chapter 1-problem identification

8/7/2019 Chapter 1-Problem Identification

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Chapter 1

P R O B L E M I D E N T I F I C A T I O N


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Interactive multisensory environmentDESIGN FOR LIVING AND LEARNING WITH AUTISM .

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PROBLEM IDENTIFICATION Chapter 1

P R O B L E M I D E N T I F I C A T I O N

1 . 1 U N D E R S T A N D I N G D I S A B I L T Y

There is no universal definition of disability; however there are two conceptualizations that most

definitions fit into: impairment and activity limitation.

Impairment is a broad concept. It is defined as a physical or mental loss or condition that limits a

persons ability to function. Example of impairment includes hearing loss or loss of a limb. Activity

limitations are a narrow concept of disability; not everyone with impairment has an activity

limitation. An activity is an impairment that leads to an ability to perform, or a limitation in

performing, roles and tasks such as reading, talking on phone or cooking dinner.

The Americans with disabilities act use an impairment definition of disability:

..a physical or mental impairment that substantially limits one or more major life activities, a

record of such an impairment or being regarded as having such an impairment.

The two definitions can be found in the national policy for education in Pakistan,

..disability means the lack of ability to perform an activity in a manner that is considered to be

normal.

..a person with disabilities means a person who, on account of injury, disease or congenital

deformity, is handicapped in undertaking any gainful profession or employment. Include personswho are visually impaired and physically and mentally disabled.

A disability may be visible or hidden, may be permanent or temporary and may have a minimal or

substantial impact on a persons abilities. A disability may affect mobility, ability to learn, or ability

to communicate easily.

The Disability Discrimination Act (1992) defines disability as:

o total or partial loss of a persons bodily or mental functionso total or partial loss of a part of the bodyo the presence in the body of organisms causing disease or illnesso the malfunction, malformation or disfigurement of a part of a persons bodyo a disorder or malfunction that results in a person learning differently from a personwithout the disorder or malfunction

o A disorder, illness or disease that affects a persons thought processes, perceptionof reality, emotions or judgment, or those results in disturbed behaviour.

The majority of people with disability have a physical disability (83.9 per cent), 11.3 per cent have

mental illness and behavioural disability and 4.8 per cent have an intellectual or developmental

disability.


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[2] American Academy of Pediatrics (AAP), Committee on children with disabilities. (2001).

The Pediatricians role in the diagnosis and management of autistic spectrum disorder

in the children. Pediatrics, 107(5), 1221-1226.

1 . 2 W H A T I S A U T I S M ?

Autism is a complex developmental disability characterized by lack of normal social interaction,

impaired communication and imagination, delayed and absent language, self-stimulating behavior

and a highly restricted range of activities and interests2 as a result of a neurological disorder that

affects the functioning of the brain, typically appears during the first three years of life.3

Autism impacts the normal 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.

Recent evidence suggests that autistic individuals suffer from a specific impairment in mentalist

reasoning and in the early capacities believed to underlie it. Autistic individual fails tasks that

require an understanding of others cognitive states, and their vocabularies rarely contain such

words as believe, think, know, and pretend. In addition their ability to imitate and engage inmake-believe play is limited. Yet other cognitive skills- especially those that involve the physical

world- are intact.4

an autistic baby may fail to notice the emotional signals of others and may

refused to cuddle or to make eye contact, may speak in a singsong voice, paying little or no

attention to the listener.5

Severely autistic children often show repetitive behaviors, such as

spinning, rocking, hand- flapping, and head- banging, and are obsessed with certain subjects, rituals,

or routines.6

1 . 3 T Y P E S O F A U T I S M

Autism refers to a group of autistic spectrum disorders (ASD) ranging from mild to severe, whichmay be more common than previously thought (Papalia, 2006). It is one of five disorders coming under

the umbrella of Pervasive Developmental Disorders, a category of brain disorders that affect the

way people speak, socialize, play and react to their environment.

Below are definitions and characteristics of these five disorders among people with an ASD.

1.3.1 Kanner's Syndrome (Classic autism) this particular type of autism was named after aDr. Kanner. He described and studied it in the 1930s and into the 1940s

7. This is the most severe

form of autism. People with classic autism have problems talking and relating to people. They can be

hypersensitive to their environment. Certain sounds, colors and textures can upset them. They

compulsively cling to rituals, want everything to be the same all of the time, such as eating the same

foods or watching the same TV show every day at the same time. Changes in routine can upset

them7, 8

1.3.2 Asperger's Syndrome in the type of autism, children are often misdiagnosed at first,and are thought to have Obsessive-Compulsive Disorder*, or perhaps Attention Deficit* Disorder.

They are often clumsy, as motor skills are under developed. Those with Asperger's are thought to

have a talent that they focus on almost exclusively, and are considered to be highly intelligent.

Recent findings indicate that Albert Einstein may have had this condition7.Itcauses problems with

social and communication skills, but does not trigger language delays. People with Asperger are can

be socially awkward, may not understand conventional social rules or may show a lack of empathy.


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[3] Papalia, D E. (2006), Human Development. 9TH

Edition. Tata Mc Grow-Hill Publishing

Company Ltd, New Delhi.

[4] Baron-Cohen, 1991; Tager- Flusberg, 1992; Berk, 2001.

[5] Sigman, Kasari, Kwon, and Yirmiya, 1992; Paplia, 2006

They may make limited eye contact, seem to be unengaged in a conversation and not understand

the use of gestures. They also have average or above-average intelligence7, 8

1.3.3 Childhood Disintegrative Disorder A type of autism that develops in children whopreviously seemed perfectly normal. Sometime between ages 2 and 4 these children

7, 8stop talking,

lose potty-training skills and stop socializing. They can stop playing, lose motor skills and fail to make

friends.

