Understanding Autism and Intervention Strategies
The diagnosis of autism is one that can shatter a parent. There is a substantial amount of confusion and controversy found in all areas of the disorder, from diagnosis to treatment. Most parents who seek treatment for a youngster labeled with autism face many dead-ends and obstacles concerning what is best for their child. Asch-Goodkin & Ten (2001) have observed that many parents are willing to try any intervention they hear about, yet pediatricians are usually at a loss on giving information on what intervention strategies will actually work.
Research in the field of autism has been proven to be useful in characterizing the behavior of the autistic child, but very little is still known about the causes of the disorder. There is difficulty in early diagnosis of the disorder because the characteristics of autism are usually not detectable in children under two years old (Sigman & Capps, 1997). The Brown University Child and Adolescent Behavior Letter from July 2001 notes “there is currently no known definitive underlying cause of autism and, consequently, no universal treatment protocol, which makes the challenge of diagnosing and managing care for the disorder even more difficult.” Unfortunately, intervention in the autistic child may begin too late. There is still much research to be done on this disorder, yet with the growing prevalence of cases of autism it is expected that new research will aid in discovering some of these mysteries plaguing researchers.
I plan to discuss early theories of autism, the characteristics found in the autistic child, possible causes, and intervention strategies for autism.
Leo Kanner made the first formal documentation of autism in 1943. The work he presented focused on a group of eleven children who shared the same difficulties. He became aware that these children suffered from social isolation, a psychological malady, which he called “infantile autism”(Sigman & Capps, 1997). He states about his patients, “There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside.”(1943). Kanner also observed that these children had a “desire for sameness”, and displayed exceptional skills in areas such as vocabulary or memorization, which he called “islets of ability”(Sigman & Capps, 1997). The children that he observed also showed more interest to pictures and objects, rather than people. Follow- up studies of Kanner (1971) also provided insight on the developing autistic child. He found that sociability increased with age, yet there was still significant problems in having interpersonal relationships.
Kanner concluded that autistic children enter the world without the ability to have affective contact with people, in the same way that physically handicapped children enter the world. He noted that this extreme social isolation was present at birth, and he believed autism had a biological cause rather than an emotional one (Schopler& Mesibov, 1986).
The development of research on autism took on a different view during the 1950s and 1960s. Psychoanalysts argued during this time that autism was a “schizophrenic withdrawal from reality”(Schopler & Mesibov, 1986). Bettelheim (1967), one of the major psychoanalytic theorists of the time, argued that autism was the result of cold and rejecting parents. He believed that separation from parents (residential programs) was the most appropriate treatment in order to induce outlets for emotional expression, and to demonstrate that autistic behaviors were oppositional and negative (Schopler & Mesibov, 1986). Many open-ended therapeutic approaches, such as play therapy, were also put forth during this period of research, yet most were found to be inappropriate (Schopler & Mesibov, 1986).
Other research that took place during the 1950s and 1960s was based on motivational theories which aimed to discover if autistic children were actually unwilling, rather than unable. Cowan’s work (1965) on this theory did not hold much validity, and ignored common characteristics of autism. Towards the end of the 1960s behavior modification began to replace the old psychodynamic theories on autism. Some behaviorists blamed “inappropriate reinforcement history provided by parents”(Schopler & Mesibov) for the occurrence of autism.
Much more research took place during the 1970s. This time there was a focus on older autistic people. Rutter (1970) came up with data very similar to that of Kannar’s follow-up studies. Both Rutter and Kanner observed that many of their subjects demonstrated an interest in social interaction but they did not possess the social skills to engage in it. Their research also provided the insight that an autistic child’s social difficulties can not be separated from their other apparent problems with cognition and communication (Schopler & Mesibov, 1986).
The 1980s introduced Wing’s theory (1983) on the classification of subgroups for autistic children based on the child’s social problem. There were three groups she labeled: 1) aloof, 2) passive, and 3) active but odd. Those in the aloof group were classified with severe impairments with verbal and nonverbal communication, have behavioral disturbances, and described as cut off from others. The passive group was seen as the easiest to manage, able to imitate, and had higher skills than those in the aloof group. The last group, the active but odd, were considered the most difficult because of their demand for social attention, which only becomes worse through response (Schopler & Mesibov, 1986). Schopler and Mesibov (1986) claim that this system is widely known and could be important to future diagnostic classifications in psychiatry.
