AUTISM

A REFLECTIVE JOURNAL ON UNDERSTANDING AND WORKING WITH AUTISTIC SPECTRUM DISORDERS.

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Table of contents

Introduction…………………………………………………………………………6

Characteristics of Autism disorders………………………………………………8

Autistic disorder…………………………………………………………………..10

Asperger syndrome………………………………………………………………10

Pervasive Developmental Disorder………………………………………………10

Impairment of social interaction…………………………………………………12

Impairment of collective communication………………………………………..12

Impairment of collective imagination………………………………………………12

Recurring and Stereotyped Behaviors………………………………………………12

Joint attention behaviors ……………………………………………………………13

Frontal lobe…………………………………………………………………………..14

Mirror neuron system……………………………………………………………….14

Temporal lobe……………………………………………………………………….15

Corpus Callosum……………………………………………………………………..16

Environmental Risk Factors……………………………………………………….16

Secondary problems for failure to understand in Autistic children……………20

Effects of autism on the families of the affected children……………………22

Individual profiles in autism……………………………………………………..22

Communication issues in autism……………………………………………….22

Sensory integration in autism………………………………………………….23

Challenging behaviors in autism……………………………………………….23

Senses and perception………………………………………………………….24
Conclusion………………………………………………………………………24

References……………………………………………………………………..26

GLOSSARY

Autism – a form of a group of disorders that is collectively known as pervasive developmental disorders

Asperger syndrome – Children with Asperger syndrome have milder symptoms that affect social interaction and behavior.

Pervasive Developmental Disorder- Pervasive Developmental Disorder can be thought of as a ‘diagnosis of exclusion’. It is used for children who share some, but not all, of the traits of autistic disorder and/or Asperger syndrome.

Impairment of social interaction – This refers to an impaired ability to engage in reciprocal social interactions. The most severely affected individuals seem aloof and uninterested in people.

Recurring and Stereotyped Behaviors- It’s a condition in which children with autism obsessively lining up toys, repeatedly spinning objects or flapping their hands in the periphery of their vision

Joint attention behaviors – attempts to monitor or direct the attention of another person. They include gaze monitoring, pointing and showing.

Genetic Risk Factors – Risk factors resulting from an individuals genetic make up

Frontal lobe – An area that is central to many functions that are associated with autism, such as language and executive functions e.g. Broca’s area, which is related to language production, is located in the inferior prefrontal lobe.

Mirror neuron system – consists of a network of brain areas that have been associated with empathy processes in both animals and humans in humans

Temporal lobe – its functions are related to many of the deficits observed in individuals with ASDs, such as receptive language, social cognition, joint attention, action observation and empathy.

AUTISM

A reflective journal on Understanding and Working with Autistic Spectrum Disorders.

Introduction

As a physical education teacher, I have had the opportunity to interact with and meet individuals with autistic disorder and therefore this has given me a wide knowledge on the condition. Similarly as a teacher, I have been able to observe a number of behaviors, general condition and ways of handling children with autistic disorders. Over the past one year that I have worked with and around autistic individuals, I have come to the realization that if understood properly, the autistic condition can be effectively managed and therefore give autistic individuals a chance to lead a better life that it is the case today. However, a majority of individuals in the society are unaware of this condition and therefore it has become difficult for them to manage this condition.

At the same time, in my experience I have come across many families who out of ignorance regard autistic condition as one that can not be taken care of subjecting the victims to trauma and rejection. Autism can be defined as a form of a group of disorders that is collectively known as pervasive developmental disorders. In this regard, the Pervasive Developmental Disorders include autism, Asperger syndrome, Childhood disintegrative disorder, and Pervasive developmental disorder and Rett syndrome. This complex condition can then often confound and confuse both the inexperienced professional and the well-intended layperson alike. It is no wonder that new families feel so confused when confronted by this so unfamiliar condition. The category of pervasive developmental disorders and the Autism Spectrum set of diagnoses are useful in naming a wide range of degrees of this neurological disorder and its heterogeneous behavioral presentations and diverse developmental patterns as they exist across the whole population of all people with and without Autism (Mash & Barkley 2003).

