Early_Intervention_for_Autism_Spectrum_Disorders

Early Identification and Intervention for Autism Spectrum Disorders For young children with, or at risk for, an Autism Spectrum Disorder (ASD), the world can be an overwhelming and confusing place. These children struggle through everyday life and tasks, without being able to efficiently communicate their most basic needs. Autism is a developmental disorder that affects a person's ability to communicate and interact with others, and often presents with a variety of other developmental delays. With the latest research showing nearly 1 out of 100 children being diagnosed with an ASD (Schwartz & Sandall, 2010); it is imperative that intervention targets these young children, doing everything in attempt to ensure the most successful outcome, not only for the child, but their families as well. Early identification and intervention, led by parental involvement within the natural environment is critical for children with, or at risk for, Autism Spectrum Disorder, to ensure the most successful outcomes. In order to achieve this success, the intervention needs to begin early for the best outcome. Not only should the intervention take place as early as possible, therapies and techniques should focus on parental involvement and participation within the child's natural environment, not only for efficiency, but for greater intensity as well. Finally, because state funded therapy programs can only provide very basic intervention services, educating parents and other caregivers to facilitate intervention techniques and supplement therapies throughout daily routines, provides an efficient and cost effective way to get the intensity of intervention for greater success. "Autism Spectrum Disorders (ASD) is the current term used to describe a group of complex neurodevelopmental disorders that includes autism, atypical autism and Asperger Syndrome," (McClure & Melville, 2007). Current research shows that the initial signs and symptoms of Autism Spectrum Disorder are most often visible within the first two years of life, providing ample opportunity to implement intervention before the age of three years. Symptoms of Autism Spectrum Disorder fall into three inter-related categories; social skills, behavior, and language (Chakrabarti, 2009). Under the category of social skills, symptoms include; failing to respond when spoken to, little or no eye contact, seemingly unaware of other's thoughts and feelings, resisting cuddling and/or other physical contact and preferring to be alone, or seemingly in their "own world." This lack of desire for social interaction can make the intervention process even more difficult. Little is known, without reciprocity in interactions between the child and interventionist, what tools and lessons from the intervention techniques are actually getting through to the child. Under the umbrella of language based symptoms lies a delay in speech, the loss of previously acquired ability to use words or phrases, unusual tone or rhythm to speech (singsong voice or robot voice), no initiation of conversation, not being able to keep a conversation going by using the typical give and take, and finally, one of the most unique characteristics, echolalia, which is the repetition of previously heard words or phrases, often times verbatim, without knowing the meaning of what is being said. Primary Care Physicians should "make sure that children are using acquired language skills purposefully and appropriately instead of in a rote, scripted, or otherwise atypical manner," at each routine check-up (Gupta, Johnson, et al., 2007). Behavioral symptoms often present the most stress for families. Children with Autism Spectrum Disorder thrive on routine. When routines are changed or disrupted, the child can experience such stress that they throw temper tantrums and can become aggressive with others or even exhibit self-injurious behavior. Repetitive movements are often observed, such as hand flapping, spinning and rocking. These motions seem to provide some type of comfort for the child. Often times the child with an Autism Spectrum Disorder seems constantly on the go, moving incessantly, may be focused on the spinning parts of an object, like a wheel or ceiling fan and lack imaginative play. Most children with Autism Spectrum Disorder also experience sensory difficulties. The child may be unusually sensitive and/or insensitive to sound, light, and touch and sometimes even oblivious to pain (Mayo Clinic, 2010). All of these symptoms are important for parents and other professionals, such as the pediatrician and educators, to be aware of in order to catch them as early as possible. Language development tends to become the first area of concern for parents who seek help. According to Wood's and Wetherby's article states that "…research findings on diagnostic features indicate that social and communication impairments are the earliest indicators of ASD" (Woods and Wetherby, 2003). There is an excellent tool that can be utilized during a routine 18 month doctor check-up which is useful in identifying toddlers at risk for Autism Spectrum Disorders. This is the Checklist for Autism in Toddlers, often dubbed CHAT, can be used as a screening instrument and contains two separate questionnaires, one for the parents to answer, and one for the pediatrician to complete based off of observation. Parents are