The Patient with Autism - Essay Example

? Pre-Primary Children with Autism Pre-Primary Children with Autism Introduction It is almost impossible for patients to come to terms with the facts that their childe may have a given condition or disorder. Autism is a disorder that has not been so in Hong Kong publicized and there is minimal information about the condition and causes of its life long crippling impacts. A study conducted in Hong Kong in 2008 reported a prevalence rate of 1.68 per 1000 for children below the age of fifteen years (Wong and Hui, 2008). With the number diagnosed children rising at an astonishing pace, researchers are to get to the bottom of the causes and managing of this disorder. This paper gives a detailed analysis of the concept of learning diversity, needs for autistic children, approaches for identification and evaluation assessment and intervention. Definition of autism Individuals get extremely confused when they think about autism, as they perceive it to be a childhood disorder. An invasive disorder influences social and communication skills and to some extent affects motor and language skills. A wide-ranging diagnosis can include children with mental retardation and high IQ and people with extreme traits in their personality. Therefore, what exactly is autism? Autism is best defined as a complicated developmental disorder presents itself in the first three years of a child’s life (Cooper, Heron and Heward, 2007). Generally, children with autism have problems with social interaction, non- verbal communication and physical activities including play. However, most children appear to be perfectly normal but spend their time engaging in disturbing behaviors that are different from those of typical children. Generally, parents or caregivers first spot symptoms of autism in the first three years of a child’s life. As earlier stated, autism is a broad-spectrum condition which means that exactly no two children will exhibit the same symptoms. In other words, autistic children have shortfalls in the following imaginative play, social awareness and verbal and non- verbal communication. The precise cause of autism is not known (Towel, 2013). However, recent medical research has pointed out a number of key probable factors including problems occurring during birth, genetics and various types of infections. Previous studies have revealed that children have a genetic inclination to autism, which means that they are predisposed to develop this condition passed on from their parents. There is ongoing research on the genes contributing to increased vulnerability. Other studies have revealed that autism develops in the uterus from an interference of early brain development. Event if there is no cure for the condition now, early detection and treatment allows for comparatively normal development of the child and reduces manifestation of undesirable behavior. Treatment entails special education, occupational therapy, occupational therapy, behavior modification, speech therapy and specific types of medication that manage some of the symptoms of the condition (Towel, 2013). On the other hand, medications cannot treat the basic symptoms of the condition although they can greatly manage seizures, depression, inability to focus and high energy levels. Identification of an autistic child Like all other diseases, autism has key symptoms. The signs and symptoms of the condition are diverse as it effects. Some pre- primary children may have difficult obstacles to overcome while some may present mild impairments. The bottom line is every autistic child has problems in the following areas. Thoughts and behaving flexibly, social interaction and verbal and non- verbal communication/ There are varying opinions among caregivers, health practitioners and parents on the causes and treatment of the disorder, and there is a lot that is not known. Nevertheless, it can be agreed on that early identification and intervention makes a huge difference in an autistic child’s life (Towel, 2013). Once the child has any of these symptoms, then the child should visit a specialist soonest possible. . Even if early prognosis does not mean complete cure of the disease, it means the condition can be controlled. This way, the child can lead a near normal life. The section below shows some of the key some of the prominent aspects that one can look out for: Social Interaction This is the most outstanding feature of an autistic child is problems with social interaction and difficulties in engaging in social engagements. This can be noticed at a tender age where infants may show difficulties in understanding and using eye contact, facial expressions, intonation and gestures. Generally, autistic children do not have good social skills. Most autistic children show little or no social or emotional reciprocity. In addition to, they do not impulsively share their feeling of sadness or joy with their parents or seek comfort and affection from them. Children with autism do not form good relationships with their peers (Towel, 2013). In other words, they are hardly interested in interacting with children of the same age and if they are, they have trouble in making and retaining friendships. Communication Their development of communication skills especially non-verbal is slow and has been described as nonexistent. Their facial expressions seem to indicate deep thoughts and they always seem anxious. Behavior They always have a far way look on their faces, indicating that they do not leave for the present moment. Most times, they will be caught gazing into space and are always absent-minded (Towel, 2013). Their body posture is slouched indicating that they are not at ease with their lives. These children have poor social skills and thus fail to create friendships with their fellow children. Unlike other people, they do not have an interest in sharing their fun activities, interests, enjoyments or achievements with their peers.  