Autism Spectrum Disorder (ASD)
Autism (ASD)
Autism
Introduction
For many years Autism has been a fast growing and controversial disorder. As common as it is world wide, very little is actually known about the disorder and its crippling effects it has on an array of people. Autism also referred to as autism spectrum disorder (ASD), is a “lifelong developmental disability that affects how a person communicates with, and relates to, other people” (The National Autistic Society, 2013). Individuals with this disorder respond differently than an individual not having autism would demonstrate. Due to ASD being the “most deeply researched,” in many areas such as “cognitive profile, …show more content…
language ability, co-morbid diagnoses, and eventual outcomes,” it has become exceedingly complex “to identify proximal causes of disorder, and especially challenging to develop and evaluate treatment” (Paul & Norbury, 2012, p.
119). Over the years, researchers and physicians have developed evaluation tools and methods to help individuals with ASD, along with treatment programs that can help with different aspects of the disorder such as speech and language impediments.
Description
Autism is a type of disorder that as of right now is a “lifelong developmental disability” that affects an individual in many aspects of their life (The National Autistic Society, 2013). This disorder is a spectrum condition (ASD), which means that it is a “group of developmental disabilities that can cause significant social, communication and behavioral challenges” that affects each individual in different ways …show more content…
(Centers for Disease Control and Prevention, 2012). The appearance of autism is typically noticed around the age of three years of life (Autism Society.org). Autism hinders with the individuals ability to comprehend what is going on around them, which can be detrimental to their everyday life, which can result in a lifetime of specialist support. There are three main areas that all individuals who are diagnosed with ASD acquire, it is known as the “triad of impairments.” They are: difficulty with social communication, interaction, and imagination (The National Autistic Society, 2013). Being diagnosed with autism, one must be taught to communicate socially and learn to have a relationship with individuals, objects and how to handle different situations in their lives. On the other hand, not all people with autism undergo the same level of impairment. Autism “affects each person in different ways, and can range from very mild to severe” impediments (Center for Disease Control and Prevention, 2012). Although, there is no exact cause for autism, research has shown that there is a multitude of factors such as “genetic and environmental” aspects, which “may account for changes in brain development” (The National Autistic Society, 2013).
Prevalence and Population
According to the Center for Disease Control and Prevention, the prevalence is estimated about 1 in 88 children who are identified with ASD.
In 2007, a parent-report diagnosis survey of ASD was conducted in households of US children ages 3 to 17 years. The results showed that the “ASD point-prevalence was 110 per 10,000, which was estimated that 673,000 US children have ASD” (Kogan, Blumberg, Schieve, Boyle, Perrin, Ghandour, Singh, Strickland, Trevathan, and van Dyck, 2009, P. 1395). The study also showed that ASD was affected four times larger for boys than it did for girls. Throughout the years, the numbers of having autism is increasing tremendously. Between 2006-2008, about 1 in 6 children in the U.S. have had a type of developmental disability, “ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism” (Center for Disease Control and Prevention, 2012). According to the Autism society, 1% of the children population in the U.S. ranging from ages 3-17 years are diagnosed with ASD and 1 to 1.5 million Americans live with ASD (Autism Society.org). This disorder can be difficult to notice at such a young age, which, in result, the behaviors of autism isn’t usually seen until the child enters school. Statistics show that the growth rate for ASD is 1,148%, which makes it a fast-growing developmental disability (Autism
Society).
Speech and Language Characteristics
Individuals with autism can range from mild to severity with speech and language characteristics. Two of the main areas of difficulty that autistic individuals have are “social communication and social interaction” (The National Autistic Society, 2013). Data shows that after spontaneous language samples, children with ASD “produce short and grammatically simple sentences” than those who do not have ASD (Paul and Norbury, 2012, p. 121). Individuals with ASD typically find verbal and non-verbal communication to be quite difficult to comprehend. Their “literal understanding of language” is taken seriously and actually think “people always mean exactly what they say” (The National Autistic Society, 2013). ASD characteristics do not allow an individual to understand or use facial expressions or tone of voice.
Autism affects all levels of language domains: pragmatics, semantics, syntax and phonology. There are some unusual word-related behaviors that are shown in children diagnosed with autism. “Most common are “metaphorical” and idiosyncratic language, including the use of unusual but meaningful words or phrases” (Wilkinson, 1998, p. 75). Communication varies on the individual with autism, in other words, some individuals “may not speak, or have fairly limited speech” where they prefer to use an alternative form of communication such as sign language or visual symbols, while others “have good language skills, but may still find it hard to understand the give-and-take nature of conversations” (The National Autistic Society, 2013).