This history of theories on autism easily shows why we are left with so many questions when it comes to this disorder. Over the years the research presented has not been much more than observable traits of autistic children, yet the causes remain speculated. Although it is important to use these characteristics in forming methods for treatments of autistic children, we still need have a more clear theory of where autism comes from.
McHale and Gamble (1986) note there to be five specific characteristics of autistic children. The first characteristic outlined was that of delays or problems in language development. Such problems arise as mutism, echolalic speech, and deficits in receptive and expressive speech in autistic children. The second characteristic outlined was that of a general failure to develop social relationships. This may cause the autistic child to have difficulties responding to requests, making eye contact with others, initiating play, forming friendships, and showing affection.
The next characteristic designated to autistic children was that of inappropriate ritualistic and repetitive behaviors. This may be seen through standing up in the middle of an activity and walking around, or excessive play with fingers in rhythmic motions. The fourth characteristic of an autistic child is that they demonstrate isolated areas of high-level functioning, yet otherwise show marked retardation in all other areas. Fisher (2000) remarks though that the “savant” abilities are actually only found in a small percentage of autism cases. The final characteristic noted by McHale and Gamble (1986) was that of apparent difficulties responding to environmental stimuli, with a tendency to respond only to visual and auditory cues. More concrete examples of McHale and Gamble’s characteristics can be seen through actual accounts of specific autistic children.
In Fisher’s article, Charlie’s World: A family battles autism. (2000), one specific case is observed. Charlie, the autistic child studied, exhibited many characteristics previously explained through his daily activities and interactions (or lack of). He was observed to sit for forty-five minutes or more looking quietly at his books and out the window, appearing to be unattached. He also shows an isolated area of high level functioning, for the fact that he always remembered where the car was parked even in large, crowded parking lots, although he was unable to do many things other toddlers could. He also displayed no language skills except for babbling and crying. He did not acknowledge other children in the playground. And with subtle changes in routine he would go into a tantrum like state.
Sigman (1997) expresses many similar characteristics prevalent in her first observed case of autism. Jeremy, in this case, has a face that does not smile or say hello. His voice sounded robotic and automated. “Jeremy presented a distinctly uneven repertoire of behaviors and abilities. He appeared extremely advanced in some areas, displaying skills one would not expect of his normally developing peers. Yet he lacked basic skills in other, often in closely related areas”(Sigman & Capps, 1997). This observation led Sigman to the belief that he was capable of more than he showed, thus returning to the problem Cowan tried to solve in the 1960s, of whether autistic children were unable or unwilling.
One last characteristic of autistic people that was noted by Ogletree and Harn (2001) that has received very little attention is that of impaired joint attention found in autistic children. By comparing these documented behaviors and characteristics apparent in autism to that of the normally developing child, knowledge of actual causes to the disorder may arise. Also, one must seek to determine any underlying mechanisms that may relate to the causes of the disorder (Sigman & Capps, 1997).
The largest mystery in the study of autism appears to be the lack of knowledge as to what may cause a child to be autistic. Fisher (2000) notes what was once said by Anders, a professor of medical psychiatry, in 1999 on the topic of discovering autism’s causes, “When you can understand the biological mechanisms underlying this disorder, you will understand how the brain works. It is that complicated of an illness.” Early psychoanalytic theorists put the cause of autistic behavior and development on parents. It was not until 1967 that this theory was challenged by Clara Park, in the first published account of the autistic child, that people started searching out more plausible causes for the disorder. With Park’s new evidence studies have plunged deeper in finding out the cause of this disorder. Along with this, an increase in the occurrence of diagnosis of autism led us to research possible causes that may have never been looked upon before.
One such idea presented by Fisher (2000) suggests that autism may arise from food intolerances, weak immune systems, or exposure to environmental toxins. He looked at an area citing a “cluster” of autism cases (150) where it was expected that there was an environmental cause to the disorder, yet no empirical evidence was detected. In 1998, Dr. Andrew Wakefield found there to be a possible link between the Measles, Mumps and Rubella vaccination and autism, yet this too was proven by Dr. Brent Taylor to be not true. Although, many still contest this to be a possible cause.
