A CASE STUDY : AUTISM

1.0 INTRODUCTION Special needs is a term used in clinical diagnostic and functional development to describe individuals who require assistance for disabilities that may be medical, mental, or psychological. For instance, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases 9th edition both give guidelines for clinical diagnosis. People with Autism, Down syndrome, dyslexia, blindness, or cystic fibrosis, for example, may be considered to have special needs. The disorder that I have chosen to do a case study on, is autism. Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood. Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations, or by rare combinations of common genetic variants. In rare cases, autism is strongly associated with agents that cause birth defects. Controversies surround other proposed environmental causes, such as heavy metals, pesticides or childhood vaccines; the vaccine hypotheses are biologically implausible and lack convincing scientific evidence. The number of people diagnosed with autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved. Parents usually notice signs in the first two years of their child's life. The signs usually develop gradually, but some autistic children first develop more normally and then regress. Early behavioral or cognitive intervention can help autistic children gain self-care, social, and communication skills. Although there is no known cure, there have been reported cases of children who recovered. Not many children with autism live independently after reaching adulthood, though some become successful. Autism causes kids to experience the world differently from the way most other kids do. It's hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can't communicate without special help. They also may react to what's going on around them in unusual ways. Normal sounds may really bother someone with autism so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable. Kids with autism often can't make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person's happy feelings. A kid who

has autism also has trouble linking words to their meanings. Imagine trying to understand what your mom is saying if you didn't know what her words really mean. It is doubly frustrating then if a kid can't come up with the right words to express his or her own thoughts. Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don't like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed. If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn't help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help. I have decided to do a case study on Jennifer. Jennifer is a 5-year-old boy with autism. He has difficulty communicating with his peers and frequently fails to respond when people speak to him. Jennifer never initiates conversations and rarely makes eye contact with other individuals. Periodically, Jennifer becomes upset and loses his temper throughout the school day. Jennifer is not the only person with autism in his family. His older brother, Matthew, exhibits some signs of autism, including certain repetitive behaviors, difficulty with social skills, and behavioral problems. Despite these barriers, Mathew has been successfully integrated into a general education classroom.

2.0 Literature Review

Autism spectrum disorders (ASD) have a rising profile in terms of recognition, definition and public knowledge, which has greatly increased the importance of ASD both in society in general and in education in particular. Research into autism has grown significantly in the last five to ten years. Prevalence figures have changed from showing autism as a lowincidence set of difficulties, to defining autism as not uncommon. Indeed internationally figures suggest that ASD is now recognised as a major problem (Gerlai & Gerlai, 2003) demanding further research and informed intervention. In Scotland a policy focus on inclusive education has served to heighten awareness of ASD across the education profession, making it an issue of central concern in relation to educational provision. Recent work has extended knowledge of the impact of autism upon interpersonal, communicative, cognitive, imaginative, sensory, perceptual, physiological and behavioural processes. This has informed a growing understanding of causes and the drive towards

