RESOURCES: UNDERSTANDING AUTISM
Autism is a pervasive developmental disorder that is marked by the presence of impaired social interaction and communication and a restricted repertoire of activities and interests. The prevalence of autism has been estimated to affect as many as 1 in 110 children and is four times more common in boys than in girls.
Children with autism show a great variance of symptoms, ranging from severe impairment in the use of nonverbal behaviors that regulate social interaction to a failure to develop peer relationships appropriate to age.
Their impairment in communication is also marked and sustained and can affect both verbal and nonverbal skills. Children with autism may have a delay in or a total lack of spoken language. In children who do speak, there may be a delay in the ability to sustain a conversation with others or a stereotypic and repetitive use of language.
Children with Autism may also show a lack of varied, spontaneous make-believe play or social imitative play and often have restricted, repetitive and stereotyped patterns of activity.
Children with Autism may have a range of behavioral symptoms, including hyperactivity, short attention span, impulsivity, aggressiveness, self-injurious behavior, and temper tantrums. They may show unusual responses to sensory stimuli as observed by a lack of response to pain or a hypersensitivity to particular sounds. In addition, children with Autism often have unusual eating and sleeping habits and are described as being either agitated and irritable or aloof and detached.
Because autism is a severe, chronic developmental disorder that results in significant lifelong disability, the goal of treatment is to promote the child's social and language development and minimize behaviors that interfere with the child's functioning and learning. Intensive, sustained special education programs and behavior therapy early in life can increase the ability of the child with autism to acquire language and to learn.
Special education programs in highly structured environments appear to help the child acquire self-care, social, and job skills. Only in the past decade have studies shown positive outcomes for very young children with autism. Given the severity of the impairment, high intensity of service needs, and costs (both human and financial), there has been an ongoing search for effective treatment.
The diagnosis of autism is a complex and often controversial issue. The most accepted standards for diagnosis come from the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM – IV), published by the American Psychiatric Association. The MADSEC report provides a useful, succinct description of the diagnosis and relevant factors comprising it.
Autism is included under DSM-IV’s pervasive developmental disorders. This is a category of disorders in which many basic areas of infant and child psychological development are affected at the same time and to a severe degree.
Autistic disorder has three major hallmarks: qualitative impairment in social interaction, qualitative impairment in communication, and restricted, repetitive, and stereotypical patterns of behavior, interests, and activities. Onset in delays is very early, prior to three years of age.
To meet DSM-IV diagnostic criteria for autism, children will display impairment in social interaction in at least two ways, impairment in communication in at least one way, and restricted, repetitive, and stereotypical patterns of behavior, interests and activities in at least one way.
According to DSM-IV, impairment in social interaction is manifested in at least two of the following ways:
Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
Failure to develop peer relationships appropriate to developmental level;
A lack of spontaneous seeking to share enjoyment, interests, or achievement with other people;
Lack of social or emotional reciprocity.
Impairment in communication is manifested in at least one of the following:
Delay in, or total lack of, the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication;
In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others;
Stereotyped and repetitive use of language or idiosyncratic language; and
Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus;
Apparently inflexible adherence to specific, non-functional routines or rituals;
Stereotyped and repetitive motor mannerisms, such as hand or finger flapping, or complex whole body movements;
Persistent preoccupation with parts of objects. (DSM-IV, 1994). (MADSEC, 2000, p. 7)
While the diagnostic criteria described above are widely applicable, it is important to note that every child with autism is unique, and there is no such thing as a "average" child with autism. Each child manifests unique strengths and skill deficits, and it is important to keep in mind that treatment must therefore be oriented to an assessment of the unique needs of each individual person, not simply prescribed based on a diagnosis.
Maine Administrators of Services for Children with Disabilities (MADSEC) (2000). Report of the MADSEC Autism Task Force.
RESOURCES: BIOMEDICAL INTERVENTIONS
CARD's Position on Biomedical Treatments for Autism
ABA VS. FAD TREATMENTS
Autism is currently among the most controversial issues in American public health. Presumably because of the mysterious nature of the disorder, autism continues to be the focus of countless "fad treatments," the vast majority of which either lack scientific support or have been scientifically disproved, outright (e.g., facilitated communication, see Jacobson, Mulick, & Schwartz, 1995). Several independent review sources have consistently found that early intensive applied behavior analytic intervention (ABA) continues to be the only treatment for autism which is backed by substantial scientific evidence (NYSDH, 1999; Satcher, 1999). The effectiveness of ABA has been replicated yet again in two recent outcome studies (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Sallows & Graupner, 2005).
