autism disorder. The writer explores what it is and how it manifests itself. The writer also discusses the teaching methods that have been used to allow the autistic student to take part in a public education. There were ten sources used to complete this paper.
Each year millions of American couples add to their family with the birth of a baby. The pregnancy is spent getting ready for the newcomer. Names are chosen, baby items are purchased and stored and other people’s children are discussed as examples of what might be produced by this child. The family becomes ready as they read up on the milestones that they can expect the baby to make at various times of the first few years of development.
By the time the baby is born the parents have studied the progress that can be expected and are ready to start their life as a larger family. As the baby begins to grow and develop it is natural to compare the milestones and skills learned to other children. When the baby begins to walk and to talk he or she may even reach the milestones at the expected ages and progress with an acceptable rate. The problem with autism is the false sense of security that parents can get when their baby spends the first 12 months doing everything that their peers are doing. Sometime between 16-18 months many parents begin to notice that their child not only stops progressing, but often times they seem to begin regressing in their progress. There may be other children in the family that the parents use as a measure or there may be children in the social circle that the parents travel in. Regardless of how the measurements are made and against whom it is a natural reaction of parents to compare their child’s developmental steps to those who have gone before them.
Parents are often told that every child develops at his or her own rate which is for the most part true. One may walk at eight months while another one does not take first steps until several months after their first birthday. Some babies begin to speak full sentences by one, while their counterparts choose to remain silent until they are almost two.
Each child develops at the rate that is comfortable and correct for them while those around them develop at their own rates. It is this diversity in developmental rates that cause the disorder called autism to be so questioned in the beginning stages of development. Parents are not sure when they should worry about the seeming developmental delays they see in their child. The child who seemed to be moving right along the developmental time line suddenly stops and seems to withdraw, leaving the parents concerned and nervous about whether or not this is considered normal development.
In the beginning they may talk to family members and friends. If the problems persist they may cautiously bring it up to their pediatrician who at first may tell them there is nothing to be concerned about, but eventually there will be no denying that something is wrong and the roller coaster of testing begins. A diagnosis of autism knocks the world out from under parents who have suspected a problem for a while but were not sure what it was. A diagnosis of autism forever alters the family by way of expectations, goals, future and present plans that they may have had. While it is a shocking and scary diagnosis at first, the advances made in recent years regarding autism provide a much more positive future for those who have it than ever before.
WHAT IS IT?
Before one can begin to understand the ramifications and treatment options of autism it is important that one first have an understanding of the disorder itself. For many years it was suggested that autism was caused by the refusal of a mother to bond with her baby. For generations mothers of autistic children were made to feel that they had been so cold that they had permanently damaged their baby. It was a guilt trip of the highest magnitude and one that threatened the confidence of every parent with an autistic child.
In more recent years however studies have concluded autism is a neurologically-based disorder that has nothing to do with the mother’s affection and love of her baby.
Most of the research has focused on specific brain structures and dysfunctions and their relation to autism. Specific underlying mechanisms of autistic behavior are unknown (Murray, 1996). No definitive explanation of autistic disorders or uniformly effective treatment has been developed; however, psychophysiological research in the last two decades, reviewed here, has provided new and important clues to the etiologies and mechanisms of autistic disorders and raised hopes for effective treatment or cure (Minshew, 1991; Nelson, 1991; Piven et al., 1991) (Murray, 1996).” http://www.alasbimnjournal.cl/revistas/4/goldbergif3.htm
FRONTAL AND TEMPORAL LOBE DYSFUNCTION IN AUTISM AND OTHER RELATED DISORDERS: ADHD AND OCD
Autism, 4 years old girl. Demonstrates hypoperfusion in areas 9 and 10 in the frontal lobes, while there is increased perfusion in areas 8 and upper 9. Area 38 in temporal lobes is hypoperfused and also both occipital lobes. Importantly in this case there is bilateral increase of function in both anterior cyngulate gyri, area 24 of Brodmann (this is related to ADD).
The above figure shows that medical science has been able to pinpoint proof that autism is a neurological disorder and not one caused by parenting techniques.