1.3.4 Rett Syndrome Rett's is a rare and relatively little-known type of autism diagnosedsince the sixties, first described by Dr. Rett

9A condition that usually affects girls and is marked by

poor head growth. People with this disorder have poor verbal and social skills, o ften have problems

with muscle atrophy*, and tend to do repetitive hand motions such as hand-wringing, excessive

hand-washing and clapping. Mental retardation is common7, 8

.

1.3.5 Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) A condition

in which some but not all of the symptoms of classic autism and another pervasivedevelopmental disorder are seen. In these cases, there can be social and speech problems, as well

as unusual sensitivities to specific sights and sounds7. They will need the same interventions and

help that autistic children require. The differences between PDD-NOS and autism are minor and

usually only obvious to researchers and doctors8.

Though there are more autism types out there, these tend to be the most common.

Aspergers disorder is most common, which affects about 1 in 500 children9 it is estimated that it

occurs in approximately 1 in every 150 individuals (quote reference over here), about 6 children in

1,000 have one of these disorders10

and is 4 times more prevalent in males than females11, 12

. It is

most prevalent in Caucasian males, although it occurs in every race. About 3 out of 4 autisticchildren are mentally retarded

13, but they do well on tests of manipulative or visual-spatial skill and

may perform unusual mental feats, such as memorizing entire train schedules14

.

1 . 4 S Y M P T O M S O F A U T I S M ?

Symptoms of Autism categorized as:

1.4.1 Possible Indicators of Autism Spectrum Disorders:

o Does not babble, point, or make meaningful gestures by 1 year of ageo Does not speak one word by 16 monthso Does not combine two words by 2 yearso Does not respond to nameo Loses language or social skills


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[6] National Institute of Neurological Disorders and Stroke, (1999, November 10). Autistic

[Fact sheets]. (NIH Publication No. 96-1877.) Bethesda, MD: National Institute of Health.

[7] http://www.iser.com/resources/autism-types.html

[8] http://www.statesman.com/metrostate/content/metro/autism/types_of.html

1.4.2 Some Other Indicators:

o Lacks eye contacto Doesn't seem to know how to play with toys in the usual mannero Excessively lines up toys or other objectso Is attached to one particular toy or objecto Doesn't smile (socially, but may smile during periods of self-stimulatory behavior)o At times seems to be hearing impaired

1.4.3 Social symptoms:

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn

toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to

faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday

human interaction. Even in the first few months of life, many do not interact and will avoid eye

contact, seeming indifferent to other people.

Autistic children often appear to prefer being alone rather than in the company of others may resist

attention or passively accept such things as hugs and cuddling without caring. Later, they seldom

seek comfort or respond to parents' displays of anger or affection in a typical way. Research has

suggested that although autistic children are attached to their parents, their expression of this

attachment is unusual and difficult to "read." To parents, it may seem as if their child is not attached

at all. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may

feel crushed by this lack of the expected and typical attachment behavior.

Children on the autism spectrum also are slower in learning to interpret what others are thinkingand feeling. Subtle social cues whether a smile, a wink, or a grimace may have little meaning.

To a child who misses these cues, "Come here" always means the same thing, whether the speaker

is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without

the ability to interpret gestures and facial expressions, the social world may seem bewildering. To

compound the problem, people on the autism spectrum have difficulty seeing things from another

person's perspective. Neurotypicals 5-year-olds understand that other people have different

Knowledge, feelings, and goals than they have. An autistic person may lack such understanding, an

inability that leaves them unable to predict or understand other people's actions.

Although not universal, it is common for autistic people to have difficulty regulating their emotions.This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem

inappropriate to those around them. The autistic individual might also be disruptive and physically

aggressive at times, making social relationships still more difficult. They have a tendency to "lose

control," particularly when they are in a strange or overwhelming environment, or when angry and

frustrated. They may at times break things, attack others, or hurt themselves. In their frustration,

some bang their heads, pull their hair, or bite their arms.

1.4.4 Self-stimulatory Behavior:


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[9] Autism-part I. (2001, July). The Harvard Mental Health Letter, 17(12), pp.1-4.

[10]Fombonne, E. (2003). The Prevalence of Autism. Journal of the American Medical

Association, 289, 87-89..

[11] Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., and Murphy, C.

(2003)The Prevalence of Autism in a US metropolitan area. Journal of the American

Medica Association, 289, 47-55.

Other indicator of autistic individual is the practice of self-stimulatory behavior. Stereotype or self-

stimulatory behavior refers to repetitive body movements or repetitive movement of objects.

Stereotype can involve any one or all senses.

senses Stereotypic Behavior

Visual Staring at lights, repetitive blinking, moving fingers in front of eyes, hand flapping.

Auditory Tapping ears, Snapping fingers, making vocal sounds

Tactile Rubbing the skin with ones hands or with another object, scratching

Taste Placing body parts or objects in ones mouth, licking objects

Smell Smelling objects, Sniffing people

Ref [15]


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[12] http://www.autism-society.org/site/PageServer

[13] American Psychiatric Association, 1994.

[14] Papalia, D E. (2006). Human Development. 9TH

Edition., Tata Mc Grow-Hill Publishing

Company Ltd, New Delhi.