more refined diagnostic protocols, and has underpinned a widening range of interventions and approaches to the education of children with ASD. In this climate of increased awareness of autism, history affords us the understanding that autism is not new (Frith, 1989). In 1906 the Swiss psychiatrist Eugene Bleuler (Ritvo, Freeman, Ornitz et al., 1976) used the word autism to describe patients in clinical reports. From the 1920s onwards, several concepts had appeared in the literature all referring to similar or over-lapping patterns of personality traits and problematic behaviours in children (mostly boys). However the main thrust to define autism began in the 1940s with the seminal work of Leo Kanner (1943) and Hans Asperger (1944). (For a historical literature review, see Gillberg, 1998 or Wing,1998). Autism has been characterised as a pervasive developmental disorder (PDD), as a disorder of affective contact, as an organic dysfunction of biological origin, and as a neurological or brain disorder, that affects a persons ability to communicate, form relationships with others, and respond appropriately to the environment, each in varying degrees. Those affected by autism fall along a spectrum of high-functioning individuals to individuals who lack any means of communicating with others. This diverse and changing expression of autism and other PDDs over the course of development presents some of the greatest challenges for education. Autism is a pervasive developmental disorder appearing in the first three years of life. Many counselors face the challenge of working with parents or children impacted by Autism; therefore, it is important for them to understand what Autism is, how it is diagnosed and a basic reference to treatment modalities. Autism is characterized by impairments in communication, language, and reciprocal social interaction and by patterns of restricted and repetitive interests or behaviors (American Psychiatric Association, 2000). These presentations are the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with Autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism Spectrum Disorder (ASD) is a broader category characterized by the same set of core symptoms, with a lesser degree of severity, inclusive of pervasive developmental disorder, not otherwise specified and Aspersers Syndrome (American Psychiatric Association, 2000). This literature overview discusses the indicators of when diagnosis of Autism is typically made, special issues related to Autism/ASD, and basic treatment of Autism. Readers should note that this literature review is an overview and Autism is a very complicated disorder which requires counselors to deeply research the disorder and subsequent treatments before beginning working with Autistic clients or their families. According to Kestenbaum (2008) the first signs of Autism most often present themselves

before the age of three. The American Psychiatric Association (2000) states that manifestations of Autism in infancy and through the first year are more subtle and difficult to define than those seen after age two. According to Gotham, Risi, Pickles & Lord (2007), the Autism Diagnostic Observation Schedule (ADOS) is a common standardized assessment of communication, social interaction, play and imagination designed for use in diagnostic evaluations of individuals referred for possible Autism/ASD. The ADOSs is intended to complement information obtained from developmental tests and a caregiver history. Therefore ADOS is a tool that can be used in diagnosis along with a complete caregiver history. Autism is characterized by what is clinically described as deficits in social reciprocity. Social reciprocity may include a range of back-and-forth actions, such as gestures, sounds, play, attention, and conversation. Further, ritualistic and obsessive behaviors are often present: for example, a child may insist on lining up objects rather than playing with them. In addition, a child with an Autism/ASD may have uncontrollable temper tantrums, an extreme resistance to change, and over- or under-sensitivity to sights and sounds. The signs may be obvious, or subtle: for example, a three year old child can read, but cant play peek-a-boo. Another child may never utter a spoken word, but rather uses pictures or signing to be understood. The symptoms are varied, but one thing is clear: the earlier a child is diagnosed and begins receiving services, the better the prognosis for the child. According to the American Psychiatric Association (2000), the diagnostic criteria for autistic disorder include a total of six (or more) items from the following areas: (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction, (2) failure to develop peer relationships appropriate to developmental level (3) a lack of spontaneous seeking to share enjoyment, interests or achievements with other people; and, (4) a lack of social or emotional reciprocity. Secondly, the child must show impairments in communication as manifested by at least one of the following: 1) a delay in or total lack of the development of spoken language, (2) in individuals with some speech, marked impairment in the ability to initiate or sustain a conversation with others, (3) stereotyped and repetitive use of language or idiosyncratic language, (4) and lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. Lastly, the child must also present with restricted or repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following: (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; (2) apparently inflexible adherence to