Autism was first recognized in 1943. At that time children who had autism were often diagnosed as being schizophrenic and treated as schizophrenics. In 1943 however, a Dr. Kanner discovered the differences between the two disorders and formally separated them from each other into two categories (Murray, 1996). Advances in the medical community has allowed technology to pinpoint the neurological underpinnings that are involved with the disorder. Many studies have gauged the parents’ education levels, occupations, methods of nurturing and other factors in several different countries and concluded that it has no bearing on which children develop autism and which children do not (Murray, 1996).
SYMPTOMS OF THE DISORDER
While there are several traits of the disorder that can manifest itself in many different ways there is a core group of symptoms present in most autistic children. The four common traits that are found in children with autism include social isolation, cognitive deficits, ritualistic motor activities and language deficits.
When the term autism was coined it meant or suggested the same thing as being self absorbed. This is because children with autism lack the ability to respond to humans around them. This symptom is often manifested by the autistic child’s refusal to have any type of eye contact with others, and they do not respond to verbal directives or suggestions. This inability to react to humans is one of the classic symptoms of the disorder (Murray, 1996).
Conversely autistic children often get inappropriately attached to inanimate objects such as brooms, lamps and vacuum cleaners. The attachments are often obsessive in nature and the removal of the item from the presence of the autistic child can cause an escalation in frustration that leads to out of control behavior (Murray, 1996).
When an autistic child is pressed to interact with humans and is not ready to do so or when the inanimate objects they are attached to are removed the child can through temper tantrums and uncontrollable crying jags are not unusual. Another issue when it comes to social interaction and autistic children is the difficulty of autistic children in interpreting emotions of others and reacting correctly to social cues that others put out. Most people begin to understand social cues at a very young age. They pick up the cues through gestures, or body language of those around them (Murray, 1996).
The autistic child has no ability to read those cues or respond to them correctly which causes them problems in groups and with others. This inability to react properly to social cues leads to an inability to have intimate relationships as adults as well.
The majority of autistic children are also mentally retarded according to the statistics. A recent study conducted at the University of Utah tested and measured the IQ’s of 241 autistic children. When the tests were complete there was a full 66% who scored below 70 points on the IQ tests. Another study in Sweden tested over 100,000 autistic individuals and in that study more than 75% of them were mentally retarded.
In Spiker and Ricks’s (1984) study, about one quarter of the 52 autistic children, 3 to 12 years old, failed to recognize themselves in a mirror self- recognition test (Murray, 1996).” http://www.autism.com/ari/dds/dds.html
While many autistic children are mentally retarded there are also many who are not. The chart below shows the distribution of the mental abilities of those who have autism during a 1997 and 1998 study.
Figure 6 – Mental Ability and Autism
These findings are conclusive but it is an interesting note that the very children being tested are unable to correctly respond to humans, therefore it would be an interesting future test to come up with different ways to measure the IQ of autistic children and see if the results are the same. But for current purposes the IQ test does report that the majority of autistic children are mentally retarded. “Autistic children generally do better on tests of sensorimotor ability, such as finding hidden figures, than on tests of language and social awareness. Twenty autistic children in special schools in London, matched in mental age with 20 normal children and 20 nonautistic mildly mentally retarded children, performed significantly better on the Children’s Embedded Figures Tests than the two control groups, and they used qualitatively different strategies. Autistic children may respond to only a limited number of cues and may not be distracted from the central figure of a puzzle (Murray, 1996).”
Another study found that autistic children are able to mimic behavior. This was an extremely important discovery because it provided an understanding of the way that autistic children might be able to learn the proper social responses that they need to function in any group or social setting in life (Murray, 1996).
Many autistic children have problems with speech and language that are particular to children with the autistic disorder. Results of research studies have concluded and agreed that more than half of the children with autism do not respond independently with independent thought, but instead they mimic what they have seen others do. All children do this initially because it is expected of them from the adults who are modeling for them, but eventually the non-affected child understands why it is a proper response and begins to give it in the proper places for the socially accepted and correct reasons. The autistic child will never grasp or understand why this is needed and the most they can do is be taught to mimic responses that have been modeled for them many times more than needed for the non-affected child (Murray, 1996).
More than one half of all autistic children do not speak at all, or simply echo what others say, or repeat snatches of television commercials. Some use personal pronouns strangely, referring to themselves as “you,” or “he,” or “she.” Those most likely to benefit from treatment usually will have developed some meaningful speech by 5 years of age (Murray, 1996).”
