Autism a Communication and Social Disorder

Autism is a brain disorder that is characterized by impaired social interaction and delayed communication skills. (Segal, 1996) Children with Autism show signs of delay in the first two years of life. Many times parents notice that their child demonstrates repetitive behaviors, or likes to spin objects, line things up or has an affinity for sameness. Some children with Autism have difficulty with transitions from one activity to another and are not able to regulate their senses. The range of these behaviors varies and that is why Autism is called a spectrum disorder. Many times, children will exhibit one or several of the symptoms. Children who exhibit fewer symptoms are diagnosed with PDD or Pervasive Developmental Delay, while children who have many of the symptoms are termed Autistic. There is recent research that shows that autism may be caused by genetics which are related to how the brain develops in early childhood. In the article, Autism and Brain development, Nancy Shute reports that some kind of mutations of genes that are important to language development may be the cause of autism in some children. Daniel Geschwind is researching the fact that these genes are sometimes turned on or off depending on the brains experiences. † (Shute). There is also a chance that â€Å"structural damage will be found, and this damage could be anything from microscopic to the grossly visible, from faults inside nerve cells to faulty development of whole cell systems. † (Frith) The causes of Autism are still being explored, but the more important thing is how people are diagnosed and treated for it. The symptoms of Autism are variable, and usually different in each child. Delay of language development, lack of social skills and lack of eye contact are a few of the symptoms. Because there is a range in the severity of the symptoms the diagnosis and treatment of autism varies and is an interesting process. The diagnosis of autism is based on a behavioral check list. â€Å"Because a diagnosis is a label or shorthand for treatment, it needs to correspond to the services to the child needs in the immediate future. † (Siegel) The parents, teachers, developmental pediatrician and sometimes other therapists all contribute to the assessment. The CHAT, Checklist of Autism in Toddlers is one way that pediatricians screen children under 2 years old for Autism. For children 4 years and older, a Social Communication Questionnaire is often used. These screenings rely on parent report and the observation of a diagnostic team. Then the child will be referred to a developmental pediatrician or a psychologist who is trained in diagnosis of Autism. There are several diagnostic tools, usually developmental checklists, and parent report along with a team of professionals who look at the behavioral symptoms that are characteristic of this disorder. The team of professionals who diagnosis autism typically include the parent, speech therapist, teacher, pediatrician and occupational therapist. The most widely used diagnostic tool for Autism is the ADOS, (Autism Diagnostic Observation Schedule). The North Bay Regional Center uses this to diagnose children with autism in this area. There are also other centers, the Mind Institute with is part of the University of Davis medical Center, where they focus only on diagnosis of Autism spectrum disorders. Bryna Siegel is a Psychologist who works at UCSF and has her own diagnostic clinic. Each case of autism has its own individual characteristics ranging between its cause, its diagnosis and the life long treatment. After being diagnosed, different therapy options are presented; PECS, play therapy and discrete trial are the three more commonly used treatments. What is best for children with Autism is an early diagnosis, and intensive speech and language therapy which includes the family. Dr. Stanly Greenspan has developed the â€Å"Floortime† approach to helping families learn to interact with their children. â€Å"Autism and ASD’s involve difficulties in relating forming relationships, communicating, and thinking. (Greenspan) Play therapy also gives parents a chance to learn to communicate nonverbally with their autistic child. One of the most effective styles of play therapy is called floor time. â€Å"In playing with their child, parents can help her develop her social skills and also connect with their child through this nonverbal style of communication. The floor time/play therapy that a speech therapist directs is used to â€Å"harness the child’s natural interests. † (Greenspan) in doing so they are able to â€Å"get a picture of what she finds enjoyable, what motivates her. (Greenspan) and is considered as the best method for supporting the language and social communication development of the child with autism. Speech therapy is one of the most important pieces of the team approach to help children with Autism develop social and communication skills. The goal of speech therapy in working with children with autism is to help the child communicate her needs and wants. A specific therapy program is individualized for each child. There are as many programs as there are children. There are a wide range of therapies that facilitate language development in children with Autism. Normally language and play go off one another when both are impaired; they are likely to mutually inhibit the development of the other. † (Siegel) While there are other therapies, play therapy is considered one of the most effective ways to understand nonverbal communication in autism. Children with Autism can benefit from play therapy. The