Autism

What is Autism?

Signs and Symptoms

• Social: Impaired, deviant and extremely delayed social development - especially interpersonal development. The variation may be from 'autistic aloofness' to 'active but odd' characteristics.
• Language and Communication: Impaired and deviant language and communication development - verbal and non-verbal.
• Thought and behaviour: Rigidity of thought and behaviour and poor social imagination, like ritualistic behaviour, reliance on routines, extreme delay or absence of pretend play.

• Social: Difficulties with social engagement may appear in different ways.
  This will include a person who is classically 'aloof', but also a person who respond to social interaction, but may not be able to initiate it, through to the 'active but odd' person who seeks social interaction but is socially naive and cannot quite 'get it right'
  A person may withdraw from social contact, or may cause others to leave them alone through their apparently 'anti-social' behaviour. They may seem cut off and passive, content to be by themselves but not resisting when others approach (especially someone familiar) who insists they join in.
  Others may appear at first to be very sociable, even socially indiscriminate. They may pester people (even strangers) with questions and monologues and approach people too closely, making no distinction for different levels of intimacy. Far from avoiding others, people on this level, especially as young adults, may be desperate for friends and may be vulnerable to abuse in their eagerness to have a 'friend' at any cost. These behaviours are clearly different, almost opposites in some cases, yet they all demonstrate a lack of social understanding.
• Language and Communication: Difficulties in all aspects of communication.
  The problem of autism concerns communication rather than language. At one end of the spectrum, a person may speak fluently, but their speech has odd intonation and may show echolalia (automatic reiteration of words or phrases which have been heard recently or in the past) and 'reversal' of pronouns - referring to themselves as 'you' and the person being spoken to as 'I' - (at least when very young). Their understanding is literal. To say you can do something 'standing on your head'; to tell someone 'Looks can kill' or describe a person as a 'bad apple' will cause confusion.
  A person with autism will often have difficulty holding conversation and tends to speak 'at' rather than speaking 'to' or 'with' people. There will also be difficulties in understanding and using facial expressions, body posture and communicative gestures. At the other end of the spectrum, a person will have the same difficulties in understanding all forms of communication, but will have no speech and will not easily compensate with sign or communicative gesture. Communication, at all levels of ability, is directed at having needs met, rather than sharing information or interests.
• Thought and behaviour: Difficulties in flexible thinking and behaviour.
  This is shown in repetitive, stereotyped behaviour and with some people, an extreme reaction to change in expected situations or routines. Play is not socially creative or symbolic (although symbolic play acts may be copied or developed) and tends to be isolated, sometimes involving spinning objects, lining objects up in a ritualistic way, or a fascination with light or angles. The more able show these difficulties in their development of obsessive interests or 'hobbies' that are pursued to the expense of everything else. Understanding of fiction is minimal, even in the more able. Learning is by rote.
  A person with autism is dependant on cueing or prompting to start behaviour or trigger thoughts and feelings. It is not that the individual cannot be creative in an artistic sense but that their behaviour is almost entirely habitual. The person is likely to have poor development with their sense of self-autonomy or the planning and reviewing of their thoughts or actions.

Characteristics

• does not respond to his/her name.
• cannot explain what he/she wants.
• language skills are slow to develop or speech is delayed.
• doesn't follow directions.
• at times, the child seems to be deaf.
• seems to hear sometimes, but not other times.
• doesn't point or wave "bye-bye."
• used to say a few words or babble, but now he/she doesn't.
• throws intense or violent tantrums.
• has odd movement patterns.
• is overly active, uncooperative, or resistant.
• doesn't know how to play with toys.
• doesn't smile when smiled at.
• has poor eye contact.
• gets "stuck" doing the same things over and over and can't move on to other things.
• seems to prefer to play alone.
• gets things for him/herself only.
• is very independent for his/her age.
• seems to be in his/her "own world."
• seems to tune people out.
• is not interested in other children.
• walks on his/her toes.
• shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants).
• spends a lot of time lining things up or putting things in a certain order.

