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Posted on May 1, 2021 by Insight Clinic
Autism spectrum disorder is a neurodevelopmental disorder that typically appears in the first two years of a child’s life. This condition is typically characterised by impaired social interactions and communication associated with repetitive and restricted interests and behaviours.
According to Diagnostic and Statistical Manual for Mental Disorders (DSM) -5, ASD is considered as a Neurodevelopmental Disorder. Other Neurodevelopmental Disorder includes Attention-Deficit/Hyperactivity Disorder- ADHD, Specific Learning Disorder, and Motor Disorders, such as Developmental Coordination Disorder, Stereotypic Movement Disorder and Tic Disorders (APA, 2013).
The word spectrum is used in Autism Spectrum Disorder is because the severity of this condition varies from mild to severe in each individual. Because there is a range of severity in each individual presentation, treating professionals are encouraged to record the severity using two distinct psychopathological domains such as “social communication” and “repetitive, restricted Behaviours”. The levels of severity as classified as,
An individual with autism struggles to related with others, which is a core feature of ASD. Social Impairments can vary in severity from mild inability to reciprocate socially or emotionally with others to extreme difficulties. The individual may also experience difficulty interpreting and understanding other’s emotions due to their restricted cognitive ability. Some individuals may have no interest in developing friendships, where others struggle to understand the social norms of interactions such as eye contact, facial expressions, body gestures and posture. This can lead into interpersonal conflicts and can also affects their ability to make or maintain friendships and other important relationships.
Another key feature of ASD is communication impairments, which ranges from a delay in the development of expressive language including challenges in initiating and maintaining conversations to excessive use of fixated, repetitive words or phrases regardless of meaning. The use of idiosyncratic language (only understood to people who are familiar with the person’s communication style) is also a common feature of this disorder. People with autism also have difficulty in understanding simple questions, directions, gestures, and humour.
Dysprosody and Echolalia are also some of the communication problem people with autism encounters. A child displays dysprosody can comprehend language and vocalise their needs, however, they experience challenges using appropriate expression to communicate these needs. Echolalia is where a child processes words or phrases and store them for future use and this way they acquire language. However, they might not have the ability to use this acquired language appropriate to situations.
Individuals exhibits restriction in the range of interests, and they tend to be often preoccupied with certain aspects of their play. This includes, they play with one part of their toy and thus restrict their play. They also display stereotyped body movements including, clicking, clapping or whole-body movements such as rocking. Attachments to certain item of clothing or toy are also common.
A number of individuals with Autism experiences are over or under sensitive to a range of environmental stimuli. This can include unusual responses to touch small, sounds, and taste. This may result in them being restricted on certain diet, may interpret a gentle touch as an attack, and may over or underreact to loud noises or pain.
Autism is considered as a complex polygenic disorder, meaning the disorder is developed from interaction between multiple genes and the environment. The genetics of autism is complex, which make it difficult to identify, which genes have contributed to the development of this disorder. Whilst, the onset of autism is dependent on certain genes, environmental factors also contribute to its development.
There has been identified abnormalities in the brain structure including cerebellum and amygdala. Low blood flow to certain parts of the brain also contributes to reduce number of certain brain cells which also contributes to the development of autism traits.
Studies have shown that the connection between cerebral cortex, amygdala and the limbic system have been disturbed creating extreme emotional response to trivial stimuli. This might be understood as a contributing factor for them to develop set routines and rules which reduces such emotional response. Individual also experience a significant level of distress if the routines have been broken.
Deficits or surplus of neurotransmitters are also contributing factors for developing ASD. Irregular neurotransmitters develop incorrect processing of information, consequently, brings struggles with language, communication and learning difficulties.
Some theorists have argued that ASD is not primary caused by genes but may develop due to exposure to environmental triggers. This includes woman who suffered rubella infection during pregnancy identified to have a 7% risk of giving birth to a baby with an ASD. It is also found that a woman who has been smocking throughout her pregnancy are 40% likely to giving birth to a child with Autism. Paternal age exceeding 40 is also considered as another contributing factor to be a father for a child with Autism. Some of the speculated reasons including the Mans’s genetic material is more at risk of undergoing genetic mutations as they get older. Other identified factors also include air pollution, pesticides and chemical exposure.
Behavioural symptoms include hyperactivity, short attention span, repetitive and restricted behaviours, requires routine and structure to function, impulsivity, self-harming behaviours and temper tantrums. Restricted eating, disturbed sleep and difficulties in regulating emotions.
Autism in Girls can also show up with characteristic include special interest in music art and literature, strong imagination sills, a desire to arrange and organise objects and not wanting to play in cooperation with other female peers.
This includes avoidance to eye contact, prefers to play alone, not interested in others interest, flat affect, challenges in understanding and exhibiting personal boundaries, avoid or resist physical contacts, shows no reaction their own name in the first 12 months of age, has trouble understanding and talking about own emotions, experiences anxiety and aggression in overwhelming situations.
Communication challenges include, Echolalia, Delayed speech and language skills, few or no gestures, difficulty in comprehension, literal interpretation of jokes or sarcasm and monotonous.