Evaluation Tools & Methods
There are various approaches for diagnosing Autism Spectrum Disorder. In today’s society, there has been advancement in genetic testing which results in (so that is why there is) a growing number of children that are being (getting) diagnosed with Autism at an early age, hence, health care professionals are getting well familiarized with this disorder. Technology has advanced in detecting this syndrome at an early stage in an individual’s life. Today more than ever, society has raised awareness
There is a diagnostic approach for patients that may have Autism such as clinical evaluation and genetic testing.
Studies show that ASD affects about 1 individual in 100 live births [12] and is on the increase with a higher prevalence than reported for congenital brain malformations or Down syndrome. Better awareness and more accurate genetic and biochemical testing are now available leading to earlier diagnosis and potential treatments at the molecular level. Approximately 30% of individuals with ASD and/or ID also requires psychological and psychiatric treatments, for behavioral problems including hyperactivity, impulsivity, inattention, aggression, property destruction, self-injury, mood disorders, psychosis, and tic disorders [22, 23]. (Butler, Young, Roberts, & Hellings, 2012, p.2)
People often question the professionals about the risk factors that may contribute to Autism during and/or after pregnancy. According to the review article Assessment and Treatment in Autism Spectrum Disorders: A Focus on Genetics and Psychiatry (2012), family studies suggest that genetic factors contribute significantly to Autism (up to 90%) [24]. The recurrence risk for ASD varies by gender for the second child to be affected (4% if the first child affected is female and 7% if a male) [25-27] . The recurrence rate increases to 25-30% if the second child is also diagnosed with ASD. Single gene conditions are identifiable in less than one-fifth of subjects with ASD, while the remaining subjects have other genetic or multigenic causes and/or epigenetic influences. Epigenetics refer to environmental factors such as nutrition, toxins, or infections that alter gene expression without changing the DNA sequence [28-30]. (Butler et al., 2012, p. 2)
There is a diagnostic approach for Autism Spectrum Disorders. First, there is an initial interview with the parents/caregivers which the professional asks a series a questions and any concerns that the parents/caregivers may have. This helps the professionals get some background history such as behavior, development, and medical history, to get a general idea and to establish a baseline to know what direction to go to. The patient then is examined for mental status and physical health. There are numerous of analysis that may be performed during this initial interview. One well known is the Applied Behavior Analysis (ABA).
Applied Behavior Analysis (ABA) intervention [58] performed for 40 hours per week is considered a validated intervention for 40 hours per week is considered a validated intervention for children with ASD, funded by some state insurance plans, and is increasingly gaining recognition as an in-home behavioral intervention program. Educational, speech, and occupational therapies are mainstream interventions that should be established for the specific needs of each individual (Butler et. al. 2012, p. 4)
It is essential to perform assessments that are age appropriate and beneficial for a child with ASD. The review article The Social Cognitive Evaluation Battery for Children with Autism: A New Tool for the Assessment of Cognitive and Social Development in Children with Autism Spectrum Disorders states that:
The Psycho-Educational Profile (PEP3) [3] specifically assesses the psycho-educative developmentof children with autism, but it has not been standardized for French populations. Moreover, various cognitive and socioemotional domains such as object permanence, symbolic play, and self-image are not specifically explored for ages of 4 to 24 months. There are also some instruments for the developmental assessment of children with pervasive developmental disorders that are domain specific: The Ugziris- Hunt scales [4] focus on infant cognitive development; the Early Social Communication Scales [5, 6], Mac Arthur communicative development inventory [7], SCATA [8] and the Communication and Symbolic Behaviour Scales [9] focus on socio-communicative development or Reynell [10] whose focus is language development. (Thiébaut, Adrien, Blanc, and Barthelemy, 2010, p. 1)
Although these assessment establish an in depth examination of the child’s communicative domains, cognition, and emotional state, they create a baseline analysis. In result, “The Social Cognitive Evaluation Battery (SCEB) covers 16 functional abilities; it aims to address the clinical needs of psychologists, by contributing to the definition of a personal therapeutic and psycho-educational project adapted to each child [4] and to further research on autism.” (Thiébaut et. al. 2012, p. 2) The Social Cognitive Evaluation Battery assessment is beneficial due to the fact that it is not a typical standardized assessment because its domains are structured and descriptive.
The SCEB covers two broad but distinct domains which are cognition and socio-emotional functions of children with Autism. The Cognitive domain is so in depth that it has 7 scales of ability that tests the infant’s psychological development, self-image, and symbolic play. The other domain is the socio-emotional. “The socio-emotional domain is defined by nine abilities: social interaction, behavior regulation, joint attention, expressive language, comprehensive language, vocal imitation, gestural imitation, affective relation, and emotional expression.”(Thiébaut et. al. 2012, p. 2).