[15]www.autismpakistan.org[16]http://www.autism-india.org/research_awareness.html

?Ref [16]


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1 . 5 T E C H N I Q U E S F O R D I A G N O S I S A N D E V A L U A T I O N

Diagnosis of autism has remained difficult at best because of a lack of etiology ascribed to this

disability. This has led the medical world to diagnose this condition based solely upon behavioral

criteria. Developing such diagnostic criteria has been important to the scientific community for a

number of reasons. First, because of the heterogeneity of the group, research is difficult. For

researchers to develop a meaningful basis for research it is necessary to develop subgroups, and

relate them based upon similar characteristics. Primarily, autism is separated into three groups for

research purposes, classically autistic, childhood schizophrenics with autistic features, and

neurologically impaired autistic children. Although each group supports many classical autistic

features, different etiology can be ascribed to each subgroup making research more reliable and

reproducible.

1.5.1 Diagnostic criteria:

For administrative and legislative purposes, a more comprehensive listing of diagnostic criteria was

developed by the national society of autism. This list attempts to create a more specific classification

for behaviors displayed by autistic individuals.

o Language deficiency.o Disturbed interpersonal relationships.o Inconsistent responses to sensory stimulation.o Developmental delays. .o Onset prior to 30 months.

Although this creates a descriptive diagnosis for autism, it does not describe symptomatic

behavioral characteristics of the individual. This becomes important because each autistic individual

may display a different series of behaviors, with little or no overlap. In evaluation and diagnosis, as

well as treatment, this heterogeneity can create problems unless a more specific evaluation of the

individual is made. Mainly due to this fact, a large number of more exact evaluation criteria have

been developed to pinpoint the behaviors elicited by the individual.

1.5.2 Related Disorders

It is important to note the similarity in behaviors that may exist between autism and other

disorders. Because of this overlap, many individuals who suffered from autism were originally

inaccurately classified under other disorders, making evaluation and treatment difficult or

ineffective. The following is a short listing of related disorders, and includes the respective

similarities and differences from autism.


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Childhood Schizophrenia

Similarities

Sustained impairment of social relations,

Resistance to make change environment,

Speech abnormalities,

Differences

Age of onset

Family history of mental illness

Poor physical health

Poor motor performance

Higher levels of language skills, and Presence of

delusions and hallucinations

Developmental Aphasia

Similarities

Echolalia,

Pronominal reversal

Sequencing problems

Difficulties in comprehension, and

Secondary problems of social relations

Differences

Language deficits not as pronounced.

Engage in imaginative play.

Usually normal intelligence

Exhibit emotional intentions, and

Meaningful communication through gesture

Mental Retardation

Similarities

Poor intellectual abilities,

Echolalia,

Self-stimulatory behavior

Self-injurious behavior, and

Attentional deficits

Differences

Display appropriate social behavior.

Willingness to communicate

Abnormal physical development

Delayed motor abilities, and

Wide ranging intellectual impairment

Environmental Deprivation

Similarities

Maternal deprivation,

Analytic depression and Hospitalism

Delayed motor skills development.

Delayed speech development

Engage in unusual motor activity, and

Show little interest in toys.

Differences:

Marked improvement in enriched environment

Do not engage in repetitious, stereotypical play.

Do not exhibit echolalia.

Do not exhibit pronominal reversal, and

Do not avoid social contact

.


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1.5.3 Evaluative procedures:

Due to the heterogeneity of the autistic population, evaluation is a key step in the diagnosis as well

as treatment phases. Each individual's behavior must be carefully evaluated to discover what

characteristically autistic behaviors exist. Many early standardized testing procedures were

inappropriate for these children due to language deficits, hyperactivity, and lack of motivation,

attention deficits, and severe withdrawal from environmental stimuli. It was therefore necessary to

develop new testing procedures utilizing interviews and observations that better assess these

children. These tests have become standardized in their own way, allowing physicians, after an

initial evaluation, to determine which tests are most applicable for assessing the child's level in the

respective problem areas. Although some standardized tests, such as is tests, are still able to yield

reliable results for children, these are now normally utilized only for supplemental information.

Assessment procedures may include evaluation in a number of areas beyond those of specific

behaviors. Appraising intellectual abilities and expressive/receptive communication will assist the

physician in creating a treatment program that will potentially yield the best results. Socialmaturation, family interaction, parental behavior, and emotional responses are examined, as well as

physical development. Testing is utilized continuously to evaluate progress in the treatment process.

A number evaluation tools have been developed in recent years, such as the behavior observation

scale for autism (1978), a checklist based upon direct observations which evaluates 67 operationally

defined behaviors. Another such tool is the childhood autism rating scale (1980), this is also based

upon direct observation, and assesses 15 separate sub-scales of behaviors. Unfortunately, test

reliability and validity are undetermined for many areas of the tests due to a lack of sufficient

numbers of subjects tested. It should be noted that evaluation is an essential part of treatment due

largely to the fact that a diagnosis of autism tells little about each individual's affliction.

Heterogeneity of the population makes any single treatment for all individuals impossible.

1 . 6 C A U S E S O F A U T I S M ?

1.6.1 What Causes Autism?

The bottom line is, no one knows for sure what causes autism. Most experts will say that autism is

probably caused by a combination of genetic and environmental factors. Even those experts,

though, do not have a definite answer. For many people, this uncertainty is terribly frustrating. On

the plus side, interest in and funding for autism research is on the rise, so new and better

information should be forthcoming in the next months and years.

1.6.2 A Controversial Topic:

The question of what causes autism is highly controversial. Many people are passionate about the

issue, and hold strong beliefs. Books, articles and TV programs have raised awareness -- and heated

up the argument. This article provides an overview of different theories, all of which have strong

supporters.