Ritualistic Motor Activity and Preservation of Sameness
The most often recognized sign that a child may be autistic is the need to perform ritualistic motor behaviors over and over again. The autistic child needs a sense of sameness and that goes to the way the day is planned, to what they wear, to what their body does each day.
Most children with autism display this symptom. It is a symptom that causes them to repeat a body motion over and over again sometimes hundreds or thousands of times a day. Some of the more typical behaviors regarding motor activities that are seen in children with autism include hand flapping, and rocking. The hand flapping often done in front of the face or just near the eyes. It is often a reaction to stimuli that excited the autistic child regardless of the fact that it is a positive or a negative reaction. The rocking is the same thing. These are both things that are thought to be self soothing for the autistic child when the outside world stimuli gets to be to much and the autistic child becomes overwhelmed.
Most autistic children tend to repeat a limited number of movements endlessly and without any clear goal. Twirling, hand flapping, and rocking are common, especially in institutionalized and psychotic children. Some stereotypical behavior can cause physical harm. Autistic children usually are anxious and obsessive about keeping surroundings completely the same. Toys must always be in the same place. Normal children at 2 1/2 years of age may also insist on unvarying routines, suggesting that development of autistic children may be stalled at this point (Murray, 1996).” http://www.autism.com/ari/dds/dds.html
Now that the world knows there is a biological component and cause to autism, the genetic research about it has begun. “Current research in autism points to genetic influences as important etiologically (Folstein & Piven, 1991; Folstein & Rutter, 1988; Nelson, 1991; Yirmiya & Sigman, 1991). Folstein and Rutter (1977a, 1977b) found 11 pairs of monozygotic (MZ) and 10 pairs of dizygotic (DZ) twins in England, in which at least one of the twins was autistic. Four of the 11 MZ twins were concordant, whereas none of the DZ twins were concordant. An MZ twin who was not diagnosed as autistic was likely to be markedly impaired in language or cognition. Although based on a small sample, the results suggest some genetic component in autism (Murray, 1996). ”
Studies have also uncovered genetic factors in autistic male triplets in Sweden and in England. The degree by which the triplets were affected by the autism did vary in the English study according to the published results.
One of the things that researchers have been looking at is the incidence of autism among the general population as compared to the degree and frequency of autism among autistic siblings. The studies indicate that there is a higher incidence of autism among children who have a sibling with the disorder than there is in the general population.
In the effort to locate causes of the disorder one study provided additional B6 to autistic children in a double blind cross study. The results indicated that the B6 was helping autistic children reduce their symptoms where as the non-vitamin group had a reported worsening of symptoms.
Another genetic possibility that has been discovered is a possible correlation between low birth weight and autism. One such study showed that the triplet weighing the least amount had more severe autism problems than the twin who had the highest birth weight.
One interesting find in the study of genetics and autism is the higher incidence of epilepsy among children and adults who have autism. This may help future studies determine the area of the brain that the disorder is caused in. http://www.autism.com/ari/dds/dds.html
Figure 1 – Distribution of Birth Dates of Regional Center Eligible
Persons with Autism
The above chart details the increase in autism discoveries and needs for services throughout the last four decades. This chart does not necessarily mean that it is occurring more often but does indicate an increased need for services and programs as the autism population continues to grow. http://www.autism.com/ari/dds/dds.html
Figure 3 – Age Distribution for Autistic Population in 1987 and 1998
WORKING WITH THE CHILDREN
Over the years there have been many discoveries about the way autism affects the child. It is important to tap into the windows of opportunity so that the autistic child can be led to correct social responses and group interactions. Autistic children are able to mimic even though they will not understand why the response they are giving is the proper and correct response. Over the years a method of teaching autistic children through modeling the desired behavior has emerged. One studied tested the theory that modeling responses and behaviors would teach the autistic children how to react in the setting. The steps that were used in the study included (Strain, 1995):
Setup. Eight categories of adult behavior occurring before the session were coded (Strain, 1995)
Introduce Strategies: Adult introduces any of the five skills that were taught in the video.
Other Discussion/Review: The adult teaches strategies that were not shown on the videotape.
Describe Skills: If “yes” was coded for Introduce Strategies, the specific skills the adult reviewed were checked off.
Role Play: Adult acts out how to perform specific Strategies with one or both children (e.g., “Let’s pretend I’m Blain and you want to share with me…”).
Rehearse: Adult has the two children practice strategies together.
