2012年1月26日 星期四

Introduction to Autism - Factors Related to It


Autism is a name given to a developmental disorder in children whereby their communication and interactions are impaired, and though many are able to stay in the mainstream of society, there are others who lead very restricted lives. Males are four times more likely to have autism than females, and out of every thousand children, at least 3-6 are likely to be autistic. Autism is limiting and restrictive, often preventing autistic children and their families from leading normal lives.

Autism can be by birth or manifest itself within the first two and a half years of a child's life. It is believed to be due to some prenatal abnormalities the causes of which have not yet been found. The physical appearance of the child is normal, but behavior is different and communication and interaction rather puzzling. Many are able to speak normally, and this makes recognition of other symptoms all the more difficult. The condition prevents most children from having normal educative learning though some can work towards joining mainstream educational activities.

Typically autistic children are self-absorbed, uncommunicative and cannot participate in creative activities. They are impaired in several areas of development. Autism is one of the 5 neurological disorders that fall under the category of Pervasive Developmental Disorders, and also the most common. There are no racial ethnic or economic boundaries for autism, the causes of which are yet unknown. It can afflict any child from any background, anywhere, and remains a lifelong problem.

Problems Created by Autistics

Autistic children do not misbehave intentionally as is often the case with normal children. Some external factors trigger specific actions.

- It is difficult for them to sit for long periods of time.

- They take everything literally;

- Matters that do not interest them will not hold their attention at all.

- They do not make eye contact and leave the other person wondering whether they have been heard and understood.

- They are aloof and unsocial.

- Many perform repetitive tasks, and strange actions like hand flapping, blinking, biting, head-banging, fiddling with things, and certain spontaneous movements.

- They sometimes lack the ability to understand emotions but can display anger and reveal their displeasure in violent ways. While many are able to express themselves with repetitive coaching, those who cannot talk resort to physical expression of their unhappiness.

- They are likely to develop some obsessive interests.

- Some are less sensitive to pain and can end up hurting themselves badly without realizing it.

- On the other hand they are hyper sensitive to touch, taste, hearing and smell.

These traits become difficult to handle especially for those who spend the maximum time with them. Parents find themselves constantly watching over them and trying to protect them outdoors. Caution cannot be forfeited at any cost with an autistic child. This can become a major encumbrance for the parent and attendant.

Causes of Autism

The exact cause or set of causes that lead to autism are unknown. It is a question that torments parents of autistic children who often tend to blame themselves for the neurological disorder that leads to this condition. Extensive research has led to multiple theories being presented about what leads to autism, though each has its set of critics trying to refute them.

- One set of scientists believes that certain vaccines given to the child especially, MMR (Mumps-Measles-Rubella) cause intestinal problems, which can lead to autism.

- Some believe the culprit to be thimersol contained in certain vaccines.

- The genetic cause of autism is widely accepted, as it is possible that autism has some genetic root, running in some families more than others. However, autism is not caused by a single gene, but is rather a consequence of several genetic differences as well as some form of environmental "insult".

- Some researchers are exploring the differences in a typical brain and autistic brain and are convinced that the autistic brain is wired in a different manner, besides being larger in size.

Research is continuing and it is clear that autism cannot be attributed to a single cause, but is perhaps the outcome of a combination of unfavorable factors like food allergies, environmental toxins leading to adverse reactions in the child's body, and immune deficiencies.

How To Identify Autism

Autistic children appear normal in appearance and the first signs can manifest themselves around twelve months, but they become very conspicuous by the time the child is three years old. Many seem to have impaired speech, never look in the eye, exhibit strange behavior and movements, not wish to play with others, seem engrossed in one particular thing or activity. It is not unusual for parents to shake off these early signs as those of an introvert or late learner. But pointers to an autistic condition include:

- The child does not point to things and objects at twelve months

- He child does not pick up even one word by 18 months

- He cannot make two word sentences at age two

- He does not respond to his own name

- He stays away from people and peers

- He does not make eye contact

- He may not laugh and smile and may not seem to hear

- He constantly flaps arms, bites, bangs his head

- He is unable to shift focus from one object to another

Parents are the first to notice some or most of these signs and must take immediate advice to be able to help the child and in case remedial measures can be taken in borderline cases, the sooner the better.

