Autism: Diagnosis, Intervention, and Social Literature Review
Excerpt from Literature Review :
The children were scored in terms of whether they imitated the action that had been modeled for them as well as for the presence of any "errors" -- the introduction of actions not in the modeled behavior. The results were then subjected to multivariate statistical analysis.
The researchers found, in contrast to previous similar research, that children with both conditions did not evidence any greater problems with either gross motor or fine motor skills but that they did make more "mistakes" in imitation and that they were subject to greater problems in maintaining their balance. They expected the children with both syndromes to have both increased motor control problems and greater errors in imitation. Thus their hypothesis was supported in part.
The diagnostic consequences for this finding are that children who have been diagnosed with Fragile X who show high error rates in imitation and problems in balancing should also be assessed for autism.
Zandt, Prior, & Kyrios (2009) assessed differences between children with obsessive compulsive disorder and those with autism spectrum disorder. Because both populations share some behaviors (a number of different types of repetitive behavior), there can be some diagnostic confusion. While generally children who exhibit such behaviors early in childhood are much more likely to have autism rather than OCD, some very young children do manifest symptoms of OCD. The researchers were primarily interested in the underlying cognitive processes of children with both of these disorders. Understanding these underlying processes has implications for both diagnosis and treatment.
The study involved 54 children and adolescents aged 7 to 16 years. They were divided into three groups: Children with OCD, children with autism, and children who showed normal development patterns. Children with a co-morbid disorder (such as Tourette's) were excluded. All of the children in the groups tested at normal or above intelligence. They were each given executive functioning tests that "were specifically designed for or had shown reliability and validity with paediatric populations, were suitable for the broad age range included in the study, allowed for the assessment of a range of executive function skills, and incorporated both summary and strategy scores."
The results of these tests had very low statistical significance. There was a slightly greater prevalence for children with ASD to perform more poorly on tasks that required a series of responses and a slightly greater prevalence for children with OCD to have problems with tasks that required inhibition.
It is important to remember that negative findings are as important as positive ones in science. The fact that tests for executive functioning are not good instruments for distinguishing between children with OCD and children with ASD is useful to know.
Brian et al. (2008) focused on protocols for diagnosing autism in children at the age of 18 months, the lowest current limit of widely accepted tests. By looking for behavioral antecedents of autism in toddlers, they were seeking to find methods of reliably assessing children at the earliest possible age, thus allowing for even earlier treatment than is now available, which would (in turn) lead to a better prognosis.
The researchers assessed 155 toddlers who were considered to be at higher than average risk because they had a full sibling with autism. A control group contained 73 children with no family history of autism. The children were assessed using the Autism Diagnostic Observation Schedule (ADOS) and Autism Observation Scale for Infants (AOSI).
The researchers found that while there were small but significant differences between the control group and those children with a sibling with autism was that those working to diagnose small children should consider not only social interaction skills (which is what is now the primary focus) and should instead include this but also assess "basic dimensions of temperament."
The most important implications of this study is that current methods for diagnosis tend to focus too narrowly on communication skills.
A large percentage of the interventions and therapeutic approaches to children with autism (as well as a substantial amount of the basic research) focuses on the ways in which autism limits people's ability to communicate with those around them and ways in which communication can be improved. People with autism tend to have difficulty not only in expressing themselves but also in understanding other people's expressions.
Chiang (2008) investigated whether
there were any significant variations in communication limitations among different types of expression for children with autism or whether there were universal or blanket problems in communication. Which conditions was true has implications for treatment as well as possible implications for understanding the underlying mechanisms of the disorder.
He tested children in special schools for children with autism, self-contained special education classes, and general education classes to determine if the surrounding environment affected communication skills. He videotaped naturalistic observations on the children as they interacted with others and coded their conversations for levels of spontaneity.
He found that children's expressive spontaneity ranged along a continuum but that it also varied substantially by "forms, functions, activities, partners and consequences, and ...across the effectiveness of requesting and rejecting functions." The key importance of this finding is that because there are a range of speech difficulties in children with autism, it may be that differential therapeutic approaches are needed.
Stephens (2008) examines the ways in which children with autism are able to imitate another's actions as a means of investigating the ways in which they are limited (or not) in their communicative skills. While ability to communicate through speech is perhaps the most obvious form of communication, imitation is also one of the ways in which people, and especially children, communicate with those around them.
Stephens asked preschool children with autism to imitate a range of tasks, including speaking and dancing. She performed pretests on the children to determine their base imitative ability. She then had them imitate an action and then imitated it back to them. She then retested them on imitative abilities.
She found that the children performed significantly better on imitative tasks after they themselves had been imitated, suggesting that imitation may be an important way for children with autism to connect with and communicate with those around them.
Wright et al. (2008) examined the ability of children with autism and those without ASD to examine faces and to determine what the expression on each face was. The researchers also asked children to guess the occupation of the person pictured through the presence of visual clues in the picture. Children with ASD are generally considered to be poor at recognizing expressions, one of the attributes of the disorder that makes it difficult for them to communicate with others. However, there has not been a significant amount of research done to determine to what degree children with different levels of symptomology are limited in their ability to assess expression.
The researchers focused on children from 7 to 17 who had high-functioning autism and matched each child with another of the same age, sex, and IQ who did not have ASD. The children were tested on faces presented without any other visual cues and then on faces in which there were visual cues about the person's occupation and emotional state. The researchers performed statistical tests to determine if there were significant differences between the children with ASD and those without and between the two different tests.
The researchers found that there was no significant difference between the children with ASD and those without in terms of their ability to recognize emotions or professions, although accuracy in the latter test improved with both increasing age and IQ for both groups. They did have an unexpected finding: Children with ASD generally imitated the expression that they saw on the test cards while those without ASD never did so.
Like the above study, this study suggests that including imitative elements in various configurations is an important therapeutic strategy for children with ASD and that different ways of including innovative methods of imitation should be developed and included. It also suggests that recognition of expressions may be less of a problem for those with fewer ASD symptoms than had been thought before.
Heaton et al. (2008) examined an area of competency in which about ten percent of individuals with autism perform significantly better than the average population. This study is thus one of a very few that focuses primarily on a strength rather than on a weakness of those with autism. Previous research has shown that this decile of the autistic population has better than good pitch recognition.
Heaton and her colleagues tested 21 intellectually high-functioning (IQ > 70) and 12 intellectually low-functioning (IQ < 70) people with autism. Their ages ranged between 11 years 6 months and 19 years. They were tested (using visual computer graphics that were correlated with musical tones) for both pitch-to-pitch distinctions and pitch recall.
Heaton et al. found that a group of individuals with autism "achieved performance scores that…
Sources Used in Documents:
Burgess, a.F. & Gutstein, S.E. (2007) Quality of life for people with autism: Raising the standard for evaluating successful outcomes. Child and adolescent mental health 12(2): 80 -- 86.
Chiang, H.-M. (2009). Naturalistic observations of elicited expressive communication of children with autism: An analysis of teacher instructions. The National Autistic Society Vol 13(2): 165 -- 178.
Fombonne, E. (2007) Modern views of autism. Canadian journal of psychiatry 48(8): 503 -- 5.
Helt, M. et al. (2008). Can children with autism recover? If so, how? Neuropsychological review 18(4): 339 -- 66.
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