Needs of autistic children Autistic children have special need and require specialized care and attention. There are many things that parents can do to overcome the challenges they face in their day-to-day lives. It is also imperative to ensure that they get the needed help (Jordan and Jones, 2012). When taking of care of an autistic child it is important to be selfless as they have diverse needs. This calls for one to be emotionally strong and understanding. Language needs Children with autism have trouble in their language. They are likely to encounter difficulties in expressing their needs, wants, opinions, experiences and ideas. There can be problems in constructing meaningful sentences, grammar and vocabulary (Jordan and Jones, 2012). In addition to, they may not understand or employ meaningful body language, written word or spoken words. They may interpret word literary or not understand them at all. Parents and caregivers may be unable to communicate and interact with autistic children as the may fail to respond and appear indifferent to an attempts of communication that are made. Parents need to establish the mode of communication that is preferred by an autistic child and build on their communicative needs (Jordan and Jones, 2012). For instance, if a child does not respond to speech or sound one can try communicating to them by use of gestures. The most common methods of communication employed by autistic children may include echolalia, using pictures, looking at objects they are attracted to or pointing at their objects of desire. Echolalia is a common feature of autistic children where they repeat words that are spoken by others with no intent of communication (Jordan and Jones, 2012). This is one of the signs that shows the child’s language and speech id developing. Consequently, autistic children will start using repetitive words and phrases in their speech to communicate comprehensive messages. Successful in communicating with children with autism not only involves understanding how they communicate but also understanding the reason behind it. Social needs Social interaction is an important aspect of our lives. One of the most notable problems facing autistic children is obscurity in social communication. Autistic children often appear disinterested in other or aloof and are unable to engage in social interactions. This is because they have problems in interpretation of non- verbal communication including gestures, facial expressions and eye contact that are the most important aspects of social interaction. They often appear to be disinterested in maintaining friendships and do no express their feelings to parents or caregivers (Jordan and Jones, 2012). They show evidence of extreme character traits as there those who are extremely sociable and others who are overly quiet showing that children need encouragement and monitoring in social interaction. They need imaginative play, as they tend to take things literally. This helps them improve their imagination. It is advisable for parents and caregivers to join autistic children on the playground and encourage them to play with others (Jordan and Jones, 2012). Additionally, pictures of them should be taken while engaging in play to remind them of the positive experience. Parents should teach children on the importance of social cues including turn taking, personal property, the need for personal space and conversation rules such as maintaining eye contact. Sensory needs Children with autism may have hitches in processing daily sensory information such as sounds, smells and sights. This is referred to as sensory sensitivity or sensory integration difficulties, which have a negative impact on these children if not properly managed. There are seven senses including sight, sound, taste, smell, touch, body awareness (proprioception) and balance (vestibular) (Jordan and Jones, 2012). Children with autism tend to be oversensitive or under sensitive in these senses. Autistic children need to be stimulated by use of music instruments and sounds to improve their sensory system. They also need visual breaks depending on the pervasiveness of the condition. Exercise and occupational therapy are also important in improving the sensory systems of autistic children. Behavior needs Children with autism will display what may be termed as ‘abnormal behavior’. Helping pre- primary children distinguish between private behavior and public behavior is importance as it enhances their independence and an important step on their path to self-esteem. As earlier stated, autistic children, do not pay attention to social cues of their peers and parents. It is therefore important to help the practice and understand social cues to improve their social interaction (Jordan and Jones, 2012). Visual aids are an important way of helping children understand certain messages and develop certain positive behavior. Some of the behaviors that may be exhibited by autistic children may include obsessive play with objects, do not like change in environment or routine, making peculiar noises, covering ears and irregular fine and gross motor skills. Autistic children should engage in activities that eliminate maladaptive behaviors that interfere with social functioning and learning. They should also engage in activities that increase functional skills and