autism assignment
TRANSCRIPT
Contents pages
Abstract 4
Introduction 4
Addressing autism spectrum disorder 6
Defining recovered 9
Intensive behavioural interaction 11
The lack of intensive interaction 13
Conclusion 15
1
Reference 17
Is it possible to cure children of their autism? Critically evaluate Dr. Deborah Fein’s claim that 1/10 can no longer meet diagnostic criteria. http://www.telegraph.co.uk/health/children_shealth/5298367/One-in-10-children-with-autism-overcome-condition-by-age-nine-study-finds.html
Abstract
It is argued that it is possible to cure autistic children that
they no longer meet the criteria of autism condition. In a recent
article, Dr Deborah Fein suggests that intensive behavioural
therapy is the best treatment and that this intervention helps
autistic children to overcome the condition. This essay will
critically evaluate this claim by talking about autism in general
and defining recovery as suggested in Fein’s article. In addition,
this essay will explain interventions and behaviour interaction and
the aspects of intervention which may require further research.
The main results were that most of the research has confirmed
there is no known cure for autistic children, but there are some
steps which may help the autistic child to overcome the condition
in some particular aspects.
2
Introduction:
“Autism is a serious psychological disorder with onset in early childhood” (Lovaas, 1987, P.3).
Lovaas explained autism in this way and many others
researcher would agree with him, it is a serious disorder and
usually appear in early childhood. The number of cases of autism
spectrum disorder has rapidly increased in recent years (Yazbak,
2004). However, there are some studies in Britain which mention
that “the autism spectrum currently affects between 60 and 100
per 10,000 children under the age of eight” (Guldberg, 2010,
P.168; (Irvine, 2009). As a result of this increase, most recent
research talks about interventions and how it might help.
Knowledge and understanding of the causes of the emergence of
autism is certainly a challenge to current research and has
important implications for practice, and theories, from both of
which future research may be directed to a different area of
Autism (Perez, Gonzalez, Comi, & Nieto, 2007). However, as long
as there are different kinds of interventions such as the intensive
behavioural therapy, the TEAACH approach (Treatment and
Education of Autistic and Communication related Handicapped
Children), the Picture Exchange Communication System and
Social Stories (Guldberg, 2010), there will be different views on
the best approach for an individual child .
Contributing to this debate on what is the best intervention
methods for autism spectrum disorders, Dr Deborah Fein
suggests that intensive behavioural therapy is the best treatment
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and that this intervention helps autistic children to overcome the
condition (Irvine, 2009). Although Fein admits that treatment
takes long time before recovery can be seen, she added that they
were at a “very early stage”(Irvine, 2009). This essay therefore
aims to talk about intensive behaviour interaction as treatment
for autism as it can help them to recover - Fein claims “studies
have shown the range for children recovering from autism is 10
percent to 20 percent” (Irvine, 2009).
Some studies have indicated that autistic students often
respond positively to interventions that aim to develop social
interaction skills with peers (Jones, 2007). From this standpoint,
we can say that as long as the intervention goes well with the
child, as well as the interaction, it is likely that the child will be
able to overcome the condition of autism, but we should
acknowledge that this depends on an individual child and what
the causes are. Most of the research centred on the fact that
intensive early intervention has a significant positive impact on
the autistic to the point that makes them engages with the
regular educational environment (Harris, 2007; Howlin, 2003;
Remington et al., 2007).
It is worth noting that the scope of this research is not fully
inclusive and is not intended to be(Humphrey & Parkinson, 2006).
Considering what Dr Deborah Fein claims, that 10 to 20 percent of
autistic children no longer meet the criteria for autism after
undergoing years of intensive behaviour therapy, this essay will
try to cover aspects of autism spectrum disorder, such as the
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definition and some of the features and causes as well as trying to
describe or define recovery as in Dr Deborah Fein’s study.
Further, the essay will discuss very carefully the intensive
behaviour interaction and the lack of this intervention using
various studies which have been carried out.