Educating an Autistic Child

The toughest part for parents is coming to terms with the autistic condition of their child. Once they are able to accept it, they become anxious to educate the child to make him acceptable in the mainstream of society. This is the toughest part as their symptoms manifest themselves all the time.

- They are different from other students, as they cannot relate to people and emotions, have some difficulty in comprehending what hey are being told.

- They are unable to identify differences in tone and speech, gauge facial expressions, or relate to reactions of peers.

- It becomes important for the teacher of autistic children to know about their condition.

- If the child is in a special school with others like himself, he will benefit from specially created learning modules, which include visual schedules that autistic children find easier to follow.

- Working in pairs is immensely beneficial as well.

- In case the child studies in a regular school, his teacher needs to know about his condition so that she can make the extra effort that may be required to explain certain things to him.

- In many schools an additional aide is provided to the teacher to help such children.

- Autistic children resent being forced to do certain things, and would rather make choices as it gives them a sense of control.

- It is better to encourage interests that they seem to prefer, for instance, many have a flair for cooking. This can become a vocation in later years.

Treatment for Autism

Treating autism is not easy as no prescribed, standardized line of treatment has yet been found, despite millions of dollars being spent on research in this field. The only generalization that can be made is linked to helpful therapies like:

- Applied Behavior Analysis

- Occupational Therapy

- Physical Therapy

- Speech Language Therapy

However, before the child can be started on any of these, the following steps need to be followed:

- An early diagnosis of autism an immediate intervention and treatment is imperative for the child. Parents must not ignore unusual behavioral traits that the child may exhibit in the second year of his life.

- The first step is to find good physicians and specialists who can guide parents about what is best for the child.

- Most treatment has to be behavioral and parents have to ensure that the child is not pressurized.

- This can be done by giving him clear instructions that are easy for him to follow.

- He must be prompted encouragingly to perform certain tasks, and praise and applause for actions well done.

- Parents must make a distinction between good and bad and gradually increase the complexity of instructions to encourage him to do better. Parents need instruction in behavioral techniques to accomplish this.

- Self help techniques have to be taught to the children so that they can eventually become independent.

- However, there are various types of autism, and each child has specific needs. His treatment also has to be custom made for his requirements.

Treatment with medication is only for symptoms like seizures, extreme mood swings; sleep difficulty, tantrums or injurious behavior patterns. One set of doctors fell that additional diet supplements like minerals and vitamins may be helpful, and also secretin infusion, but none of these treat the underlying condition.

At present, Risperidone is the only drug that has been approved for treating children in the 5-16 age group for aggression and irritability due to autism. Finally, the present treatment prescribed by medical specialists includes a gluten-free and casein-free diet. Gluten is contained in wheat, barley and rye, and casein in milk and dairy products.

Improving Autism Communication

Communication and social interaction are the biggest problems associated with autism. The autistic child struggles in the fields of language and being able to express him. Communication is crucial as it helps the child understand people around him, comprehend environment cues, follow directions and instructions, perform organizational tasks and also express himself. Communication is much more complicated than mere speech, requiring multiple skills like attention, absorbing information, interpreting that information and finally formulating an appropriate response.

A lot of research is being done in this field, and some drugs have been developed that improve communication behavior and increasing attention spans. Mineral and vitamin supplements, psychotherapy and medication related to it have all been tried, but there is no documented evidence of significant improvements.

Autistic children understand better when information is provided to them verbally as well as visually. Studies conducted on children who were instructed verbally and with sign language, revealed that they responded with greater vocalization, mastered signs and used them appropriately, and were able to communicate better with their peers. Visual tools include body movements, use of pictures, objects and environment cues. Step-by-step instructions are also important. Autistic children relate best to models, objects, signs and boards explaining the verbal communication.

While no standardized treatment has yet been developed to improve communication abilities of autistic children, some amount of success has been achieved by studying individual requirements. Treatments first necessitate an in-depth analysis of needs and then seeking therapy from speech-language pathologists, from occupational and physical therapists to modify unacceptable social behavior.

