WHAT IS AUTISM SPECTRUM DISORDER (ASD)

Pervasive Developmental Disorders (PDD) are a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate, and to use imagination. There is a spectrum within the PDD disorders: Autism spectrum disorder (ASD) is the name for a group of developmental disorders. ASD includes a wide range, a spectrum, of symptoms, skills, and levels of disability. Included on the spectrum, are Aspergers Syndrome, Rett Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), and Autism Disorder.

Below are the characteristics of ASD:

  • Ongoing social problems that include difficulty communicating and interacting with others
  • Repetitive behaviors as well as limited interests or activities
  • Symptoms that hurt the individuals ability to function socially, at school or work, or other areas of life
  • The most obvious signs of ASD tend to emerge between 12 and 18 months of age
  • Some infants and toddlers begin develop normally until the second year of life, when they lose skills a pattern called regression.

Rett syndrome: Rare non-inherited genetic postnatal neurological disorder that occurs almost exclusively in girls and leads to severe impairments, affecting nearly every aspect of the child's life:

  • Ability to speak
  • Ability to walk
  • Difficulties to eat
  • Difficulties to breathe easily
  • Problems with muscles and coordination: girls may develop jerky, stiff-legged gait
  • Uncoordinated breathing and seizures

PDD-NOS: Became the diagnosis applied to children or adults who are on the Autism Spectrum, but do not fully meet the criteria for another ASD such as autism:

  • Delays in the development of socialization: Difficulty relating to people
  • Delays in using and understanding language
  • Unusual play with toys and other objects
  • Difficulty with changes in routine or surroundings
  • Repetitive body movements or behavior patterns
  • Uneven skill development (motor, sensory, visual-spatial organizational, cognitive, social, academic, behavioral)
  • Increased or decreased sensitivities to taste, sight, sound, smell and/or touch\
  • Perseverative (repetitive or ritualistic) behaviors, for example, opening and closing doors repeatedly or switching a light on and off

Autism Disorder: The severity of symptoms varies greatly, but all people with Autism have some core symptoms in the areas of:

  • Social interactions and relationships:
  • Lack of interest in sharing enjoyment, interests, or achievements with other people;
  • Difficulty understanding listener’s perspective (interpret the communication word for word and fail to catch the implied meaning);
  • Lack of empathy: Difficulty understanding another person’s feelings, such as pain or sorrow
  • Verbal and nonverbal communication: Delay in, or lack of, learning to talk; Problems taking steps to start and continue a conversation
  • Stereotyped and repetitive use of language: Repeat a phrase they have heard previously (echolalia)
  • Difficulties with play: Limited interests in activities or play; unusual focus on pieces
  • Preoccupation with certain topics, for example, older children and adults may be fascinated by video games, trading cards, or license plates
  • A need for sameness and routines
  • Stereotyped behaviors. These may include body rocking and hand flapping.

CAUSES

There is no particular cause for ASD. Scientists have identified a number of rare gene changes, or mutations, associated with ASD. However, most cases involve complex and variable combinations of genetic risk and environmental factors that influence early brain development.

Various risk factors can involve events before and during birth. They include advanced parental age at the time of conception (both mother and father), maternal illness during pregnancy, extreme prematurity and very low birth weight and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the babys brain. Other theories suggest (although not always proven): The body’s immune system may inappropriately produce antibodies that attack the brains of children, causing ASD. This theory is not widely thought of as being valid[/list_item]; Abnormalities in brain structures (children with ASD have abnormal timing of the growth of their brains. Early in childhood, the brains of children with ASD grow faster and larger than those of normal children. Later, when normal children’s brains get bigger and better organized, the brains of kids with ASD grow more slowly; MMR vaccine which contains mercury and Thimerosal.

SYMPTOMS

Symptoms must be present in the early developmental period, but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life.

Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. These disturbances are not better explained by Intellectual Disability (ID) or global developmental delay.

The severity of symptoms varies greatly, but people diagnosed with ASD have some core symptoms in the areas of communication, social and play skills, self-help skills and repetitive behaviors. For each person the symptoms are different. For example, each person with ASD has different communication skills. Some people can speak well. Others cant speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%-30% of children with ASD have some words at 12 to 18 months of age and then lose them.Others might speak, but not until later in childhood. The symptoms could be:

Play and Social Skills:

  • Does not respond to name
  • Unusual focus on pieces: Individuals with ASD often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy
  • Preoccupation with certain topics: Older children and adults may be fascinated by video games, trading cards, or license plates
  • A need for sameness and routines for example, an individual with ASD may always need to eat bread before salad and insist on driving the same route every day to school
  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Avoids eye-contact
  • Prefers to play alone
  • Not point at objects to show interest (point at an airplane flying over)
  • Not play pretend games (pretend to feed a doll)
  • Only interacts to achieve a desired goal
  • Has flat or inappropriate facial expressions
  • Does not understand personal space boundaries
  • Avoids or resists physical contact
  • Is not comforted by others during distress
  • Has trouble understanding other people’s feelings or talking about own feelings

Verbal and non-verbal communication:

  • Delayed speech and language skills
  • Repeats words or phrases over and over (echolalia)
  • Reverses pronouns, for example, says You instead of I
  • Gives unrelated answers to questions
  • Problems taking steps to start a conversation and continuing a conversation after it has begun
  • Does not point or respond to pointing
  • Uses few or no gestures, for example, does not wave goodbye
  • Talks in a flat, robot-like, or sing-song voice
  • Stereotyped and repetitive use of language
  • Difficulty understanding their listener’s perspective, for example, a person with ASD may not understand that someone is using humor, sarcasm or is teasing

Unusual Interests and Behaviors:

  • Lines up toys or other objects
  • Plays with toys the same way every time
  • Preoccupied with parts of objects (e.g., wheels)
  • Very organized
  • Gets upset by minor changes
  • Has obsessive interests
  • Has to follow certain routines
  • Flaps hands, rocks body, or spins self in circles

Other Symptoms:

  • Hyperactivity
  • Impulsivity (acting without thinking)
  • Short attention span
  • Get upset with minor changes
  • Aggression
  • Causing self injury
  • Tantrums
  • Unusual eating and sleeping habits
  • Unusual mood or emotional reactions
  • Lack of fear or more fear than expected
  • Unusual reactions to the way things sound, smell, taste, look, or feel
  • Idiosyncratic phrases.