Addressing autism spectrum disorder:
First of all, there are many definitions for autism which all
outline the same features as below being the most appropriate
one made by the American Psychological Association.
“Autism Spectrum Disorders (ASD) are a group of related development disorders that are characterized by impairments in reciprocal social interaction, language development and intentional communication, and restricted interests and stereotyped motor behaviours (American Psychological Association 1994)” (Helt et al.,2008,P.339).
One of the most important aspects, after defining autism, is
knowing the age at which it can be identified. Nowadays, most
children with autism are identified between the ages of 2 and 4
years as having major deficits in social communication, even
though some parents have noticed the difference in the first year
of life (Lord & Richler, 2006; Perez et al., 2007). Generally, the
first symptoms are observed by the parents and the earliest
symptoms sometimes show before the parents are aware that
something is wrong but usually it is difficult to be observed before
the close of the first year (Perez et al., 2007). In other words, the
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first and most recurrent to be observed, most of the time by
parents as pointed out earlier, is the regressive and fluctuating
behaviours (Perez et al., 2007). After we talk briefly about the age
and the symptoms we should, however, talk a little bit about
diagnosis.
According to Lord and Richler (2006, p.39) “A diagnosis of
autism is based on symptoms in three areas: difficulties in
reciprocal social interaction, difficulties in communication, and the
presence of restricted and repetitive behaviours or interest”
Alongside symptoms are the deficits which might affect most of
the children with autism. Researchers noted that children with
autism have deficits in social and communication skills which can
be organized into two main areas: the first difficulty is in
concentration, which reflects the common difficulty of interest
among people and objects at the same time (Wetherby, 2006).
The second difficulty is in the use of symbols which reflect
traditional or common meanings and the difficulty of learning
these codes as well (Wetherby, 2006).
Other research represents other features that appear in
autistic children which is that they prefer isolated activities and
stand beside spending a long time in aimless behaviours or
engaging in problematic behaviours rather than in social
interaction (Harris, 2007). Furthermore, researchers noted that it
is important to take into account that children with autism
spectrum disorder develop differently from their peers (Guldberg,
2010). So, often researchers do not expect the same outcome
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from the children with autism as their peers. Moreover,
researchers pointed out that there are different types of autism,
including lower-functioning autism and some of them have
accompanying learning difficulty; there is another type like
Asperger's Syndrome and high-functioning autism (Humphrey &
Parkinson, 2006). In addition, some research indicates that those
autistic children sometimes are able to gain educational and
language skills easier than social and emotional skills (Harris,
2007). So, as we can see, there are many different features and
deficits and so on but if we want to know what causes these
deficits it may be hard to find.
There is no doubt that all the studies and research prove
that the causes of autism are unknown and it is possible that the
causes of neurological or genetic conditions present many
possible causes (Hayward, Eikeseth, Gale, & Gale, 2009; Lovaas,
1987; Pelios & Lund, 2001). However, the fact is nobody yet
knows exactly or for sure what causes autism. To explain more
about what is going on with autistic children, this essay will talk
about some personal characteristics. According to Wetherby,
(2006), children with autism communicate, but for, reasons other
than social and communication it is often aimless. The strong
indicators of very young autism is language delay which is often
first concern for parents (Lord & Richler, 2006). However, the
most common thing for parents to say about their child’s
difficulty is the deficits in social and communication skills, lack of
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self-help skills and sleeplessness (Dillenburger, Keenan, Doherty,
Byrne, & Gallagher, 2010).
In addition, there are other problems facing this category of
autistic children and their family in addition to a lack of self-help
skills and sleeplessness, such as educating them and creating
community awareness of how to deal with them and so on.
Nonetheless, Dillenburger et al. (2010) argue that despite the
increasing number of autistic students joining the mainstream
learning environment, the teachers and professional sometimes
do not have enough experience for this category and other
impacts can occur from having a child with autism in the
classroom. As well as this, they are generally not trained in
carrying out intervention behaviour therapy or any other
treatments (Dillenburger et al., 2010). This discussion about
autism, from the definition to some of the problem is in order to
be able to evaluate what Professor Deborah Fein claims about
autistic children; that children with autism can recover, in order to
agree with that we need to know what exactly the meaning of
“recovery” equates to in her study.