A substantial percentage of children with autism currently receive "biomedical" treatments, despite a current lack of evidence to support or refute most of them. In a recent survey of parents of children with autism (Green, et al., 2005), 27% of parents reported that their children with autism currently receive treatment in the form of special diets and 43% reported using vitamin supplements.
THE CARD POSITION - SOUND EMPIRICAL RESEARCH
CARD's position on the use of biomedical treatments in clinical practice is centered around three basic points:
many parents of children with autism believe that various biomedical treatments have been responsible for substantial improvement in their children,
very little research has been conducted on the effects of biomedical treatments for autism, and
parents must ultimately make the decision as to which treatments are appropriate for their children, regardless of diagnosis or disorder.
CARD's position on research on biomedical treatments and on the collaboration of behavior analysts with clinicians and researchers from other disciplines is based on the points elaborated above.
At least two factors contribute to what we perceive as a grievous need for sound empirical research on the effects of biomedical treatments for autism. First, as the Green, et al., (2005) study demonstrates, biomedical treatments are being implemented on a widespread basis. This fact alone is more than ample justification for conducting research on their safety and effectiveness. Such widespread use must be tempered with sound research. Second, many parents honestly believe that their children have significantly benefited from biomedical treatments. As clinicians and applied scientists, we have an ethical responsibility to take the concerns and beliefs of our clients seriously. To dismiss the convictions of our clients would be tantamount to disrespect for those who are mostly closely affected by autism. At the same time, ample research has demonstrated that clients can be made to believe that an intervention is or is not effective, regardless of the actual effects produced, and therefore opinion alone (be it that of a client or a scientist) is never to be accepted or rejected outright. Sound empirical treatment research is the only path toward addressing such concerns in a sufficient manner.
Throughout the history of science, particular schools of thought and areas of research have risen and fallen amidst ubiquitous controversy. Ultimately, controversy may have very little effect on which approaches to a problem are borne out. When a useful solution to a problem is discovered, and the results are replicated many times over, little is left to controversy. The use of ABA for children with autismwas once highly controversial but the unrelenting work of parents and the repeated and consistent replication of beneficial results in the scientific literature has moved the field of ABA closer to the mainstream. Most biomedical treatments for autism have not yet been subjected to repeated, rigorous outcome research. Thus conclusions regarding their effectiveness (either for or against) cannot be made.
SKEPTICISM: THE BEST DEFENSE
The best safeguard against controversy in the evaluation of scientific issues may be skepticism. Skepticism does not refer to disbelief. It refers to the practice of withholding judgment on a given topic until such time as sufficient evidence warrants judgment one way or the other (Shermer, 2002). In the absence of conclusive evidence, then, one might be advised to be skeptical of the view that an intervention works, as well as to be skeptical of the view that it does not. It is CARD’s position that conclusive evidence for or against the effectiveness of most biomedical treatments for autism does not at this time exist. Hence the urgent need for empirical investigation and the futility of blind acceptance or denial of the validity of the biomedical treatment of autism.
CONTROVERSY AND RESULTING POLARIZATION
A common feature of any controversy is polarization. A casual review of the major clinical, research, and advocacy factions within the field of autism today reveals that most parties ardently maintain that biomedical treatments are either extremely effective or a total sham. Many who advocate for biomedical treatments appear to believe that all biomedical treatments are equally effective and all are virtual cures for autism. Many who reject the utility of biomedical treatments, on the other hand, do so across the entire range of treatments, without regard to the particular case for or against the many divergent treatments which fall under the biomedical umbrella. Particularly given the still largely unknown etiology of autism, either position appears premature at the current time. Autism is a spectrum disorder which is comprised of millions of individuals who present with widely divergent characteristics. It is not yet even known whether all cases of autism share a common etiology. Given the widely divergent manifestations of the disorder, if any biomedical treatments are proven to be effective in the future, it seems unlikely that any particular one will prove equally effective for all persons with autism. Even less likely is the notion that all biomedical treatments will be equally effective or ineffective, if the large variability within autism is ignored.