Accounts of partial or complete recoveries of autism lead to hope in finding an actual biological cause. Although genetics have been seen to play a role in the development of autism, many parents are still convinced of a possibility of external agents as a cause, Fisher (2000) notes. The Brown University Child and Adolescent Behavior Letter (2001) also suggests pediatricians should give a higher-level of suspicion to children of autistic siblings, or to those who live in lead-prone environments. Again, no definitive cause is supported. Autism is seen in all cultures and in all socioeconomic groups and all parents find few answers to why their child is the way he/she is. Fisher (2000) furthermore states, “We were to learn that even the most firmly established facts about autism are not widely known.” As a result of these mysteries researchers have sought to find many different intervention strategies.
There has been much evidence that reports on the importance of early intervention for autism. Fisher (2000) also states “it has even been hypothesized that rigorous early intervention modifies the neural circuitry in a young brain damaged by autism.” This calls for early diagnosis of the disorder. Sigman and Capps (1997) mention that autistic symptoms are not generally recognizable until a child is two to three years old, thus treatment will not begin until the end of the third year. The Brown University Child and Adolescent Letter (2001) stresses that pediatricians should pay careful attention to all childrens development, by becoming familiar with at least one autism screening tool, and perform it on all children to promote the early diagnosis of the disorder. The Brown University article also proposes the point that early intervention results may seem impressive, yet in reality the lapse of time between the onset of parental concerns about their child’s development, and the implementation of a management strategy is far too great to offer effective results. Due to the lack of autistic traits recognized in infancy, making early intervention very troublesome, researchers have continued to add to approaches on intervention of the autistic individual.
One such approach to intervention noted in The Brown University Child and Adolescent Letter (2001) suggests a multi-step model as an effective way to manage the disorder. This approach makes use of parental education and support, early intervention for children under 3 and school-based intervention for children over 3, behavior management, medical treatment, and community services. Applied behavioral analysis has also proven positive in autistic children developing abilities sufficient to attend regular education classrooms. In this technique a child is rewarded for imitating tasks until ultimately the reward is replaced by verbal praise. Although it has been found that autistic children can attend to the task through repetitive training, they usually do not understand why they are completing that task (Fisher, 2000)
McHale and Gamble (1986) discuss the effects of mainstreaming autistic children. Although this technique seems to be one of the most difficult to pursue, it may be one of the more effective approaches. It has been found by various investigators that peers may have a significant role in the success of an autistic child in a regular classroom when they take on the role of tutor and model. McHale’s research (1983) noted that peers could serve as effective behavior change agents without being trained to do so. More so than peers can promote changed behavior in autistic children it has also been widely known that parents have an important role as co therapist in treating their child. This approach began with the TEACCH program in 1966, after Park had diminished the notion that parents were the cause to the emergence of autism. Thus far this step in the treatment has only been proven positive, and ironically is now one of necessity since many intervention approaches involve intensive home-based programs.
The Brown University Child and Adolescent Letter (2001) presents the fact that “alternative therapies have taken the frontline with parents” recently. Some of these alternative strategies work on the basis that there may be environmental and dietary factors in the underlying causes of autism. Alternative treatments would include nutritional supplements, elimination diets, immune globulin therapy, and secretin therapy. Although there has been varied success in these management systems, parents may be led to these methods of treatment due to dissatisfaction in the results produced by more traditional strategies.
In reference to the case of Charlie mentioned earlier Fisher (2000) found success in the implementation of an intensive home-based program, where Charlie was taught through repetitive drills to identify objects, imitate sounds, color and draw and associate socially. Along with this they too employed a more alternative technique by placing Charlie on a specialized diet, eliminating all gluten and casein. Charlie was also takes megavitamins, and other nutritional supplements. At the time of the report Fisher (2000) found Charlie’s progress to be astonishing. It now can be concluded that intensive parental involvement along with early implementation of intervention can be seen to hold the most positive outcomes in treating autistic children.
In conclusion to the research done in this paper it can easily be determined that autism is an extremely difficult disorder to understand. The biological roots of the disorder have yet to be uncovered, yet continuing knowledge of the development of the autistic child in correlation to a normally developing child will aid in treating and diagnosing autistic children with somewhat more ease. As well, with easier diagnosis, early intervention is more plausible; which seems to yield positive results in treating the disorder. There is still much research to be done concerning this mysterious disorder, but one can hope that through greater knowledge of the disorder, one day there will be a universal, ideal means to treat autism.
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