What is Autism Spectrum Disorder (ASD)?
Autism is a severe disruption of the normal development process and is often diagnosed within the first few years of life. Autism is viewed as a spectrum or a continuum of disorders, with varying degrees of severity and levels of functioning.
What are the signs and symptoms of ASD?
Autism spectrum disorder typically appears during the early years of life. Early assessment and intervention are crucial to a child’s long-term success.
Some early signs and symptoms include:
- No social smiling by 6 months to no two-word phrases by 24 months
- Poor eye contact
- Not showing items or sharing interests
- Unusual attachment to one particular toy or object
- Not responding to sounds, voices, or name
According to the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM 5, there are some excesses or deficits in children with autism in 3 main domains:
- Verbal and non-verbal communication,
- Behaviour and interest.
At this point, the cause of autism remains unknown, however, the one theory that has strong scientific evidence is that genetics play a significant role in contributing to the occurrence of ASD. Studies show the concordance rate for identical twins is much higher than for fraternal twins, and ongoing research is beginning to identify genes that may put an individual at risk.
Additionally, in the last decade, there are more postulations on the relationship between environmental toxins, diets, vaccines and autism, but up till now, there is no convincing scientific evidence that demonstrate a causal link between ASD and these toxins, life-saving vaccines or diets. As a result, adherence to these speculative beliefs is tragic because more children are harmed by not receiving life-saving vaccination.
Finding the answer will require long-term, painstaking, rigorous, and sophisticated scientific investigation. Professional responsibility and ethics demand that care be taken not to over-speculate, misrepresent nor present mere hypotheses as facts for the causes of autism.
- 1 in 68 children has been identified with autism spectrum disorder (ASD) in the United States, 30 percent higher than previous estimates reported in 2012 of 1 in 88 children (Center for Diseases Prevention and Control, CDC 2014)
- In Singapore, due to the lack of statistical studies to establish the prevalence rate locally, an estimate figure of 1% of the population is diagnosed with ASD.
- 1,100,000 cases of autism in China; 650,000 in the UK; 500,000 in the Philippines; and 180,000 in Thailand (the World Health Organization, WHO, 2009)
- 49 children in every 10,000 is diagnosed with the disorder in Hong Kong (epidemiological study by V. Wong & S. Hui (2007) of The University of Hong Kong)
- 5 times more common among boys (1 in 42) than among girls (1 in 189). (Centers for Disease Control and Prevention, CDC, ASD)
- Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of about 1%. A study in South Korea reported a prevalence of 2.6%. (Centers for Disease Control and Prevention, CDC, ASD)
- Approximately 67 million people worldwide are affected by autism.
It is generally believed that the prevalence is similar across countries and cultures, although the numbers obtained in prevalence studies vary according to the methodology and diagnostic criteria used.
Boys are affected by autism at a much higher rate than girls, for reasons that are not entirely clear. A similar pattern is seen in other childhood disorders such as Attention Deficit Hyperactivity Disorder (ADHD).
With the advancement in diagnostic tools, most children with autism can be reliably diagnosed by the age of 3, and earlier diagnosis is even possible for children as young as 12 months old. Parents are usually the first to notice peculiarities with their child’s development that do not follow the typical norm. Some of these peculiarities noted by parents include sudden regression and onset of social aloofness and/or a lack of progress after the child has reached certain developmental milestones.
Although symptoms of autism vary from child to child, the core areas affected include:
- Deficits in language and communication
- Impairments in socialization and social interactions
- Undeveloped cognitive and adaptive functioning
- Restricted repetitive and stereotyped patterns of behavior and interests
These essential skill deficits cause children to fall progressively further behind their typical peers as they grow older. The cause is unknown, but evidence points to physiological and neurological abnormalities. Children with autism generally do not learn in the same way that children normally learn, because, in part, they lack the fundamental skills which enable them to acquire and process basic information. These difficulties result in significant delays in their development of language, play and social skills, including their failure to notice and learn through imitation of their peers.
What most children do by age of 2:
What most children do by age of 3:
There are many factors that contribute to the long-term treatment outcome of a child with autism. Some of these factors can be controlled and some cannot.