This assessment discloses into three stages which are behavior coding, developmental coding, and developmental profiling. In the behavior coding stage the examiner assess the child in a calm environment with materials that may be of interest. This helps the examiner to collect data at best to establish a baseline and the development. The examiner completes an observation grid that covers 188 items. In the Development Coding, the examiner completes a 128 item evaluation on the level of aptitude. Lastly, the Development Profiling stage is examiner find the developmental level based on the scores she/he collected and creates a profile. This assessment also had developmental levels. “The children’s developmental scores from the SCEB were placed in one of four developmental levels, 4–8, 8–12, 12–18 or 28–24 months, and the mean chronological age of the children in each level was computed.” (Thiébaut et. al. 2012, p. 5) There is definitely room for improvement when it comes to using this assessment, but shows that it goes in depth and not just a typical standardized test. Furthermore, this test is in the process of changing so it can be suitable for other cultures.
Treatment Programs or Methods
Although Autism is significantly less prevalent than Specific Language Disorder (which affects 7-10% of children), there is still a large body of research done on treatment programs and methods for those who fall under the umbrella of the autism spectrum disorder (as cited in Pence and Justice, 2008). However, it should be immediately noted that the majority of the research is somewhat limited due to small sample size. Some experts note that it is difficult to obtain a large sample size in an autism study (Marcus, 2013). This becomes apparent when examining reviews. For example, in Goldstein 's Communication Intervention for Children with Autism: A Review of Treatment Efficacy (2002) in which he examines 60 studies on autism, the median number of participants in the 60 studies was 4 participants. In fact, out of all of the studies, only two had more than 50 participants. Therefore, there are some limitations when generalizing the outcomes to the larger population.
It should also be noted that dependent variables in autism studies often vary due to the wide variety of behaviors associated with autism spectrum disorder and its subcategories, including language delay, social interaction problems, repetitive language, etc. (as cited in Pence and Justice, 2008). Some studies focus on just spoken language, while others might focus on spoken language as well as pragmatics.
Some studies have indicated that specific treats can improve the communicative abilities of children with autism who have been identified as non-verbal. About 25% of children with Autism Spectrum Disorders are considered to be non-verbal and, until the last couple of years, few interventions appear to have demonstrated significant growth in their speech output (Wan et. al. 2011). For example, in Auditory-Motor Mapping Training as an Intervention to Facilitate Speech Output in Non-verbal Children with Autism: A Proof of Concept Study, researchers evaluate the Auditory-Motor Mapping Training, a strategy that “trains the association between sounds and articulatory actions with the goal of facilitating speech output. It combines intonation (singing) and the use of tuned drums to facilitate auditory motor-mapping (Wan et. al, 2011, p. 1). During this treatment, which is implemented on six autistic children who do not produce intelligible words, the clinician taps on a drum tuned to the same pitches and the intonation of the words they are trying to teach the child. The researchers find that the AAMT method can be effective in increasing “the range and complexity of their vocal productions” with improvements that are maintained even eight weeks after therapy ceases (Wan et. al, 2011, p. 4). Finally, the researchers find that the children learned how to vocalize both speech sounds that they experienced in therapy as well as speech sounds that had not been trained by the clinician. Several studies examine different treatments to improve speech and language in children with autism. One recent study by Ingersoll, Meyer, Bonter and Jelinek (2012) compares three naturalistic approaches and conditions– the responsive interaction condition, the milieu teaching condition, and the combined condition (that consisted of both previous teaching strategies) and the effect that these strategies have on language and social effects of five children with autism. All treatments are naturalistic. They occur in a natural-like environment and the play activities for the treatment sessions are selected by the clients. The first approach, the responsive interaction condition, emphasizes adults’ response, language modeling, narration, and expansion, but it does not utilize direct elicitation of speech. When the milieu condition is presented, the therapist uses direct elicitation. Questions are asked of the client until he/she makes an obvious attempt to answer, at which time the behavior is reinforced. The combined condition meshes the two previous strategies together.
These researchers draw several conclusions regarding these two strategies. They find that milieu teaching and implementing combined condition are more successful in increasing the rate of specific expression language targets for all five of the children. For example these two conditions help to substantially increase prompted requests in the children with autism. In addition all of the subjects display an increase in their social engagement ratings after experiencing at least one type of the three conditions (Ingersoll et. al. 2012).