Perhaps most disturbing is the notion that it is not possible to reliably evaluate the separate and combined effects of ABA and biomedical treatments for autism. This perspective is based on a fundamental misunderstanding of the nature of experimental scientific investigation. Virtually all disciplines of experimental science agree that experimentation consists of altering one variable at a time and observing the effects that the alteration produces on another variable. Sound experimentation depends on manipulating one variable at a time while simultaneously controlling for the influence of extraneous variables. To the extent that this is done (regardless of the particular scientific field or research topic), inferences can be made about the effects of one variable on another. There is nothing peculiar about autism, ABA, or biomedical treatments which preclude this sort of experimentation. It is common for clinicians (behavioral, medical, or other) to manipulate multiple variables simultaneously in order to bring about optimal treatment outcome and any time this is done it is likely to preclude precise analysis of which variables were responsible for improvement. In order to produce sound research on the separate and combined effects (if any) of each approach, experiments must hold one variable constant while manipulating another. This approach to autism research is largely untouched within the ABA and biomedical communities, but this fact does not preclude such research from being developed, and indeed it is currently under way at several research sites.
COLLABORATION BETWEEN BEHAVIOR ANALYSTS & MEDICAL PROFESSIONALS
Toward this end, CARD is currently collaborating with medical doctors to conduct sound research on biomedical treatments for autism. The focus of this effort is to identify which, if any, biomedical treatments result in which particular improvements for particular individuals with autism, given their unique biomedical and behavioral status. All research conducted is interdisciplinary in nature and all treatment studies evaluate multiple behavioral and biomedical measures. The goal is to establish a model for interdisciplinary collaboration between behavior analysts and medical doctors in researching treatment for individuals with autism. It is our hope that the research produced will forge a path toward addressing the debate regarding biomedical treatments for autism with sound scientific data, thereby displacing the current culture of hearsay and controversy.
In summary, the CARD position on the biomedical treatment of autism is not one of belief or disbelief, it is one of uncertainty. It is our hope that the coming decade will yield the evidence which is so desperately needed to transform the current debate about biomedical treatment from one based on subjective report to one which is grounded in sophisticated analysis of sound scientific data.
Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., Sigafoos, J. (in press). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities.
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.
Jacobson, J., Mulick, J. A., & Schwartz, A. A. (1995). A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication. Americal Psychologist, 50, 750-765.
New York State Department of Health Early Intervention Program. Clinical Practice Guideline: Report of the Recommendations, Autism/Pervasive Developmental Disorders, Assessment and Intervention for Young Children. 1999. Publication #4215. Health Education Services, P.O. Box 7126, Albany, NY 12224.
Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors American Journal on Mental Retardation, 110, 417-438.
Satcher, D. Mental health: A report of the surgeon general. U.S. Public Health Service. 1999. Bethesda, MD
Shermer, M. (2002). Why people believe weird things: Pseudoscience, superstition, and other confusions of our time. New York, NY: Henry Holt.
RESOURCES: AUTISM ASSOCIATIONS
FOR AUTISM RESOURCES IN YOUR AREA, CLICK HERE.
ACT Today! is a national nonprofit organization whose mission is to raise awareness and provide treatment services and support to families to help their children with autism achieve their full potential.
The Autism Society, the nation's leading grassroots autism organization, exists to improve the lives of all affected by autism.
Since 1967 ARI has focused on studying treatments that improve the quality of life--sometimes to the point of recovery--for those on the autism spectrum.
Autism Resources has information and links regarding the developmental disabilities autism andAsperger's Syndrome.
Autism Speaks aims to bring the autism community together as one strong voice to urge the government and private sector to take action to address this urgent global health crisis.
TheAutSpot.com is a free online community linking family members and specialists nationwide who deal with children diagnosed with autism.
The mission of the National Autism Association is to respond to the most urgent needs of the autism community, providing real help and hope so that all affected can reach their full potential.
The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.
We monitor all the major news sources, websites and the latest research for important and practical news and developments with a balanced, no-spin presentation.
TACA provides support and education for families affected by autism through local chapters, coffee talks, parent support, educational events, and more.
USAAA is a leading nonprofit organization for education, support, and solutions.
Inspire builds online health and wellness communities for patients and caregivers, in partnership with national patient advocacy organizations, and helps life science organizations connect with these highly engaged populations.
RESOURCES: AUTISM EDUCATION RIGHTS
Securing Funding for Your Child's Program
Under both State and Federal Law, your child is entitled to a Free and Appropriate Public Education (FAPE). Therefore, if it is established that the system of public education available to your child is not "appropriate" for his or her needs, it may be possible to secure funding for an ABA program which may be considered more appropriate to meet the educational needs of your child.
Since Autism encompasses educational delays as well as behavioral aberrations, you may be able to secure partial funding from your school district or local education authority for the educational needs of your child, and partial funding from your local regional center or Medicaid agency for the behavioral needs of your child. Often, education authorities and Medicaid or similar state agencies work out a formula to share the cost of your child's ABA program.
