 Autism
Q: What is autism?
Autism
is neurobiological developmental disorder caused by a dysfunction in
the central nervous system, which leads to disordered development. Also,
known as 'classical autism' or autistic disorder, this disorder severely
affects the course of development in a child. The onset of symptoms
occurs within the first three years of life and is present in three
major areas, namely, impairment in communication and play, impairment
in social interaction, and the presence of repetitive and restricted
patterns of behavior.
Q:
What are the symptoms of autism?
Children with autism exhibit three major symptoms:
· Delays and disorders of communication
· Impairment in social relatedness
· Presenting restricted, repetitive and stereotyped behavior patterns
Qualitative
Impairments in Communication
Impairments in communication include both verbal and nonverbal
deficits. Children with autism presents poorly developed language,
and often stereotyped language, in which they are unusually repetitive
(i.e., repeating phrases or words heard from advertisements or
TV program over and over), or have absence of speech. Other unique
features are echolalia (rote repetition of what has been heard,
or parroting), pronoun reversal (confusion in referring self in
second or third person), verbal preservation (repeating certain
phrases over and over, or dwelling on a single topic), and abnormalities
of prosody (rate, rhythm, inflection, or volume of speech).
In some cases, children with autism initially developed some language
but showed a loss in language or regression, usually during the
second year. On the other hand, some has significant delay in
all aspects of language and communication.
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Qualitative
Impairments in Social Interaction
Children with autism are described as "aloof", "unresponsive",
and "in their own world". They have significant deficits in relating
to others and often, do not use gestures, such as pointing and
shaking or nodding their heads, fail to respond to their name,
avoid eye contact, and have difficulty interpreting what others
are thinking or feeling.
Parents have
reported that they have first notice the symptoms since infancy,
as they find their child have poor eye contact, lack interest
in being held, or stiffens when held. As they grow older, these
children may express their social impairment by ignoring people
or interacting only to have their needs met. And older or higher
functioning children may desire social relationships but is insensitive
to others' reactions, and has difficulty picking up social cues.
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Restricted
Repetitive and Stereotyped Patterns of Behavior, Interest and
Activities
Many children with autism engage in repetitive movements such
as rocking, spinning, flapping their hands, or in self-abusive
behavior such as head-banging and biting. They also very narrow
interests, for instance, lining up cars, building towers, and
sorting out CDs in colors. In terms of activities, they have a
tendency to be preoccupied with parts of objects such as the wheels
of a car, or shiny objects. |
Q: Is autism
inherited?
A
few medical conditions has been found to occasionally give rise to autism,
These include genetic disorders such as tuberous sclerosis, fragile
X Syndrome, and phenylketonuria. However, there is still no single case
of identifiable medical disorder found to explain autism. Recent studies
have also shown that autism may run in families. About 3% of siblings
of a child with autism also develop autism (Piven and Folstein, 1994).
This is greater than the risk for the general population, and researchers
are looking for clues about which genes contribute to this increased
susceptibility.
In short, there are studies that show strong relations between autism
and the role of genetics. But, efforts are still in the process to determine
the gene responsible for autism.
Q:
Can autism be cured?
As
autism is a spectrum disorder with a wide range of presentations with
no known specific etiology or cause, it is difficult to pinpoint a single
cure. On the other hand, various interventions have shown promise in
improving some symptoms of autism in some children.
Q:
What kind of therapy is available to treat autism?
Several
studies have shown that treatment approach using the methods in Applied
Behavioral Analysis (ABA) can result in dramatic improvements for children
with autism. ABA employs methods based on the principles of learning
theory, to increase or build socially useful skills and reduce problematic
or dysfunctional behaviors.
In ABA, its treatment focuses on teaching small, measurable units of
behavior systematically. Each step is taught in an one-on-one teaching
situation with presentation of prompts or cues. Teaching trials are
repeated many times, until the child performs a response readily without
any prompts. All responses are recorded and evaluated according to the
specific definitions and objectives set.