ASD TREATMENTS

There are thousands of treatment methods for ASD. Below we are just explaining the most popular methods of treatments currently used in the USA

Floor Time Therapy: The premise is that adults can help children expand their circles of communication by meeting them at their developmental level and building on their strengths. Floor time takes place in a calm environment. Formal treatment sessions range from two to five hours a day. They include training for parents and caregivers as well as interaction with the child.

Behavior Analysis: Focuses on various principles. Positive reinforcement is one such principle. When a behavior is followed by a reward, the behavior is more likely to be repeated. Through decades of research, the field of Behavior Analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning. Applied behavior analysis (ABA) is the use of these techniques and principles to bring about meaningful and positive change in behavior. ABA strategies can be incorporated within Early Intensive Behavioral Intervention, Intensive Behavioral Interventions (age 5 and up) and Behavioral Interventions with adults.

Early Intensive Behavioral Intervention: Involves a child’s (age 0-4 years old) entire family, working closely with a team of professionals. In some early intervention programs, Behavior Technicians come into the home to deliver services. This can include parent training with the parent leading intervention sessions under the supervision of the behavior Technician. Often the recommended number of hours of structured intervention is 25 hours per week during the preschool period. For school-age children the Early Intensive Behavior Intervention may be provided during the school day and/or there may be additional interventions provided outside of the school day in the home.

Effective ABA intervention is not a one size fits all approach and should never be viewed as a canned set of programs or drills. On the contrary, a skilled Behavior Technician customizes the intervention to each learner’s skills, needs, interests, preferences and family situation. For these reasons, an ABA program for one learner will look different than a program for another learner. That said, quality ABA programs for learners with Autism have the following in common:

  • A qualified and trained Behavior Analyst designs and directly oversees the intervention
  • The Behavior Analyst develops treatment goals from a detailed assessment of each learner’s skills and preferences and may also include family goals
  • Treatment goals and instructions are developmentally appropriate and target a broad range of skill areas such as communication, self-help skills, play and social skills, motor development and community skills
  • Goals emphasize the skills that will enable learners to become independent and successful in both the short and long terms
  • The instruction plan breaks down desired skills into manageable steps to be taught from the simplest (e.g. imitating single sounds) to the more complex (e.g. carrying on a conversation).
  • The intervention involves ongoing objective measurement of the learners progress
  • The Behavior Analyst frequently reviews information on the learners progress and uses this to adjust procedures and goals as needed
  • The Behavior Analyst meets regularly with family members and program staff to plan ahead, review progress and make adjustments as needed.

TIPS FOR PARENTS FOR CHILDREN WITH ASD

Be consistent: Individuals with ASD have a hard time adapting what they have ve learned in one setting (such as the therapists office or school) to others, including the home. For example, your child may use sign language at school to communicate, but never think to do so at home. Creating consistency in your childs’ environment is the best way to reinforce learning. Find out what your childs’ therapists are doing and continue their techniques at home. Explore the possibility of having ABA sessions take place in more than one place in order to encourage your child to transfer what he or she has learned from one environment to another. Its also important to be consistent in the way you interact with your child and deal with challenging behaviors.

Stick to a schedule: Individuals with ASD tend to do best when they have a highly-structured schedule or routine. Again, this goes back to the consistency they both need and crave. Set up a schedule, with regular times for meals, therapy, school, and bedtime. Try to keep disruptions to this routine to a minimum. If there is an unavoidable schedule change, prepare your child for it in advance.

Reward good behavior: Positive reinforcement can go a long way with individuals with Autism Disorder, so make an effort to catch them doing something good. Praise them when they act appropriately or learn a new skill, being very specific about what behavior they’re being praised for. Also look for other ways to reward them for good behavior, such as giving them a sticker or letting them play with a favorite toy.

Create a home safety zone: Carve out a private space in your home where your child can relax, feel secure, and be safe. This will involve organizing and setting boundaries in ways your child can understand. Visual cues can be helpful (colored tape marking areas that are off limits, labeling items in the house with pictures). You may also need to safety proof the house, particularly if your child is prone to tantrums or other self-injurious behaviors.

Look for nonverbal cues: If you are observant and aware, you can learn to pick up on the nonverbal cues that persons with ASD use to communicate. Pay attention to the kinds of sounds they make, their facial expressions, and the gestures they use when theyre tired, hungry, or want something.

Figure out the need behind the tantrum: It’s only natural to feel upset when you are misunderstood or ignored, and its no different for individuals with Autism Disorder. When individuals with ASD act out, its often because youre not picking up on their nonverbal cues. Throwing a tantrum is their way of communicating their frustration and getting your attention

Pay attention to your childs’ sensory sensitivities: Many individuals with ASD are hypersensitive to light, sound, touch, taste, and smell. Others are under-sensitive to sensory stimuli. Find out what sights, sounds, smells, movements, and tactile sensations trigger your kids challenging behaviors and what elicits a positive response

Finally, keep in mind that no matter what ABA treatment plan is chosen, parents involvement is vital to success. Parents can help their child get the most out of treatment by working hand-in-hand with the clinical team and following through with the intervention sessions at home.