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Autism Spectrum disorders

Autism Spectrum disorders

Introduction

Autism awareness in today's society has moved from the shadow of shame and unknown to the forefront of research and education as an increasing number of children and people with Autism Spectrum disorders gain attention in every aspect of their everyday lives.  This paper will attempt to explore the many faces of autism: identification, possible causes, treatment, societal reaction/interaction, the learning/teaching cooperative, and expectations for the future regarding this disorder in an ever evolving and expanding society.

What is Autism? How does it manifest? Are there specific characteristics inherent to the disorder? How was it discovered? Who gets it? How is it diagnosed? When? Has the cause been identified? Is it hereditary, environmental or societal? Is there a cure?  What kind of treatment is available, and how has it changed since discovery of the disorder? Do autistic children face specific learning challenges? What teaching methods best reach autistic children? Are some methods more effective than others? Autism is very broad, far-reaching and involved, but herein I expect to go from a brief discussion of the broad topic to the specific: 'How does autism affect the learning/teaching relationship between children and teachers?'

What is Autism?

Autism was first thought to be mental retardation or insanity. In 1943, Leo Kanner noticed that these children did not fit the pattern of emotionally disturbed children and instead recorded patterns of being slow learners. Hans Asperger, making similar discoveries, discovered what has come to be known as Asperger's Syndrome - often used to label autistic people that can talk.  Leo Kanner and Hans Asperger, working completely independent of one another, recognized autism for what it was: a developmental disorder that interferes with a child's communication, social and interaction behavior. (Carew, 2009)

Autism Spectrum Disorder (ASD) is a Pervasive Developmental Disorder (PDD). It is a bio-neurological developmental disability usually appearing before the age of three, best known for impairing a child's ability to communicate and interact.  Life-long disabilities significantly impact several areas of development: communication impairments, social difficulty, sensory processing deficits and a need for solid routines within their lives. Characteristics of Autism manifests in a myriad of ways: delay in verbal development, a need to finish what they begin, a rather h3 resistance to change in daily routine, lack of spontaneity, distress at being touched and the ability to show any kind of emotion, as well as an inability to process and respond to humor.

There are five subcategories associated with ASD, each with it's own distinctive and unique features: Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder (CDD), Rett's Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Treatment within each subcategory is as diverse and varied as the individual being treated, depending on the individual's personality, unique symptoms and manifestation of autism.

How is it Diagnosed?

To help determine the difference between autism and mental retardation, a qualified professional will examine and score children who are suspected of having autism through a questionnaire based on direct observation by professionals and reports given by parents, family members, and teachers. This test is known as CARS (Childhood Autism Rating Scale) and was developed by Eirc Shopler, Robert Reichier and Barbara Rochen Reiner. (Schopler, Reichler, DeVellis, & Daly, 1980) CARS was published in 1980, but the development began a lot earlier, in 1966. A Study conducted by the University of Texas Health Science Center determined an accuracy rating of 98% in diagnosing children and showed encouraging results in diagnosing adolescents as well.  CARS incorporates the criteria of Leo Kanner (1943) and Creak (1964), and characteristic symptoms of childhood autism. (Schopler et al., 1980)

The test focuses on 15 categories of behaviors, characteristics, and abilities and how the expected development is different than the actual development if autistic symptoms are present. The categories are: Relating to people, imitation, emotional response, body use, object use, adaptation to change, visual response, listening response, taste, smell and touch response and use, fear or nervousness, verbal communication, nonverbal communication, activity level, level and consistency of intellectual response, and general impressions. A child can score on a scale of one to four. Scoring a one meets a normal range for a child's age and scoring a four means the child is severely abnormal.  (Secor, 2009)

Who Gets It?