While the previous study focuses on the effect of adult’s behavior in improving the language of children with autism, other studies focus specifically on the parent’s role. In a study by Gillett and LeBlanc (2006), three parents of children with autism are taught how to successfully carry out the treatment of the Natural Language Paradigm. Changes in the children’s speech and language are subsequently analyzed.
Though this study is small and consists of only three parents with three children with autism spectrum disorder, the results indicate that this strategy may be extremely beneficial for children with autism (Gillett and LeBlanc, 2006). For example, all three children exhibit immediate and continued increase in the frequency of their vocalizations. The two children with the more advanced language at the beginning of the treatment (according to the baseline measures) demonstrate a considerable increase in their mean length of utterance per vocalization and in their spontaneous vocalizations while the third child displays improvements in prompted vocalizations. These results, which are consistent with the results from previous studies, indicate that this type of treatment outside of a speech-language pathologist’s direct therapy may depend on the initial level of the student but can also significantly improve the speech and language of a child with autism (as cited in Gillett and LeBlanc, 2006).
To maximize the efficacy of treatment and research studies, a clinician cannot simply implement a treatment that he/she read about without taking further steps to both determine the limitations of the study and its suitability for the particular client in question. Evidence-based practice emphasizes clinical decisions that are determined by considering research, the wishes of the client/family, and the knowledge and past experience of the clinician (Gillam and Gillam, 2006). The third step of the “Seven-Step Decision-Making Process” of evidence-based theory requires the clinician to “determine the level of evidence and critically evaluate the study” (Gillam and Gillam, 2006, p. 306). Therefore, before any of these three studies may be used, a clinician would have to assess different factors within the study to figure out the nature of the results. By critically examining the nature of past research, along with ensuring that other factors are considered such as student-parents elements, correct clinical questions, the outcomes of the clinical decisions, the clinician ensures that he/she is making a data-driven decision taking both the client and clinician into consideration.
It should additionally be noted out of these studies that, though they have a low number of subjects, steps are taken in all studies to maximize the validity of the studies. A Comparison of Developmental Social-Pragmatic and Naturalistic Behavioral Interventions on Language Use and Social Engagement in Children with Autism and Parent-Implemented Natural Language Paradigm to Increase Language and Play in Children with Autism both include substantial information about training clinicians and parents and required scores from the training for their data to be valid (Ingersoll et. al. 2012; Gillett and LeBlanc 2006).
Section V: Personal Reaction We learned that, though children with autism may only make up 0.02% of the population, they may present as a significant proportion of a speech-language pathologist’s caseload. In addition, we have found that these clients might prove to be a particularly difficult group to treat due to the wide variety of types, conditions, levels, and behaviors exhibited by those who have been diagnosed with autism spectrum disorder. One of the greatest discoveries throughout this process that will affect our future practice surrounds the vast amount of research that may be necessary to narrow in on the best treatment of a specific child’s unique speech, language, and behavior.
Another essential discovery during this process is the nature of parents when treating children with autism. Two of the studies we examined focused specifically on adult behavior while one found significant improvements in autistic children’s speech and language when their parents are trained. Therefore, it is very important for us to understand the powerful tool of parents when treating this particular group. References
Autism Society. (2013). Facts and Statistics. Retrieved February 7, 2013, from http://www.autism-society.org/about-autism/facts-and-statistics.html
Butler M.G., Youngs E.L., Roberts J.L., and Hellings J.A. (2012). Assessment and treatment in autism spectrum disorders: a focus on genetics and psychiatry,” Autism Research and Treatment, 2012, 1-11. doi:10.1155/2012/242537
Centers for Disease Control and Prevention. (2012). Autism Spectrum Disorders (ASD). Retrieved February 7, 2013, from http://www.cdc.gov/ncbddd/autism/index.html
Goldstein, H. (2002). Communication intervention for children with autism: a review of treatment efficacy [PDF document]. Journal of Autism and Developmental Disorders, 32 (5), 373-396. http://dcautismparents.org/yahoo_site_admin/assets/docs/Speech_Therapy_1.9262857.pdf
Gillam, S.L, & Gillam R.B. (2006). Making evidence-based decisions about child language intervention in schools. Language, Speech, and Hearing Services in Schools, 37, 304-315.
Gillett, J.N.& LeBlanc, L.A. (2006). Parent-implemented natural language paradigm to increase language and play in children with autism. Research in Autism Spectrum Disorders, 2007,247-255.
Ingersoll, B., Meyer, K., Bonter, N. & Jelinek, S. A comparison of developmental social- pragmatic and natualistic behavioral interventions on language use and social engagement in children with autism. Journal of Speech, Language, and Hearing Research, 55, 1301-1313.
