Autism

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Autism is a disorder that is usually diagnosed in early childhood. Also called autistic spectrum disorder (ASD), autism is considered a pervasive developmental disorder (PDD).

Autism is caused by a problem with the brain and impacts a persons functioning at different levels, from very mildly to severe.

There is usually nothing about how a person with autism looks that sets them apart, but they may communicate, interact, behave, and learn in ways that are different from most people.

The thinking and learning abilities of people with ASD can vary from gifted to severely challenged. Autistic disorder is the most commonly known type of ASD, but there are others, including pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger's Syndrome.

Autism Symptoms

The main signs and symptoms of autism involve communication, social interactions and repetitive behaviors. Children with autism might have problems talking with you, or they might not look you in the eye when you talk to them. They may have to line up their pencils before they can pay attention, or they may say the same sentence again and again to calm themselves down. They may flap their arms to tell you they are happy, or they might hurt themselves to tell you they are not. Some children with autism never learn how to talk.

A Child with Autism Might:

• Not play pretend games (pretend to feed a doll)
• Not point at objects to show interest (point at an airplane flying over)
• Not look at objects when another person points at them
• Have trouble relating to others, or not have an interest in other people at all
• Avoid eye contact and want to be alone
• Have trouble understanding other peoples feelings or talking about their own feelings
• Prefer not to be held or cuddled, or might cuddle only when they want to
• Appear to be unaware when other people talk to them, but respond to other sounds
• Be very interested in people, but not know how to talk, play, or relate to them
• Repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language (echolalia)
• Have trouble expressing their needs using typical words or motions
• Repeat actions over and over again
• Have trouble adapting when a routine changes
• Have unusual reactions to the way things smell, taste, look, feel, or sound
• Lose skills they once had (for instance, stop saying words they were once using)

* Note: Contact your child's doctor or nurse if your child experiences a dramatic loss of skills at any age.
Because people with autism can have very different features or symptoms, health care providers think of autism as a spectrum disorder. Asperger's Syndrome is a milder version of the disorder.

The Cause of Autism

The cause of autism is not known, but autism lasts throughout a persons lifetime.

Diagnosing Autism

Usually a team of specialists is involved in the diagnosis of autism.  This team may include a neurologist, psychiatrist, developmental pediatrician, psychologist, gastroenterologist, audiologist, speech therapist, occupational therapist, and other professionals. There is no specific autism test, rather diagnosis is based on observation of the child's behavior, educational, and psychological testing, along with the parents observation.

Warning Signs of Autism Include

• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles or other facial expressions by nine months or thereafter
• No words by 16 months
• No two-word meaningful phrases (without imitating or repeating) by 24 months
• Any loss of speech or babbling or social skills at any age

Treatment of Autism

There is no cure for autism, but treatment can help. Treatments include behavior and communication therapies and medicines to control symptoms. If your child is diagnosed with autism, early intervention should begin when he or she is diagnosed. While there is no single treatment for all children with autism, most respond best to highly structured behavioral programs. According to The National Institute of Child Health and Human Development and The Autism Society of America, these are the most popular treatment options.

Applied Behavior Analysis (ABA)

Many of the interventions used to treat children on the autism spectrum are based on the theory of Applied Behavior Analysis (ABA). Behavior analysis is a natural science of behavior that was originally described by B.F. Skinner in the 1930s. Positive reinforcement is used to improve a child's skills in communication, play, social, academic, self-care and other skills, and to reduce troubling behaviors. The guiding principle of this approach is that the behavior that is rewarded is more likely to be rewarded than the behavior this is ignored.

Floortime

Floortime is a treatment method developed by child psychiatrist Stanley Greenspan. Its called floortime because the parent actually gets down on the floor with the child to meet and work with him at his own developmental level. This method builds upon the child's strengths and taps into the child's own motivation. In addition to having speech, occupational and physical therapists trained in the floortime technique work with the child, the parents also do floortime activities with the child, and the parents learn how to adapt how they relate to their child.

Nutrition Therapy

Making changes to an autistic child's diet is thought to help the child's brain function. Its important to consult a registered dietician before trying any of these approaches to make sure your child receives the proper amount of vitamins, minerals and fiber. Before meeting with the dietician, parents should record how the child is currently eating and what behaviors occur after eating. This is necessary to evaluate if changing the diet has changed behavior.
 
One popular dietary treatment involves removing gluten (a protein found in barley, rye, oats and wheat) and casein (a protein found in dairy products) from the autistic child's diet. This is called the Gluten Free, Casein Free diet. While this diet is currently being studied, some parents report that eliminating gluten and casein from their autistic child's diet has helped regulate bowel habits, sleep activity, and behaviors.