Although it is unclear how much of the surge reflects better diagnosis, recent data suggests a 10-fold increase in autism rates over the past decade.  The journal, Pediatrics, released on October 5, 2009, reported one percent of U.S. children ages 3-17 have an Autism Spectrum disorder, a prevalence of 1 in 91. This is a dramatic increase from the 2007 report by the Center for Disease Control reported 1 in 150 children diagnosed with Autism.  Boys are diagnosed four times more often than girls. There has been no connection established regarding socio-economic status, race or religion in identifying autistic individuals. (Kogan, 2009)

Cause of Autism

All over the world, researchers are working to find just what causes Autism. However no direct, specific cause of Autism has been determined, to date.  The pressure to identify a cause is a top priority among researchers and it appears, due to the various levels of severity and combinations of symptoms, there may be multiple causes and scientific evidence suggests both genetic and/or environmental factors. Because of intense research, there are several specific claims that have been disproven.

Bruno Bettelheim, a once well-renowned child psychologist, blamed autism on parents, specifically mothers, claiming they did not properly bond with their children. There is no evidence to support that claim.  Due in large part to Dr. Bernard Rimland, who has an autistic son, founded the Autism Society of America and the Autism Research institute.  Dr. Rimland was instrumental in helping to determine autism as a biological disorder not a causal effect, ie., neglect, isolation, cold, indifferent or 'bad' parenting.  He disproved the theory by defining ASDs as biological disorders, not emotional illnesses in his book, Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior (Rimland, 1964). However, Dr Rimland is a proponent of another high profile controversial claim suggesting vaccinations given to children during babyhood may be a cause of the disorder. Despite Dr Rimland's advocacy and beliefs, this claim has little or no scientific backing. In fact, in a timely ruling Friday, March 12, 2010, the so-called 'vaccine court', a special branch of the U.S. Court of Federal Claims, found that the mercury-containing vaccine preservative thimerosal is not to blame for autism, and concluded the last of three cases on theories related to a vaccine-autism relationship. A 2009 ruling rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine, which perhaps was based on a discredited medical journal article published in 1998 by British physician, Dr. Andrew Wakefield, linking a particular type of autism and bowel disease to the measles vaccine. The 2009 ruling predicated the dropping of a second case based on a theory that certain vaccines alone cause autism. Interestingly, in this third case, the court found that "none of the expert witnesses who argued mercury can have a variety of effects on the brain, offered opinions on the cause of autism in any of the three specific cases argued." (Schmid, 2010)(emphasis added)

Two studies conducted by researchers at the Children's Hospital of Philadelphia link specific genes to autism.  "One study pinpoints a gene region that may account for as many as 15 percent of autism cases, while another study identifies missing or duplicated stretches of DNA along two crucial gene pathways. Significantly, both studies detected genes implicated in the development of brain circuitry in early childhood." (Wang, 2009)

A specific connection between fragile x (FXS) and autism has also been found. Dr. Don Bailey , director of the Frank Porter Graham Institute, and colleagues found that in young boys with FXS, 25% met the criteria for autism using the (CARS).  Their profile of behaviors was very similar to that of children with autism but without fragile X. Consequently, they also found that children with autism and FXS together, had a lower IQ than children with either FXS alone or autism alone. (Bailey, Jr., Hatton, et al., 2001)

Methods of Treatment

Since 1943, many ways have been developed to help the autistic child.  Then, the famous Sigmund Freud discovered that parents who did not attempt to communicate with an autistic child saw no progress, while a close parent/child relationship seemed to cause the child to thrive and move forward.  Although it lingered well into the 50's and 60's, Freud's theory lacked two critical bits information: first, oftentimes the parent didn't try to interact with the child due to the Autistic behavior; and second, in some cases it was a genetically inherited personality.  For a time, children were removed from their home to see if they would recover although there was no clear-cut evidence of any value in future use of this method.

Due to research and study, it was found that facilitated communication could teach the child to communicate with the world; for example an autistic child could be taught to manage and control his emotions; a parent could help a child desensitize from the over sensitivity to sound.

Today, Applied Behavior Analysis (ABA), Occupational Therapy (OT), Pivotal Response Training (PRT), Physical Therapy (PT), Sensory Integration Therapy, Floortime, and medications, all have a place in accepted scientific treatment.  Alternative methods are also sometimes used.  These can include Dietary intervention, Vitamins and Minerals, Social Skills Groups, Music and Art Therapy, and even Dolphin Therapy.