asked questions such as, whether the child uses the index finger to point at objects and whether the child shows interest in other children. The parent's checklist is made up of nine questions in total, while the health care practitioner makes five simple observations (Baron-Cohen, Wheelwright, Cox, Baird, Charman, Swettenham, et al, 2000). The CHAT is convenient, easy and a reliable tool that demonstrates the risk for an Autism Spectrum Disorder, enabling referrals to appropriate professionals in a more time efficient manner. Though typically the Checklist for Autism in Toddlers is utilized during the 18 month routine check-up, many believe this should be repeated again at 24 months and even possibly at 36 months because regression in acquired skills is often seen in children with Autism Spectrum Disorder (Pivalizza, 2007). Much research has been done in the past five years that proves that intervention is most successful when implemented before the age of five years old, when typically the child is entering kindergarten. It is during these formative years that a baby's brain is forming connections and growing at a remarkable rate. During these early years, young children learn through socialization the skills that will serve them throughout their entire lives. Ideally, according to many psychologists, intervention is most beneficial when it is incorporated even before the age of three. This leads to the conclusion that these intervention techniques should begin when the risk for Autism Spectrum Disorder is observed, rather than waiting for the formal diagnosis (Schwartz and Sandall, 2010). Before the child who is at risk for, or previously diagnosed with an Autism Spectrum Disorder, is of age to attend school, it is vital that intervention takes place to provide the child with the best possibility of being successful in a general education program. By educating parents and caregivers on intervention techniques, the child is provided more opportunity to learn throughout his/her daily routines. Actively participating in therapies outside of a clinical setting, the parent and/or caregiver is able to facilitate these techniques more regularly to give the child more tools to cope with stressors that will inevitably take place on a daily basis. Parents of children with or at risk for an Autism Spectrum Disorder are typically the first people to observe worrisome behaviors in their children. When atypical behaviors are observed, the first stop for parents is usually the pediatrician's office. It is crucial for the pediatrician to be knowledgeable not only about the early warning signs, but also all of the "developmental, educational, and community resources, as well as medical subspecialty clinics," available (Johnson, Meyers and the Council on Children with Disabilities, 2007). Being able to direct parents to such resources is important to ease the burden and save valuable time. This time for the family can prove to be one of great stress and pressure, not only emotionally, but financially as well, as some families will try anything to help their child, including alternative medicines and therapies. "Parents usually have to wait for extended amounts of time just to schedule the necessary appointments with specialists…they do not have any clear answers as to what treatments to begin or services to seek," (Layne, 2007). Most primary care physicians are not versed in services available and how to pursue them, so the time between getting a referral for a specialist who is able to diagnose and the diagnosis tends to be an anxiety ridden waste of valuable time. So many regional centers are inundated with cases, services are not available without a diagnosis, and even with diagnosis, the severity of the Autism comes into question. Many regional centers simply do not have the funding to provide intensive intervention for all children who can benefit from it. Considering this, parents and caregivers should be used as an invaluable tool for leading intervention for these children. By implementing intervention techniques into a child's natural environment, the child learns functional skills. This process of teaching and learning can then take place during normal daily routines and parents and/or caregivers can utilize play, socialization and self help skills to further support the intervention (Woods & Wetherby, 2003). A natural environment is any environment in which the child finds themselves throughout their normal routines. The most obvious of natural environments is in the home, however, the natural environment can also include a preschool, play group, church or any other regular environment that the child encounters on a regular basis. Implementing intervention techniques in the natural environment allows for the child to learn functional coping skills such as the give and take of social interactions and expressing needs. These skills will assist the child in coping in similar situations outside of these natural environments and give the child tools to use in new situations. Making and reinforcing these connections in the brains and utilizing them in other, similar settings. With the increasing rate of diagnoses and limited state funding for therapy programs for children with or at risk for Autism Spectrum Disorders, educating parents to use intervention techniques in the natural environment is essential in providing the most efficient