therapy is based on the child’s own interests. Children with autism do not play with toys in a functional way. â€Å"One thing that is often different about the sensory development of autistic children is its repetitiveness. This is also referred to as perseveration. Instead of pulling a string or handle on a â€Å"speak and say† five or six times, the autistic of PDD child may engage in such an activity for 20 minutes without stopping. † (Siegle) Play therapy teaches the child to play with toys in ways that use imagination and are symbolic. And since imagination is obscured in autistic minds this is very important. Even though it may not be clear in a young child it can be observed in some situations such as a â€Å"Two year old autistic children (who) ‘play telephone’. They pick up the receiver and punch the buttons on the toy phone. Then they put the receiver down, less often will you see the autistic two year yammering, as if talking to someone. What is really never seen in the successive ‘calls’ – say to grandma, big bird, or the family dog. That type of elaboration on a toy thing is beyond the slope of imagination of most autistic children instead, the physical actions copied strictly from what has been observed in the past is playlalia. † (Siegle) Play and speech therapy, paired with pictures is one of the ways that speech therapists and parents encourage language. Often the child with Autism uses a picture to exchange for a desired item this is called PECS. This picture exchange system is important and can be used after observing and playing with the child to determine what toys the child is interested in. It is used as a stepping stone for communication with the outside world. The picture exchange system is a way for children with Autism to communicate using pictures. This is a good way for them to make their needs and wants met. Many children with autism have tantrums or do not want to cooperate with their teacher or parents. The best way to find out what a child with autism wants is to use this simple system. Since many people on the autism spectrum tend to learn visually, it makes good sense to communicate with images. Just as important, images are a universal means of communication – and they are just as understandable by strangers or young peers by parents or therapists. † (Rudy) When the parent knows what the child wants, they can use the picture of the desired item as a reinforcer to help the child cooperate with the parents directions. Sometimes the parent will offer the child two pictures as choices. Other times the parent can use the picture of an activity that needs to be accomplished and a picture of a desired item. Then the parent can say, first wash hands and then you can have bubbles. The child learns this routine and is able to communicate, and follow the parent’s directions. There is a more complex style of picture exchange system where the speech therapist starts with one item paired with an object. The speech therapist then asks the child â€Å"want cookie†, showing the child a picture of a cookie and the cookie. When the child understands that the picture represents the cookie then the child is ready to use the pictures for other choices. Later the child is using pictures to help form sentences. There are many ways that speech therapists use pictures to encourage language. Often the speech therapist works with the behaviorist to develop a system that will provide reinforcers for the child. These reinforcers help the child to stay motivated during therapy. The behavioral therapy or Discrete Trials therapy is often used along with speech therapy. â€Å"Discrete trial training is conducted using intensive drills of selected materials. A specific behavior is prompted or guided, and children receive reinforcement for proper responses. † (What is Discrete Trial Training? This is a program that teaches a child with autism specific information in small units which are less distracting for the child. Because children with autism are so distractible or may want to obsess on spinning or other behaviors, the discrete trial helps them to focus on learning vocabulary, names of animals, math and pre reading skills. The occupational therapist is also important to the treatment of children with Autism. This therapist often uses sensory integration techniques to help the child with Autism develop self regulation. Many of the children with autism have self stimulatory behaviors with are sometimes their way to regulate, their senses. These self stimulatory behaviors may not be as effective as the specific movement, vestibular, or deep pressure, proprioceptive, or sensory, touch and brushing that the occupational therapist uses. The parents of the child with autism are invited to observe what the therapist recommends, and then they can use many of the recommendations at home to help calm their child. Many children with autism are sensitive to loud noises, and are sometimes very sensitive to tags in the back of their shirts, or the seams on their socks. The book, â€Å"The Out of Sync Child† by Carol Stock Kranowitz, has many suggestions for children who are sensitive to noise, light, and touch. The research is clear that the first step is early intervention using a team approach early diagnosis and treatment specific to the individual child is the most helpful thing you can do. Although it takes patience and understanding (with the trial and error); with the numerous treatments available every child can be helped. The diagnosis is the first step, and when treatment is started early, the team approach is the beginning of optimal treatment for the child.