One of the most tried and true methods utilized today, Applied Behavior Therapy (ABA) is usually accompanied by Physical Therapy and Occupational therapy.  As with any treatment there are good and bad points associated with each.  ABA was developed by Dr. Ivar Lovaas and contains the B.F. Skinner's theories on operant conditioning. This treatment includes rewards which may include toys or treats, for acceptable behavior. There is no punishment for wrong or incorrect behavior, however. There are a myriad of steps involved, and a fairly rigid structure to this method. ABA is very time-consuming and has shown many positive results.

According to some ongoing research, diet may be fueling Autism.  There is convincing empirical evidence that special diets help autistic individuals.  Karl Reichelt of Oslo has been a pioneer in this area for decades, showing the highly significant effects of removing gluten, gliadin and casein from the diets of autistic children. There are now about forty research studies in Norway, the U.K., Italy, and the United States supporting this finding.  Special diets are, most often, hard to implement.

Eighteen research reports have been published since 1965, by scientists in six countries showing that about half of all autistic children and adults improve significantly when given large amounts of B6. Unlike drugs, B6 is a safe, natural substance that the brain requires.  This vitamin, along with the mineral magnesium, is used in the production of serotonin.

In a comprehensive review of the neurochemistry of autism, published in 1990, Dr. Edwin Cook wrote, "The most consistent finding has been that over 25% of autistic children and adolescents are hyperserotonemic.  However, after 29 years of investigation, the mechanism of hyperserotonemia has not been determined." (Genetics, autism and priorities, 1997)

Teaching Methods

Autistic children all have specific learning challenges; however, the method of approach depends entirely on the child.  When teaching an autistic child, environmental considerations, a set schedule and routine for the student and a visual structure the student can see clearly to enable them to understand what is expected of them, and when it is expected of them.  No one method is necessarily better than another. Many of the various methods utilize the same basic principles needed to help focus and teach a child with autism.

An effective instructional strategy is one that incorporates structure, a communication system, sensory accommodations, individualized programming, inclusion, social integration and access to the general curriculum. It is important to find research-based methodology that has proven effective through application and data collection.  This helps enhance the effectiveness and accountability of the program. 

There are also different teaching approaches enabling students with this disorder to learn and function as well as any other student in the classroom.  No one approach has proven more effective.  However, Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) (Shopler, E 1997) incorporates several methodologies and techniques into one program.

Developed in the 1970's at the University of North Carolina's School of Medicine, the philosophy behind TEACCH was: the environment should be changed to meet the needs of the students, not the students changed to meet the needs of the environment.  Techniques are developed to meet the specific communication, social and coping needs of the student. The goal is to help students with ASDs learn functional skills so they can live productively and reach their full potential at school and home, and later in their community and working lives.  TEACCH stresses the need for elements of behavioral and cognitive interventions, direct teaching of social skills, the need for structure, and the use of visual cues to show tasks to be done in work or play areas.

Another stand alone method of teaching, also one of the components within TEACCH, Structure-Positive-Empathetic-Low Arousal- Links (SPELL), emphasizes a clear routine and an atmosphere that helps maximize positive relationships and reduce anxiety while teaching children with ASD. This can be accomplished by trying to anticipate the experiences, settings, or problems the children may consider threatening.  This methodology has been integrated into most of the centers run by the National Autistic Society.

Basic strategies need to be implemented inside a classroom to help transition students with ASD. These include:

  • A clear structure and daily routine
  • Use of clear and unambiguous language (not a lot of humor or irony)
  • Make clear which behaviors are unacceptable
  • Address the child individually
  • Provide a warning if there is an impending change in routine or activity switch
  • Know the student's ticks and what 'abnormal behavior might be
  • Specific teaching using photographs, video recording, how feeling are expressed and communicated so they can be recognized.
  • Regular opportunity for simple conversations to help increase the use of 'how' and 'why' questions
  • Use charts to record behavioral progress reinforcement

How Does Autism Affect the Learning/Teaching Relationship Between Children and Teachers?