behaviors specifically in spheres of academic, communication and vocational skills that allow autistic children to be successful in society (Jordan and Jones, 2012). Studies done on behavioral intervention have revealed some promising results as autistic children have been reported to improve in their families, schools and society after such an intervention. Different approaches of identification CHAT checklist in UK Definition This is an autism-screening instrument that is commonly used in the United Kingdom to identify children who are below the age of eighteen months who are at risk of developing social communication conditions. To begin with, what is a CHAT (Checklist for Autism in Toddlers) checklist? It a brief questionnaire that is issued to parents and primary health care givers at the 18 month check up for the child’s development (The National Autistic Society). It seeks to identify children who are at risk of developing social communication disorders including autism. How is it Administered? The CHAT checklist contains two broad sections: the first nine questions target the parents while the last five questions are asked to the primary health care giver. The last five questions are mainly observations that have been made by the caregiver on the child’s development. The CHAT checklist is mainly focused on the basic features that can be used to establish whether a child is likely to suffer from a social- communication disorder (The National Autistic Society). The primary behaviors for these are pretend play, for example, if a child is pretending to pour tea from a toy teapot and joint attention that entails pointing to show. How is the Checklist Scored? The checklist is easy to complete and even easier to score. It is made up of five items A5 (pretend play), A7 (protodeclarative pointing), Bii (following a point), Biii (pretending) and Biv (producing a point). If a child fails in all the items, they are at a very high risk of developing autism (The National Autistic Society). Those who fail in A7 and Biv have a relative risk of developing the condition. Actions taken after the test If a child passes the test, no further action is taken no remedial action is taken as they are assumed not to be at risk However, passing the test does not mean that the child will not develop some sort of social communication disorder in future. It is advisable for parents to take a referral if they are afraid that their children may be at risk. M-CHAT checklist in the US This is known as the Modified Checklist for Autism in Toddlers. It is defined as a scientifically approved instrument that is used for testing children between the ages of sixteen to thirty months to evaluate the risk for autism. The test is made up of twenty-three items, a short form that is completed by the parent and takes a short time to be completed and for the caregiver to assess. The answers to the questions are simply ‘yes’ and ‘no’. In addition to this, parents are advised to discuss the results of the test with a specialist who will advise them accordingly. A clinical psychologist Marianne Barton and neuropsychologists Deborah Fein and Diana Robins proposed this test (Charman and Stone, 2006). The American Academy of Pediatrics (APP) advocates for all children between eighteen and twenty for months to receive autism screening. M- CHAT is one of the highly recommended instruments to perform the screening. The M- CHAT is mainly focused on detecting the highest cases of autism spectrum disorder (ASD). Therefore, there is the risk of a high false positive level, meaning that children who get a high tally at the risk for ASD are not likely to be diagnosed with the disorder. This explains why the M- CHAT Follow- up Interview that is used addresses these issues. However, even with this follow- up interview, a large number of children who have positive rates for ASD fail to meet the diagnostic criterion on a further evaluation by a specialist (Charman and Stone, 2006). Nevertheless, these children are at increased prevalence for a variety of delays and developmental disorders and should receive further assessment. It is important for parents to note that the M- CHAT may not detect the early signs of developmental delay and autism in children. If they have concerns about their children, they should talks to a specialist. Other approaches There are various approaches adopted in assessing the prevalence of autism among pre- primary children. First, is the Childhood Autism Rating Scale (CARS) that is suitable for use on children over the age of two years (Charman and Stone, 2006). It entails items that are drawn from five pronounced systems for diagnosing the condition with each item touching on a specific behavior, ability or characteristic. Second is the Autism Diagnosis Interview – Revised (ADI-R) that evaluates autism in children and adults. It mainly focuses on communication, behavior and movement. Last, is the Autism Diagnostic Observation Schedule (ADOS-G) which is an observational screening method that identifies abnormal or absent behavior among autistic children. Evaluate assessment and intervention Assessment service and tools Children below the age of three-year s who are suspected of having autism or a given form of developmental delay can be evaluated and assessed through an earl intervention program at home or at a health care center (Goldstein, Naglieri and Ozonoff, 2008). The decision concerning timing and location of the assessment should be done in collaboration with the family. It is important for Infants and Toddlers Program workers to get detailed information during the assessment. This includes information