Nonetheless, this means that, even if a family member or service professional have known a dozen people with Autism, we have only begun to know about the condition as a society. Therefore, it helps to seek out professionals with long term experience in working with this disorder across the Autism community, if you are seeking a clear and accurate primary and secondary diagnostic identification. As a result therefore, an individuals childhood behavioral symptoms must then meet a specific set and degree of neurologically allied features from the consistent criteria for what is a larger category .This means, that as a group, people within the whole Autism Spectrum do share certain aberrant developmental characteristic features, but with exceedingly wide-ranging presentations that create exceptional sensor motor, communication, and social behavior profiles.

In the following reflective journal and discussion, I will provide the recognized diagnostic principles for Autism and reliable and valid professional tools for differential diagnostic criteria to be able to more precisely but not utterly discern Autism from other distinct developmental conditions. This is because Autism often co-occurs with related neurological and developmental conditions, which will require professional expertise to identify and sort out for our families as autism spectrum disorders are developmental their presentation, will vary with age and, in any one individual, vary over time (Mesibov and Shea, 1996).

Characteristics of Autism disorders

The characteristics of autism spectrum disorders may be more prominent at some ages than others. Thus a clearer understanding of normal social, behavioral and language development is required among parents, careers and professionals. Existing child developmental surveillance programmes undertaken by primary care teams, including health visitors, offer a context within which better detection can occur. It is important to remember that autism spectrum disorders may occur in those with medical conditions such as early epilepsy and that learning and psychiatric co-morbidities are common.

These disorders are characterized by difficulties in communication, social deficits, stereotyped behaviors, repetitive behaviors and interests and cognitive delays. Individuals with these disorders are thought to be on the spectrum because of differences in severity across these domains. Autism is characterized by delays in the normal functioning of a child before the age of three in one of the domains such as social interaction, communication, stereotyped patterns of behavior, interests and abilities. Social and communication impairments may also result in a lack of symbolic or imaginative play. Restricted and repetitive behaviors may include unusual preoccupations with narrow interests, inflexibility to nonfunctional routines, stereotyped and repetitive mannerisms.

Social impairments are marked by poor use of nonverbal communication, difficulty in peer relations, lack of social-emotional reciprocity and a lack of shared enjoyment. Communication deficits may include failure to develop speech, use of stereotyped or delayed echolalia and difficulties maintaining conversations.

In addition, pervasive developmental disorder is sound thought as a typical autism or a subthreshhold autism since it is characterized by much milder symptoms in only one domain. An individual with pervasive developmental disorder demonstrates pervasive behavior in the development of common social interaction but it does not meet the criteria for a specific developmental disorder or other psychological disorders. Autism spectrum disorders tend to be highly comorbid with other disorders. Comordibility may increase with age and may worsen the course of youth with Autistic Spectrum Disorder and make intervention/treatment more difficult. Distinguishing between Autistic Spectrum Disorder and other diagnoses can be difficult because the traits of Autistic Spectrum Disorders often overlap with symptoms of other disorders and the characteristics of Autistic Spectrum Disorders make traditional diagnostic procedures difficult. In spite of these difficulties, comorbid disorders are readily identified and tend to fall into six categories, medical conditions, intellectual disabilities, anxiety disorders, mood disorders, behavior-related disorders, and sensory processing disorders. Autistic spectrum disorders are a range of related developmental disorders that begin in childhood and continue all the way through adulthood. They incorporate both autism and Asperger syndrome.

The condition can cause a wide range of symptoms, which are grouped into three extensive categories which are; Problems and difficulties with social interaction, such as a lack of understanding and awareness of other people’s emotions and feelings. Impaired language and communication skills, such as delayed language development and an inability to start conversations or take part in them properly. Unusual patterns of thought and physical behavior. This includes making repetitive physical movements, such as hand tapping or twisting. The child develops set routines of behavior, which can upset the child if the routines are broken Types of Autistic Spectrum Disorder. In extensive terms, there are three main types of Autistic Spectrum Disorder, which are; Autistic disorder, sometimes known as classic autism, Asperger syndrome and Pervasive Developmental Disorder.

Autistic disorder

Children with autistic disorder usually have significant problems with language, social interaction and behavior. Many children with autistic disorder will also have learning difficulties and below-average intelligence.