|Cognitive Ability||Research has shown that children starting at the same age, with the same intensity, consistency of treatment, and same treatment choice, may have different treatment outcomes. This, we believe, is due to the individual cognitive ability of the child. Some children may learn very fast and others may learn slower. Some children may find it difficult to learn abstract concepts, while others may become fluent in all areas.|
|Treatment Age||It has been well documented that children with ASD benefit the most in the early years. Early intervention is critical to ensure the maximum progress. This is not to say that older children do not benefit from treatment; they do, however as children get older the developmental gaps become wider and more difficult to catch up. Thus, it is recommended that intervention be done as early as possible.|
|Quality of Treatment||It is critical to ensure that the treatment your child receives is of a high quality. There is tremendous variability in the quality of treatment services. Providers may claim to provide treatment services without the proper training or quality control. Professional and well-qualified treatment Therapists should receive ongoing extensive training and supervision by experts in the field. Your program should be as good as the person who designs the curriculum and the people that implement it.|
|Treatment Intensity||Children with autism face the formidable challenge of not only trying to catch up the developmental gaps that already exist but also they need to keep up their learning pace with their peers to ensure that the gaps do not widen. For example, a child who has a 2-year delay in language may only learn one year of language in a year. This would normally be ideal as it represents a lot of progress. However, the two-year delay still exists because the child is older and his peers have acquired another year of knowledge. In order to actually catch up, the student needs to learn more than one year of language in a year. If the student caught up 1.5 years of language every year, it would then take him or her 4 years to finally catch up with peers. This then presents a real challenge. Given the multitude of deficits that are often present with autism, it is critical that all areas are taught intensively and systematically. It is not unlike taking a child and training him or her to become an Olympic swimmer. Spending one hour a week on one of the deficit areas that is 2 years behind is unlikely to yield the results we may wish for. Research has consistently shown that a high volume of hours is ideal to maximize a child’s learning progress.|
|Consistency||In order to maximize program progress, it is critical that the whole treatment team provides service in a consistent approach. If the student is doing sign language in the morning and using pictures to communicate in the afternoon, it is likely to result in confusion on the part of the student. If a number of practitioners are working together, it is then essential that they meet regularly to formulate a comprehensive plan so that the treatment can be consistent. This is also true for the consistency between parents and the treatment team. Parents need to be involved and develop knowledge and expertise in treatment so as to help their child learn and generalize skills.|
Early Intensive Behavior Intervention (EIBI)
Recommended as an intervention option for children with ASD (AMS-MOH Clinical Practice Guidelines, 2010)
Recovery and Treatment
There is much debate and disagreement about whether it is possible for a child to recover from a diagnosis of autism. There is also varying views on what constitutes recovery. The first use of the term “Best Outcome” was in the seminal research study by Dr Ivar Lovaas. This term was used to describe a group of children that no longer carried the diagnosis when tested by an independent diagnostician, had normal IQ’s, were placed in mainstream classrooms with no supports and were indistinguishable from their peers. Later studies have also used these criteria to define outcome of children in their treatment programs. It is possible that children reaching this best outcome criteria may still have some quirks or have some very minor deficits that would not be able to be observed by a layman. These children might go on to university, have good careers and may get married.
Unfortunately, there has also been great misuse of the term and parents can be misled by certain providers to believe that all children will attain this kind of outcome if you just do the right kind of treatment or take the right doses of medications. The research on ABA certainly does not show that this is the case. The current research shows that just under 50% of children who receive very intensive (30 hours per week) ABA services at a young age will attain this kind of best outcome.
Autism Partnership firmly believes that the best outcome is possible for many children with early intervention. However, we also believe strongly that for those who do not attain the best outcome, early intervention can have a profound effect on their quality of lives. Many of the children who do not meet the best outcome can have jobs, relationships, contribute to society and have happy meaningful lives. This is our objective for all the children we treat.
What is the right treatment for your kid?
Parenting a child with autism can present many challenges and one of them is searching for the right treatment for children diagnosed with ASD.
Every year there are new treatments declared to be highly effective in treating individuals with autism, or professional interpretations and suggestions, anecdotal reports from parents, and drugs and medications claiming to cure autism, yet most lack the scientific rigor and testing to support its claims. Applied Behavior Analysis (ABA) is the only approach that has the most extensive research and has been scientifically proven to be the most effective treatment for children with autism to date. There is no other treatment shown to be more effective or has the same scientific rigor as do ABA, yet with the increasing number of children diagnosed, along with poor access to effective treatments and the broad range of autism treatments abound, families often resorted to complementary and alternative Medicines (CAM) treatments, biologically-based or not, in spite of the absence of supportive scientific data and/or presence of contradictory data and warnings from scientists.
Whether a treatment has been widely tested, adopted, and proven in scientific research and history is extremely crucial in determining the treatment outcome. As a result, parents should and must critically evaluate and scrutinize all treatment options available, inquire whether there is scientific evidence supporting each treatment’s claim of effectiveness, and look at what really works and select a treatment that can deliver results and progress.
Critical Questions to ask when researching treatment options:
- What is the treatment program’s rationale and purpose?
- Is there written information?
- What is involved for the child and family?
- What is the length of treatment, frequency of sessions, time and costs to the family?
- Does the treatment focus on one skill or is it a comprehensive program?
- Will the treatment result in harm to the child?
- Is the treatment developmentally appropriate?
- What is the background and training experience of the staff?
- Does the treatment staff allow input from the family?
- Are assessment procedures specified and is the program individualized for each child?
- How will progress be measured?
- How often will effectiveness of the intervention be evaluated?
- Who will conduct the evaluation?
- What criteria will be used to determine if treatment should be continued or abandoned?
- What scientific evidence supports the effectiveness of the program?
- How will failure of treatment affect the child and family?
- How will treatment be integrated into the child’s current program?
Frequently Asked Questions
We have found that ABA can be of benefit to ALL children in reaching their individual potential. We have also found that the extent of benefit depends on the following factors:
- the quality of the Service Provider, including qualifications and extensive experience;
- the personal and social resources available to the parents, including how whole-heartedly they embrace ABA philosophy and practices, as well as how available they are to participate meaningfully in their child’s program;
- and the extent of the child’s own skills and challenges.
Perhaps the most important factor is the successful interaction of all of these components, resulting in a cohesive team working towards the same goal: your child’s growth and learning.
Certainly. Not every child achieves “recovery.” However, a high percentage of children make outstanding progress and are able to enjoy a much higher quality of life.
It is critical that parents have realistic expectations but also understand that recovery is a possibility if their child receives quality treatment at an early age. Although less than 50 percent of children under the best conditions “recover,” the vast majority of children can make outstanding progress.
There are signs that are favorable, but not absolute. Children that have the presence of language, social interest and disruptive behavior tend to do better than those children who do not communicate, are socially unresponsive and passive.