Autism Spectrum Disorder

Autism is a severely incapacitating, lifelong developmental disability. The word ‘Autism’ comes from “autos”, the Greek word for “self”, and an autistic child is often referred to as someone who lives in a world of his own. Autism affects a child’s ability to communicate, understand language, play, and relate to others. It is a condition with wide-ranging degrees of severity, which is why it is often referred to as Autistic Spectrum Disorder (ASD).

It is present at birth or appears within the first three years of life. However, difficulties in diagnosis may mean that it is not detected until much later in life. Autism occurs by itself or in association with other disorders

Prevalence

Once considered to be a very rare condition, affecting only 3-4 individuals in every 10,000, recent studies have suggested much higher prevalence rates, mainly due to the raised awareness and availability of diagnosis services. If people within the wider 'autistic spectrum' are included the prevalence rate can be as high as 60 per 10,000. The current estimate of the number of people with an ASD from the Centers for Disease Control and Prevention in the USA is 2 to 6 per 1,000.

There have been no accurate studies made in Singapore to establish exact prevalence rates here but it is likely that, based on prevalence rates worldwide, the figure will be in the region of 56 per 10,000 of the total population. As it is a spectrum disorder, prevalence figures depend on the criteria used. If one counts only those with classical autism the figure would be much lower. Lack of awareness and misguided feelings of stigma disguise the fact that this disability is more common than once thought

Autism strikes males about four times as often as females in all countries.

Cause

There is no theory of the cause of autism which everyone has found convincing. There is no single known cause for ASD - there may be multiple causes. It has been found throughout the world in families of all racial, ethnic and social backgrounds. Family income, lifestyle and educational levels do not affect the likelihood of a child having autism. No known factors in the psychological environment of a child have been shown to cause autism. The patterns of behavior from which ASD is diagnosed may not be the result of a single cause. Research is continuing to discover the possible causes and the gene(s) involved.

Characteristics

The range of intellectual ability in children with an ASD is considerable. It ranges from those who are severely learning-disabled to those who have average or above average intellect. There are some children who are linguistically fluent whilst others are mute. No two people with ASD will be affected by this disability in the same way. One person will have strengths in areas where another experiences a weakness.

Children with ASD do not look any different from other people and sometimes this leads us to refer to autism as the “invisible disability” This makes awareness more problematic.

ASD can occur in association with a psychological or physical disability such as epilepsy, Down's Syndrome or Cerebral Palsy. Children with ASD may also have extra problems such as Dyslexia or a language disorder.

The severe form of the syndrome may include extreme self-injurious, repetitive, highly unusual and aggressive behavior. Most individuals with autism have limitations in their ability to understand the meaning of their experiences. Even the most intelligent students with autism are frequently confused or uncertain about expectations and customs. Everyone with ASD has impairments, in varying degrees, in three distinct areas referred to as the Triad of Impairments:

1. Social & Emotional Understanding
Social interaction is for most people an essential part of life. For people with autism being sociable is difficult, scary and very confusing. Some appear to withdraw and become isolated; others try very hard to be sociable but never seem to get it right. People with autism can find friendships difficult. Other people's feelings and emotions can also be difficult to understand. This must feel like coming from another planet.

2. Communication
Autism affects the ability of a person to understand the meaning and purpose of spoken and body language and the written word. Words can be misunderstood, interpreted literally or not understood at all.

3. Lack of Flexibility
A change of routine can be very difficult to cope. Most individuals with autism prefer to stick to the same routine. Rituals and routines bring order to chaos and confusion and also provide a sense of comfort.

Individuals with ASD may also exhibit some or all of the following problems:

Speech - absent, delayed or showing abnormal patterns.

Play - isolated, destructive unimaginative, obsess ional, repetitive, e.g. arranging objects in a line or watching the same video repeatedly.

Obsessions - with objects, places, people, activities, food, or staring at things that spin.

Body movements - toe walking, flapping, tapping, flicking or spinning objects.

Self injury - hand biting or head banging.

Repetitive actions - e.g. switching the lights on and off constantly. Many researchers believe that repetitive movements and activities are a strategy that children with ASD may develop to screen out excessive stimulation from an environment that they find confusing, distressing and complex.

Sensory Sensitivities - Abnormal sensory perception in all or some senses: sight, hearing, touch, smell, taste, balance, pain.

Other characteristics could be
o Poor eye contact.
o Poor motor co-ordination leading to clumsiness, odd gait and posture.
o Over- or under-activity.
o Abnormalities of mood.
o Abnormalities of eating, drinking, sleeping.
o Additional developmental disorders.

Many people with autism are described as having behaviors that are challenging or disruptive. Impairments in Communication and Social Interaction and the cognitive difficulty in understanding what is expected of them produce a range of behavior that have become linked with autism spectrum disorders. It is extremely rare for a student with autism to be deliberately defiant or provocative. The student might be driven by strong impulses to act regardless of rules or consequences, or might be agitated and overwhelmed by sensory stimulation in the room. The rules might be too abstract or too vague.

Special Abilities

Approximately 1 per cent of people with ASD have special abilities in some areas such as music, art, and mathematical calculations. Some have remarkable memories, and can remember facts about specific subjects such as train timetables. This is the form of autism that most people have some knowledge of, through watching the film "Rain Man". It must be stressed that this is the exception, and not the norm
Studies have shown that Autism is
NOT a form of mental illness
NOT a result of bad parenting
NOT due to psychological trauma
NOT due to an impoverished environment
NOT contagious
NOT a gift of intelligence

Diagnosis

To date, there are no medical tests like x-rays or blood tests that detect autism. And no two children with the disorder behave the same way. In addition, several conditions can cause symptoms that resemble those of autism. It is important to distinguish autism from retardation or mental disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques.