Asperger syndrome

Children with Asperger syndrome have milder symptoms that affect social interaction and behavior. Their language development is usually impervious; although they often have problems in certain areas of lingo. Children with Asperger syndrome usually have above-average intelligence. Some children are skilled in fields requiring logic, memory and creativity, such as math’s, computer science and music. (But only 1 in 200 children are exceptionally skilled, so-called ‘autistic savants’).

Pervasive Developmental Disorder.

Pervasive Developmental Disorder can be thought of as a ‘diagnosis of exclusion’. It is used for children who share some, but not all, of the traits of autistic disorder and/or Asperger syndrome.

Most children with Pervasive Developmental Disorder – Not Otherwise Specified have milder symptoms than children with autistic disorder, but they do not share the good language skills and above-average intelligence associated with Asperger syndrome. The outlook for children with Autistic Spectrum Disorder usually depends on how severe their symptoms are and, especially, their level of intelligence. Children with mild to moderate symptoms who have average or above-average intelligence often grow up to be independent adults with jobs, long-term relationships and children.

Children with more severe symptoms who have below-average intelligence are unlikely to be able to live as independent adults. They may need additional care and assistance for the rest of their lives. However, according to Schultz (2005), there is no reason why they cannot enjoy a good quality of life just like each and every one of us.

The specific cause of Autistic Spectrum Disorders is not known, but following a line of investigation, researchers point out those genetic factors is important. In some cases autism spectrum disorders may also be associated with various conditions affecting brain development, such as maternal rubella, tuberous sclerosis or post-encephalitic states but the frequency of such findings remains uncertain.

The range of intellectual ability of individuals who are considered to be on the autism spectrum differ from one another and extends from the severely learning disabled range right up to normal or even superior levels of intellect. Similarly, linguistic skills range from those who are mute to those who display complex, grammatically correct speech. All such individuals have difficulties in three main areas. Different terminologies describe this cluster of symptoms but the concept of the Triad of impairments is widely used. Triad of impairments describes these symptoms as in the following cases as discussed below.

Impairment of social interaction

This refers to an impaired ability to engage in reciprocal social interactions. The most severely affected individuals seem aloof and uninterested in people. Others desire contact, but fail to understand the reciprocal nature of normal social interaction. In consequence their attempts at social interaction are clumsy, awkward and one-sided. Some passively accept the attentions of others but do not reciprocate.

Impairment of collective communication.

The whole range of communicative skills may be affected. A significant proportion of individuals with classical autism fail to develop useful speech. Even when the mechanics of language are mastered, the person with autism has difficulty using it for the purpose of communicating with others. Intonation is inclined to be abnormal and the non-verbal aspects of communication such as eye-to-eye gaze, use of gesture and facial expression can be impaired.

Impairment of collective imagination

People with autism have great difficulty thinking imaginatively. This is demonstrated by pretend play, which will be absent or repetitive in children with autism spectrum disorders. Whether this is directly related to the development of rigid and repetitive behaviors has not been established.

Recurring and Stereotyped Behaviors.

People may be familiar with the image of children with autism obsessively lining up toys, repeatedly spinning objects or flapping their hands in the periphery of their vision. As development proceeds, however, the focus of attention tends to shift from physical activities to the collection of information. This is particularly true of more able children who may accumulate facts about specific topics.

Characteristically, the themes of such preoccupations are unusual and the focus extremely restricted. Additionally, they do not become the currency of social exchange in the way that collecting football stickers or knowledge about computer games often does for typically developing children.

Joint attention behaviors

Joint attention behaviors are attempts to monitor or direct the attention of another person. They include gaze monitoring, pointing and showing. These behaviors are normally present by age nine to fourteen months but are rare or absent in children with autism. Screening

There is no suitable test for the universal screening of preschool children for autism spectrum disorders. However identification of autism spectrum disorders can be improved by recognizing those signals which might be a sign of further assessment is needed. These signs include concerns around communication for example, not responding to name, delayed language, poor social interaction like for example seems to prefer playing alone, is very independent, does not smile socially and much more.

Koenig, Tsatsanis & Volkmar (2001) explain that the causes of autism differ in different individuals depending on the prevailing circumstances and condition on various individuals. In this regard, a specific cause or specific causes of autism spectrum disorders has yet to be found, but many risk factors have been identified and they include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. According to earlier studies, all these play a substantial role in causing the autistic condition in a number of individuals especially young children.