1.6.3 Is Autism Genetic?


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It is likely that autism has a genetic basis of some sort. Many studies have shown that parents from

families with autistic members are more likely to have autistic children. It is also the case that many

families with one autistic child are at increased risk of having more than one autistic child.

1.6.4 Is Autism Caused By Atypical Brain Development?

Some researchers have found differences between the autistic brain and the typical brain. Autistic

individuals seem to have larger brains. They also seem to process information differently; in other

words, their brains are "wired" differently. Research on this issue is ongoing at The University of

Pittsburgh.

1.6.5 Is Autism an Immune Deficiency Problem?

There is some evidence that autism is linked to problems in the immune system. Autistic individuals

often have other physical issues related to immune deficiency. Some researchers say they have

developed effective treatments based on boosting the immune system. The NIH, however, statesthat the evidence is not yet strong enough to show a causal relationship.

1.6.6 Is Autism Caused By Food Allergies?

There is some evidence that allergies to certain foods could contribute to autistic symptoms. Most

people who hold to this theory feel that gluten (a wheat product) and casein (a dairy product) are

the most significant culprits. Explore the Autism Institute's website for more on this theory.

1.6.7 Is Autism Caused By Poor Nutrition?

It seems unlikely that malnutrition can cause autism. But megavitamin therapies have been used for

many years to treat autistic symptoms. Dr. Bernard Rimland, of the Autism Institute, has been a

leader in this area.

1.6.8 Do Vaccines Cause Autism?

Two theories link autism and vaccines. The first theory suggests that the MMR (Mumps-Measles-

Rubella) vaccine may cause intestinal problems leading to the development of autism. The second

theory suggests that a mercury-based preservative called thimerosal, used in some vaccines, could

be connected to autism.

1.6.9 So...What DOES Cause Autism?

It likely seems, from the researches so far that autism is genetic, as it seems to run in families,

sometimes environmental factors, such as exposure to certain viruses or chemicals may trigger an

inherited tendency towards it. But most experts will say that several factors combine to cause

autism. For example, it may be that certain children are genetically more susceptible to certain

types of food allergies, or more likely to react badly to certain environmental toxins. The claim that

the rise in autism rates is related to administration of the measles-mumps-rubella vaccine has not

been substantiated.
http://www.autism.about.com/od/causesofautism/a/AutismBrain.htmhttp://www.autismwebsite.com/ari/dan/dan.htmhttp://www.autismwebsite.com/ari/dan/dan.htmhttp://www.autism.about.com/od/causesofautism/a/AutismBrain.htm


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Until we have more definitive answers, though, it seems to make sense to focus more on treatments

-- and to support researchers as they learn more about causes.

1 . 7 D I F F I C U L T I E S F A C E D B Y A U T I S T I C S

1.7.1 Communication:

Autistic children nearly always start learning to talk late, if at all. Their progress with speech is often slow and

the things they say are sometimes quite odd. They may have difficulty understanding what other people say,

and may not seem to notice when people talk to them.

1.7.2 Socialization:

Autistic people lack awareness of other people. They may not respond to other people, or may respond

oddly.

1.7.3 Imagination:

Autistic children rarely have much pretend play. Instead they tend to concentrate on the physical properties

of things, so will like to look at things from odd angles, or line them up, or tap or spin things. They are not

usually able to play interactively with other children.

Other common features:-

o General learning disabilities. About a third of autistic people have severe learning disabilities,and another third have moderate learning disabilities.

o Obsessive interests, for example in trains, or vacuum cleaners, or collecting bottle tops.o An insistence on doing certain things exactly the same way every time; for example always

taking the same route to school. Many autistic children get very upset if their usual routine is

disrupted.

o A patchy profile of abilities; for example some autistic children are very good at computing, orat jigsaw puzzles, or at reading, despite having great difficulties with more simple tasks.

o Odd physical mannerisms, typically hand flapping and jumping up and down when excited, andwalking on tiptoe. The more severely affected children often rock, or bang their heads, or bite

the back of their hands.

1.7.4 Personality Differences:

While autistic people do differ from one another radically, it is fairly typical for people on the

spectrum to:

o Engage in repetitive behaviors and ritualized activities, ranging from lining up items tofollowing a rigid routine,

o Have one or a few passionate interests,o Have difficulty in making and keeping multiple friends,o Prefer activities that require relatively little verbal interaction.


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It also seems to be the case -- for as-yet-undetermined reasons -- that certain interests are of

particular interest to many people on the autism spectrum. For example, an enormous number of

young children with ASD's are fascinated by trains (and the Thomas the Tank Engine toy), while a

great many older children and adults on the spectrum are interested in computers, science,

technology, and animals.

1 . 8 E F F E C T S I N E D U C A T I O N

Autism presents in a wide degree,Children with autism are affected with these symptoms everyday. These unusual characteristics set them apart from the everyday normal student. Because they

have trouble understanding peoples thoughts and feelings, they have trouble understanding what

their teacher may be telling them. They do not understand that facial expressions and vocal

variations hold meanings and may misinterpret what emotion their instructor is displaying. This

inability to fully decipher the world around them makes education stressful. Teachers need to be

aware of a student's disorder so that they are able to help the student get the best out of thelessons being taught.

Some students learn better with visual aids as they are better able to understand material

presented this way. Because of this, many teachers create visual schedules for their autistic

students. This allows the student to know what is going on throughout the day, so they know what

to prepare for and what activity they will be doing next. Some autistic children have trouble going

from one activity to the next, so this visual schedule can help to reduce stress.