Along with ABA, other approaches to enhance and maximize skill development
in children with autism are namely, Speech and language therapy, Occupational
therapy, and Music therapy, just to name a few.
Q:
Is there any medication/vitamins/diets to cure autism?
Various
medical interventions, such as psychoactive drugs, hormone therapies,
anti-yeast therapies and immunologic therapies, have been suggested
in the treatment of autism. However, the usage of these therapies is
controversial and requires intensive research and conclusive evidence
before it is to be given to individuals with autism.
Vitamin therapies have also been proposed in the treatment of autism.
Again, this therapy is not recommended as studies showed that its efficacy
have mixed results. Although short-term side effects are reported to
be mild, its side effects in the long time are not known.
The use of special diets that eliminates milk-products, gluten properties,
or other specific foods from diets has been strongly advocated by some
parties, with promising results. Diet therapies, however, are not generally
accepted as the standard forms of treatment for autism, and is still
considered experimental by many experts. Studies have not shown definite
evidence
and advantages to special elimination diets for children with autism,
but limitations have been recorded, in which it may cause some children
to get inadequate nutrition, besides being very costly.
Q:
What are the causes of autism?
The
cause of autism is still unknown. However, it is known that there is
a genetic component that puts some children susceptible to autism. Studies
have been conducted and some found that people with autism have abnormal
levels of serotonin or other neurotransmitters in the brain, while other
studies found irregularities in several regions of the brain. While
these findings are intriguing, further study needs to be carried out
as they are still in the preliminary stages.
Q:
What are the procedures in assessing a child suspected of having autism?
To
arrive with a formal diagnosis of autism, assessment involves experienced
professionals gathering information about the particular child's behavior
from parents and from direct observation of the child. An autistic assessment
as well as a comprehensive assessment will be carried out, where the
child is assessed in the following areas of development:
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Cognition |
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Communication |
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Social interactions and relationships |
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Adaptive behaviors |
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· Motor skills |
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Behavior and responses to environment |
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Relationship between family and child |
Typical
autism assessment instruments are, Childhood Autism Rating Scale (CARS),
Checklist for Autism In Toddlers (CHAT), and Autism Behavior Checklist
(ABC).
A comprehensive health evaluation is also recommended to obtain a general
health status of the child, as well as identifying other medical conditions
that are sometimes confused with autism, in a child who does not have
autism.
Q:
What is Pervasive Developmental Delay (PDD)?
The
term pervasive developmental delay is used to describe a group of childhood
disorders with similar behavioral features. The disorders that make
up this group of disorders are:
· Autistic Disorder
· Asperger's Disorder
· Childhood Disintegrative Disorder
· Rett's Disorder
· PDD-not otherwise specified
Q:
How early can autism be diagnosed?
As
more studies are done on the area of autism, there is an increasing
ability to recognize this disorder at an early age. In many cases, a
young child, even as young as under the age of three, can be identified
and recognized by his/her difficulty in orienting to social stimuli,
lack of social gaze, deficits in attention and motor imitation, and
presentation of underdeveloped language abilities.
However, it is difficult to make a definite diagnosis at an early age
with reliability, or ascertain whether the diagnosis will be accurate
and predictive in a later diagnosis. Thorough and multiple observations
are required, sometimes over an extended period of time, to confirm
the diagnosis of autism.
Q:
Who can make the diagnosis?
Most
of the time, symptoms of children with autism are fairly apparent and
noticeable by many others, it is important that qualified professionals
are consulted to obtain a formal diagnosis.
Professionals qualified to provide a formal diagnosis are:
· Psychiatrist
· Clinical Psychologist
· Pediatrician (will require to send child for referral to the above
professionals)
· Doctors (will require to send child for referral to the above professionals)
Q:
What is Autism Spectrum Disorder (ASD)?
