This is from a presentation I heard on autism by a clinical psychologist...
Autistic Disorder
A. Essential Feature
- markedly abnormal social interaction and communication and a
markedly restricted repertoire of activity and interests.
- A neurological disorder that overwhelms the brain with sensory
information. (Not from DSM.) This is a guess as to what is going on
in the minds of children with autism.
B. History
1.) Leo Kanner, 1943, was the first to conceptualize autism as (1)
sense of isolation and aloneness, (2) sense of sameness, (3) muteness
C. Diagnostic Criteria
a) Qualitative impairment in social interaction , as manifested by at
least 2 of the following.
b) Qualitative impairments in communication as manifested by at least
one fo the following:
c) Restricted repetitive and stereotyped patterns of behavior,
interests, and activities, as manifested by at least one of the
following:
2.) Onset prior to age 3 years
D. Causes-unknown. Some suspected causes are:
1.) Structural Brain Abnormalities-abnormal size and shape of
cerebellum and abnormal prefrontal and cingulated cortex.
2.) Chromosomal abnormality (most likely polygenetic)
3.) Genetics may influence the likelihood of autism, but it is not
deterministic. There is only a 3-8% reoccurrence within families that
already have one autistic child.
4.) Myth
- MMR vaccine. Symptom onset coincides with first vaccine at 12 to 15 months.
- In 1998 Wakefield et al. study based on 12 patients
- Speculated that the MMR vaccine caused bowel problems which then
caused a decreased absorption of essential vitamins and nutrients.
This si what supposedly caused the developmental disorders.
- There was no scientific analysis with this.
- In at lest 4 of the 12 cases behavioral problems were apparent
before the vaccine.
- There has been no further evidence supporting this.
E. Prevalence -- approximately 4 in 10,000
- approximately 4 to 5 times more prevalent in males than in females
F. Associated Findings
1.) Age of onset is typically before 30 months, but parents usually
report noticing subtle signs before 12 months.
2.) Approximately 75% are also mentally retarded (IQ below 70) and 50% have an IQ
below 50.
3.) Problems with generalization and understanding of rules.
4.) Lack of initiative.
5.) Do not internalize the information that has been learned. There
must be environmental stimuli and rewards.
6.) Savantism ? approximately 100 reported cases in the past 100 years
of world literature. Occurs in males more frequently than females
(6:1). This can occur with any serious developmental disability, but
it has most frequently been seen in autism. There are approximately
25 officially recognized savants alive today.
8.) Medical Findings
- Seizures may develop in as many as 25% percent of cases. If
seizures develop it is often in adolescence.
- EEG abnormalities.
G. Treatment ? there is no ?cure?
1.) Early Theory
a) Bettleheim ? psychoanalytic approach, the mother caused the
disorder. Completely discounted now. Parents may believe this and
may need counseling on their own to deal with this or other related
problems of having a child with special needs.
2.) Medical
a) Secretin ? found to be ineffective
? Digestive hormone that promotes the secretion of bile form the liver
? Originally recommended because 3 autistic children with GI problems
were given 1 dose of secretin as part of a diagnostic test. Parents
later reported improved social and communicational skills.
? December 1999 New England Journal of Medicine reported no statistic
significance when secretin was tested on 56 autistic children.
? Now they suspect that improvement was shown because secretin
relieved some discomfort associated with the GI problems which lead to
the decrease in behaviors.
b) Typically medication is used to treat specific symptoms related to
autism. For example, haloperidol, a dopamine receptor-blocker, may
decrease the level of some symptoms.
3.) Behavioral
a) Floortime ? Stanley Greenspan
- Theory
? Knowledge is based on sensory information that is categorized by its
physical characteristics and emotional qualities.
- A parent gets on the floor and interacts with his or her child
continuously for 30 minutes.
- Mimic a child?s behavior and get into his or her world to draw him
or her out, but do not directly teach the child. Parents interrupt a
child and engage with them in what they are doing to get them to
connect.
- Two parts of floortime
1) Child-centered: parents follow the child?s interest. Goal is to
expand the child?s abilities.
2) Problem solving: discussion of behavior, problems, and decisions
that the child experiences. Works to develop verbal expression and
problem solving.