Research has shown that working in pairs may be beneficial to autistic children. Autistic students

have problems in schools not only with language and communication, but with socialization as well.They feel self-conscious about themselves and many feel that they will always be outcasts. By

allowing them to work with peers they can make friends, which in turn can help them cope with the

problems that arise. By doing so, they can become more integrated into the mainstream

environment of the classroom.

A teacher's aide can also be useful to the student. The aide is able to give more elaborate directions

that the teacher may not have time to explain to the autistic child. The aide can also facilitate the

autistic child in such a way as to allow them to stay at a similar level to the rest of the class. This

allows a partially one-on-one lesson structure so that the child is still able to stay in a normal

classroom but be given the extra help that they need.

There are many different techniques that teachers can use to assist their students. A teacher needs

to become familiar with the childs disorder to know what will work best with that particular child.

Every child is going to be different and teachers have to be able to adjust with every one of them.

Students with Autism Spectrum Disorders typically have high levels of anxiety and stress, particularly

in social environments like school. If a student exhibits aggressive or explosive behavior, it is

important for educational teams to recognize the impact of stress and anxiety. Preparing students

for new situations by writing Social Stories can lower anxiety. Teaching social and emotional

concepts using systematic teaching approaches such as The Incredible 5-Point Scale or other


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`

[17(a) the Basics by Lisa Jo Rudy, About.com Guide, Updated August 21, 2007

About.com Health's Disease and Condition content is reviewed by the Medical Review Board PROBLEM IDENTIFICATION Chapter 1

Cognitive Behavioral strategies can increase a student's ability to control excessive behavioral

reactions.

1.9 TREATEMENT AND THERAPIES FOR AUTISTIC DISORDER17(a):

Autism has no known cure, but improvement, sometimes substantial, can occur, especially with

early diagnosis and intervention. Some autistic children can be taught to speak, read, and write.

Behavior therapy can help them learn such basic social skills as paying attention, sustaining eye

contact, and feeding and dressing themselves and can help control problem behaviors. Physical and

occupational therapy, highly structured social play situations, and extensive parent training may be

part of the prescribed treatment (Papalia, 2006). Newer, safer medicines have shown effectiveness

in managing specific symptoms (AAP Committee on children with disabilities, 2001; Papalia, 2006).

However, only about 2% of autistic children grow up to live independently; most need some degree

of care through life. Children with Aspergers syndrome generally fare better (Autism -Part II,

2001).

Becausetheir isolation is so moving and their symptoms so pronounced, great deal of attention has

been given to trying to improve the condition of children with autism. More recently, various psych

pharmacotherapies have been studied with positive results. Treatments for autistic children usually

try to reduce their unusual behavior and improve their communication and social skills. Sometimes

an eagerly sought, after goal for a family is simply to be able to take their autistic child to a

restaurant or a market without attracting negative attention.

1.9.1 Behavioral treatment of children with autism:

Using modeling and operant conditioning, behavioral therapists have taught autistic children to talk,modified their echolalia speech, encouraged them to play with other children, and help them

become more generally responsive to adults. There is reason to believe that the education provided

by parents is more beneficial to the child then is clinic or hospital based treatment. Parents are

present in many different situations and thus can help children generalize the gains they make. For

example, Koegel and his colleagues (1982) demonstrated that 25 to 20 hours of parent training was

as effective as 200 hours of direct clinic treatment in improving the behavior of autistic children.

More recently Koegels research group has focused on comparing different strategies for behavioral

parent training with interesting discoveries. One of the first intervention that sought to include

parents in the treatment process TEACHC program, or treatment and education of autistic and

related communication handicapped children, developed by Schopler and colleagues at theUniversity of North Carclina (Schopler, 1986) this Community based intervention emphasizes

parents and teachers working together in the treatment of autism. It must be clearly understood,

however that some autistic and other severely disturbed children can be adequately cared for only

in a hospital or in a group home staffed by mental health professionals.

1.9.2 Psychodynamic treatment of children with autism:

Bruno Bettelheim 1967, 1974 argued that a warm, loving atmosphere must be created to encourage

the child to enter the world and what Rogerinans would call unconditional positive regard were

believed to be necessary for the child with autism to begin to trust others and to take chances in


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establishing relationships. At his ORTHOGENIG SCHOOL at the University of CHICAGO, Bettelheim

and his colleagues reported many instances of success, but the uncontrolled nature of their

observation makes it difficult to evaluate their claims.

1.9.3 Applied Behaviour Analysis:

Applied Behaviour Analysis (ABA) is based on the principle that influencing a response associated

with a particular behaviour may cause that behaviour to be shaped and controlled. ABA is a mixture

of psychological and educational techniques that are tailored to the needs of each individual child to

alter their behaviours. ABA involves the use of behavioural methods to measure behaviour, teach

functional skills, and evaluate progress.

ABA techniques have been proven in many studies as the method of choice on treating deficits in

the behaviours of children with Autism Spectrum Disorder (ASD) at any level. ABA approaches such

as discrete trial training (DTT), Pivotal Response Training (PRT), Picture Exchange Communication

System (PECS), Self-Management, and a range of social skills training techniques are all critical inteaching children with autism. Ultimately, the goal is to find a way of motivating the child and using

a number of different strategies and positive reinforcement techniques to ensure that the sessions

are enjoyable and productive. In all ABA programs, the intent is to increase skills in language, play

and socialization, while decreasing behaviours that interfere with learning. The results can be

profound. Many children with autism who have ritualistic or self-injurious behaviours reduce or

eliminate these behaviours. ABA helps to establish better to normal eye contact and encourages

learning to stay on task. Finally the children acquire the ability and the desire to learn and to do

well. Even if the child does not achieve a best outcome resu lt of normal functioning levels in all

areas, nearly all autistic children benefit from intensive ABA programs.