Each
case of autism can be placed along a continuum ranging from milder to
more severe based on the level of functional skills in area such as
communication, cognitive abilities, social interactions, etc. Most specialists
believe that the boundaries along the continuum are overlapping and
indistinct. The term autism spectrum disorder is, therefore, used to
describe a group of childhood developmental disorder that has similar
behavioral features. It is also sometimes used interchangeably with
pervasive developmental disorder.
Q:
Is there a link between MMR and autism?
Recent
studies on the prevalence of autism have shown an increased in children
afflicted with autistic disorder. And some studies have noted the increase
correlates with the introduction of MMR vaccine given to children at
about the age of 13 months to 18 months, which also coincides with some
cases where some children later diagnosed to be autistic, appeared to
have autistic-like symptoms and lose their language ability.
However, this issue is still in hot debate and controversial. Many specialists
question the evidence and further studies are being done rigorously.
Q:
What is Asperger Syndrome?
Asperger
Syndrome is a developmental disorder on the autistic spectrum. Children
with asperger syndrome, show impairments in social interaction and restricted
patterns of behavior, as seen in autistic children however, they often
shown normal language and intellectual functioning. Many specialists
believe that asperger syndrome may be a mild form or a higher functioning
autistic disorder. While some other specialists believe that asperger
syndrome may be a distinct disorder from autism. Nevertheless, research
has yet to demonstrate that asperger syndrome is a different disorder
as compared to autistic disorder.
Q:
Is there a prenatal test for autism?
Currently,
there is no genetic test for autism. However, prenatal biological test
that investigates other medical conditions associated with autism, such
as fragile X Syndrome and phenylketonuria, can be carried out.
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 Early
Intervention (coming
soon)
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 Behaviour
Modification
Q:
What is Behaviour Modification?
Behaviour modification is simply translated to "changing one's behaviour".
It is the application of behaviour principles to improve specific behaviours.
However, this term has been used interchangeably with Applied Behavioural
Analysis (ABA) and Behavioural Therapy. In ABA, it is behaviour modification
in which there has been attempt to analyse or control the variables
affecting the behaviour of concern, whereas behaviour therapy is behaviour
modification carried out on dysfunctional behaviour, generally in a
clinical setting. Hence, the term behaviour modification has a broader
meaning and includes both Applied Behavioural Analysis and Behavioural
Therapy.
Q:
What is Applied Behavioural Analysis (ABA)?
Applied Behavioural Analysis (ABA) also called, behavioural modification,
behavioural intervention or behavioural treatment, is the application
of specific methods based on scientific principles of behaviour in therapeutic
settings, to build socially appropriate behaviours and reduce problematic
ones especially in individuals with autism. With careful examination
and continuous assessment of behaviours, information obtained from the
analysis of behaviours, provides understanding what triggers (antecedents)
and maintains (consequences) an individual's behaviours. Strategies
can, then, be implemented to change or modify the antecedents and consequences,
thus, resulting in a change of behaviour in the individual.
Q:
What is the Lovaas Approach?
The Lovaas Approach is just another term for the employment of techniques
of Applied Behavioural Analysis and Discrete Trial Training. It is named
after O. Ivar Lovaas who first demonstrated the efficacy of this approach.
Using behaviour change techniques, Lovaas focused on strategies to teach
social behaviours, eliminate self-stimulatory behaviours, and develop
language skills in children with autism.
Q:
What is Discrete Trial Training (DTT)?
Discrete Trial Training (DTT) is one of the methods or techniques used
in behaviour modification or applied behavioural analysis. It is effectively
used, especially in building language and skills such as mathematics
and social skills, in autistic individuals. It is a very structured
method, and involves teaching the individual on a one-on-one basis.
The individual learns through presentation of tasks in a series of separate
(discrete), brief sessions (trials), and is expected to focus only on
the task. Only successful attempts are rewarded, whereas unsuccessful
attempts are corrected through prompting.