If your child is under the age of three, you will not be eligible to gain funding from your school district. Because of this, you may be able to gain the bulk of your funding from your state Medicaid or Health Department agency. To gain partial or full funding for your child's ABA program from such an agency, you must contact the service coordinating agency in your area (such as a Regional Center) and request that an assessment of your child be conducted. A Medicaid caseworker will be assigned to you and an intake and subsequent multidisciplinary assessment will be arranged. After the assessment an Individual Family Service Plan (IFSP) meeting will be conducted. The purpose of the meeting is to discuss the results of the multidisciplinary assessment and propose goals and objectives. Once goals and objectives are agreed upon, placement and services that will assist your child in meeting those goals will be discussed. At this time you may be offered behavioral services. It is your responsibility to ascertain the level of experience of the vendor offered to you and also to determine if the number of hours you have been offered is appropriate. Therefore, it would be necessary for you to gain the advice of a well-known private ABA professional if you are unsure about the options given to you by the state agency.
If your child is over the age of three, you may be able to gain funding from your local education authority (school district). If your child already qualifies for special education services and has a classroom placement and/or has been receiving special services, you may request a change in services and/or placement. In other words, you may request that the district funds for an ABA program. In order to request such funding, you must ask your district to hold an Individualized Education Plan (IEP) meeting. All such requests should be made in writing. If you are approaching your school district for the first time, they will want to ascertain the eligibility of your child for special education services. An assessment will be scheduled and following the assessment an IEP meeting will be arranged to discuss the results of the evaluation and propose goals and objectives. Once goals and objectives are agreed upon, placement and services will be offered. Once again, if you have questions about the appropriateness of the offer, it would be necessary for you to consult with a private ABA professional who specializes in such treatment. Furthermore, many school districts provide ABA programs themselves and CARD recommends that you observe and evaluate the programs offered by your local education authority as these programs may be able to meet your child's needs.
Another option you may have for funding is your insurance company. If your insurance policy does not exclude Autism as a disorder or Applied Behavior Analysis as a treatment, you may be able to gain some funding for ABA services. Often, insurance companies will only provide funding if the provider is a licensed psychologist or physician.
INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA)
IDEA, the Individuals with Disabilities Education Act, mandates that eligible children with disabilities have available to them special education and related services designed to address their unique and individual needs. IDEA has six principles that provide the framework around which special education services are designed and provided to students with disabilities. These principles include:
Free Appropriate Public Education (FAPE)
Individualized Education Program (IEP)
Least Restrictive Environment
Parent and Student Participation in Decision Making
Free Appropriate Public Education: IDEA guarantees that each child with a disability will have available a free appropriate public education, often identified as FAPE. FAPE refers to special education and related services that:
"Have been provided at public expense, under public supervision and direction, and without charge
Meet the standards of the State Educational Agency
Include an appropriate preschool, elementary or secondary school education
Are provided in conformity with the Individual Education Program (IEP)" (Section 602(8))
"Appropriate" is the critical term in FAPE - the education that a child with disabilities receives needs to address his or her specific and individual educational needs. As such, what is "appropriate" for one student may not be "appropriate" for another. Determining what is "appropriate" for each student involves several processes. First, an individualized evaluation is conducted. The purpose of the evaluation is to identify the student's areas of strength and weakness in as much detail as possible. The next step is for the IEP team to discuss and develop an IEP for the student. The IEP team generates and identifies appropriate goals and objectives for the student to work on throughout the year. Furthermore, placement and the type of special education and related services appropriate for the student are identified. This decision is based on the goals and objectives that have been developed as well as the child's individual needs. In addition to specifying an appropriate placement, the team must identify and provide the supplementary aids and services in order for the child to succeed in the given educational setting.
Appropriate Evaluation: This principle assures that all children with disabilities are appropriately assessed for the purpose of determining eligibility, educational programming, and individual performance monitoring. Moreover, evaluation activities should gather information related to enabling the child to be involved in the general curriculum. Furthermore, testing and evaluation materials must be selected and administered so as not to be racially or culturally discriminatory. The information gained through the evaluation should be used to assist in the determination of what an "appropriate" education would be for the child.
