The Handbook Of Autism By: Maureen Aarons and Tessa Gittens

>> Saturday, November 21, 2009

In 1994, Maureen Aarons and Tessa Gittens wrote The Handbook Of Autism that is a guide for parents and professionals.
Autism is a comparatively rare condition which fascinates the majority of the population and is creating knowledge without having any direct contact with a child with autism. Although the diagnosis may explain the confusing pattern of developmental difficulties, every autistic child is autistic in his/her own particular way. The traits of autism in each child is variable in what is affected.

As with most self help books on autism, there is a section on the history of autism. We learn about Kanner in 1943. Kanner’s classic autism included the inability to develop relationships. Have a delay in the acquisition of language. Have non-communicative use of spoken language after it develops. Delayed echolalia or repetition of words and phrases is also common. Pronominal reversal where the child substitutes “you” for “I” . Repetitive and stereotyped play by repeating the same activity and do not develop imaginative pretend play. Maintenance of sameness without disruptions is common among those with autism. Remarkable feats of memorization and good rote memory is a skill among autistics, and also having a normal appearance. Later on Kanner reduced these points to two essential features which are; maintenance of sameness in children’s repetitive routines. Extreme aloneness, with onset within the first tow years. In 1979, Dr. Lorna Wing and Dr. Judith Gould carried out an epidemiological study of children within a particular part of London. They included in the study any child with autistic features, as well as the mentally handicapped. This study led them to suggest that the core deficit in autism is social in nature. Whereas a mentally handicapped child can be sociable, relative to his/her mental age, an autistic child, regardless of intellectual ability, will have observable social impairments. These three different areas of functioning were described as “The Triad of Impairments of Social Interaction”. This also suggest that autism is on a continuum. The three aspects of the Triad are:

1.) Impairment of social relationships: Aloofness and indifference to others. Accepting of social approaches by others (passive). May be indulged in strange and unusual interests, and makes social contact, but lacks understanding the rules of social behavior.
2.) Impairment of social communication: absence of any desire to communicate with others. Communication confined to the expression of needs only. Often irrelevant to the social context. Talks excessively, and does not engage in reciprocal conversations.
3.) Impairment of social understanding and imagination: Copying and pretend play are absent, but may copy without understanding their purpose and meaning. Repetitive and stereotyped enacting of a role, but without variation or empathy. Awareness that something goes on in the minds of others, but has no strategies to discover what this may be.
Terms such as “refrigerator mother” and “cold intellectual parents” were used since Kanner’s discovery in 1943. Tinbergen and Tinbergen claimed that autism is caused by the breakdown in the bonding process between mother and child, and this provides the basis of a cure. Martha Welch who was an American psychiatrist introduced what is known as “holding therapy”. This was a forced hold of the child by the mother which has to be maintained, despite resistance by the child, and involves much struggling, crying and shouting. Holding therapy is just on of the number of so-called “cures” for autism which emerge from time to time in the media. This can be quite inappropriate, so I will not tell much about it.

Recent research has shown that relatives of autistic people stand a greater than average chance of being autistic, but the autistic people’s families have an unusually high percentage of relatives with speech disorders, learning difficulties, and other minor cognitive disabilities. Studies show results where identical and non-identical twins (one or both) are affected by autism. Physical disorders such as Fragile X-Syndrome and Rett’s Syndrome have been know to be associated with autism. Certain viruses, as well as rubella, may be a factor in autism. The herpes simplex virus as well as the cytomegalovirus virus have been mentioned in literature about possibly having connections with autism. Candida albicans, which is a yeast overgrowth called thrush has been linked with autism. There is an interesting theory that a virus can infect a baby in utero, but it will be only minimally damages and appear normal at birth. Yet the virus may be dormant in the child and can be activated by the normal stresses of life. Remember that epilepsy is in 25 percent of autistic cases and is usually more prominent in the low functioning end of the spectrum. One-third of autistic children testes in various studies to have a raised blood level of serotonin. Reducing these levels is still considered experimental. Vitamin therapy is also successful. Speculation about the parts of the brain which are affected autism is the right hemisphere and the cerebellum.

Problems relating to the diagnosis of autism have been present since Kanner’s time. A descriptive approach to diagnosis is essential. Only then will the full extent of the autistic continuum be recognized and understood. “The tendency is for professionals either not to believe that a rare condition could be presented to them, and therefore fail to recognize it, or their own knowledge of the disorder being scanty, any non-classic autistic child is again not recognized because he does not conform to the expectation of what an autistic child “should be”. IQ scores show that 60 percent of autistic children have scores below 50, 20 percent between 50 and 70, and only 20 percent greater than 70. Many of the recurring diagnostic problems could be alleviated if the training of professionals include greater input on the subject of autism. Once autism has been diagnosed or identified, them emphasis shifts away from the clinical to an educational setting. Autism does not only require medical treatment, but also educational management. Diagnostic problems arise because of the unwillingness of local authorities to acknowledge autism as a viable consideration. Since the Education Act of 1981 is concerned with children's individual needs, rather than what are termed” diagnostic labels”; autism is no longer a recognized special education category. The reluctance of some authorities to recognize the disorder because it could lead to demands for additional educational provision which they would have to finance. Demand exceeds the number of places available. The professionals most likely to be involved will include health visitors, speech and language therapists, pediatricians, psychiatrists, clinical and educational psychologists. A diagnosis of autism should not always imply a “no hope-doom and gloom” outlook for parents.