Marcus, M.B. (2013, March 4). Most kids with autism overcome language delays, study finds.
Retrieved from http://www.nlm.nih.gov/medlineplus/news/fullstory_134562.html.
Pence, K.L., Justice, L.M. (2008). Language development from theory to practice. Upper Saddle
River, NJ: Pearson Education, Inc.
The National Autistic Society. (2012). What is Autism. Retrieved March 10, 2013, from http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-an-introduction-aspx
Thiébaut E., Adrien J.L., Blanc R., and Barthelemy C. (2010). The social cognitive evaluation battery for children with autism: a new tool for the assessment of cognitive and social development in children with autism spectrum disorders, Autism Research and Treatment, 2010, 1- 9. doi:10.1155/2010/875037.
Wan, C.Y., Bazen, L. Baars, R. Libenson, A., Zipse, L., Zuk, J., Northon, A., & Schlaug, G.
(2011) Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: a proof of concept study. PLoS ONE, 6 (9) Retrieved from http://web.ebscohost.com.dist.lib.usu.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=9356e816-6116-49ee-ad40-713005959c16%40sessionmgr112&hid=108plosone.org Resources
Merlin G. Butler, Erin L. Youngs, Jennifer L. Roberts, and Jessica A. Hellings, “Assessment and Treatment in Autism Spectrum Disorders: A Focus on Genetics and Psychiatry,” Autism Research and Treatment, vol. 2012, Article ID 242537, 11 pages, 2012. doi:10.1155/2012/242537
.
Autism
Introduction
For many years Autism has been a fast growing and controversial disorder. As common as it is world wide, very little is actually known about the disorder and its crippling effects it has on an array of people. Autism also referred to as autism spectrum disorder (ASD), is a “lifelong developmental disability that affects how a person communicates with, and relates to, other people” (The National Autistic Society, 2013). Individuals with this disorder respond differently than an individual not having autism would demonstrate. Due to ASD being the “most deeply researched,” in many areas such as “cognitive profile, …show more content…
language ability, co-morbid diagnoses, and eventual outcomes,” it has become exceedingly complex “to identify proximal causes of disorder, and especially challenging to develop and evaluate treatment” (Paul & Norbury, 2012, p.
119). Over the years, researchers and physicians have developed evaluation tools and methods to help individuals with ASD, along with treatment programs that can help with different aspects of the disorder such as speech and language impediments.
Description
Autism is a type of disorder that as of right now is a “lifelong developmental disability” that affects an individual in many aspects of their life (The National Autistic Society, 2013). This disorder is a spectrum condition (ASD), which means that it is a “group of developmental disabilities that can cause significant social, communication and behavioral challenges” that affects each individual in different ways …show more content…
(Centers for Disease Control and Prevention, 2012). The appearance of autism is typically noticed around the age of three years of life (Autism Society.org). Autism hinders with the individuals ability to comprehend what is going on around them, which can be detrimental to their everyday life, which can result in a lifetime of specialist support. There are three main areas that all individuals who are diagnosed with ASD acquire, it is known as the “triad of impairments.” They are: difficulty with social communication, interaction, and imagination (The National Autistic Society, 2013). Being diagnosed with autism, one must be taught to communicate socially and learn to have a relationship with individuals, objects and how to handle different situations in their lives. On the other hand, not all people with autism undergo the same level of impairment. Autism “affects each person in different ways, and can range from very mild to severe” impediments (Center for Disease Control and Prevention, 2012). Although, there is no exact cause for autism, research has shown that there is a multitude of factors such as “genetic and environmental” aspects, which “may account for changes in brain development” (The National Autistic Society, 2013).
Prevalence and Population
According to the Center for Disease Control and Prevention, the prevalence is estimated about 1 in 88 children who are identified with ASD.
In 2007, a parent-report diagnosis survey of ASD was conducted in households of US children ages 3 to 17 years. The results showed that the “ASD point-prevalence was 110 per 10,000, which was estimated that 673,000 US children have ASD” (Kogan, Blumberg, Schieve, Boyle, Perrin, Ghandour, Singh, Strickland, Trevathan, and van Dyck, 2009, P. 1395). The study also showed that ASD was affected four times larger for boys than it did for girls. Throughout the years, the numbers of having autism is increasing tremendously. Between 2006-2008, about 1 in 6 children in the U.S. have had a type of developmental disability, “ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism” (Center for Disease Control and Prevention, 2012). According to the Autism society, 1% of the children population in the U.S. ranging from ages 3-17 years are diagnosed with ASD and 1 to 1.5 million Americans live with ASD (Autism Society.org). This disorder can be difficult to notice at such a young age, which, in result, the behaviors of autism isn’t usually seen until the child enters school. Statistics show that the growth rate for ASD is 1,148%, which makes it a fast-growing developmental disability (Autism
Society).