Q:
Does ABA/DTT therapy cure autism?
It is best to term 'recovery' in whether ABA/DTT therapy is beneficial
in the management of autism. Some studies have shown that some children
(about 40% to 50%) can achieve 'symptom free' status, while other children
have show or make partial recovery.
Q:
Does ABA/DTT therapy work with other disabilities?
ABA/DTT can work other disabilities but often the results are not as
remarkable.
Q:
How much therapy does a child with autism need?
Support recommendation about 35-40 hours per week is suggested based
on Lovaas (1987). However, it is generally accepted that a minimum of
20 hours a week over a two-year period is necessary. Note that therapeutic
activities need not be confined to tabletop activities or indoor activities
especially when the child progresses, so that generalization and maintaining
of training in different environments can be introduced and learned.
Q:
Who are the professionals qualified in behavior analysis or ABA?
Professionals who are qualified to provide behavior analysis training
or ABA should have either a master's or doctorate degree in the area
of clinical or developmental psychology, special education, and other
human services disciplines such as occupational therapy, and speech
and language therapy. These professionals often have formal training
in psychology and behavior analysis training as course work. However,
the more significant the problem behavior, the more extensive the training
and usually require more clinical component. In other words, children
with severe problem behaviors are often trained by clinical psychologists,
who have experience in managing this kind of problems through course
work and internship.
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 Speech
Therapy (coming
soon)
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 Occupational
Therapy
Q: What is Occupational Therapy?
Occupational Therapy is therapy concerned with promoting health
and the well being through occupation.
Occupation is activities that people do during the course of everyday
life, which gives meaning and purpose to their lives (who you are and
how you feel about your self).
Q:
What is the aim of Occupational Therapy?
The principal aim of occupational therapy is to help enhance a person's
ability to participate in everyday activities. It focuses on working
with people on every aspect of their daily lives that are essential
for independent functioning, health and well being to reduce avoidable
dependency.
Q:
Who needs Occupational Therapy?
People who are disadvantaged by physical, mental illness (psychiatric)
and/or social problems either since birth or as a result of accident,
illness or ageing. It could be anyone who for whatever reason cannot
do the things in life they want or need to do including those with:
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Work related injuries including lower back problems or repetitive
stress injuries |
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· Limitations following a stroke or heart attack |
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Arthritis, multiple sclerosis or other serious chronic conditions |
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Birth injuries, learning problems or developmental disabilities
like autism attention deficit disorder, attention deficit hyperactive
disorder, cerebral palsy |
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· Mental health or behavioural problems including Alzheimer's,
schizophrenia and post-traumatic stress |
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Burns, spinal cord injuries or amputations |
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· Broken
bones or other injuries from falls, sport injuries or accidents |
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Vision or cognitive problems that threaten the ability to drive |
Q:
How
can Occupational Therapy help?
Occupational Therapy uses a systematic approach to help a person develop
means and opportunities to identify, engage in and improve their function
in the occupations of life. Many can achieve or regain a higher level
of independence. When skill and strength cannot be developed or improved,
occupational therapy offers creative solutions and alternatives for
carrying out daily activities. It can prevent the worsening of existing
conditions or disabilities which may otherwise require institutionalization
or other long term care.
Children
Within the school system occupational therapist helps children facing
physical, cognitive or mental health challenges that affect their school
performances, socialization and health focusing on certain areas:-
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Activities of daily living (self-needs like eating, dressing and
toilet habits) |
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· Education (achieving in the learning environment) |
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Play (interacting with age appropriate toys, games, equipment
and activities) |
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Socialization (developing appropriate relationships and engaging
in behaviour that does not interfere with learning r social relationships) |
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· Work (developing interests and skills necessary for transition
to community life after school) |
Adults
Occupational therapists performs services for adults in rehabilitation
therapy after a work injury or accident. They also work in consultation
with employers on programme and facility design to day-to-day operations
and serves as advisors to manufacturing and service companies in areas
of wellness, ergonomics and rehabilitation.