Defining recovered:
Some researchers have assumed that the construction of a
special environment, intensive and comprehensive education of
very young children with autism, might allow them to be as their
‘normal’ peers (Lovaas, 1987). And that is exactly what Dr
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Deborah Fein claims: “Although the right support at the right
time can make an enormous difference” (Irvine, 2009). So both
suggest that intervention should be early, intensive and in a
special environment in order to see the impact on the child.
However, there will always be questions remaining for each of
these assumptions; “How?” While some of the other researchers
say that the treatment succeeded because they were originally
non-autistic (Lovaas, 1987) this is another variable and reverses
the previous theory. According to Helt et al. (2008) what they
meant by “recovery” is losing the behavioural characteristics of
ASD.
This essay, as mentioned earlier, will define and discuss
what Dr Deborah Fein meant by “recovery” in her study in order
to see to what extent this might be true. Helt et al. (2008) point
out that studies have documented improvement of all aspects of
behaviour, including academic life, language, adaptive skills and
misconduct, but there are other studies which have not
documented improvement in these skills and behaviour. From this
point, it appears that researchers still cannot be sure that autistic
children can recover or that they might overcome some aspects,
such as the level of IQ, language delay and academic skills
(Howlin, 2003; Remington et al., 2007). On the other hand, they
use specific elements for “recovery:” The first element by history
which means the child was diagnosed with ASD in early childhood
and the second element by current functioning which means they
have slightly different criteria like difficulties with attention,
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organization or specific academic difficulties (Helt et al., 2008) so
we could say they are not really autistic or they do not show the
usual autistic symptoms or deficits.
Although most of the studies argue that autistic children
undergo diagnosis between the ages of 2 to 4 years (Perez et al.,
2007) others believe that it could appear later so this age range is
no longer a key condition (Pelios & Lund, 2001). If so, that means
the element for recovery no longer meets those who diagnose
after the ages of 2 or 4 years. According to ‘The Telegraph’,
“Those with Asperger Syndrome may have their conditions
diagnosed later than the age described sometimes until their
teens or adulthood” (Irvine, 2009). To explain more, this would
not meet the element by history that Professor Deborah Fein and
her colleague described before. Clearly, what makes “recovery”
or “overcoming” the autism condition really hard is that we still
do not know what exactly causes autism spectrum disorder, until
we know this; we might say that there are such treatments for
autism.
Intensive behavioural interaction:
In order to address intensive behavioural interaction this
section will talk briefly about the background of this intervention.
As Humphrey & Parkinson (2006) pointed out “The many variants
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of early intensive behavioural intervention in autism originates
from the work of Lovaas (1987), who pioneered the UCLA Young
Autism Project” (Pelios & Lund, 2001, P.77). Early intensive
behavioural intervention (EIBI) using applied behaviour analysis
(ABA) has by far been the intervention choice which has been put
under the spotlight arousing interest in this field for researchers
and professionals. Indeed for many parents and professionals it
has become a much sought-after and preferred treatment. This
intrigued many researchers, not least because of the claims of
learning recovery and improvement in disability in a substantial
minority of children chosen to receive this intervention. (Butter,
Mulick, & Metz, 2006).
Nevertheless, to discuss this intervention it should be
considered more carefully what it means and what the conditions
of work are, and is the intensive behavioural interaction actually
helps autistic spectrum disorder to overcome or not. To define
intensive behavioural interaction, one must consider what is
meant by “intensive.” Generally, it means behavioural
treatments that are delivered in high doses. For example, 40
hours per week in many children on a daily basis (Schreibman,
2000). To address the meaning of intensive interaction we realise
that there are many definitions but they are not really so
different. However, according to Firth, Elford, Leeming and Crabbe
(2008, p.58) “Intensive Interaction is an approach to developing
the pre-verbal communication and sociability of people with
severe or profound and multiple learning disabilities and autism”.