and cost effective intervention for the child. According to the Harvard School of Health, the cost of caring for a person with an Autism Spectrum Disorder can range up to three million dollars over their lifetime (Harvard School of Health, 2006). These costs include medical costs, but the figure fails to incorporate alternative therapies and other miscellaneous out of pocket expenses the family is responsible for. Without assistance, many people with Autism Spectrum Disorders fail to provide for themselves and become independent as adults, relying on disability and public assistance to fill in the gaps. By some accounts, the annual societal cost of autism can reach up to 35 billion dollars; however, this can be a great underestimation (Harvard School of Health, 2006). These figures illustrate the great costs, not only to families with a child or children with an Autism Spectrum Disorder, but to society as a whole. By providing early intervention and support, not only are you ensuring success emotionally, but potentially saving taxpayers in the long run. However, this brings light to the limited funding available for early intervention through federal resources. Most comprehensive treatment models call for at least 15 hours per week of intervention therapies, but most young children with developmental delays, including Autism Spectrum Disorders, only qualify for 90 minutes per week of therapy (Schwartz & Sandall, 2010). So where does the other 13.5 hours of therapy come from' This question remains a daily struggle for all of those affected by children with Autism. By training the parent and/or caregiver to facilitate intervention techniques, this gap in treatment can be reached, not only in a cost efficient manner, but timely as well. Unfortunately, "there are no 'cures' for autism but early diagnosis and early intervention can improve long term outcome of autistic children," (Chakrabarti, 2009). Early intervention, before the child with Autism Spectrum Disorder reaches school age, can help the child adjust socially, enabling a child that originally may not have been able to function in a general education classroom environment, to thriving in such environment. Teaching the child social appropriateness before school age, gives the child the tools required to function and learn in an otherwise challenging setting. Parental led intervention techniques are imperative to a comprehensive intervention model for young children with, or at risk for, Autism Spectrum Disorders; and the best outcome happens when the ASD is identified as early as possible and intervention takes place in a natural environment. It is widely accepted that indicators of Autism are noticeable from a very young age, providing excellent opportunity for intervention to take place before school years. Parental involvement in the intervention in the child's natural environment proves to be the most comprehensive and efficient. Finally, with limited state funded therapies available, parent facilitated intervention provides the most cost-effective supplement to those therapies. More education is definitely needed to assist doctors, educators, therapists, parents and caregivers in recognizing early indicators of ASD to ensure appropriate intervention. Therapies and government programs need to shift focus from providing therapies outside of the child's natural environment (i.e. centers, hospitals, treatment facilities), in a clinical setting, to educating and supporting the family and caregivers in the natural environment to facilitate and participate throughout the intervention process. References Baron-Cohen, S., Wheelwright, S., Cox, A., Baird, G., Charman, T., Swettenham, J., & ... Doehring, P. (2000). Early identification of autism by the CHecklist for Autism in Toddlers (CHAT). Journal of the Royal Society of Medicine, 93(10), 521-525. Chakrabarti, S. (2009). Early identification of autism. Indian Pediatrics, 46(5), 412-414. Gupta VB, Hyman SL, Johnson CP, et al. (2007, January). Identifying children with autism early. Pediatrics. 119(1), 152-153. Harvard School of Health. (2006, April 25). Autism has high costs to U.S. society. Retrieved from http:/www.hsph.harvard.edu/news/press-releases/2006-releases/press04252660.html Johnson, C.P., Meyers, S.M. and the Council on Children with Disabilities (2007, November). Identification and Evaluation of Children with Autism Spectrum Disorders. Pediatrics, 120(5), 1183-1215. Layne, C. (2007). Early Identification of Autism: Implications for Counselors. Journal of Counseling and Development, 85(1), 110-114. Mayo Clinic Staff. (N/d). Autism. Retrieved from http://www.mayoclinic.com/health/autism/DS00348/DSECTION%3Dsymptoms McClure, I., & Melville, C. (2007). Early identification key in autism spectrum disorders. The Practitioner, 251(1697), 31. Pivalizza, P. (2007, June). Early Autism Identification [Letter to the editor]. Pediatrics, 119(6), 1253-1254. Schwartz, I., & Sandall, S. (2010). Is autism the disability that breaks part C' A commentary on "infants and toddlers with autism spectrum disorder: early identification and early intervention," by Boyd, Odom, Humphreys, and Sam... Boyd, B. A., Odom, S. L., Humphreys, B. P., Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32, 73-96. Journal of Early Intervention, 32(2), 105-109. Woods, J. & Wetherby, A. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34(3), 180-193.