Another dietary treatment is a Specific Carbohydrate diet. This diet was initially designed to treat inflammatory bowel disease. It was created to remove the foods that cannot be properly broken down. Some parents have tried this diet with their autistic children and have reported positive results.

The third diet that some people feel might be beneficial to children with autism is the Elimination diet. Many children with autism have been found to have food allergies that can contribute to some of their autism behaviors. The foods found to be responsible for 90 percent of allergic reactions include milk, egg, peanut, fish, wheat, soy, tree nuts, and shellfish.

Occupational Therapy of Autism

Your child's coping skills, fine motor skills, play skills, self help skills, and socialization skills can all be improved through occupational therapy. Occupational therapists can also help autistic children respond to the information coming through the senses. In addition, since children with autism sometimes have problems with transitions, occupational therapists can help create soothing strategies for them. Usually, an occupational therapist will evaluate a child to determine if he or she has accomplished tasks appropriate to the child's age, such as dressing and play skills, and then use occupational therapy methods to improve his or her skills.

It is usually part of a team effort with other members of the medical and educational community, as well as family members.

PECS

This technique teaches autistic children to communicate via picture cards, which can be effective for autistic children who sometimes tend to learn visually. By using these pictures, children learn how to communicate what they need, want or feel. This technique has helped some children with autism improve their communications skills, and for some, this improvement has resulted in the ability to speak. These pictures can be purchased or parents can make them from pictures in magazines and other books.

Some feel the success of this program comes from letting the child communicate at first non-verbally, which is less frustrating.

Relationship Development Intervention (RDI)

This program, based on the work of psychologist Steven Gutstein, is a parent-based treatment that helps address issues such as gaining friendships, feeling empathy, expressing love and being able to share experiences with others.
According to Drs Gutstein's research, individuals with autism seemed to lack certain abilities necessary for success in managing the real life environments that are dynamic and changing. He defines these six aspects as:

• Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.
• Social Coordination: The ability to observe and continually regulate ones behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.
• Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings, and coordinate your actions with others.
• Flexible Thinking: The ability to rapidly adapt, change strategies, and alter plans based upon changing circumstances.
• Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no "right-and-wrong" solutions.
• Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner.

The SCERTS Model

(Prizant, Wetherby, Rubin, Rydell & Laurent, 2006)

SCERTS stands for Social Communication and Emotional Regulation, and implementing Transactional Supports. This was developed by Barry Prizant, Amy Wetherby, Emily Rubin, Amy Laurent and Patrick Rydell, a multidisciplinary team of clinicians, researchers, and educators who have more than 100 years experience, and have published extensively in the field of autism.
Social Communication is defined as, developing spontaneous, functional communication and secure, trusting relationships with children and adults.

Emotional Regulation can be defined as, the ability to maintain a well-regulated emotional state to be most available for learning and interacting.
 
Transactional Support is defined as, supporting children, their families, and professionals to maximize learning, positive relationships and successful social experiences across home, school and community settings.
This model has families and educators working together. Its different from other approaches in that it focuses on child-initiated communication. In addition, it promotes communication via extensive use of visual, such as photos and picture symbols. The SCERTS model has been designed to help those with autism learn and apply functional skills in different settings with a variety of individuals. In order to be effective, the SCERTS model needs the involvement of teachers, therapists, parents, siblings, and peers.

Speech Therapy

The communications problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak, whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child's language abilities by a trained speech and language pathologist.

Two pre-skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterances, and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some, verbal communication is realistic for others gestured communication or communication through a symbol system, such as picture boards, can be attempted. Periodic evaluations must be made to find the best approaches and to reestablish goals for the individual child.

Therapeutic Listening

Just because a child can hear doesn't mean he or she is listening. Hearing is passive and it doesn't mean paying attention to the sound and what those sounds mean. Listening is different because it is active and voluntary. Listening requires a person to want to communicate and focus the ear on certain sounds. The entire brain is needed to listen. If a child with autism has listening difficulties, it will interfere with his ability to accurately perceive, process, and respond to sounds. This can impact the child's perception, motor, attention, and learning. Here are some of the outcomes that might be possible with a therapeutic listening program:

Modulation/Self-Regulation

• Improvement in sleep/wake cycles
• Reduction of sensory defensive behaviors
• A smoothing out of mood variance and arousal state
• Improvement in toilet training, especially over the age of 5 years old
• Increased regularity of hunger and thirst cycles
• Improved focus and attention
• Postural Tone/Postural Attention

Establishment of body midline

• Ability to sustain active posture on stable and dynamic surfaces
• Improved co-contraction around shoulders and hips
• Active use of rotation in movement patterns
• Motor Control