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This program reinforces the theory that human behaviour is
subject to precedents and consequences, it focuses on specific
behaviours and assumes that it is possible for children to learn
new skills through amendments and to provide encourage for the
immediate good behaviour strengthening, as well as this is what
happening with children between the ages of two and four years
(Humphrey & Parkinson, 2006; Schreibman, 2000). To explain
more, intensive behaviours interaction, based on principles
derived from more than 60 years of ABA research, underpin the
teaching methods of EIBI and include the use of the practice and
promotion of functional analysis and single case experimental
designs (Butter et al., 2006). Some of the studies have argued
that early intensive interaction should involve of a minimum of
around 15 to 20 hours a week lasting at least 6 months (Howlin,
2003). Others think that the minimum number of hours of the
intensive behaviour interaction should be around 30 to 40 per
week including activities for 3 years or more and children may be
enrolled on this programme from as young as 2 years old (Butter
et al., 2006).
Of the most important factors in the diagnosis and
treatment of autism effective communication is cooperation
between parents, teachers and other specialists (Dillenburger et
al., 2010). Scheibman (2000) indicates the same factors in her
study and emphasises the great role played by parents, siblings
and peers and others, and the inclusion of daily appropriate
environmental aspects including the home, classroom and the
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community as being the most important benefits of this quality of
intervention (Howlin, 2003). Also, not forgetting the importance of
effective training programs and the enhanced treatment benefit
achieved (Schreibman, 2000). One important characteristic of
intensive interaction is to enable children with autism to raise the
level of social interaction between the skilled and the less skilled
(Barber, 2007; Harris, 2007), mainly because the autistic children
will try to copy others or as Barber (2007) pointed out, that
intensive interaction depends somewhat on imitation. Moreover,
although there are a number of parents who have achieved
success with a variety of different approaches and learned their
benefits and shortfalls, most of them clearly preferred ABA-based
intervention (Dillenburger et al., 2010). In fact many researchers
have emphasised the success of this intervention in many cases
(Butter et al., 2006; Lord & Richler, 2006). It has also been argued
in a lot of research that around 40% of the children involved in
such intensive interactions treatment become “indistinguishable”
from their normally developing peers (Howlin, 2003; Lovaas,
1987). Furthermore, other studies emphasise the positive aspects
of behavioural treatment that can build complicated behaviours
such as language and can help to suppress pathological
behaviours such as aggression (Lovaas, 1987). Clearly, intensive
behaviours interaction has huge benefits with children with
autism but still not reliable and we need more studies using this
approach. For this reason next section will consider some lack or
problems facing this intervention.
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The lack of intensive interaction:
“Interventions for autism have come a long way since the
condition was described by Kanner in the 1940s” (Howlin, 2003,
P.250). Even though intensive interaction has been known and
practised for so long, it is still not well established and more
work, with more appropriate samples, is needed. It is crucial that
most of the studies do not really have an appropriate sample, for
example, in some of the studies their sample was taken
randomly, while in others their sample was really small and there
were many variables in the given examples which resulted in the
studies not being of a very exact specification. According to
Butter et al.(2006) the combination of a lack of well-controlled
studies, producing conflicting information about the natural
course and variability of functioning for children with autism, as
well as the fact that attempts at replicating the original Lovaas
findings were somewhat haphazard, questions still remain
concerning behavioural intervention. In my opinion, one of the
most confusing points in these interventions is that it is indicated
or referred to differently in various research, , for instance, some
of the research calls it Early Intensive Behavioural Interaction
(EIBI) (Butter et al., 2006; Humphrey & Parkinson, 2006) other
intensive interaction (Harris, 2007) and intensive behavioural
treatment (Schreibman, 2000). And many other examples which
make the researcher think that although all of them agreed about
intensive, there is different belief in the importance of early and
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so on. This intervention is considered in spite of success with
many cases (Butter et al., 2006), but it lacks established rules and
basic principles which would make it possible to intervention
effectively to cases of autism spectrum disorder.