A number of individuals with Autism experiences unusual responses to touch small, sounds, and taste. This may result in them being restricted on certain diet, may interpret a gentle touch as an attack, and may over or underreact to loud noises or pain.
The earlier the child receives treatment, the better they can develop skills. Early treatment has proven to have significant reduction in symptoms regardless of age and severity of the condition. Parent’s education and involvement is very importance for the effectiveness of the treatment programs. Treatment programs are more effective if they were built on the child’s unique interests, engage the child in structured activities using a predictable schedule and provide regular rewards in the form of words and objects.
To ensure an effective outcome, treatment for ASD must aim for the following:
Applied Behaviour Analysis (ABA) is based on the principle that influencing a response associated with a particular behaviour may cause that behaviour to be shaped and controlled. ABA is a mixture of psychological and educational techniques that are designed to meet the needs of each individual child to alter their behaviours.
ABA approaches such as Discrete Trial Training (DTT), Pivotal Response Training (PRT), Picture Exchange Communication System (PECS), Self-Management, and a range of social skills training are all critical in the treatment of children with ASD.
Discrete Trial Training (DTT) is a technique that can be an important element of a comprehensive educational program for the individual with ASD. DTT involves breaking skills down to their most basic components and teaching them to the child, step by step. All achievements are rewarded, to encourage the child to learn. DTT is used to teach a variety of new skills to children with ASD, ranging from very simple skills (for example, following instructions, dressing, and using utensils) to more complex behaviours (for example, using language and holding a conversation), depending on the specific needs of the child. This approach can be implemented using instruction, modelling, rehearsal, feedback, and reward.
For example, a therapist may give the instruction to “pick up the cup”, and then follow it with modelling (such as pointing at the cup or maybe even picking it up the first time themselves), if needed. Successful completion of the task is rewarded with praise and feedback (e.g., “that’s great”), and something the child likes. This is repeated a few times until the child has clearly demonstrated they have learnt the new behaviour.
Pivotal Response Training (PRT) is a behavioural treatment based on the principles of Applied Behaviour Analysis. PRT builds on learner initiative and interests, and is particularly effective for developing communication, language, play, and social behaviours. This style of training is particularly effective in establishing sociodramatic skills with adults as play partners. PRT was developed to create a more efficient and effective intervention by enhancing four pivotal learning variables: motivation, responding to multiple cues, self-management, and self-initiation.
The assumption of this approach is that these skills are pivotal because they are the foundational skills upon which learners with ASD can make widespread and generalised improvements in many other areas, as they will also lead to the development of new behaviours. Improvements in these areas will promote a variety of social-communicative behaviours, such as communication, imitation, play skills, and joint attention. They will reduce inappropriate, maladaptive behaviours, thus improving a quality of life.
Video modelling is a procedure used to teach a variety of skills to children with ASD. It involves having the child watch a model perform a target skill on a video and then practice the skill that he or she observed. This style of training can be used to teach a wide variety of skills, including basic communication skills using gestures (for example, saying goodbye and waving goodbye), daily living skills such as hand-washing, and social skills such as making comments during play. This use of this technique has been known to result in rapid acquisition of new behaviours in autistic children without the use of response prompting or reinforcement. The general procedure of this technique follows the steps outlined below:
Children on the ASD spectrum are often perplexed when it comes to picking up social cues. Social stories for children with behavioural problems can help to teach these skills in an easy and direct way. The primary purpose of social stories is to provide descriptive information concerning a social concept or situation, such as the sequence of events involved and thoughts and feelings of others. Social stories help the child gain a better understanding of other people’s thoughts, feelings, and views. They also help the child to better predict another person’s behaviour based on their actions.
Various situations are presented in a structured and direct way through the social story so the child can understand a situation without having to “read between the lines”. This technique provides the child with accurate information about situations that they may otherwise find difficult or confusing. The child is encouraged to describe the situation in detail and focus on certain elements such as: the important social cues, the events and reactions the child might expect to occur in the situation, the actions and reactions that might be expected of them, and the reasons for such behaviours and reactions. The goal of the story is to increase the individual’s understanding and interpretation of the events that may occur during a social environment.
A picture exchange communication system (PECS) is a form of augmentative and alternative communication that uses pictures instead of words to help children communicate. PECS was designed especially for children with autism who have delays in speech development. This approach is designed for early communication training and is intended for use during typical activities within natural settings, such as the classroom and the home. When first learning to use PECS, the child is given a set of pictures of favourite foods or toys as a form of reinforcement. When the child wants one of these items, they give the picture to a communication partner (a parent, therapist, caregiver, or even another child). The communication partner then hands the child the food or toy. This exchange reinforces communication. As the child begins to understand the usefulness of communication, the hope is that they will begin to use natural speech. PECS can also be used by the child to make comments about things seen or heard in the environment. For example, a child might see an aeroplane overhead, and hand a picture of an aeroplane to his or her parent.
References:
Woodburry-Smith, M.R., & Volkmar, F.R. (2009). Asperger syndrome. European Child and Adolescent Psychiatry, 18, 2-11.
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