Elderly people
As we get older we get less able. Illness and disabilities can make
daily tasks like shopping, cooking, washing and getting around the house
harder to manage. Occupational Therapy helps them to regain or maintain
a level of independence for as long as possible.
Q:
Where
do Occupational Therapist practice?
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In community agencies |
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· Health care organizations - hospitals, chronic care facilities,
rehabilitation centres, clinics, hospices, nursing facilities,
psychiatric facilities |
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Education settings - preschools, schools, colleges, universities |
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Social services and social work agencies |
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Vocational rehabilitation |
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Geriatric care services |
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Terminal and palliative care services |
Occupational therapists works as part of a multidisciplinary team collaborating
with parents/caregivers and other team members, including physicians,
nurses, speech-language pathologists, psychologists and teachers to
target desired outcomes and determine the services, supports and modifications
and accommodations needed to achieve those outcomes.
Q:
What qualifications/training does an Occupational Therapist have?
In
Canada an Occupational Therapist have
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A degree from an accredited university program with a 4 year baccalaureate
degree or a master's degree in occupational therapy. |
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· Successfully completed a minimum of 1000 hours of fieldwork
education. |
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Successfully passed the certification examination administered
by the Canadian Association of Occupational Therapist or met provincial
registration qualifications. |
In
USA an Occupational Therapist
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Can be credentialed at either the professional (occupational therapy)
or technical (occupational therapy assistant) level |
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· Completes a baccalaureate, entry-level master's pr entry-level
doctoral degree for occupational therapy |
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A 2 year associate degree (occupational therapist assistant) programme
at one of the 300 accredited programme at collages and universities
in the US |
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Occupational therapist and occupational therapist assistant must
complete a supervised fieldwork programme and pass a national
certification examination |
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Mandated periodic continuing education requirements |
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Beginning January 1 2007 occupational therapy will be credentialed
at post baccalaureate degree level |
In
United Kingdom an Occupational Therapist have
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Completes a accreditation programme with College of Occupational
Therapists at diploma or degree (3 years) or masters (2 years)
level in occupational therapy |
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· Completes supervised clinical internship |
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Registered with Health Professions Council to practice |
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Mandated periodic continuing education |
In
Malaysia an Occupational Therapist have
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University graduate from the Ministry of Health College or |
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· Completed a 3 year diploma course from University Technology
of Mara and/or a further 2 year degree course |
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Completed supervised clinical fieldwork |
Q:
What is a typical first Occupational Therapy session?
First
the occupational therapist will check a client's physical ability to
carry out everyday tasks (strength, co-ordination and balance) and mental
abilities such as memory. It involves the assessment, intervention and
evaluation of the client in relation to occupational performance in
self-care, work, study and leisure.
Next the occupational therapist will review which activities a client
would like to perform more easily. Then the occupational therapist will
look what support is available (things a client needs) to carry out
the desired activity (furniture, equipment, clothes) and the surrounding
environment (the layout of your home, classroom or your work place).
A treatment plan is then drawn up setting out the targeted goals/outcomes
with a specific time frame. The plan will be periodically reviewed and
adjusted according progress made. A reevaluation of goals and approaches
may also be necessary.
Q:
What Does
It Take To Be An Occupational Therapist?
It takes a person with these SPECIAL QUALITIES:
Creativity
In planning activities and designing tools and equipment that will meet
people's needs and interests.
Warmth
Toward people of all ages and backgrounds.
Flexibility
In revising programs to meet ever-changing needs to keep up with new
techniques.
Responsibility
For selecting and supervising programme activities to meet specific
goals.
Determination & Patience
Even when progress is very slow and difficult. The therapist must boost
self-confidence and the will to succeed, as well as build strength and
skills.