Frontal lobe

The frontal lobe is central to many functions that are associated with autism, such as language and executive functions. For instance, Broca’s area, which is related to language production, is located in the inferior prefrontal lobe. Other important areas of the frontal lobe include: the prefrontal cortex (involved with aspects of executive function such as working memory, inhibition, and planning, organizing, set-shifting and cognitive flexibility), the orbitofrontal cortex (involved in social cognition and theory of mind) and the inferior frontal gyrus (part of the mirror neuron system). Current research suggests that dysfunction in the frontal lobe may be associated with some of the deficits observed in individuals with ASD, including social cognition, imitation, face processing, language, attention, working memory, and problem-solving. For example, it has been found that individuals with autism have decreased concentrations of N-acetyl-aspirate (NAA) and reduced glutaminergic neurons in the frontal lobe, suggesting some dysfunction in this region. Orbitofrontal cortex deficits have also been implicated with autism, as individuals with high-functioning autism have shown decreased functioning in this area when participating in a task that involved the perception of fearful faces.

Mirror neuron system

Ghaziuddin (2005), asserts that the mirror neuron system consists of a network of brain areas that have been associated with empathy processes in both animals and humans in humans; the Mirror Neutron System has been identified in the inferior frontal gyrus and the inferior parietal lobule and is thought to be activated during imitation or observation of behaviors. It has been suggested that the MNS generates internal representations of the self and others, which facilitates an understanding of other people. Several studies using functional brain-imaging have found evidence of mirror neuron dysfunction in autism, suggesting this neural system is associated with social impairments in individuals with ASDs. Specifically, various studies have established that reduced mirror neuron activity and MNS cortical thinning are highly correlated with autism severity.

Temporal lobe

According to Rutter (2000), functions of the temporal lobe are related to many of the deficits observed in individuals with ASDs, such as receptive language, social cognition, joint attention, action observation and empathy. The temporal lobe also contains the superior temporal sulcus (STS) which may mediate facial processing. It has been argued that dysfunction in the STS underlie the social deficits that characterize autism. Compared to typically developing individuals, one FMRI study found that individuals with high functioning autism had reduced activity in the STS when viewing pictures of faces Other studies have suggested that the role of the STS may be more complex than simple face processing, as research has found that individuals with ASDs have shown reduced functioning when viewing fear-provoking faces; implying that the STS is involved in understanding the emotions of others. Other areas of the temporal lobe have also been implicated in ASDs. For instance, the FMRI research suggests that individuals with ASDs have reduced activity in the right temporoparietal junction and other regions during imitation and observation tasks.

Corpus Callosum

Chilvers (2007) explains that Empirical studies have found evidence of reduced size of the corpus callosum in individuals with autism. These findings suggest that there may be a link between autism and impaired communication between brain hemispheres which as a result interferes with normal child development leading to the autistic disorder.

Environmental Risk Factors

A wide variety of environmental risk factors have been proposed as contributing to autism. These include gastrointestinal or immune system abnormalities, allergies, and exposure of children to drugs, vaccines, infection, certain foods, or heavy metals. The evidence for these risk factors is anecdotal and has not been confirmed by reliable studies. The subject remains controversial and extensive further searches for environmental factors are underway.

At the same time, Hall (2000) asserts that there are many theories that explain autism spectrum disorders. For instance, the refrigeratory mother theory explains that autism autistic behaviors arise as a result of rejecting demeanor of a child’s mother, lack of warmth and cold and finally, emotional frigidity. In real sense, the guardians or parents of children with autism tend to be blamed, lack confidence, feel guilty and lack the sense of well being. Another controversial theory discourages continuous watching of television as it is believed to be another cause of autism. However, this theory has not been supported by research. Another theory that explains autistic behaviors is the vaccine theory which suggests that autism results from brain damage that is caused by mumps, measles, thrimerosal, and vaccines such as ethyl mercury which is a vaccine stabilizer, the rubella vaccine and much more.

According to Bogdashina (2004) there are very many behavioral problems in children that suffer from autistic spectrum disorders. As I have witnessed, these behaviors vary among individuals and the tendency of having repetitive behaviors seems to be a major problem in autistic individuals. There are many more behaviors that seem to be adopted by autistic patients such as; sleeping problems, uncontrollable temper, phobias, aggression, and even self injurious behaviors.