1.9.4 Speech Therapy:

Almost all people with autism have issues with speech and language. Sometimes these issues are

obvious; many people with autism are non-verbal or use speech very poorly. Sometimes the issues

relate not to articulation or grammar but to "speech pragmatics" (the use of speech to build social

relationships). Across the board, though, speech and language therapy is likely to be helpful for

people with autism.

o Why Would a Person With Autism Need to See a Speech Therapist?Almost anyone diagnosed with an autism spectrum disorder will be recommended for speech

therapy. This may seem odd, as many autistic people are either non-verbal (at the lower end of the

spectrum) or extremely verbal (at the upper end of the spectrum). But even very verbal people with

Asperger Syndrome are likely to misuse and misunderstand language on a regular basis. And even

non-verbal people can certainly develop communication skills - and may even develop spoken

language skills over time.

o What Does a Speech Therapist Do for People with Autism?


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Speech therapy involves much more than simply teaching a child to correctly pronouncewords. In fact, a speech therapist working with an autistic child or adult may work on a wide

range of skills including:

Non-verbal communication: This may include teaching gestural communication, or trainingwith PECS (picture exchange cards), electronic talking devices, and other non-verbal

communication tools.

Speech pragmatics: It's all well and good to know how to say "good morning." But it's just asimportant to know when, how and to whom you should say it.

Conversation skills: Knowing how to make statements is not the same thing as carrying onconversations. Speech therapists may work on back-and-forth exchange, sometimes known

as "joint attention."

Concept skills: A person's ability to state abstract concepts doesn't always reflect their abilityto understand them. Autistic people often have a tough time with ideas like "few," "justice,"

and "liberty." Speech therapists may work on building concept skills.

1.9.5 Occupational Therapy:

Occupational therapy focuses on building daily living skills. Since many people with autism have

delays in fine motor skills, occupational therapy can be very important. Occupational therapists may

also have training in sensory integration therapy - a technique which may help autistic people

manage hypersensitivity to sound, light, and touch.

o Why Would a Person With Autism Need to See an Occupational Therapist?In the case of autism, occupational therapists (OT's) have vastly expanded the usual breadth of their

job. In the past, for example, an occupational therapist might have worked with an autistic personto develop skills for handwriting, shirt buttoning, shoe tying, and so forth. But today's occupational

therapists specializing in autism may also be experts in sensory integration (difficulty with

processing information through the senses), or may work with their clients on play skills, social skills

and more.

o What Does an Occupational Therapist Do for People with Autism? Since people with autism often lack some of the basic social and personal skills required for

independent living, occupational therapists have developed techniques for working on all of

these needs. For example: Provide interventions to help a child appropriately respond to information coming through

the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole

gamut of other activities aimed at helping a child better manage his body in space.

Facilitate play activities that instruct as well as aid a child in interacting and communicatingwith others. For the OT specializing in autism, this can translate specifically into structured

play therapies, such as Floortime, which were developed to build intellectual and emotional

skills as well as physical skills.

Devise strategies to help the individual transition from one setting to another, from oneperson to another, and from one life phase to another. For a child with autism, this may


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involve soothing strategies for managing transition from home to school; for adults with

autism it may involve vocational skills, cooking skills and more.

Develop adaptive techniques and strategies to get around apparent disabilities (for example,teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to

enhance focus; etc.)

1.9.6 Social Skills Therapy:

One of autism's "core deficits" is a lack of social and communication skills. Many children with

autism need help in building the skills they need to hold a conversation, connect with a new friend,

or even navigate the playground. Social skills therapists can help out setting up and facilitating peer-

based social interaction.

o Why Would a Person With Autism Need to See a Social Skills Therapist?One of the most significant problems for people on the autism spectrum is difficulty in socialinteraction. This difficulty is, of course, made more significant by problems with speech and

language. But autism also seems to create problems with "mind reading" -- that is, with knowing

what another person might be thinking. Most people can observe others and guess, through a

combination of tone and body language, what's "really" going on. In general, without help and

training, autistic people cant. This "mind blindness" can lead even the highest-functioning person

on the autism spectrum to make social blunders that cause all kinds of problems. Without knowing

why, a person on the autism spectrum can hurt feelings, ask inappropriate questions, act oddly or

generally open themselves up to hostility, teasing, bullying and isolation.

o What Do Social Skills Therapists Do for People with Autism? Since there is no official certification for social skills therapists, techniques vary. In a school

setting, social skills therapy may consist of group activities (usually games and conversation)

with autistic and typically developing peers. Groups may be overseen by school psychologists

or social workers, and may be held in the classroom, lunchroom or playground. Generally

speaking, school social skills groups focus on game playing, sharing and conversation.

Out-of-school social skills groups are similar in style, but are paid for privately (medicalinsurance is unlikely to cover such programs). Children are grouped by age and ability, and

may make use of specific social skills curricula as developed by well-established practitionersof social skills therapy.

Drama therapy, a variation of social skills therapy, is somewhat unusual -- but where it'soffered, it has the potential to be both fun and educational. Video modeling, video critiques

of interactions, group therapy and other approaches may also be available in your area, and

are especially appropriate for teens and adults. Typical cognitive therapy with a psychologist

or psychiatrist may also be helpful.