on the child’s strengths and needs, any family history that would influence the child’s development as well as any information in the present that would affect the child’s prevalence to the condition. Infants and Toddlers Program workers should asses the child’s language and communication abilities, developmental and cognitive abilities and social development through play, interactions and observation. After completion of the diagnostic assessment, a parent feedback is conducted whereby parents are taken through the results of the test and given treatment recommendations (Goldstein, Naglieri and Ozonoff, 2008).. The health practitioners also assist parents to find community centered treatment services that are suitable for the child’s needs. Most assessment tools have been formulated to detect ASD specifically and focus on communication and social impairment for children below the age of eighteen months and older. It can be noted that most of these tools concentrate on Diagnostic and Statistical Manual of Mental Disorders (DSM) (Goldstein, Naglieri and Ozonoff, 2008). Their major limitation arises from the fact hat there are no validated assessment tools for children below eighteen months. Ideally, autism assessment should follow a developmental screening that has shown some concerns. The clinician should thereafter observe the child I addition to using the assessment tool. There are a number of assessment tools including Screening Tool for Autism in Toddlers (STAT) which is empirical in nature and it is an interactive measure that is designed for children between eighteen and twenty four months of age. Intervention Theory of mind This theory alludes to the notion that autistic children fail to understand the thoughts and opinions of others. Moreover, they have difficulties in understanding other the attitudes and emotions of their parents and peers. This theory has been used to test typical children and those with mental retardation; its phenomenon seems to be distinctive for autistic children. The theory appears to be independent of intelligence (Ordetx, 2012). Interestingly, pre- primary children with autism have trouble understanding when others do not have an answer to their question. They are likely to get upset. These children do not realize that other people are different from them and this result to difficulties in communication and social interactions as earlier explained. Additionally, they may have difficulties understanding how to react in different situations and seem to be overly distracted at all time. Social story This approach is used to help children with ASD better understand the essence of interpersonal communication to promote effective interaction (Reynhout and Carter, 2009). It can be described as a written or visual demonstration of various skills, concepts, behaviors or situations. The main objective of social stories is to share accurate information in a manner that can be easily understood as well as reassuring. This method is commonly used as an intervention for autistic children however; their effectiveness should be researched as there is no clear evidence showing the factors leading to success o failure of the intervention. Floor time (Greenspan Floortime Approach) This form of intervention is based on Developmental Individual-difference Relationship-based model (DIR) that was developed by Stanley Greenspan, M.D., a child psychiatrist (Winnick, 2010). It states that adults can help autistic children develop and improve their communication skills through play. This approach challenges children to push themselves to the best that they can be and seeks to develop who they are rather than their diagnosis. Families are advised to use to together with other behavioral therapy approaches. Parents and caregivers engage the children in enjoyable games and guide them throughout activities. Therapists guide parents on how to introduce complex interactions in a process referred to as opening and closing circles of communication (Winnick, 2010). This approach enable autistic children reach crucial milestones for intellectual and emotional growth. These are emotional thinking, complex communication, intimacy and self- regulation. It can be concluded that this approach focuses on emotional development of autistic children. References Charman, T., & Stone, W. (2006). Social and communication development in autism spectrum disorders: Early identification, diagnosis, and intervention. Guilford Press. Cooper, J., Heron, T., & Heward, W. (2007). Applied Behaviour Analysis. New Jersey: Pearson Education Goldstein, S., Naglieri, S. A., & Ozonoff, S. (2008). Assessment of autism spectrum disorders. Guilford Press. Jordan, R., & Jones, G. (2012). Meeting the needs of children with autistic spectrum disorders. Routledge. Ordetx, K. (2012). Teaching theory of mind: A curriculum for children with high functioning autism, asperger's syndrome, and related social challenges. Jessica Kingsley Publishers. Reynhout, G., & Carter, M. (2009). The use of Social Stories by teachers and their perceived efficacy. Research in Autism Spectrum Disorders, 3, 232-251. The National Autistic Society. Checklist for Autism in Toddlers (CHAT). Retrieved from http://www.autism.org.uk/working-with/health/screening-and-diagnosis/checklist-for-autism-in-toddlers-chat.aspx Towel, P. O. (2013). The early identification of autism spectrum disorders: A visual guide. Jessica Kingsley Publishers. Winnick, J. P. (2010). Adapted physical education and sport. Human Kinetics. Wong, V. C., & Hui, S. L. (2008). Epidemiological study of autism spectrum disorder in China. Journal of Child Neurology. Read More