Nonetheless, Frith (1991) is of the idea that there are ways of managing these behaviors. However, people wit autism spectrum disorders do not respond to these management techniques as it should be. This treatment is carried out by clinical psychologist and mental health psychologists. In real sense, no credible scientific studies have come up with a permanent cure of autism problems but they reduce the long term effects of autism. Schultz (2005) is of the idea that none of autism treatments have worked for children with autism and research outcomes explains the nature of autism as that of a wide spectrum disorder. Brain scanning technologies are also used by researchers as they carry out their research in autism. More to that there are traditional and biomedical treatments have emerged and are being used to address certain issues of biomedical problems. Conversely, scientists and researchers are coming up with ways of promoting the total management of autism and management of peoples brains.

Neural developmental model of autism gives the connection between sensory overload and sensory dysfunction and how they affect and contribute to autistic spectrum disorders in children. Autistic children are very sensitive to touch and they are not able to tolerate touch on their bodies, on their head or even inside the mouth. They are also not sensible to pain or feelings such as hot or cold. Some children are more sensitive in some of their body parts like for example hands, on their head, the legs and much more. The most excellent way to handle sensitive autistic children is to assess each child individually.

In addition, Bogdashina (2003) advises that one should be very careful when dealing with people with autism. There are certain ways in which these people should be handled because they are not like other normal persons. For example, some people with autism have Consultations with people with autism have vague sensitivity to pain or they may even experience the texture of certain fabrics as painful or discomforting. Also people with autistic disorders often feel uncomfortable having to often break their daily routine ton visit their doctors , some are greatly affected by noise and others have phobia of being in large crowds. The people with autistic disorders differ and they hence should be handled differently, and the people around them should watch closely those things that affect them and avoid them. Also people with autism normally have difficulties in understanding what is said to them and they have difficulties in understanding non-literal communications such as jokes, figures of speech or even sarcasm hence one should be very careful of not to say something that my hurt these people with autistic disorders. The people with autistic disorders have ways of relating with other people and hence there are certain aspects which should be considered when dealing with them.

Autism spectrum disorders are thought to follow two continuous procedures. Some parents have given their views that the autistic problems started occurring in the first year of life. In fact, parents start getting concerned when the child is like two years old and diagnosis is made when the child hits three to four years. Some early signs of autistic disorders include failure or decreased looking of faces, failure to respond when called, or delayed play and poor self help skills. Nonetheless, many individuals show improvements as they grow older (Kurtz, 2007)

Figure one

Early Symptoms of Autism

Collective behavior	Natural development	Characters and behaviors in children with autistic disorders that is not in normal children.
Looking at faces	Birth	Less at 12 months
Following person’s gaze	6-9 months	Less at 18 months
Turning when name called	6-9 months	Less at 9 and 12 months
Showing objects to others	9-12 months	Less at 12 months
Pointing at interesting objects	9-12 months	Less at 12 months and 18 months
Pointing to request	9-12 months	Not delayed at 18 months
figurative play	14 months	Absent at 18 months

According to Baron-Cohen (2001) children with autistic spectrum disorders have problems in both verbal and nonverbal communication. Verbal communication may or may not be affected by autistic spectrum disorders depending on an individual. Verbal communication includes semantic language, the ability to speak each word clearly (articulation), and ability to understand spoken words and ideas clearly, the ability of knowing the meaning of sounds and words and also the ability to distinguish similar sounds. Similar sounds, and to pick out the main voice from background. Also children with autistic spectrum disorders have problems in nonverbal communication such as eye contact, body language, physical expressions, symbolic play skills and much more.

Secondary problems for failure to understand in Autistic children.

Autistic children have problems in understanding and there are secondary problems for failure to understand. These problems are;

Anxiousness and tension This is because they do not have an idea of what is going on and they do not know what to do in particular situations.

Adamant on sameness and showing ritualistic deeds. Change means that previously hard learned strategies will not help in this situation. This is because these children barely learn new things.

Inattentive, the children suffering from autistic spectrum disorders are normally inattentive in most cases because they cannot understand whatever is going on hence they do not have to be attentive to what is going on around them.

Autistic children seem to be Rude-appearing because they do not know what to say in different situations. for example, they don’t know when to say excuse me, thank you, please and other words that show courtesy.