Speech and Language Characteristics
Individuals with autism can range from mild to severity with speech and language characteristics. Two of the main areas of difficulty that autistic individuals have are “social communication and social interaction” (The National Autistic Society, 2013). Data shows that after spontaneous language samples, children with ASD “produce short and grammatically simple sentences” than those who do not have ASD (Paul and Norbury, 2012, p. 121). Individuals with ASD typically find verbal and non-verbal communication to be quite difficult to comprehend. Their “literal understanding of language” is taken seriously and actually think “people always mean exactly what they say” (The National Autistic Society, 2013). ASD characteristics do not allow an individual to understand or use facial expressions or tone of voice.
Autism affects all levels of language domains: pragmatics, semantics, syntax and phonology. There are some unusual word-related behaviors that are shown in children diagnosed with autism. “Most common are “metaphorical” and idiosyncratic language, including the use of unusual but meaningful words or phrases” (Wilkinson, 1998, p. 75). Communication varies on the individual with autism, in other words, some individuals “may not speak, or have fairly limited speech” where they prefer to use an alternative form of communication such as sign language or visual symbols, while others “have good language skills, but may still find it hard to understand the give-and-take nature of conversations” (The National Autistic Society, 2013).
Evaluation Tools & Methods
There are various approaches for diagnosing Autism Spectrum Disorder. In today’s society, there has been advancement in genetic testing which results in (so that is why there is) a growing number of children that are being (getting) diagnosed with Autism at an early age, hence, health care professionals are getting well familiarized with this disorder. Technology has advanced in detecting this syndrome at an early stage in an individual’s life. Today more than ever, society has raised awareness
There is a diagnostic approach for patients that may have Autism such as clinical evaluation and genetic testing.
Studies show that ASD affects about 1 individual in 100 live births [12] and is on the increase with a higher prevalence than reported for congenital brain malformations or Down syndrome. Better awareness and more accurate genetic and biochemical testing are now available leading to earlier diagnosis and potential treatments at the molecular level. Approximately 30% of individuals with ASD and/or ID also requires psychological and psychiatric treatments, for behavioral problems including hyperactivity, impulsivity, inattention, aggression, property destruction, self-injury, mood disorders, psychosis, and tic disorders [22, 23]. (Butler, Young, Roberts, & Hellings, 2012, p.2)
People often question the professionals about the risk factors that may contribute to Autism during and/or after pregnancy. According to the review article Assessment and Treatment in Autism Spectrum Disorders: A Focus on Genetics and Psychiatry (2012), family studies suggest that genetic factors contribute significantly to Autism (up to 90%) [24]. The recurrence risk for ASD varies by gender for the second child to be affected (4% if the first child affected is female and 7% if a male) [25-27] . The recurrence rate increases to 25-30% if the second child is also diagnosed with ASD. Single gene conditions are identifiable in less than one-fifth of subjects with ASD, while the remaining subjects have other genetic or multigenic causes and/or epigenetic influences. Epigenetics refer to environmental factors such as nutrition, toxins, or infections that alter gene expression without changing the DNA sequence [28-30]. (Butler et al., 2012, p. 2)
There is a diagnostic approach for Autism Spectrum Disorders. First, there is an initial interview with the parents/caregivers which the professional asks a series a questions and any concerns that the parents/caregivers may have. This helps the professionals get some background history such as behavior, development, and medical history, to get a general idea and to establish a baseline to know what direction to go to. The patient then is examined for mental status and physical health. There are numerous of analysis that may be performed during this initial interview. One well known is the Applied Behavior Analysis (ABA).