Autism specialists use a variety of methods to identify the disorder. Using a standardized rating scale, the specialist closely observes and evaluates the child's language and social behavior. A structured interview is also used to elicit information from parents about the child's behavior and early development.

Diagnostic Criteria

After assessing observations and test results, the specialist makes a diagnosis of autism only if there is clear evidence of:
• Poor or limited social relationships
• Underdeveloped communication skills
• Repetitive behaviors, interests, and activities

People with autism generally have some impairment within each category, although the severity of each symptom may vary. The diagnostic criteria also require that these symptoms appear by age 3.
However, some specialists are reluctant to give a diagnosis of autism. They fear that it will cause parents to lose hope. As a result, they may apply a more general term that simply describes the child's behaviors or sensory deficits. "Severe communication disorder with autism-like behaviors," "multi-sensory system disorder," and "sensory integration dysfunction" are some of the terms that are used. Children with milder or fewer symptoms are often diagnosed as having Pervasive Developmental Disorder (PDD).

Although terms like Asperger's Disorder and PDD do not significantly change treatment options, they may keep the child from receiving the full range of specialized educational services available to children diagnosed with autism. They may also give parents false hope that their child's problems are only temporary.

Cure

There is also no known cure for ASD at this time. Children with ASD become adults with ASD. Education and training will help, but not cure. Some behaviors may moderate over time, especially when the child reaches adulthood. It is treatable and manageable, especially if children receive early intervention treatment to maximize their skills.

Studies of adults with ASD show that, most need some form of support, to varying degrees, throughout their lives. The level of independence and quality of life the person with ASD achieves depend on a number of factors, including the severity of the disorder and the availability of specialist support services. Some people with high functioning autism or Asperger Syndrome do manage to lead reasonably independent lives. Several of them have gone on to tell their stories in autobiographies.

Treatment & Education
There is no standard, universally accepted treatment of autism. There are several well-developed and widely used approaches the treatment of Autism and education of autistic children that are quite different, and parents of an autistic child might find themselves involved in such a program without being fully aware of the alternatives or the general opinions on the approach. In general, each of the methods of treatments has its enthusiastic supporters (or it wouldn't exist) and its detractors, thus there is a "camp" associated with each treatment.
Some approaches which have large circles of adherents:
• Biochemical (food allergies, medication, food and vitamin supplements)
• Neurosensory (Sensorial Integration, over stimulation and patterning, Auditory Integration Training, Speech & Language Therapy, Picture Exchange Communication System (PECS), Facilitated Communication, daily life therapy)
• Psycho-dynamic (holding therapy, psychotherapy and psychoanalysis, option institute (which also falls in behavioral))
• Behavioral (Discrete trials (Lovaas and others), behavior modification with and without aversive, TEACCH)

A number of treatment approaches have evolved in the decades since autism was first identified. Clearly, it is important to have centers of expertise for PDD, autism, and related disorders in order to help families and institutes in experimenting and choosing the right therapy for each child. Researchers have begun to identify factors that make certain treatment programs more effective in reducing- or reversing-the limitations imposed by autism. Treatment programs that build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior, seem to produce the greatest gains.
Behavioral approaches are backed by scientific studies as well as anecdotal evidence. The best known, because of the amount of related scientific literature, are Lovaas' version of discrete trial and the North Carolina TEACCH programs. Both are very structured programs with a lot of positive reinforcement, two factors that seem to be important.
Some therapeutic programs focus on developing skills and replacing dysfunctional behaviors with more appropriate ones. Others focus on creating a stimulating learning environment tailored to the unique needs of children with autism.
There are a number of methods & techniques used in the education of autistic children. Any educational program if done intensively, produces some positive results. There are rare cases of recovery claimed by every educational method. In addition, some methods have been reported by parents as producing negative results.
Many teachers use a variety of combination of methods. Some teachers attempt to identify an individual student's learning style and modify curriculum and materials to suit the student's learning style. For example, many children with autism are visual learners. Teachers will use pictures, charts and visual representations when teaching. Materials developed for children with learning disabilities who are visual learners are often helpful. Teachers also use concrete materials for students who learn well through their tactile senses.
A general comment: autistic people don't generalize very well, and one technique used to accommodate this is to give them the opportunities to practice skills in real situations, not mock-ups. Use real money to teach about money, use real foods to teach about food, cooking, and nutrition, use real public places (stores, libraries, etc) to teach about public behaviors.

Parent involvement has also emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home. Research is beginning to suggest that mothers and fathers who are trained to work with their child can be as effective as professional teachers and therapists.

Hope

Today, more than ever before, people with autism can be helped. A combination of early intervention, special education, family support, and in some cases, medication, is helping increasing numbers of children with autism to live more normal lives. Special interventions and education programs can expand their capacity to learn, communicate, and relate to others, while reducing the severity and frequency of disruptive behaviors. Medications can be used to help alleviate certain symptoms. Older children and adults may also benefit from the treatments that are available today. So, while no cure is in sight, it is possible to greatly improve the day-to-day life of children and adults with autism.

A child who receives effective therapy and education has every hope of using his or her unique capacity to learn. Even some who are seriously mentally retarded can often master many self-help skills like cooking, dressing, doing laundry, and handling money. For such children, greater independence and self-care may be the primary training goals. Other youngsters may go on to learn basic academic skills, like reading, writing, and simple math. Many complete high school. Some, like Temple Grandin, may even earn college degrees. Like anyone else, their personal interests provide strong incentives to learn. Clearly, an important factor in developing a child's long-term potential for independence and success is early intervention. The sooner a child begins to receive help, the more opportunity for learning. Furthermore, because a young child's brain is still forming, scientists believe that early intervention gives children the best chance of developing their full potential. Even so, no matter when the child is diagnosed, it's never too late to begin treatment.