Any teacher can get very frustrated with children in general, and if a disability is added to the equation, it can make for a difficult learning and teaching experience for both parties involved.  It is important to remember what the student is going through and having to deal with.  Patience truly is a virtue for the teacher, combined with empathy, understanding, encouragement and compassion. 

Within any teaching strategy, to work and develop a method of structured teaching, there must be an understanding of the unique features and characteristics of the autistic child. A teacher must organize the child's environment so the child is able to focus on relevant information and not be distracted by irrelevant things. The teacher must also develop appropriate activities to engage the student and not frustrate them.  The instructor must also help the student understand what is expected of them so they do not have any disruptions to their routine or be inadvertently thrust outside of their comfort zone.

Despite a teacher's best efforts to reduce the stress, anxiety and frustration of the environment, behavioral challenges will still arise, depending on the characteristics of the autistic child.

Conclusion

Autistic Spectrum Disorder has come out of the shadows and gained notoriety in today's society through the actions of celebrities, organizations, and parents of autistic children as awareness of this increasingly prevalent disorder increases exponentially with research, education and mainstreaming.   Since it was identified just a little over a half century ago, ASD has gained attention and momentum and tremendous strides in identification, possible causes, treatment, societal reaction/interaction, the learning/teaching cooperative, have provided lofty expectations for the future.

While teaching students with ASD is challenging, it can also be hugely rewarding. Teaching methods like TEACCH, which encompass the basic principles and techniques found to be most effective and least upsetting for the autistic child: consistency in a passive environment, an unvaried schedule and basic repetitive routine-- enable teachers to help the autistic student learn and progress within a safety zone geared toward their own individual learning style.

Although there is no cure, there have been significant strides in identifying, developing and implementing new treatments every day. Children with ASD are often able to lead full, happy, and productive lives, interacting with society on their own terms.  One can only hope that the strides of today will be not only matched but outpaced in the future as ASD becomes not a mysterious disorder of unknown origin, but a minor affliction overcome by millions, unidentifiable and without stigma in the mainstream world.

Bibliography

Carew, Betty. (2009, January 28). The History of autism. Retrieved from http://healthmad.com/children/the-history-of-autism/

Kogan, Michael, et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 10.1542(1522)

Schopler, E, Reichler, RJ, DeVellis, RF, & Daly, K. (1980). Toward Objective classification of childhood autism: childhood autism rating scale (cars). J Autism Dev Disorder, 10(1), 91-103.

Secor, M.L. (2009, january 6). Child autism rating scale. Retrieved from http://autism.lovetoknow.com/Childhood_Autism_Rating_Scale

Rimland, Bernard. (1964). Infantile autism: the syndrome and its implications for a neural theory of behavior. New York: Prentice Hall.

Schmid, Randolph. (2010, march 12). Court says thimerosal did not cause autism. Associated Press,

Wang, Kai, et al. (2009). common genetic variants on 5p14.1 associate with autism spectrum disorders. Nature, 459(528-533), Retrieved from http://www.nature.com/nature/journal/v459/n7246/full/nature07999.html

Bailey, D. B., Jr., D. D. Hatton, et al. (2001). Autistic behavior, fmr1 protein, and developmental trajectories in young males with fragile x syndrome. Journal of Autism and Developmental Disorders , 31(2), 165-174.

Genetics, autism and priorities. (1997). Autism Research Review International, 11(2), Retrieved from http://autism.about.com/gi/o.htm?zi=1/XJ/Ya&zTi=1&sdn=autism&cdn=health&tm=27&f=00&tt=14&bt=1&bts=1&zu=http%3A//www.autism.com/ari/faq/faq_diets.htm

Exkorn, Karen Siff. (2005). The autism sourcebook everything you need to know about diagnosis, treatment, coping, and healing. New York, NY: HarperCollins.

Shopler, E (1997) Implementation of TEACCH philosophy. In D. Cohen and F. Volkmar (eds). Handbook of Autism and Pervasive Developmental Disorders. New York: Wiley.


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