Another research reveals that participation of the father in teaching the child showed a marked improvement in the child's ability to communicate. This was especially true in verbal communications with the child's usage of vocabulary revealing a 50% increase.

Structured behavior modification programs like Applied Behavior Analysis are beneficial for some, while others benefit from informal coaching in a familiar home environment. Music therapy and sensory integration therapy attempt to enhance the child's ability to respond to information using his sense organs. Social stories narrated to children time and again have also helped many improve their social skills.

Yet another specialist has found that early intervention with peer directed interaction helps autistic children communicate better. Less adult directed communication and greater participation from trained peers in an informal, natural setting helped in maximizing the results of communication improvement.

The Pivotal Response Treatment (PRT) has been rated as one of the best innovative treatments for handling communication issues of autistic children. Based on 20 years of research by Robert and Lynn Koegel, this has helped advance children's communication abilities, foster friendships and social interactions and improves school performance besides controlling disruptive behavior. PRT works with every child's natural motivation promotes functional learning and helps him develop skills that can be used in the world outside. Rote learning is discouraged and the child's cognitive abilities are enhanced. Prompting him to respond gives him the impetus to do so.

Treatments have to be personalized but starting sooner will yield far better results than delays in taking action by the parents.

How to get Autistic Children accepted by other Children

Autistic children do have communication and behavioral issues which are often unacceptable to others. They are therefore the target of criticism, made fun of, teased, ignored and neglected. But all autistic children are not retarded and with help and support can become part of mainstream society. The role of the parent and the teacher becomes important in gaining social acceptance for their child. They need support not pity, sympathy and a bit of care. It is important for the school to reinforce its commitment to these children and explaining to others how they can reach out to these special children. They need to be told that autism does not explain the whole character of the child-it is only one aspect and the child in question is blessed with other far more acceptable traits. He can think too, get hurt and upset and he struggles with things he cannot do. Acute hearing, sight and smell compensate for his language limitations. Children can be made to see the good in the child, what he can do and with that focus, help him. Often if one child comes forward to help the special child, others follow suit and the result is that he gains friends from whom he is able to learn much more than parental training.

How do I help in Emotional Circumstances

Children with autism are often highly emotional, getting hurt and upset about small things. Unfortunately, it takes them longer to overcome them and it is challenging for parents to help him cope. In an emotional state, the child first needs to be calmed, and this can be accomplished by helping him take a few deep breaths. This must be practiced with him before and becomes useful during stressful times. It is best to remove him from the scene where he has got upset and talking gently in a manner that he comprehends, is helpful. The child needs encouragement, reinforcement of affection and loving reassurance. If the child can talk, hearing him out also helps. Many of them are overly sensitive to others' emotions, seeing another child cry, makes them cry as well. They need to be taught that another person's feelings must not be mixed up with their own.

A few steps that can help the child include, first understanding his emotional needs, speaking in a language that he understands, he must also get the facts correct, and not have any false notions. It is important to look for warning signs that reveal an emotionally disturbed state like facial expression, nervous tics, speech variations, sweating, avoidance and irritability. Social stories narrated to children may help them feel they are not alone in feeling in a particular manner, and others are like them too. The bottom line is keeping the child calm and secure.

The Child's Future

A child being diagnosed as autistic is one of the worst nightmares for any parent. The first thoughts after the why's and how's is the anxiety about his future. His future is largely determined by the type of autism he has, and his intelligence level, which may assist him to practice some vocation and even be gainfully occupied. Many are able to lead near normal lives and become responsible, independent individuals. Others with more serious problems may never be able to lead a normal life and be independent. In such cases the future of the child is largely determined by the parents, how they plan for times ahead. They need to make the child functional and ensure that adequate resources are put aside to sustain him. Researchers believe that parents need to be responsible for providing them with a social world in which they can build meaningful relationships. Those alone can sustain them, despite the fact that the child may never go to work, earn, and do other adult things. Special education can help him do better than lack of any education. It may suffice to have him occupied and happy rather than stressed and agitated, provided for and having someone.

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