Applied Behavior Analysis (ABA) intervention [58] performed for 40 hours per week is considered a validated intervention for 40 hours per week is considered a validated intervention for children with ASD, funded by some state insurance plans, and is increasingly gaining recognition as an in-home behavioral intervention program. Educational, speech, and occupational therapies are mainstream interventions that should be established for the specific needs of each individual (Butler et. al. 2012, p. 4)
It is essential to perform assessments that are age appropriate and beneficial for a child with ASD. The review article The Social Cognitive Evaluation Battery for Children with Autism: A New Tool for the Assessment of Cognitive and Social Development in Children with Autism Spectrum Disorders states that:
The Psycho-Educational Profile (PEP3) [3] specifically assesses the psycho-educative developmentof children with autism, but it has not been standardized for French populations. Moreover, various cognitive and socioemotional domains such as object permanence, symbolic play, and self-image are not specifically explored for ages of 4 to 24 months. There are also some instruments for the developmental assessment of children with pervasive developmental disorders that are domain specific: The Ugziris- Hunt scales [4] focus on infant cognitive development; the Early Social Communication Scales [5, 6], Mac Arthur communicative development inventory [7], SCATA [8] and the Communication and Symbolic Behaviour Scales [9] focus on socio-communicative development or Reynell [10] whose focus is language development. (Thiébaut, Adrien, Blanc, and Barthelemy, 2010, p. 1)
Although these assessment establish an in depth examination of the child’s communicative domains, cognition, and emotional state, they create a baseline analysis. In result, “The Social Cognitive Evaluation Battery (SCEB) covers 16 functional abilities; it aims to address the clinical needs of psychologists, by contributing to the definition of a personal therapeutic and psycho-educational project adapted to each child [4] and to further research on autism.” (Thiébaut et. al. 2012, p. 2) The Social Cognitive Evaluation Battery assessment is beneficial due to the fact that it is not a typical standardized assessment because its domains are structured and descriptive.
The SCEB covers two broad but distinct domains which are cognition and socio-emotional functions of children with Autism. The Cognitive domain is so in depth that it has 7 scales of ability that tests the infant’s psychological development, self-image, and symbolic play. The other domain is the socio-emotional. “The socio-emotional domain is defined by nine abilities: social interaction, behavior regulation, joint attention, expressive language, comprehensive language, vocal imitation, gestural imitation, affective relation, and emotional expression.”(Thiébaut et. al. 2012, p. 2).
This assessment discloses into three stages which are behavior coding, developmental coding, and developmental profiling. In the behavior coding stage the examiner assess the child in a calm environment with materials that may be of interest. This helps the examiner to collect data at best to establish a baseline and the development. The examiner completes an observation grid that covers 188 items. In the Development Coding, the examiner completes a 128 item evaluation on the level of aptitude. Lastly, the Development Profiling stage is examiner find the developmental level based on the scores she/he collected and creates a profile. This assessment also had developmental levels. “The children’s developmental scores from the SCEB were placed in one of four developmental levels, 4–8, 8–12, 12–18 or 28–24 months, and the mean chronological age of the children in each level was computed.” (Thiébaut et. al. 2012, p. 5) There is definitely room for improvement when it comes to using this assessment, but shows that it goes in depth and not just a typical standardized test. Furthermore, this test is in the process of changing so it can be suitable for other cultures.
Treatment Programs or Methods
Although Autism is significantly less prevalent than Specific Language Disorder (which affects 7-10% of children), there is still a large body of research done on treatment programs and methods for those who fall under the umbrella of the autism spectrum disorder (as cited in Pence and Justice, 2008). However, it should be immediately noted that the majority of the research is somewhat limited due to small sample size. Some experts note that it is difficult to obtain a large sample size in an autism study (Marcus, 2013). This becomes apparent when examining reviews. For example, in Goldstein 's Communication Intervention for Children with Autism: A Review of Treatment Efficacy (2002) in which he examines 60 studies on autism, the median number of participants in the 60 studies was 4 participants. In fact, out of all of the studies, only two had more than 50 participants. Therefore, there are some limitations when generalizing the outcomes to the larger population.
It should also be noted that dependent variables in autism studies often vary due to the wide variety of behaviors associated with autism spectrum disorder and its subcategories, including language delay, social interaction problems, repetitive language, etc. (as cited in Pence and Justice, 2008). Some studies focus on just spoken language, while others might focus on spoken language as well as pragmatics.
