Defining the Problem Autism is a severe and lifelong developmental disability that typically appears within the first three years of the child’s life. Children with autism display specific developmental deficits, particularly in language and in social skills, along with a num- ber of other developmental abnormalities. The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV) considers autism a Pervasive Development Disorder (PDD), a disorder that causes developmental problems in multiple areas. There are four other disorders under the cate- gory of PDD: Asperger Syndrome, Child Disintegrative Disorder, Rett’s Disorder, and PDD Not Otherwise Specified (PDD-NOS). Severely impaired social development is a major factor in diagnosing children with autism. Autistic children do not typically seek out or develop relationships with other people, but rather prefer to remain in their own private world. They do not show empathy or share their own interests or This Instant Help Chart was written by Jerilyn Famighetti Various medications have been used to control the behavioral and social abnormalities associat- ed with autism. For example, selective sero- tonin reuptake inhibitors such as Prozac have been used to relieve the repetitive behaviors that are typical of autistic children; theses drugs sometimes help reduce aggression and irritability and improve social responsiveness. Antipsychotic drugs such as clozapine (Clozaril) and risperidone (Risperdal) have also been tried and in some cases help to reduce symptoms such as withdrawal and stereotypical behavior. Some stimulants, such as Ritalin, may help the autistic child to focus and may reduce hyperactivity. All these drugs have significant side effects, and their use must be moni- tored carefully. Instant Help for Children and Teens with Autism Instant Help for Children and Teens with Autism This chart is intended to provide a summary of the critical information available on helping children and teens with autism to insure that every child gets the most appropriate and compre- hensive consideration. There is no evidence that autism is caused by psychological factors originating in either the child or the family. It is caused by a brain disor- der, which likely has a genetic basis. There are no medical tests for the disorder, and diagnosis is made by observation and elimination of other possible causes for the observed behaviors, such as physical illness, mental retardation, or deafness. As part of the evaluation, the professional will observe the child’s behavior and development and obtain a detailed developmental history from the parents and, if appropriate, from other caregivers and teachers. The professional may also adminis- ter one of several available screen- ing tests. These include: The Childhood Autism Rating Scale (CARS), which uses a 15- point scale to assess several aspects of the child’s develop- ment, including relationship to people, verbal ability, and adap- tation to change. The test can discriminate between autism and other development disorders. (Western Psychological Services) Assessing Autism About Instant Help Charts Treating Children and Teens with Autism There are many methods of treatment for the autistic child, and different methods are normal- ly used for different problem behaviors. Some treatments have empirical evidence that sup- ports their efficacy; others are supported only by case studies and qualitative evidence. Variations on behavior therapy have proved most effective in treating the behaviors that define autism. Medications, such antidepres- sants, antipsychotics, and psychostimulants, can sometimes help alleviate behavioral abnor- malities and improve social responsiveness. There is anecdotal evidence that the use of special diets and vitamins can improve some of the behavioral problems associated with autism. Treatment may also include animal or music and art therapy, as well as physical or sensory stimulation. Major treatment approaches include: Applied Behavioral Analysis, which aims to reward adaptive and prosocial behaviors while extinguishing inappropriate ones. Discrete Trial Training (also called Lovaas Therapy), where every task given to the child consists of a request to perform a spe- cific action, a response from the child, and a reaction from the therapist. This therapy is not just about correcting behaviors; it is also designed to teach skills, from basic ones, such as sleeping and dressing, to more involved ones, such as social interaction. Picture Exchange Communication Systems (PECS), developed at the Delaware Autistic Program, which helps autistic children communicate by exchanging a picture for an item or an activity that they want. Goals in Developing a Treatment Plan The goals of those treating autistic children must take