The researcher Harris (2007) pointed out, that there is
evidence to document the modest benefits of early intensive
intervention. As well as, some research have explained that
despite the success and benefits of this approach, but it has lacks
in some of the philosophical, practical and organizational adoption
of this approach (Firth, Elford, Leeming, & Crabbe, 2008). Another
researcher was also caution with use of the word “overcome” or
“recover” and mentions that there is not much evidence that very
early intensive interventions could considerably alter the long-
term course of the disorder (Howlin, 2003). To support this more,
Hayward et al. (2009) also pointed out that in his research the
result were very disappointing the participants showed no
significant change in IQ as well as none of them obtained best
outcome rank. In addition, according to Howlin (2003) who argue
that there is a risk that focus on the importance of early pre-
school interventions would affect older children. Moreover, Pelios
and Lund (2001) have argued that many kinds of treatments, not
in the prescribed standards of scientific validation, but instead are
rooted theories and false assumptions regarding the causes and
nature of autistic disorder.
Clearly, as some studies claim that early intervention
programmes are still required longer term evaluations as well as
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covering many different aspects of functioning to be more
effective programmes (Howlin, 2003). Also some studies have
also unanimously agreed that it is difficult to predict the results
are not based on age or on anything else (Hayward et al., 2009).
The reason for this probably because the lack in our knowledge of
what is the causes of autism. On the other hand, according to
Humphrey and Parkinson (2006) there is another concern about
this research in this area it is the common focus on the variables
and outcomes among children and its consequences for every
child. But this trend is difficult for several reasons, first because it
reinforces the notion that the root of the problem lays within the
child and the second the impact of environmental factors
(Humphrey & Parkinson, 2006). In other hand, some research
stated that some children with higher functioning have a
tendency to do better over the long term without being enrolled
in an intensive behaviour intervention program (Butter et al.,
2006).
Conclusion
In conclusion, returning to the original question: Is it possible
to cure children of their autism? “The answer must be probably
but we still lack the data to prove this” (Howlin, 2003, P.257). This
what Dr Deborah Fein would agree with as she warned that “even
after lots of therapy, most autistic children remain autistic”,
adding that recovery was "not a realistic expectation for the
majority of kids” (Irvine, 2009). Furthermore, that what most of
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the research conclude with the fact that were not the
expectations of this intensive behaviour interaction intervention
realistic. Although at the large number of excellent research in
this area, but it is still needs more research to be done
(Humphrey & Parkinson, 2006). Also as many researcher point out
that even if the teachers already committed to inclusive they do
feel that they do not have enough training for the autism
(Humphrey & Parkinson, 2006).
It is important to note that currently the need to address
issues related to autism spectrum is huge (Humphrey &
Parkinson, 2006) and this is likely explain the growing number of
people with autism, as noted earlier. Since 1990, ABA has been
recommended as useful intervention for many children with
autism (Hayward et al., 2009; Lovaas, 1987) and regarding this it
is recommended that a lot more research is done in this specific
area. However, as Schreibman (2000) argues, these
interventions have played a huge role in influencing children with
autism; they have been successful in changing some of the
behaviours and social life and increasing the language and
academic skills and reducing some severe behavioural problems.
In fact, most of the research confirmed the importance of early
intervention success with autistic children and agree that it helps
them to be integrated into mainstream schools more and more
(Lovaas, 1987).
As also indicated some research argued that IQ gains are
possible for children with autism at the very least and intensive
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behaviour intervention may help to strengthen these gains
(Butter et al., 2006).Finally, but perhaps most importantly, this
area still needs further research to try to reach more clear results
(Hayward et al., 2009; Humphrey & Parkinson, 2006).In addition,
according to Howlin (2003, P.260) “We need many more studies
to look at what is going on with the autistic children growing up
that may account for the differences within the groups”. In
conclusion, this research pointed to some clear evidence that “at
present there is no known cure” even though as we mentioned
earlier that the right support at the time can make big different to
autistic children (Irvine, 2009).
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