- Goals are engagement, emotional thinking, shared meaning, and
two-way communication.
- More effective with higher functioning children though most
information on floortime advocates it for all children with any
developmental disability.
b) TEACCH (Treatment and Education of Autistic and Related
Communication Handicapped Children; Watson et al., 1989)
- Focus is mainly on communication.
- Try and assess what it is that is impeding normal language
development and tailor the program to each specific child.
- Language is made relevant to each child?s interests and is made
reinforcing by enabling children to understand that language is a
powerful means for getting what is wanted.
- Comprehension is facilitated by having adults simplify language and
use additional gestures.
c) Rutter (1985)
- Tries for more of a holistic approach.
- Language-emphasizes social, communicative aspects. Parent should
have a half-hour period each day of uninterrupted interaction and
conversation with their child.
- Social development through deliberate intrusion on the children?s
solitary pursuits with activities that are reciprocal and enjoyable
for both parent and child.
- Does not specifically include methods for developing cognitive development.
- Reduce rigidity through small steps that are acceptable to the
child. Introduce activities that are incompatible with stereotyped
behaviors
- Use of pharmacological intervention to reduce specific behaviors as legitimate.
- Help the parents cope with feelings of guilt and the burden of
having to care for a child with special needs.
- Outcome (Rutter, 1970) was only 1.5% of his group (n=63) achieved
normal functioning, 35% showed fair or good adjustment, 60%remained
severely handicapped
d) Applied Behavior Analysis (ABA) ? O. Ivar Lovaas
- Initial research in 1987 and its follow up experiment in 1993
? 1987 research
? 19 children (age 40-46 months) received 40 hours of one on one
behavioral modification treatment per week.
? Conceptual basis for the treatment was operant theory and the
treatment relied on discrimination learning.
? Also extensive parent training to have parents carryover therapy
into every situation.
? First year focused on reducing self-stim and aggressive behaviors,
building compliance to verbal requests, teaching imitation,
establishing appropriate play, and promote extension of treatment into
the family.
? Second year focused on expressive and early abstract language and
interactive play with peers to function in a preschool group.
? After 2 years of ABA the control group (n=40) demonstrated 2% normal
intellectual functioning; 45% mildly retarded; and 53% severely
retarded.
? Experimental group 47% normal intellectual functioning; 40% mildly
retarded; and 10% profoundly retarded.
? Follow up study in 1993 of the same children at approximately 11.5
years of age showed the improvements were sustained so much so that 8
children were indistinguishable from average children in intelligence
and adaptive behavior.
- The age that ABA begins is one of the biggest predictors of its
success. When ABA is initiated later, gains are not as substantial,
but it often still causes improvements that are significant enough to
warrant its utilization.
- ABA therapy is also called Discrete Trial Therapy (ABC Model).
Every task given to a child has a distinct beginning and end and
consists of:
? Antecedent (SD) ? a directive or request for the child to do something.
? Behavior ? the child?s response.
? Consequence ? the reaction from the therapist. (ABA does not
prescribe the use of punishers. The consequence is typically
differential reinforcement. Premack Principle. No punishers. Deal
with adversive behavior by not attending to it. Sometimes if behavior
is self injurious use restraint.)
- An ABA program is developed with the help of a highly skilled
coordinator who trains a group of therapists/tutors to work with the
child.
- The therapists are taught the basics of Discrete Trial methodology.
- Fundamental principle is to make it SUCCESSFUL. Then it is reinforcing.
- Beginning skills taught are attending, imitation, and receptive skills.
- These skills are built upon to develop more complex skills through
shaping and chaining. Primarily chaining.
- Teach reading through sight words memorization. Chain the words
together to form sentences. Teach spelling through sight words. Can
teach the categorization or words.
- Use photographs to teach actions, identifications, tie together
photographs with sight words, genders.
- Very intense training. The child usually participates in
approximately 30 to 40 hours a week (this includes school, if
applicable).
- VERY EXPENSIVE!!!
- ABA is a comprehensive intervention. Skills and knowledge taught in
the strict ABA setting must be practiced and generalized to the
natural environment. |