In theory, social skills therapy will provide people on the autism spectrum with the ability toconverse, share, play and work with typical peers. In an ideal world, such therapy will allow

people on the autism spectrum to become almost indistinguishable from their typical peers.


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In fact, social skills therapy tends to be offered no more than an hour or two a week -- andwhile it may provide autistic learners with specific skills and techniques ("look at a person's

face when you're conversing," for example) it's unlikely to make an autistic person appear

typical. A program most likely to have such an impact would be very intensive -- unlike the

vast majority of existing social skills programs.

1.9.7 Physical Therapy:

o Why Would a Person With Autism Need to See a Physical Therapist?Autism is a pervasive developmental disorder. This means that most people on the autism spectrum

have delays, differences or disorders in many areas -- including gross and fine motor skills. Children

on the spectrum may have low muscle tone, or have a tough time with coordination and sports.

These issues can interfere with basic day-to-day functioning -- and they're almost certain to

interfere with social and physical development. Children with autism would rarely be termed

physically disabled (though there are some autistic children with very low muscle tone, which maymake it difficult to sit or walk for long periods). Most children with autism do, however, have

physical limitations.

o What Does a Physical Therapist Do for People with Autism? Physical therapists may work with very young children on basic motor skills such as sitting,

rolling, standing and playing. They may also work with parents to teach them some

techniques for helping their child build muscle strength, coordination and skills.

As children grow older, physical therapists are more likely to come to a child's preschool orschool. There, they may work on more sophisticated skills such as skipping, kicking, throwingand catching. These skills are not only important for physical development, but also for social

engagement in sports, recess and general play.

In school settings, physical therapists may pull children out to work with them one-on-one,or "push in" to typical school settings such as gym class to support children in real-life

situations. It's not unusual for a physical therapist to create groups including typical and

autistic children to work on the social aspects of physical skills. Physical therapists may also

work with special education teachers and aides, gym teachers and parents to provide tools

for building social/physical skills.

1.9.8 Play Therapy:

One of autism's "core deficits" is a lack of social and communication skills. Many children with

autism need help in building the skills they need to hold a conversation, connect with a new friend,

or even navigate the playground. Social skills therapists can help out setting up and facilitating

peer-based social interaction.

o Why Would a Person With Autism Need to See a Play Therapist?Autism is largely a social-communication disorder. Children with autism find it extremely difficult to

relate to others -- particularly to peers -- in ordinary ways. Instead of playing with toys in


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imaginative or symbolic ways (pretending a doll is really "my baby," for example) they may

perseverate on objects, use them for self-stimulation, and become entirely self-absorbed. Play is a

wonderful tool for helping children (and sometimes even adults) to move beyond autism's self-

absorption into real, shared interaction. Properly used, play can also allow youngsters to explore

their feelings, their environment, and their relationships with parents, siblings and peers. Very

often, too, play therapy can allow parents to take an active role in their autistic child's growth and

development. Play therapy can be taught to parents, and, over time, parents can become their

child's therapist while also building a stronger, more meaningful relationship.

o What Does a Play Therapist Do for People with Autism? A good play therapist will get down on the floor with your child and truly engage him

through the medium of play. For example, the therapist might set out a number of toys that

a child finds interesting, and allow her to decide what, if anything, interests her. If she picks

up a toy train and runs it back and forth, apparently aimlessly, the therapist might pick up

another train and place it in front of the child's train, blocking its path. If the child responds --verbally or non-verbally -- then a relationship has begun.

If the child doesn't respond, the therapist might look for high-interest, high-energy optionsto engage the child. Bubble blowing is often successful, as are toys that move, squeak,

vibrate, and otherwise DO something.

Over time, the therapists will work with the child to build reciprocal skills (sharing, turn-taking), imaginative skills (pretending to feed a toy animal, cook pretend skills) and even

abstract thinking skills (putting together puzzles, solving problems). As a child becomes

better able to relate to others, additional children may be brought into the group, and more

complex social skills are developed.

Many parents find they can do play therapy on their own, using videotapes and books as aguide. Others rely on the experience of trained play therapists. And still others choose to

simply bring their children to a play therapist or have the therapist come to their home. In

any case, play therapists can provide parents with tools to connect with and have fun with

their children on the autism spectrum.

1.9.9 Behavior Therapy:

Children with autism are often frustrated. They are misunderstood, have a tough time

communicating their needs, suffer from hypersensitivities to sound, light and touch ... no wonder

they sometimes act out! Behavior therapists are trained to figure out just what lies behind negativebehaviors, and to recommend changes to the environment and routines to improve behavior.

o Why Would a Person With Autism Need to See a Behavior Specialist?Almost everyone on the autism spectrum has at least some challenging behaviors. These may range

from the odd (spinning, flapping) to the self-injurious (head banging) to the truly dangerous (hitting,

kicking, dashing into traffic). Autistic people may also find undesirable ways to avoid doing what

they don't want to do: they may hum, slide under the table, or otherwise avoid non-preferred

activities. Often, parents and teachers are uncertain how to manage these behaviors. Unlike many

people, they are not deliberately misbehaving -- nor are they seeking attention. For the average


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educator or caregiver, it's hard to know how to improve behaviors while also, for example, cooking

dinner or teaching 20 other children.

o What Does a Behavior Specialist Do for People with Autism? The role of the behavior specialist is to walk into a setting, observe the environment, the

activities, and the person in question; to gather data about what seems to set off or calm

difficult behaviors; to suggest appropriate changes and/or interventions; and to troubleshoot

until the interventions are successful. Interventions may range from behavior charts with

stickers and motivational prizes to changes in an environment that is creating sensory

overload or undue frustrations.