specific, non functional routines or rituals, stereotyped and repetitive motor mannerisms; and (3) persistent preoccupation with parts of objects. Furthermore, the child must also demonstrate delays or abnormal functioning in at least one of the following areas, prior to age 3 years: (1) social interaction, (2) language as used in social communication, or symbolic or imaginative play. Finally, the disorder is not better accounted for by Retts Disorder or Childhood disintegrative disorder (p. 75). Children with Autism are known to have larger head circumferences than their peers and can also have greater weights. In their study of the elevated levels of growth-related hormones in autism and autism spectrum disorder, Mills et al., (2007) found children with Autism had significantly higher levels of growth related hormones than controls and they also had particularly dramatic brain overgrowth in early life. Furthermore, Mills et al. found that although it has been hypothesized that androgenic hormones play a role in Autism and ASD, because of the preponderance of male cases the role of hormones in the unusual growth pattern seen in these cases has received little attention by other researchers. The researchers believe their findings could help explain the significantly larger head circumferences and higher weights seen in children with Autism but they conclude by stating further studies are needed to examine the potential role of growth-related hormones in the pathology of Autism and ASD. Another area of interest to researchers includes understanding sexuality and sexual behaviors of individuals with Autism. According to Sullivan and Caterino (2008) in the past there has been a tendency to believe that Autistic individuals are unaffected with sexual interests and when sexual interests were noted, those behaviors were generally viewed in a negative manner due to related social stereotypes and impairments associated with the disorder. Nonetheless, research by Sullivan and Caterino (2008) suggested that most adolescents and adults with these disorders engage in sexual behaviors and many desire intimate relations with others. They also say that past case studies have focused on negative social perceptions and draw attention to deviant sexual behaviors such as public masturbation, fetishism, compulsive sexual behaviors among this population. Individuals with Autism/ASD generally follow a normal physical sexual development path with the emergence of secondary sex characteristics at puberty; however, the normal emergence of emotional changes and increasing sexual urges are often delayed (Sullivan & Caterino, 2008). Inappropriate sexual behaviors are often concerning for others because Autism/ASD individuals do not connect the sexual drives with appropriate socialization and understanding of social norms. Since sexual knowledge and behavior is connected to social interactions from which people with Autism are often excluded because of their social and communication deficits, Sullivan and Caterino say there is a need for specialized sex education for individuals with Autism. Their research has shown that there is a high

frequency of sexual behaviors among this population; consequently caregivers and others must be prepared to facilitate appropriate learning opportunities for sexual expression when working with Autistic clients. Self-management techniques and social skill training may also be effective in reducing inappropriate sexualized behaviors. Since Autism/ASD can occur on a continuum, treatment approaches can vary greatly. Typically clinicians utilize a combination of medication management and therapeutic interventions when treating individuals with the disorder. Since the condition is pervasive and continues throughout the life span, interventions focus on improving behavioral, social and cognitive functioning (McDougle, Stinger, Erickson, & Posey, 2006). Because Autism/ASD is biological in origin, medical researchers have made extensive efforts to find effective medications for children with the diagnosis (McDougle, et al., 2006). Medications are helpful in reducing destructive behaviors such as tantrums, aggression or repetitive ritualistic behaviors Drug treatment strategies can target specific symptom domains including motor hyperactivity and inattention, interfering repetitive behavior, aggression and self-injurious behaviors. Drug treatment studies in Autism have focused on the use of one drug to target one symptom domain or group of related symptoms. In a review of drug trials treating Autism, McDougle, et al. found the psychostimulant methlphnidate and clonidine are useful for treating motor hyperactivity and inattention. Antipsychotics have also been used for the treatment of aggression and self-injurious behavior. Many other types of mediations have been studied, but none have clearly been shown to be helpful for all clients with Autism/ASD. Therapeutic interventions include speech and language therapy, behavior therapy, play therapy, cognitive behavioral therapy and social skills training. One therapeutic intervention called Applied Behavioral Analysis (ABA) employs methods that are believed to produce comprehensive and lasting improvements in important skill areas for most people with ADS. ABA employs therapeutic interventions which are based on behavioral modification techniques that build useful social skills while reducing problematic ones. The effective and ethical use of ABA requires specialized training but in essence can be described as a treatment focusing on teaching small, measurable units of behavior systematically Every skill the child with Autism/ASD does not demonstrate, from simple responses like making eye contact, to complex acts such as spontaneous communication and social interaction is broken down into small steps (Maurice, Green & Luce, 1996). According to Kestenbaum (2008) the chief goal of any therapeutic or medication intervention is to help the child become a member of society, and help the child interact in a more productive level with their world. The most salient point brought forward about treating children with Autism/ASD is that

each child presents with a unique set of developmental strengths and deficits therefore treatment can often be a difficult and complex puzzle.

