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A neurodevelopmental disorder that is characterized by pervasive developmental problems that must include impairments in social engagement, difficulties with language use, and fixations often associated with repetitive behaviors accompanied by rigidity.
A child labeled today as having an Autism Spectrum Disorder may look very different from the child diagnosed 30 years ago with Autism. At that time we diagnosed children who more closely resembled the children first described by Dr. Leo Kanner, in the seminal paper.
Kanner, L. (1943), Autistic Disturbances of Affective
Please fill out the following about how your child usually is. Please try to answerevery question. If the behavior is rare (e.g. you've seen it once or twice), pleaseanswer as if the child does not do it.
1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No2. Does your child take an interest in other children? Yes No3. Does your child like climbing on things, such as up stairs? Yes No4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No5. Does your child ever pretend, for example, to talk on the phone or take care of dolls or pretend other things? Yes No6. Does your child ever use his/her index finger to point, to ask for something? Yes No7. Does your child ever use his/her index finger to point, to indicate interest in something? Yes No8. Can your child play properly with small toys (e.g. cars or bricks) without justmouthing, fiddling, or dropping them? Yes No9. Does your child ever bring objects over to you to show you something? Yes No10. Does your child look you in the eye for more than a second or two? Yes No11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No
A child fails the checklist when 2 or more critical items are failed OR when any three items are failed. Yes/no answers convert to pass/fail responses. Below are listed the failed responses for each item on the M-CHAT. Bold capitalized items are CRITICAL items. Not all children who fail the checklist will meet criteria for a diagnosis on the autism spectrum. However, children who fail the checklist should be evaluated in more depth by the physician or referred for a developmental evaluation with a specialist.1. No 6. No 11. Yes 16. No 21. No2. NO 7. NO 12. No 17. No 22. Yes3. No 8. No 13. NO 18. Yes 23. No4. No 9. NO 14. NO 19. No5. No 10. No 15. NO 20. Yes
Applied Behavioral Analysis is a systematic study and measure of observable behavior and then manipulating the environment to modify behavior. The environmental modifications are designed to increase more socially appropriate and adaptive behaviors.
Observation for what behaviors look like and their frequency. What leads to the behavior and what are the consequences positive and/or negative for the behavior?
Breaking down desired skills into steps.
Teaching the steps through repeated presentation of discrete trials.
Data on performance is tracked to show changes over time.
DIR (Developmental, Individual-Difference, Relationship-
Based)/Floortime
Floortime is based on the premise that children learn skills from relationships with significant others in their lives. It is child directed and based on interactive experiences in a low stimulus environment ranging from two to five hours a day. There is a stress on early intervention. The longer a child is left to engage in his/her own world the more difficult engagement with the “outside” world becomes. Integration with typical peers is also important.
Parent collaboration: parents work with professionals as co-therapists for their children so that techniques can be continued at home.
Assessment for individualized treatment: unique educational programs are designed for all individuals on the basis of regular assessments of abilities.
Structured teaching: it has been found that children with autism benefit more from a structured educational environment than from free approaches.
Skill enhancement: assessment identifies emerging skills and work then focuses upon these. (This approach is also applied to staff and parent training.)
Cognitive and behavior therapy: educational procedures are guided by theories of cognition and behavior suggesting that difficult behavior may result from underlying problems in
Professionals in the TEACCH system are trained as generalists who understand the whole child, and do not specialize as psychologists, speech therapists etc.
(Extract from Approaches to autism: an annotated list published by The National Autistic Society, 1993 revised 2003).
Complementary and alternative treatments can include vitamin supplements, medications, antibiotics, antifungals, diet strategies, chelation/mercury detoxification, and non-biologic treatments for language and communication or for sensory problems.
Complementary alternative medical and other biological treatments seem to relieve some symptoms, but there is no rigorous peer reviewed research supporting any of the treatments.
Make sure all your treatment professionals, especially your physicians, know the treatments given your child.
Research indicates that parents of children with autism experience greater stress than parents of children with intellectual disabilities and Down Syndrome. (Holroyd & McArthur, 1976; Donovan, 1988).
Lack of language can lead to problems with frustration both for the parents and the child. Frustrations can lead to tantrums and aggressive behavior towards self and others.
Families struggle with the additional challenges of getting their child to sleep through the night or eat a wider variety of foods. All of these issues and behaviors are physically exhausting for families and emotionally draining.
Maladaptive behaviors may prevent families from attending events together. For example, Mom might have to stay home while Dad takes the sibling to their soccer game. Not being able to do things as a family can impact the marital relationship. In addition, spouses often cannot spend time alone due to their extreme parenting demands and the lack of qualified staff to watch a child with autism in their absence.
Having a child on the autism spectrum can drain a family's resources due to expenses such as evaluations, home programs, and various therapies. The caregiving demands of raising a child with autism may lead one parent to give up his or her job, yet financial strains may be exacerbated by only having one income to support all of the families' needs.
Current theories of grief suggest that parents of children with developmental disabilities experience episodes of grief throughout the life cycle as different events (e.g., birthdays, holidays, unending caregiving) trigger grief reactions (Worthington, 1994). Experiencing "chronic sorrow" is a psychological stressor that can be frustrating, confusing and depressing.
There are also potential sources of stress for siblings. Not all siblings will experience these issues, but here are some to be aware of: • Embarrassment around peers. Jealousy regarding amount of
time parents spend with their brother/sister • Frustration over not being able to engage or get a response
from their brother/sister • Being the target of aggressive behaviors • Trying to make up for the deficits of their brother/sister • Concern regarding their parents stress and grief • Concern over their role in future caregiving
• Individual, marital or family counseling• Joining others in advocacy efforts at the local, state or
federal level• Keeping a daily schedule of things to accomplish • Writing in a journal• Deep breathing / relaxation exercises / meditation• Exercise / yoga• Prayer
Above slides on Family Stressors adapted from ASA website Adrianne Horowitz, CSW, Director of Family Services for the Eden II Programs for Autistic Children.
Remember parents are the experts on their child. Others may be expert on autism spectrum disorder, behavioral interventions, education, medication or the like but only the parents are expert with regards to their child with Autism Spectrum Disorder.