Ideally, by involving a behavior specialist, a parent or teacher can develop a positive set oftools to manage behaviors, improve outcomes, and generally make life easier for everyone.

In the best of circumstances, it may be relatively simple to change a situation for the better.

Changes in lighting, the addition of a visual schedule, extra warning time before transitions

and similar small tweaks can vastly improve the lives of people on the autism spectrum.

1.9.10 Developmental Therapies:

Floortime, Son-rise, and Relationship Development Intervention (RDI) are all considered to be

"developmental treatments." This means that they build from a child's own interests, strengths and

developmental level to increase emotional, social and intellectual abilities. Developmental therapies

are often contrasted to behavioral therapies, which are best used to teach specific skills such as

shoe tying, tooth brushing, etc.

o Pros and Cons of Developmental Therapies for AutismIt's important to note that developmental therapies are extremely child-oriented, which means that

there is no one-size-fits-all approach. In addition, they demand a great deal from parents.

Developers of these therapies see the family as the key to an autistic child's development, and they

want to see parents take on the lion's share of actual, day to day intervention. But because there is

no specific curriculum or single "approved" approach (after all, each child is unique), parents are

called upon to be very creative, engaged and energetic -- and must be willing and able to become a

therapist to their own child.

When a parent is personally and financially available, developmental therapy can be terrific.Speaking from my own experience with Floortime, I can say that therapeutic play can be fun,

exciting and fulfilling. But there is a danger that parents who take on developmental therapy in their

own home can become exhausted, overwhelmed, and even guilt-ridden. This is especially the case

when, as so often happens, mothers leave their careers to care for their autistic child -- and find that

they may not be cut out to be fulltime therapists to their own offspring!

Of course, help is available -- but very little of that help is supported financially through insurance.

And while it's possible to convince a school district to provide developmental therapy for a

preschooler, it is a gargantuan task to push a district into individualized developmental

programming as a child moves into elementary school.


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Unlike behavioral therapies, developmental therapies are relatively new -- and relatively poorly

researched. While there is evidence that developmental approaches can be effective, no one has

actually compared developmental therapies head to head. And there is very little research

comparing the relative outcomes of developmental versus behavioral therapies. It may be the case

that the outcomes depend largely upon (a) the child's constellation of issues, deficits and strengths

and (b) the parent's ability to provide a great deal of high quality engagement.

All this said, however, developmental therapies have several great advantages.

First, their impact is almost instantly obvious. After just one or two sessions, parents see thattheir child really CAN engage with them, even if on a very simple level -- and that

engagement is inspirational.

Second, if you have the inclination, it is possible to do a creditable job of developmentaltherapy in your own home for very little money (just invest in a book and set of videos).

Third, if you enjoy pretend play than developmental therapy can be a lot of fun. Fourth, again, if you enjoy the process, developmental therapy can be a terrific way to build

a relationship with your child with autism.

It's really impossible to injure a child through developmental therapy; the worst thathappens is that nothing really comes of it!

o Floortime/DIR (Developmental, Individual Difference, Relationship Based Therapy:Floortime/DIR was developed by Dr. Stanley Greenspan and associates. Its basic premise is that

autistic individuals learn to communicate when they are engaged at their own level, and by things

that interest them. Whether a child is lining up cars, flapping their hands or reading Harry Potter,there is a way to connect. As the therapist begins to establish a relationship with the child, the child

begins to respond -- whether verbally or non-verbally. Over time, the child starts to open and close

"circles of communication" -- at first by knocking the parent's hand away, or by leading the parent to

a favored toy that's out of reach; later through words and multiple exchanges.

o RDI(Relationship Development Intervention)RDI is similar to floortime in that addresses "core deficits" through individualized therapy -- and the

parent is the primary therapist. Some of the most important differences appear to be the level of

support and clarity of direction provided by the RDI organization. Dr. Steven Gutstein, creator ofRDI, has established a formal organization which trains consultants. Consultants work with parents

to evaluate children and create personalized therapeutic programs. They also put together concrete

benchmarks, so that parents know they have reached their goals.

o Son-RiseThe therapeutic concept behind Son-Rise is very similar to that of Floortime: parents become

therapists, and engage with their child at their child's own level of interest. Over time, relationships

and skills emerge. Some of the key differences include a tremendous focus on the idea of the family

as the key to success, and love and respect as the tools for success. There is also a focus on the


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home as the source of security and the foundation for growth. In practice, this translates into a

series of on-site workshops for parents and children, followed by a very unusual lifestyle in which

parents (or one parent) are homebound for a very protracted period of time. Son-Rise does

recommend that families recruit volunteers to work with their children in the home.

1.10 CONCLUSION:

Autism is not a disease but a neurological disorder, characterized by multiple disabilities. They are

slow learners and could not interpret and analyze what others are thinking and expecting of them,

their ability to instinctively empathize with others is also much weaker than normal peoples. But

they do feel love, happiness, sadness and pain just like everyone else. Just because some of them

may not express their feelings in the same way others do, does not mean at all that they do not

have feelings they do!!

The children are not crazy or retarded but simply cannot react or respond to normal stimulus

around them; autistic children act as though they were indifferent to everything around them, asthough they were in a world of their own. The condition is often accentuated by lack of early

diagnosis and detection, due to its varying nature and complicated symptoms, and individual

specific interventions. With early detection and help many can live a normal live but all can surely

improve with specialized professional help and therapy and the sooner the child receives said help

and therapy, the better for the child and family.

chapter 1-problem identification

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