3.0 Methodology Observer Child Age of Child Date Time Setting :Puspa Devi Munisamy :Jennifer Jothi :10 years five months :Jenniferuary 8th 2012 :10:15 to 11:30am :Sunday School Room and Outdoor Play Ground, Lady of Lourdes Church Klang. Activities :Short Lesson, Craft Activity, Free Play

Introduction I observed Jennifer during a Sunday school activity at our local church. A short lesson was given on Jesus dying on the cross and what that meant for us as Christians. The children then proceeded to make crosses out of wooden Popsicle sticks before adjourning outside to play on the playground adjacent to the church. There were 15 children present, including Jennifer, that were between ages 8 and 10.

1. Communication Jennifers verbal communication abilities were limited. When she did speak, it was

mostly in three to five word phrases. When asked a question she would repeat the question without the subject and then answer the question. Jennifer, would you like red yard or blue yarn? yarn?Blue! For example, one of the helpers asked, Jennifer replied, Red yarn or blue

She also spoke much more loudly compared to the other children and was Each time the request was made she would repeat the

asked several times to whisper.

word whisper in a hushed voice. However, the next time she would speak she would regain her excessive volume. She knew what the word whisper meant but did not understand that she needed to apply it to her own behavior or that a request was being made of her to change her behavior. At one point one of the other children asked Jennifer to pass the glue to which Jennifer replied, Pass glue, but did not carry out the action. She understood that the items on the table had labels/names but seemed unable to process or express requests. When Jennifer needed at item on the table that was out of her reach, she would repeat the name of the item several times until another person retrieved it for her. She neither pointed at the item nor

got out of her seat to get the item. When the item was given to her she would say thank you

in a flat voice as if she knew she was supposed to say thank you but did not understand why she was supposed to say it, or what it really meant. Although she seemed oblivious to the conversations going on around her, Jennifer would occasionally look at the other children and laugh when they laughed at a joke. She would also look at what they were doing with their projects when she was frustrated or unsure about hers and try to imitate what they were doing. These imitative behaviors are uncommon for a child with Autism. When it was time to go outside, Jennifer did not respond to the instruction, OK, its time to put on your coats! When asked individually if she wanted to go outside she repeated She then followed the other students, put on her coat,

outside then followed with yes. and went outside.

The whole time she was getting ready to go outside she kept repeating

outside in an excited manner. Once outside, another child asked Jennifer if she wanted to swing. Jennifer followed the other child but did not get on the 2nd swing. Instead she

watched the other child swinging and stood in front of the swing set repeating up and down. This went on for about 5 minutes until the other child stopped swinging and went to the jungle gym. Jennifer then walked to the classroom door and stood waiving her hands until one of the helpers took her back into the room. While by herself in the room, she stood and looked at the shelving where the toys had been put away. Jennifer was given a baby doll by the helper and asked if she wanted the baby. Jennifer took the doll, sat down, and began rocking back and forth with the doll cradles in her arms while saying sweet baby over and over. She then put the baby on her shoulder and said, burp as she patted its back. She went back to rocking the baby saying nothing until the other children returned and the parents came to pick up the children. At that time I

discovered that she had a baby brother and was probably imitating her mothers actions with the baby. Jennifers primary expressive communication was in the form of echoed words. She did not use gestures such as pointing and did not initiate conversation at any time. Occasionally she seemed aware of others around her and imitated certain actions and reactions. Her limited communication abilities, however, prevented her from being a part of the group and sharing experiences with others.

2. Social Functioning Jennifer had little or no social skills to speak of. She was not able to initiate or engage in conversation at any level. She had been trained to politely respond in certain situations

with words such as please and thank you, but seemed to have no concept of their intent. When she would speak loudly, the other children would look surprised or angry. Jennifer did not respond to these facial expressions any more than she responded to the teachers facial expression when telling Jennifer to whisper. She was unaware of what the other children

thought of her actions. She did laugh when the other children laughed at a joke or funny action, but seemed to just be imitating rather than sharing in the experience. When she laughed, she was not smiling, but only held her mouth open while verbalizing Ha ha ha ha ha. Additionally, Jennifer was unable to participate in the activities when outside on the playground. She did not seem to understand what the equipment was for and only attended to the movement being made on the swing, not the child on the swing or the idea that she could do the same. She seemed to view the child on the swing as just another object involved in the movement. impacts the number of Her inability to join the others in conversation and activity opportunities she could/should have in learning social

appropriateness, language, and other interaction skills. It also impacts her ability to become self-aware and how she fits into the scheme of life.