INDIVIDUAL EDUCATION PROGRAM:
The term Individualized Education Program or IEP refers to "a written statement for each child with a disability that is developed, written and as appropriate, revised at least once per year." Each child's IEP contains statements as to the following:
The child's present levels of educational performance including how the child's disability affects his or her involvement in the general curriculum
Measurable annual goals including benchmarks or short-term objectives
The special education and related services and supplementary aids and services to be provided
The program modifications or supports that will be provided to the child
An explanation of the extent to which the child will not participate with nondisabled students in the regular class and in extracurricular and nonacademic activities
Any individual modifications made in the administration of State and District wide assessments
The projected date for the beginning of services, and the anticipated frequency, location and duration of those services
How the child's progress toward the annual goals will be measured and how the parents will be kept regularly informed of that progress, at least as often as they are informed of their nondisabled children's progress
LEAST RESTRICTIVE ENVIRONMENT:
The Least Restrictive Environment (LRE) is determined based upon each child's individual needs. The law's presumption is that the student should be educated in the regular classroom with nondisabled children, with supplementary aids and services provided as necessary to enable the student to succeed in that setting. A student's placement in the general education classroom is the first option the IEP team must consider. If it is determined that a student cannot be educated in the general education classroom, even when supplementary aids and services are provided, an alternative placement must be considered. As such, schools are required to ensure that a continuum of alternative placements are available. These may include, but are not limited to, special classes, special schools or home instruction.
PARENT AND STUDENT PARTICIPATION IN DECISION MAKING:
Schools are required to involve each child's parent(s) in the development of the child's IEP. Parents must be notified, must give consent, and parent's input must be solicited and considered. Students may be members of the IEP team and participate to the extent possible.
There are three main components of the law's procedural safeguards
To protect the rights of children with disabilities and their parents
To ensure that the children and their parents are provided with the information needed to make decisions about the provision of FAPE
Procedures and mechanisms are in place to resolve disagreements between parties
Camp Discovery: Objects
What it is: More than just flash cards, Camp Discovery: Objects teaches over 50 common household and community objects to children through a series of various levels. A pre-reading skills app, Camp Discovery: Objects utilizes unique prompting strategies in order to teach children in the most errorless method possible.
How Does It Help: Based on the teaching and reinforcement principles of Applied Behavior Analysis, Camp Discovery: Objects teaches its targeted objects using multiple methods. This ensures that the subject is learned thoroughly by matching identical objects, sorting similar objects, and comprehending the objects’ names respectively. Children must answer questions in each level correctly in order to advance through the game. If a child answers incorrectly, a prompting system is automatically activated that guides the child to answer correctly with help and then independently.
Who is it for: Although Camp Discovery: Objects was designed for children with Autism Spectrum Disorders, all children can benefit from the carefully planned errorless learning system and use of visual and verbal reinforcement. The target age for Objects Game is 2-5 years, depending on the individual child’s abilities.
What makes this different: Camp Discovery: Objects has been developed using the world renowned Center for Autism and Related Disorders (CARD) curriculum. Hours have been spent ensuring that the teaching procedures used will be the most beneficial in having the child acquire new skills while he/she has fun doing it.
What does the interface feel like: The Camp Discovery: Objects was designed for easy interface by the user. All responses require only the touch of a finger or the dragging of a picture in order to be successful. The settings menu is created so that an adult can customize the child’s gaming experience. The time between trials can be modified thus making the game move faster or slower. The time before a trial “times out” (ends due to no response) can also be modified in order to assist children who require more processing time. The specific objects that are to be taught can be turned on and off. Finally, entire levels can be enabled/disabled at the adult’s request if that area is too difficult for the child at that time.
Get it here - https://itunes.apple.com/us/app/camp-discovery-objects/id585678823?mt=8
YOUR SOURCE FOR AUTISM INFORMATION
Autism Live is an interactive webshow providing support, resources, information, facts, entertainment and inspiration to parents, teachers and practitioners working with children on the Autism Spectrum.
Viewers are encouraged to participate by asking question of experts, offering suggestions for topics to be discussed and sharing progress their children have made.
Host Shannon Penrod
Shannon Penrod is the proud mother of a nine-year old who is recovering from Autism. Her son Jem was diagnosed at the age of two and a half after having lost virtually all of his language and social skills.
Helping her son on his journey through Autism became Shannon’s top priority. Whether it was researching new diets, learning the legal ins and outs of special education law or finding funding for ABA therapy, Shannon became her son’s best advocate and an advocate for many other families. In 2009, Shannon began the host and producer of Everyday Autism Miracles, a weekly radio show that focuses solely on Autism and hope.
An award winning stand-up comedienne, director and author, Shannon’s goal is to provide families with information and hope while on their journey through autism.