Interested in objects rather than people. After all, objects are more predictable.

Autistic children also hang back from friends, peers and those people who are close to them. This is simply because they do not know how to effectively relate with other people around them and they also keep away because thy feel as they are less important than others.

Odd/ unusual looking. This is because the children suffering from autistic spectrum disorders often keep to themselves and they behave in strange way that are off the ordinary or the normal way in which a child is expected to behave.

As a result therefore I would term the notion that the parents or guardians of children with autistic spectrum disorders have often given their concerns that the diagnosis process has failed and they are hence dissatisfied with the diagnosis process and this has brought about concerns in the entire process as untrue. Based on my experience I can however say that it takes a couple of years before a diagnosis is made and therefore such parents should be cautious with whatever decision they make regarding these children.

Effects of autism on the families of the affected children

The parents or the families of the children with autism spend time finding ways in which they will help their autistic child. When parents have an autistic child, they have to find time for the child with autistic disorders, for their other children and also for themselves. The ‘normal’ children can be very adversely affected both mentally and emotionally and some of these effects can be caused by genetic makeup, stress, or even minor autism which is not easily noticeable. As a physical education teacher, I have realized that there is no question that autism affects the entire family of the autistic child.

Individual profiles in autism

Children with autism have different ways in which they live and also in which they relate with others. Autism affects these autistic children differently and therefore the autistic disorder is managed in different ways. The autistic individuals have individualized treatment protocols.

Communication issues in autism

Autistic children are very poor in socializing and they do not communicate effectively. They experience obscurity in verbal and non-verbal communication, social interaction, emotional adjustments, and they also have problems with language. I would also use this experience and knowledge to create a better societal understanding on children with autism by creating awareness of the condition and making families understand that a child wit this condition does not have a death penalty on their face. In my capacity as a teacher I would assist this group of children understand their condition as well as try to lead a normal life like the others do. And this brings about communication problems between the autistic children and their relations. Bogdashina (2004)

Sensory integration in autism

Sensory integration is a form of professional therapy that is offered by specially trained occupational therapists. It involves specific sensory activities that are intended to help the patient regulate his or her sensory response. The results of these activities may lead to an improvement of behavior, lowered anxiety, and even better focus.

Challenging behaviors in autism

Autistic children do not behave like normal children and they tend to be very different in so many ways. They have unordinary characteristic such as; Self-injury, attack others, , Physical aggression, destruction of property, self-injury, physical violence to themselves, threatens others and does physical violence to others, exhibits stereotyped behaviors, physical assault upon others, stereotypic and repetitive movements.

I have desired to write on challenging behavior because it is the biggest setback in autism and it greatly affects both the autistic individual and their relations. It is very tricky to deal with autistic children because they do not behave like other normal children hence one should be very careful. Also the occupation therapy of sensory integration is very important and as a physical education teacher, I advise the parents of autistic children to ensure that they have consulted occupational therapists on ways in which they can help their autistic children.

Senses and perception
there are five main senses that a normal human being should poses; to see, hear, touch, smell, and taste. Two other sensory systems are the vestibular system and the proprioceptive system. The vestibular system relates to the positioning of the head in relation to the body. The proprioceptive system relates to the position and movement of the body in relation to space and objects. Each of these senses uses its receptors to detect the environment and produces nerve signals to carry this information to the brain. the brains of autistic individuals does not function the same as those of normal persons.

Conclusion

In conclusion, autism spectrum disorder is a group of developmental disorders that begins when one is a child. Children with autistic spectrum disorders require help in many ways such as in their education. The parents of children with autism should seek advice from doctors on how they should handle their children. In addition to that, occasional psychiatric treatment should be given to these children. It’s important to note tat autistic children as a result of their condition need specialized handling, care and equipment that would help them significantly develop and despite their condition lead close to normal lives. In future, I would therefore use my experience and understanding of autistic children ads has been gained over the last one year in my position as a P.E teacher to enhance the welfare of these children. I would also use this experience and knowledge to create a better societal understanding on children with autism by creating awareness of the condition and making families understand that a child wit this condition does not have a death penalty on their face. In my capacity as a teacher I would assist this group of children understand their condition as well as try to lead a normal life like the others do.

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