3. Repetitive/Stereotypic/Restrictive Patterns of Behavior Jennifers repertoire of repetitive/stereotypic patterns of behavior pervaded the entire observation. At the beginning of the Sunday school lesson, the children were asked to sit in a circle of chairs placed at one end of the room. Jennifer sat in a chair, then got up and She did this 3 times before sitting She also performed the

walked around the circle before returning to her chair. down permanently.

The teacher later said this is a habit for her.

same ritual around the craft table before taking her seat.

While the teacher was talking

about the lesson, the other children were engaged and answering questions: Jennifer sat in her chair rocking back and forth repetitively. During the craft activity, as discussed previously, when she wanted and object she would say the name of the object repetitively until the object was brought to her. While one of the helpers was explaining how to make the cross, Jennifer was engaged in feeling the texture of the wooden stick. stick. She kept running her thumb up and down the front and back of the

She stood outside the classroom door and repetitively shook her hands until

someone came to open the door. Most of her repetitive behavior seems to occur when she is in need of something but does not know how to ask for it, or that she has the power to ask. The other children were familiar with Jennifers behaviors and mostly ignored them. However, in a setting where others are not familiar with Jennifer and her disability, she would probably draw negative attention. I am not so sure that she would realize the negativity or that it would impact her in any way.

4. Secondary Characteristics During the craft activity Jennifer was unable to plan out the steps necessary to make the cross. She began by wrapping a piece of yarn around one stick rather that crossing the

sticks and wrapping them together. She then noticed that hers did not look the same as the

others and attempted to put the second stick on top of the yarn. When it wouldnt stay, she sat back in her chair and began rocking. One of the helpers came over and showed her

how to begin again, but Jennifer did not attend fully to the instruction. She did not complete the task by the end of the session. The transition to go outside went smoothly, probably because she was used to the routine in this setting. At first, when she was with the child on the swing, she was standing too close to the activity and was in danger of getting hit by the other child in full swing. The other child told her to move back, but Jennifer did not respond. danger of getting hit. She was unaware of the

One of the other children helped by taking Jennifer by the arm and When the child stopped swinging, Jennifer was unable to This could be

moving her backward.

independently structure the free time and went back to the classroom door.

because she was looking for the structure that had been provided in the room. Once in the room, she was again unable to structure her free time until prompted by the helper. Jennifer did not seem to respond to stimuli in an oversensitive manner. Her repetitive

behaviors appeared to be more from communication frustrations than to a response to over stimulation. Her safety was impacted in this setting because of her lack of fear of danger Not being able to complete the craft task was a direct result of her Being unable to self-

while at the swings.

inability to attend to instruction and plan and organize the task.

structure free time impacted her ability to play imaginatively and become part of the group socially. 5. Impact on Inclusion and Participation The other children in the observed group were normally developing children without disabilities. During the lesson they were able to attend to the teacher, answer questions, and give personal examples of the material being discussed. (The teacher had asked, What do you think Jesus has done for you?) When making the cross, the children were able to attend to instruction and therefore follow the given directions. The frequently asked for help and participated in animated conversations. Almost all of the children were able to complete the task. While outside, the children engaged in game playing, use of the available equipment, and were able to shift comfortably from one activity to another. The children

were able to express frustration, happiness, and confusion verbally and through body language other than repetitive behaviors. They were able to learn through the experiences they had. Jennifer was not able to fully participate in any of the activities. She went through the

motions that were requested of her and little else. She required direct commands/requests to perform tasks and movements. She was not able to initiate or respond to conversation.

