. Many individuals with autism enjoy their lives and contribute to their community in a meaningful way. People with autism can learn to compensate for and cope with their disability, often quite well.

While no one can predict the future, it is known that some adults with autism live and work independently in the community (drive a car, earn a college degree, get married); some may be fairly independent in the community and only need some support for daily pressures; while others depend on much support from family and professionals. Adults with autism can benefit from vocational training to provide them with the skills needed for obtaining jobs, in addition to social and recreational programs. Adults with autism may live in a variety of residential settings, ranging from an independent home or apartment to group homes, supervised apartment settings, living with other family members or more structured residential care. An increasing number of support groups for adults with autism are emerging around the country. Many self-advocates are forming networks to share information, support each other, and speak for themselves in the public arena. More frequently, people with autism are attending and/or speaking at conferences and workshops on autism. Individuals with autism are providing valuable insight into the challenges of this disability by publishing articles and books and appearing in television specials about themselves and their disabilities.

Evidence shows that early intervention results in dramatically positive outcomes for young children with autism. While various pre-school models emphasize different program components, all share an emphasis on early, appropriate, and intensive educational interventions for young children.

Studies show that individuals with autism respond well to a highly structured, specialized education program, tailored to their individual needs. A well designed intervention approach may include some elements of communication therapy, social skill development, sensory integration therapy and applied behaviour analysis, delivered by trained professionals in a consistent, comprehensive and coordinated manner. The more severe challenges of some children with autism may be best addressed by a structured education and behaviour program, which contains a one-on-one teacher to student ratio or small group environment. However, many other children with autism may be successful in a fully inclusive general education environment with appropriate support.

A generation ago, the vast majority of the people with autism were eventually placed in institutions. Professionals were much less educated about autism than they are today; autism specific supports and services were largely non-existent. Today the picture is brighter. With appropriate services, training, and information, most families are able to support their son or daughter at home. Group homes, assisted apartment living arrangements, or residential facilities offer more options for out of home support. Autism-specific programs and services provide the opportunity for individuals to be taught skills, which allow them to reach their fullest potential.

Understanding of autism has grown tremendously since it was first described by Dr. Leo Kanner in 1943. To cure means "to restore to health, soundness, or normality." In the medical sense, there is no cure for the differences in the brain, which result in autism. However, better understanding of the disorder has led to the development of better coping mechanisms and strategies for the various manifestations of the disability. Some of these symptoms may lessen as the child ages; others may disappear altogether. With appropriate intervention, many of the associated behaviours can be positively changed, even to the point in some cases, that the child or adult may appear to the untrained person to no longer have autism. The majority of children and adults will, however, continue to exhibit some manifestations of autism to some degree throughout their entire lives.