Use of bilateral motor patterns

• Emergence of praxis
• Improved articulation
• Improved fine motor skill

Spatial-Temporal Organization

• Improved timing of motor execution
• Improved timing of social interactions
• Discrimination of dimensionality and directionality of spatial concepts
• Improved ability to maneuver through space
• Improved handwriting and visual motor skill

Communication

• Greater range of non-verbal communication
• Non-verbal communication matches communicative intent
• Greater emotional expressiveness

Frick, Sheila, Listening with the Whole Body, 2000, p. 3-16

TEACCH

TEACCH, which stands for, Training and Education of Autistic and Related Communication Handicapped Children, dates back to the 1960s when doctors Eric Schopler, R.J. Reichler, and Ms. Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children.

What makes the TEACCH approach unique is that the focus is on the design of the physical, social and communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways.

Like other programs created to help autistic children, TEACCH takes in consideration that autistic children are often visual learners. This program puts children in a highly structured environment, which is believed to help autistic children learn.

Alternative Treatment Options

Many new treatments have been developed that might be effective, but have not yet been scientifically proven. You might want to discuss these alternative treatments with your child's medical team.

Facilitated Communication

This technique assumes that by supporting a nonverbal child's arms and fingers so that he or she can type on a keyboard, he or she will be able to type out his or her inner thoughts. There have been several scientific studies that have shown that the typed messages actually reflect the thoughts of the person providing the support.

Holding Therapy

With holding therapy, the parent continues to hold the child for long periods of time, even if the child resists. Proponents of this technique say it forges a bond between the parent and the child; however, there is no scientific evidence to support this claim.

Auditory Integration Therapy

The child listens to a variety of sounds with the goal of improving language comprehension. Advocates of this method suggest that it helps people with autism receive more balanced sensory input from their environment. When tested using scientific procedures, the method was shown to be no more effective than listening to music. However, some parents report that children make significant behavioral and language gains following this treatment.

Dolman/Delcato Method

People are made to crawl and move as they did at each stage of early development, in an attempt to learn missing skills. Again, no scientific studies support the effectiveness of this method.

More Information on Autism

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institutes Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
Phone (800) 352-9424
Website: http://www.ninds.nih.gov

Association for Science in Autism Treatment
P.O. Box 188
Crosswicks, NJ 08515-0188
Phone 781-397-8943
Fax 781-397-8887
Website: http://www.asatonline.org
E-mail info@asatonline.org

Autism National Committee (AUTCOM)
P.O. Box 429
Forest Knolls, CA 94933
Website: http://www.autcom.org

Autism Network International (ANI)
P.O. Box 35448
Syracuse, NY 13235-5448
Website: http://ani.autistics.org
E-mail jisincla@mailbox.syr.edu

Autism Research Institute (ARI)
4182 Adams Avenue
San Diego, CA 92116
Phone 619-281-7165
Fax 619-563-6840
Website: http://www.autismresearchinstitute.com
E-mail director@autism.com

Autism Society of America
7910 Woodmont Avenue
Suite 300
Bethesda, MD 20814-3067 Phone
301-657-0881
800-3AUTISM (328-8476)
Fax 301-657-0869
Website: http://www.autism-society.org

MAAP Services for Autism, Aspergers, and PDD
P.O. Box 524
Crown Point, IN 46308
Phone 219-662-1311
Fax 219-662-0638
Website: http://www.maapservices.org
E-mail info@maapservices.org

Autism Speaks, Inc.
2 Park Avenue
11th Floor
New York, NY 10016
Phone 212-252-8584
California: 310-230-3568
Fax 212-252-8676
Website: http://www.autismspeaks.org
E-mail contactus@autismspeaks.org

National Dissemination Center for Children with Disabilities
U.S. Dept. of Education, Office of Special Education Programs
P.O. Box 1492
Washington, DC 20013-1492
Phone 800-695-0285
Fax 202-884-8441
Website: http://www.nichcy.org
E-mail nichcy@aed.org

National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD 20892-2425
Phone 301-496-5133
Fax 301-496-7101
Website: http://www.nichd.nih.gov

National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Phone 800-241-1044
800-241-1055 (TTD/TTY)
Website: http://www.nidcd.nih.gov
E-mail nidcdinfo@nidcd.nih.gov

National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
Phone 301-443-4513
866-615-NIMH (6464)
301-443-8431 (TTY)
Fax 301-443-4279
Website: http://www.nimh.nih.gov
E-mail nimhinfo@nih.gov

The sources for some of this information is the Center for Disease Control and Prevention and the National Institute of Neurological Disorders and Stroke

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