Assessment

Assessments procedure usually involves the following:

Assessments are usually conducted by

• Pediatricians
• Psychiatrists
• Speech Therapists/Speech-Language Pathologists
• Occupational Therapists
• Special Educators.

Early Intervention

Intervention programs - Interdisciplinary approach

Professionals involved in intervention

• Speech-Language Therapists
• Occupational Therapists
• Psychologists
• Special Educators
• Counselors

Approaches used

• being extremely silly and unresponsive
• laughing uncontrollably
• losing control of his body i.e. getting extremely limp and/or clumsy
• becoming either hyper- or hypo-sensitive to pain and other physical stimuli
• getting aggressive such as pinching or spitting
• flapping hands
• humming and clicking while wandering around aimlessly

WHEN TO USE THESE ACTIVITIES:

Tips for parents

• Always be patient and allow your child to be expressive by listening only to them.
• Provide frequent positive feedback on the individual's performance.
• Keep routines and possessions organized. Try to maintain a regular daily routine. Avoid any sudden changes as autistic children frequently have trouble adapting. Gradual transitions are important if there are any changes to be made.
• Be consistent with rules and consequences.
• Keep an activity schedule or calendar posted.
• Behaviors should be addressed immediately during the situation, whether it is positive or negative. Give more attention and positive reinforcements for good behaviors and let your child know you are upset (using facial expression/body language/stern voice) when he shows negative behaviors like throwing tantrums.
• When your child is doing any physical play or activity (jumping) leave the child alone but always set a time frame. Average duration - 10 mins a day.
• Use positive reinforces to encourage positive behavior. Not always eatables.
• Try to spend as much time with them as possible, especially when the child is idle.
• Always tell them before-hand when its time to do something e.g. talking about bedtime or making the bed together, maybe 30 minutes ahead of time so they will know what to expect and reduce the chance of anxiety.
• Prepare the child before doing any activity. Give him verbal instructions
• Create specific routines for troublesome times of day (meal time or getting ready for school).
• Discuss upcoming anticipated changes in routine at a point in time that is beneficial for your child. You will have to experiment with how early the child "needs to know."
• Try to indirectly use your child's sensory preferences for fun rewards to help you handle behavior. However, try not to restrict movement activities when your child is being disciplined. For example, taking away recess time or playground time for not sitting at the table appropriately during study time may not be the most effective way to deal with these issues. Your child may need that movement time, and by removing it, his or her behavior may actually become more difficult later.

• If your child improves after receiving several treatments, it will be impossible to determine which one(s) really made a difference. A general rule is to try a treatment for atleast three months before beginning to determine whether or not the treatment was helpful. However, in some cases we can see clear indications that the child is improving, even after a week or two. In some cases it might take a 6 month intervention program before seeing any visible progress.
• If at all possible, tell no one when a child starts a new treatment. This includes teachers, friends, neighbors, and relatives. If there is a noteworthy change in the child, it is likely that the people who come in contact with the child will say something about the improvement. It is also a good idea not to ask "Have you noticed any changes in my child?" In this way, any spontaneous statements regarding the child's improvement will be credible.
• People who do know that the child received a specific treatment can, independently, compile a list of what changes they have noticed in the child. After a month or two, you can compare their observations. If similar changes are observed by different people, then there is a reasonable chance that these changes are real. It is important they these observations be written down; otherwise, when appropriate behaviors replace inappropriate ones, you may not remember what the child's behavior was like before the treatment, especially if the behavior was an undesirable one.
• Parents and others should note in writing when the child's behavior 'surprises' them. Basically, parents usually know how their child will respond in various situations; and once in a while, their child may do something that is unexpected. If a child improves soon after an intervention is begun, one can assume that the child will act differently than before; and his/her behavior will likely lead to more 'surprises' than usual-hopefully good ones!