into account the range of deficits common in such children—interpersonal, communicative, language, and behavioral. Treatment must address these deficits indi- vidually and collectively. Broadly speaking, the goals of treatment must be: To improve the child’s ability to commu- nicate and engage the outside world To lessen the use of stereotyped behaviors and rituals To enable the child to behave as appro- priately as possible in social situations and engage in meaningful interactions with others To minimize the occurrence of aggres- sive or dangerous behaviors that threat- en either the child or others with whom he comes in contact Scientists have not yet uncovered the biological basis of autism. They are studying a number of possible factors and interactions in brain biology, including the possibility of a genetic susceptibility to autism and the role of viruses, environmental triggers, and metabolic imbalances. Several specific brain sites and abnormalities have been identified as possibly involved in the development of autism. These include so-called Fragile X syndrome and Angelman’s syndrome. A number of others are also being investigated. All researchers are agreed that autism is caused by pervasive brain dysfunction. (continued on p. 2) 4 • Instant Help for Children and Teens with Autism The Brain and Autism Pivotal Response Treatment (PRT), which is a naturalistic intervention model produc- ing positive changes in critical behaviors, leading to generalized improvement in communication, social, and behavioral areas. Rather than target individual behav- iors one at a time, PRT targets pivotal areas of development, such as motivation, responsiveness to multiple cues, self-man- agement, and social initiations. Floor Time, developed by child psychiatrist Stanley Greenspan, which uses play therapy techniques to increase the interac- tion of a child and an adult through six stages of emotional development. Social Stories, developed by Carol Gray, which helps a child recognize feelings, points of view, and expected responses. The stories, written in the first person and present tense, are written to a child’s spe- cific needs and can incorporate pictures, photographs, and music. Sensory Integration Therapy, which treats children who are hypo- or hyperreactive to sensory input by helping the child recog- nize, integrate, and react appropriately to that input. Treating Children and Teens with Autism (continued) Medication and Autism Books for Kids Taking Autism to School. Andreanna Edwards, JayJo Books, 2001 My Friend with Autism: A Coloring Book for Peers and Siblings. Beverly Bishop and Craig Bishop, Future Horizons, 2003 Russell Is Extra Special: A Book about Autism for Children. Charles A. Amenta, Magination Press, 1992 Books for Parents Autism: Handle with Care. Gail Gillingham, Tacit Publishing, 2001 A Slant of Sun: One Child’s Courage. Beth Kephart, Harper Perennial, 1999 Autism Spectrum Disorders: The Complete Guide to Understanding Autism, Asperger’s Syndrome, Pervasive Developmental Disorder, and Other ASDs. Chantal Sicile- Kira and Temple Grandin, Perigee, 2004 Books for Professionals Addressing the Challenging Behavior of Children with High-Functioning Autism/Asperger Syndrome in the Classroom. Rebecca A. Moyes, Jessica Kingsley Publishers, 2002 Autism: Nature, Diagnosis, and Treatment. Geraldine Dawson (Ed.), Guilford Publications, 1989 Assessing and Treating Infants and Young Children with Severe Difficulties in Relating and Communicating. Stanley I. Greenspan et al, Zero to Three Publications,1997 Activity Schedules for Children with Autism: Teaching Independent Behavior (Topics in Autism). Lynn E. McClannahan, Ph.D., and Patricia J. Krantz, Woodbine House, 1999 Resources for Helping Children and Teens with Autism The Checklist for Autism in Toddlers (CHAT), developed in the early 1990s to evaluate the possibility of autism in chil- dren as young as 18 months. The check- list has two sections; one is completed by the parents and the other by the child’s pediatrician. The parents’ sections asks, for example, whether the child enjoys interpersonal games, such as peek-a- boo, or points out to the parent interest- ing things in the environment. (available for download at www.firstsigns.org) The Social Communication Questionnaire, which is used in children ages four and up to evaluate communica- tion and social skills. (Western Psychological Services) The Screening Test for Autism in Two- Year-Olds, which is being developed at Vanderbilt University and which uses direct observation to evaluate toddlers. Assessing Autism (continued) (continued on p. 4) (continued on p. 4) Published by Childswork/Childsplay © 2005 Childswork/Childsplay Childswork/Childsplay A Brand of The Guidance Group 1.800.962.1141 www.guidance-group.com