Introduce Rules/Guidelines: Adult gives the children rules to follow during the session (e.g., “You have to play with Blain for the next 5 minutes” or “The two of you need to stay in this area for the whole session”).
Contingency: Adult formally or informally offers some type of reward or reinforcer to the children for doing what she or he asks during the session.
Goals/Objectives: Any specific intentions or ambitions that the adult specifies for the session are listed here.
During. Four categories of adult behavior occurring during the session were coded. These included:
Prompts: Reminders could be specific or general in nature. An example of the general is the adult cueing the children with nonspecific directions such as “play together,” or “give an idea.” An example of the specific is the adult encouraging the children to interact by using specific strategies such as “share the crayon,” or “ask for help coloring.”
Questions: The adult asks questions during the session that attempt to get the children to interact verbally or nonverbally (e.g., “Can you think of a way to get Blain to help you? Could you try that?”).
Feedback/Praise: The adult commends the children at least once during the session by saying something such as, “You did a good job sharing” or “I like the way you helped your sister, Blain (Strain, 1995).!”
Involvement: Adult involvement spans three categories: none, some, a lot. In none, the adult has no involvement in the play session (i.e., sits back and watches without any prompting, praising, or questioning directed to the children).
After. Two categories of adult behavior occurring after the session were coded.
Summarize: The adult verbally reviews how the children did at the end of the session (e.g., “You two built a zoo together by sharing and helping each other”)(Strain, 1995). ”
Reward: The adult gives the children a reinforcer at the end of the session (Strain, 1995).”
There have been many studies on the topic of autism with varied results. One of the studies dealt with communication abilities of those who have the disorder. Many with autism are non-verbal. This creates frustration them as well as difficulty for those who try to understand what they want or need. One study looked at the success rate of teaching autistic people to communicate using computers.
For many years facilitated communication was said to be a positive way for autistic individuals to communicate their needs and thoughts. But until recently there was very little empirical evidence to support this theory (Simpson, 1996).
The study used here involved 18 children with autism. They ranged in age from four years old to elementary school and teens. All of the participants were non-verbal or had very limited verbal abilities and each one was in a special education program for autism.
The participants were then asked to answer questions with the use of the facilitator technology. There were informational questions and yes and no questions for the participants to study and provide answers for. “As shown by means and standard deviations of percentage correct answers, seven students (38.9%) had yes/no card scores of greater than 55%, suggesting that their response probability exceeded that of chance (i.e., >50%). The remaining 11 children and youth (61.1%) either made no responses to yes/no questions or demonstrated response patterns suggestive of nothing more than chance guessing or random pointing (Simpson, 1996).”
Only one of the seven students who showed the ability to use yes no cards showed the correct response in 35% of the cases. This statistically shows that it was not random guessing that caused the percentage, but the correct choices being made by the participant.
The study concluded that the students who used the yes/no answers scored better than those who used the more complicated answers. While this creates a possible problem with future facilitated communication needs, the current study does open the door to the use of yes no cards for autistic students and others to be able to communicate their more simple needs to those around them (Simpson, 1996).
While some are studying the best ways to communicate with autistic people others are determined to figure out what the causes of the disorder are. In one study the results pointed to genetic influences as the most important etiologically sound path to take.
The study indicated that there seem to be genetic factors operating in the realm and cause of autism (Murray, 1996).
The autism disorder has been around since the beginning of time. Years ago it was believed to be the same thing as schizophrenia. In 1943 it was separated from schizophrenia and recognized as a disorder in its own right. The 1960s saw the institutionalized millions of those who had autism but civil rights movements began to change that. Today people with autism are worked with so that they can participate in educational opportunities as well as social opportunities. Studies have concluded that the disorder is probably genetic and with each passing year the medical community gets closer to discovering its cause. Many things have been found in the search for answers. One of the major elements of the disorder is the inability to communicate well. There have been studies that conclude facilitator tools can be useful in the communication efforts of people with autism.
As the world moves into the future the medical community will continue to search for answers but until they are found the efforts to connect the autistic people with the world is commendable.
The ability to communicate, and the ability to recognize self-frustration are two big steps toward becoming successful in the integration process between the world and the autistic.
Address: Richard L. Simpson, University of Kansas Medical Center, Department of Special Education, 3901 Rainbow Blvd., Kansas City, KS 66160-7335.
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