Because of her deficits, Jennifer seemed to receive very little satisfaction from being in

Sunday school. She missed out on the experiences necessary for normal development during this activity, and I would suspect, throughout many other activities in her life.

3.1 Interview with the parents 1. How did having an autistic child change your life? It changed the direction of our lives. We have much less freedom than other families. Jennifers autism limits our ability to do things as a family unless we have a helper for him. We have had to set up our house in a specific way to keep him safe. For example, instead of having a dining room, we use that space as a time-out room if Jennifer is exhibiting destructive behavior.

2. Tell me about your daughter. Jennifer is six and a half, and was diagnosed with autism four years ago. She has been attending school full-time in our local school district since age 3 through early intervention programs. Currently she is in their ASD program at our local elementary school. Academically she is extremely high functioning, above grade level, but she has some severe sensory and motor skill issues.

3.What kind of sensory issues does she deal with everyday? Jennifer is very sensitive to sensory stimulation. On the one hand, she needs constant input but on the other hand, she can only handle certain things. Shes extremely sensitive to certain types of noise. Her oral issues are awful she wont chew anything that is wet. She has severe textural aversions when it comes to food, as well as being a very picky eater flavor-wise. Shes also sensitive to the feel of fabrics. She lives pretty much completely in soft cotton knits from places like Gymboree because those and a few polyester pajamas are all she can tolerate. She needs constant input. We discovered pretty quickly when she was an infant that the only way she would fall asleep was in her vibrating bouncy chair in front of a Baby Einstein video. If we put her in her crib in a quiet room, she would literally scream until she puked. Of course, knowing what we know now about her autism and the need she has for constant sensory input, we understand why that was. Now, most nights she falls asleep with a video running in her room. The funny thing is that with all of her sensitivities, her most favorite place on earth is DisneyWorld a place designed to completely overload your senses! She loves the 3D movies, getting whipped around on rides, and especially the fireworks.

4. How does her limited communication affect her interaction with other children her age? Jennifer doesnt interact a lot with other kids. Partially that is due to the communication and partly due to her being used to being by herself. Shes an only child so shes used to being by herself at home. It takes someone actively engaging her. Mostly she will parallel play with other kids more than play actively with them.

5.What do you find to be the greatest challenge? A change in a routine can set off a major tantrum with destructive behavior. As Jennifer gets older and stronger, this becomes more challenging to handle. Jennifers unpredict-able behavior also limits our ability to do things in the community.

6.What have you learned from raising Jennifer? Raising Jennifer has taught us a lot about patience. Weve also learned to value individual successes. For -example, Jennifer has learned to ask a question. To others that may seem trivial, but we celebrate every small -accomplishment.

7.What advice can you give other families who are raising an autistic child? Learn as much as possible about autism and the different kinds of treatments so you can see what works for your child. Make sure that the school is able to provide the appropriate education. Autistic children are entitled by law to a free and appropriate education. Parents must be their childs advocate in this area. I would advise families to use whatever funds are available to them to get care in the home. One-on-one attention for autistic children not only helps them progress, but also gives family members a break. Also, try to keep autistic children actively engaged. The more engaged they are, the more likely that they will progress, pick up new skills, and lead a more normal life.

8. What kind of treatment have you tried with Jennifer so far? Her doctor often prescribes an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity. We also tried a programme called IEI (Early Intervention) for children with autism. This was recommended by our therapist. It comes with use of highly structured and intensive skill-oriented training sessions to help children develop social and language skills. We

believe that family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child.

9.How old was Jennifer when you first began? Jennifer was just under three when we began IEI. He's ten years old now.

9.Do you remember what he was like your first day? Yes! Enough said! Jennifer tantrumed like a champ. Although it was distressing, I had expected her to have this reaction. This behavior quickly faded away during her first week of therapy. She began to make rapid gains in her programs, particularly receptive language. For us, the fact that IEI was a very powerful therapy method became quickly apparent.