Understanding autism: assessing the autistic child.

A child’s development is key when assessing a child with autism. Areas that will be looked at include medical history and early development, general observations of the child relating to appearance, behavior, and social development, the ability of the child to attend and concentrate, perceptual abilities related to vision and hearing as well as other senses, the ability to use objects meaningfully, to play constructively, socially and imaginatively, grasp the concepts which range from simple matching to more complex levels of understanding, the use of speech and language, and intellectual capability.

Parents reported food allergies and other manifestation in their autistic children. The majority of autistic children start life as if nothing particular was wrong, and there is nothing of particular significance in records of their early development. The avoidance of eye contact is associated with autism and is a great diagnostic importance. It is also not unusual to observe young children walking on tiptoe. It may be accompanied by hand flapping and even writhing movements of the fingers which have a sinuous quality. It is as if he is in a world of his own as some parents describes their autistic children. The active autistic children may engage in repetitive activities and more able ones may show more complex repetitive actions. They may line up objects in a set order or adhere to certain routines. To understand the autistic’s functioning it is necessary to evaluate evidence of goal-oriented behavior. It is also common for autistic children to show great distress when exposed to minor changes in their familiar routines. One of the greatest difficulties for those with autism is the ability to generalize. They may know what to do in a certain situation, but they are unable to use the experience and adapt it when a new situation arises. They may not be able to anticipate an identical hazard in an unfamiliar setting. They may need to learn strategies for coping with now and unusual situations, and may remain vulnerable throughout life. Some children know how to disturb and annoy people around them and often causing mayhem. Such children require considerable structure, and may respond well to behavior modification approaches. They still have not learned to understand and gain pleasure from human contact. As they get older, the majority learn not only to accept physical contact, but may learn to enjoy it. Autistic children enjoy rough and tumbling games. Many will learn to co-operate in group activities organized by adults. The more able individuals will allow themselves to be used by socially normal children in their games and it is possible for them to learn how to behave appropriately in familiar situations. Autistic children can be easily distracted unless he is focused on a particular interest to him. Those who develop beyond this level of attention are mostly likely to make academic progress. Visual perception, or the awareness and recognition of visual stimuli, is commonly an area of ability in autistic children. Autistic’s display particular traits in auditory. Sometimes they are considered deaf because they do not become alert to human voice and seem quite impervious to loud noises. Another characteristic of autism is the lack of awareness of pain, heat and cold. They are less likely to locate and express sources of discomfort.

Symbolic understanding means that the understanding a child displays in relation to objects and their use which does not involve language. We look at the quantity and quality of a child’s play. Lining up cars and spinning wheels are common traits of autistic children. There are others as well. The essence of developing symbolic understanding in relation to play is variety, inventiveness and imagination. They highlight the characteristics of normal play, contrasted with the play often shown by even more able autistic children.

Concept formation describes the development of a child’s understanding of the world about him. Autistic children often display skills and abilities which are where they should be or advanced of their chronological age. Assessing concept development in children with autistic features includes at a basic level of matching colors, shapes and objects. They require little understanding and they increase in complexity towards sorting and classification skills. Autistics will then usually run into problems. Autistic children will be able to learn how to sequence colors or shapes in order but may not be able to use this facility to arrange pictures in sequence to form a meaningful story, especially if the story involves the attribution of states of mind. Many children learn to appreciate the passing of time. Awareness and enjoyment of rhythm and music is common in the autistic community, and they show good musical abilities. Music therapy is useful in their education and especially when spoken language is absent.

It is common for autistics to require very little sleep and many parents report having interrupted nights that seem to never end. My oldest would never sleep as a baby. I practically had to hold him the entire time while he slept in my arms. I would lay him down away from me and he would just wake right back up. Once he was about 13 months old and I could not rock him to sleep anymore, we used a rocking car seat that he was getting to big for. Once my youngest was born, he no longer had trouble staying asleep… once he got there of course. He still has difficulties at night, and taking Clonodine really helps out with that. Without it he would be up until midnight or later.

Joining a parent support group can be a gift. There are many parents just like you who are going through the same things that you are. You can share stories and try to solve problems that may occur such as behavior issues. Counseling is also a choice that you may need to make for your child or entire family. My boys have wonderful counselors that are always there if we need them. The boys teachers are also a big help for us. We have come to know them and their families well.

Humans acquire language because of a strong and innate desire to communicate. When motivation to communicate is impaired, then this will contribute to a delayed acquisition as with autistic children. Although the child may acquire adequate linguistic structures to communicate and may do relatively well in standardized language assessments, but fail to engage successfully in interactive communication. Will speech and language therapy help? They do have an important role in the diagnosis and assessment of autism and are likely to be the first specialist to work with your child.

You can find this book at Amazon. I have the red copy, but there is a newer version of the book. Hope that you will enjoy it as much as I did. I really learned a lot and is great for a beginner in learning about autism.

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