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 Music
Therapy
Q: Who is qualified to practice music therapy?
A music therapist is an accomplished musician, able to play several
instruments (usually including piano and guitar), to sing and to improvise
in a variety of styles. Music therapists have a degree in music therapy
from university programs approved by the relevant Music Association
[like the American Music Therapy Association, British Music Association,
Canadian Association for Music Therapy,]. Grounding in the theory, research
and practice of music therapy and psychology is necessary to provide
individuals and groups with effective therapeutic services. They also
complete at least six months of full-time supervised clinical training
[internship] and must also be board certified by [they become “MT-BC”]
taking a national examination.
Q: What is music therapy?
Music Therapy is the prescribed use of music and musical interventions
to assist or motivate a person towards specific, non-musical goals.
Music interventions are developed and used by the therapist based on
her/his knowledge of music’s effect on the behaviour of the client’s
strength and weakness and the therapeutic goals. Goal areas include
improving communication skills, decreasing inappropriate behaviour,
improving academic and motor skills, increasing attention span, strengthening
emotional and social skills.
Q: Where do music therapist work?
Music therapists work in a variety of settings, including educational,
medical, psychiatric, day care treatment centers, rehabilitative facilities,
correctional facilities, halfway houses and gerontology facilities.
In all work settings, music therapists function as part of the multi-disciplinary
team, their observations adding greatly to the understanding of each
client’s needs, abilities or problems.
Q: How is music used therapeutically?
Music is the primary therapeutic tool. Using music to establish a trusting
relationship, the music therapist then works to facilitate contact,
interaction, self-awareness, learning, self-expression, communication
and personal development through carefully structured activities. Examples
can include:
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Singing
Used to help people with speech impairments improve their articulation,
rhythm and breath control. In a group setting individuals develop
a greater awareness of theirs by singing together. Lyrics are
used to help people with mental disabilities sequence a task.
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Listening
It helps develop cognitive skills such as attention and memory.
It facilitates the process of coming to terms with difficult issues
by providing a creative environment for self-expression. Actively
listening to music in a relaxed and receptive state stimulates
thoughts, images and provides a way to explore and understand
our own and other cultures.
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--Instruments
Can improve gross and fine motor coordination n individuals with
motor impairments. Playing in instrumental ensembles helps a person
with behavioural problems to learn how to control disruptive impulses
by working within a group structure. Learning a piece of music
and performing it develops musical skills and helps a person builds
self-reliance, self-esteem and self-discipline.
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--Composing
Is used to develop cooperative learning and to facilitate the
sharing of feelings, ideas and experiences. For hospitalized children,
writing a song is a means of expressing and understanding fears.
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--Rhythmic
movement
To facilitate and improve an individual’s range of motion, joint
mobility/agility/strength, balance, co-ordination, gait consistency,
respiration patterns and muscular relaxation. The rhythmic component
of music helps to increase motivation, interest and enjoyment
and acts as a nonverbal persuasion to involve individuals socially.
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Through whatever form the therapy takes, the therapist aims to facilitate
positive changes in the behavioural, physical, cognitive or social functioning
and emotional well-being of individuals with health or educational problems.
Q: How can music therapy help?
Music is essentially a social activity involving communication, listening
and sharing. These skills may be developed within the musical relationship
with the therapist and, in group therapy , with other members. Children,
adolescents, adults and the elderly with mental health needs, developmental
and learning disabilities, physical disabilities, brain injuries and
sensory impairments can greatly benefit from music therapy.
Q: What are the misconceptions about music therapy?
That the client has to have some particular music ability to benefit
from music therapy - they do not. That there is one particular style
of music that is more therapeutic than all the rest - this is not the
case. All styles of music can be useful in effecting change in a client’s
life. The individual preferences, circumstances and need for treatment
and the client’s goals help to determine the types of music a music
therapist may use.
If you have any futher enquiries, do not hesitate to email us here. |