10. How intrusive is this method on your time and family? The method itself is intrusive because you constantly have therapists in your home and in and out of therapy we are addressing problem areas. But having a child with autism is much more intrusive than any therapy. Prior to IEI, I felt constant pressure to keep Jennifer engaged in some productive activity rather than having her constantly "stimming". Now when she has therapy, her time is productive, she is learning, and usually having fun. While she is getting therapy, I actually get a break from feeling the need to do everything myself. Yet, I am intimately involved in all aspects of Jennifer's therapy. Jennifer's older sister has adapted well to our unusual situation. In fact, to her, our lives don't seem unusual. We have a pretty happy home.

11.How does the "inclusion" aspect of Early Intervention work? Jennifer goes to a typical preschool with her own aide. The idea is for Jennifer to learn, through normal models, age appropriate speech, language and behavior. At this time, Jennifer has become a true part of the class. She participates in all the class activities, plays with the other children, and is developing appropriate reciprocal interactions with his peers.

12.Did the teacher in Jennifer's class accept the shadow? The teachers do accept the shadow. At times they are very grateful to have another adult in the room. There is an initial adjustment period where the teacher and aide need to establish their own relationship and develop an understanding of the shadow's role in helping your child.

13. Are there any negatives about this method that families need to consider before choosing this approach?

No. There are negatives but to me not doing this therapy would be much more difficult. Once your child is diagnosed with autism your life is dramatically changed. This is true regardless of the treatment you choose. Any inconveniences associated with IEI pales in comparison to the progress that Jennifer is making.

4.0 Findings Autism (sometimes called classical autism) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Jennifer has Autism. The earliest signs of ASD are usually not actions that kids do that seem abnormal, but rather the absence of normal behavior. That would include a child who doesn't respond to his name or only responds to his name if someone goes right up to him and makes faces. That would also include a history of having a few words and losing them, or a child who really seems to have a marked social regression some time in the second year of life. For example, a child who could play patty-cake and peekaboo and wave goodbye and then loses those skills. Or a child who has a few words that are used meaningfully, like "daddy" or "bottle" or "duck," and then gradually loses those words and doesn't develop other words. That seems to be something that happens in about a quarter of kids with autism. It doesn't happen in all children with autism, but very rarely happens in other disorders. Characteristics that have been observed in Jennifer are very much similar to other children who suffer from autism. There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling. The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they cant understand social cues, such as tone of voice or facial expressions, and dont watch other peoples faces for clues about appropriate behavior. They lack empathy.

Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of I or me. Children with autism dont know how to play interactively with other children. Some speak in a singsong voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking. Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged. Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism. These behaviors are: y impaired ability to make friends with peers

impaired ability to initiate or sustain a conversation with others

absence or impairment of imaginative and social play

stereotyped, repetitive, or unusual use of language

restricted patterns of interest that are abnormal in intensity or focus

preoccupation with certain objects or subjects

inflexible adherence to specific routines or rituals

Jennifer exhibits all these characteristics as Ive observed in the second part of this research paper. Doctors will often use a questionnaire or other screening instrument to gather information about a childs development and behavior. Some screening instruments rely solely on parent observations; others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of autism, doctors will ask for a more comprehensive evaluation.

Autism is a complex disorder.

A comprehensive evaluation requires a

multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team

members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be

mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis. Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Children who develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative disorder. Girls with autistic symptoms may be suffering from Rett

syndrome, a sex-linked genetic disorder characterized by social withdrawal, regressed language skills, and hand wringing.

What causes autism? As far as Ive spoken to Jennifers parents, they seem to say the same thing as her doctor. There isnt a specific cause for autism. Scientists arent certain what causes autism, but its likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that

people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of

normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved.

What role does inheritance play? Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive

behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.

How is autism treated? There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better. Jennifers parents use the following two methods to treat her. Educational/behavioral interventions: Therapists use highly structured and

intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child. Medications: Doctors often prescribe an antidepressant medication to handle

symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.