Some studies have indicated that specific treats can improve the communicative abilities of children with autism who have been identified as non-verbal. About 25% of children with Autism Spectrum Disorders are considered to be non-verbal and, until the last couple of years, few interventions appear to have demonstrated significant growth in their speech output (Wan et. al. 2011). For example, in Auditory-Motor Mapping Training as an Intervention to Facilitate Speech Output in Non-verbal Children with Autism: A Proof of Concept Study, researchers evaluate the Auditory-Motor Mapping Training, a strategy that “trains the association between sounds and articulatory actions with the goal of facilitating speech output. It combines intonation (singing) and the use of tuned drums to facilitate auditory motor-mapping (Wan et. al, 2011, p. 1). During this treatment, which is implemented on six autistic children who do not produce intelligible words, the clinician taps on a drum tuned to the same pitches and the intonation of the words they are trying to teach the child. The researchers find that the AAMT method can be effective in increasing “the range and complexity of their vocal productions” with improvements that are maintained even eight weeks after therapy ceases (Wan et. al, 2011, p. 4). Finally, the researchers find that the children learned how to vocalize both speech sounds that they experienced in therapy as well as speech sounds that had not been trained by the clinician. Several studies examine different treatments to improve speech and language in children with autism. One recent study by Ingersoll, Meyer, Bonter and Jelinek (2012) compares three naturalistic approaches and conditions– the responsive interaction condition, the milieu teaching condition, and the combined condition (that consisted of both previous teaching strategies) and the effect that these strategies have on language and social effects of five children with autism. All treatments are naturalistic. They occur in a natural-like environment and the play activities for the treatment sessions are selected by the clients. The first approach, the responsive interaction condition, emphasizes adults’ response, language modeling, narration, and expansion, but it does not utilize direct elicitation of speech. When the milieu condition is presented, the therapist uses direct elicitation. Questions are asked of the client until he/she makes an obvious attempt to answer, at which time the behavior is reinforced. The combined condition meshes the two previous strategies together.
These researchers draw several conclusions regarding these two strategies. They find that milieu teaching and implementing combined condition are more successful in increasing the rate of specific expression language targets for all five of the children. For example these two conditions help to substantially increase prompted requests in the children with autism. In addition all of the subjects display an increase in their social engagement ratings after experiencing at least one type of the three conditions (Ingersoll et. al. 2012).
While the previous study focuses on the effect of adult’s behavior in improving the language of children with autism, other studies focus specifically on the parent’s role. In a study by Gillett and LeBlanc (2006), three parents of children with autism are taught how to successfully carry out the treatment of the Natural Language Paradigm. Changes in the children’s speech and language are subsequently analyzed.
Though this study is small and consists of only three parents with three children with autism spectrum disorder, the results indicate that this strategy may be extremely beneficial for children with autism (Gillett and LeBlanc, 2006). For example, all three children exhibit immediate and continued increase in the frequency of their vocalizations. The two children with the more advanced language at the beginning of the treatment (according to the baseline measures) demonstrate a considerable increase in their mean length of utterance per vocalization and in their spontaneous vocalizations while the third child displays improvements in prompted vocalizations. These results, which are consistent with the results from previous studies, indicate that this type of treatment outside of a speech-language pathologist’s direct therapy may depend on the initial level of the student but can also significantly improve the speech and language of a child with autism (as cited in Gillett and LeBlanc, 2006).
To maximize the efficacy of treatment and research studies, a clinician cannot simply implement a treatment that he/she read about without taking further steps to both determine the limitations of the study and its suitability for the particular client in question. Evidence-based practice emphasizes clinical decisions that are determined by considering research, the wishes of the client/family, and the knowledge and past experience of the clinician (Gillam and Gillam, 2006). The third step of the “Seven-Step Decision-Making Process” of evidence-based theory requires the clinician to “determine the level of evidence and critically evaluate the study” (Gillam and Gillam, 2006, p. 306). Therefore, before any of these three studies may be used, a clinician would have to assess different factors within the study to figure out the nature of the results. By critically examining the nature of past research, along with ensuring that other factors are considered such as student-parents elements, correct clinical questions, the outcomes of the clinical decisions, the clinician ensures that he/she is making a data-driven decision taking both the client and clinician into consideration.
It should additionally be noted out of these studies that, though they have a low number of subjects, steps are taken in all studies to maximize the validity of the studies. A Comparison of Developmental Social-Pragmatic and Naturalistic Behavioral Interventions on Language Use and Social Engagement in Children with Autism and Parent-Implemented Natural Language Paradigm to Increase Language and Play in Children with Autism both include substantial information about training clinicians and parents and required scores from the training for their data to be valid (Ingersoll et. al. 2012; Gillett and LeBlanc 2006).
Section V: Personal Reaction We learned that, though children with autism may only make up 0.02% of the population, they may present as a significant proportion of a speech-language pathologist’s caseload. In addition, we have found that these clients might prove to be a particularly difficult group to treat due to the wide variety of types, conditions, levels, and behaviors exhibited by those who have been diagnosed with autism spectrum disorder. One of the greatest discoveries throughout this process that will affect our future practice surrounds the vast amount of research that may be necessary to narrow in on the best treatment of a specific child’s unique speech, language, and behavior.
Another essential discovery during this process is the nature of parents when treating children with autism. Two of the studies we examined focused specifically on adult behavior while one found significant improvements in autistic children’s speech and language when their parents are trained. Therefore, it is very important for us to understand the powerful tool of parents when treating this particular group. References
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