Literature Review on "Autism: Diagnosis, Intervention, and Social Adjustment"

Literature Review 15 pages (4495 words) Sources: 25

[EXCERPT] . . . .

Autism: Diagnosis, Intervention, And Social Adjustment

This literature review is a comprehensive introduction of autism to people with little or no specialized knowledge. The review, including a clear summary of existing knowledge on the condition, addresses the complexity of autism, assessing practical issues such as diagnosis, intervention, and social adjustment. In addition, it will examine how all research into autism should have the eventual goal of increasing the well-being and career development of those persons affected by the disorder. The results can provide parents, teachers, and clinical trainees with a heightened awareness, and prompt them to a possible reevaluation of the subject, since it neatly synthesizes historic and current findings on autism.

Thesis

As is the case for all serious illnesses and detrimental conditions, early diagnosis of autism is extremely important. The earlier that a child is diagnosed with the disorder, the earlier treatment and interventions can begin. and, in turn, the earlier treatment begins the better chance that a child will have to be able to live a "normal" life. There is currently no cure for autism, but recent research has clearly demonstrated that the earlier treatment begins the better the prognosis is for the child in terms of improving his or her ability to communicate with other people, to connect with them emotionally, and to succeed in activities like school. Until there is a clear etiology of the disorder and a cure for autism, the best possible strategy for caregivers of children with autism is to ensure that their children are screened at the earliest suggestion of the condition and, if diagnosed with autism, are treated with the most completely documented therapies.

Introduction

Early identification and diagnosis of young children with an autism spectrum disorder (ASD) can lead to earlier entry into intervention programs that support improved developmental outcomes. This has been found to be true regardless of where the child falls on the spectrum of ASD, from severely disabled by the condition to being only mildly affected. Without proper diagnosis and treatment, a child with autism will in general not see any relief from the condition on his or her own. "Autism is a highly variable neurodevelopmental disorder that first appears during infancy or childhood, and it generally follows a steady course without remission" (World Health Organization, F84, 2007).

There is controversy within the world of autism treatment about whether children can recover or grow out of the condition or if those who are initially diagnosed with autism and later assessed as not having it were have in fact recovered or if they were misdiagnosed to begin with. Scholars universally acknowledge that no cure is known" (Levy, Mandell, & Schultz, 2009; Sacks, 1995). However, "children recover occasionally, so that they lose their diagnosis of ASD; sometimes after intensive treatment and sometimes not" (Helt, Kelley, & Kinsbourne, 2008). Although core difficulties tend to persist, symptoms often become less severe with age. It is not known how often recovery happens, and few high-quality studies address long-term prognosis, thus making it impossible to form any empirically-based model for what conditions may be associated with recovery (Newschaffer, et al., 2009).

Autism has been recognized as a disorder for decades, although until the last decade or so it was not something that was well-known to the general public. In the late 1960s, researchers established that autism should be seen as a distinct by demonstrating that it is a unique type of developmental disorder. From the beginning, researchers have also demonstrated the benefits of involving parents ly in a range of therapeutic programs. While the condition must have existed before it was first formerly recognized, it seems to have been increasingly in incidence at a dramatic rate. It is impossible to know to what extent this increase in frequency is do to an actual increase in the number of children affected by the condition and to what extent it is the result of greater public awareness of autism.

Recent research generally place the frequency of autism at about 1 -- 2 children per 1,000 for autism 6 per 1,000 for ASD (Newschaffer, Croen, & Daniels, 2007). (the same researchers report that the reported rate for autism in the 1960s was about .5 per 1000.) However, there are inadequate data for researchers and medical professionals to be certain as to the actual frequency and so the true incidence may not much higher (Fombonne, 2009). "A real increase would suggest directing more attention toward changing environmental factors instead of continuing to focus on genetics" (Sapir, 2006). The reason for this assumption is that any aspect of health that changes as quickly as the incidence of autism has must be environmental since the environment can change this quickly but the human genome cannot. It is important to note, however, that there is fairly clearly some genetic element to the condition as identical twins are much more likely to share the condition than either fraternal twins or siblings (Ho, Todd, & Constantino, 2005).

Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination (Burgess & Gutstein, 2007). Their families are often detrimentally affected too -- beyond the emotional costs associated with caring for a child with disabilities. "Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems," note Sharpe & Baker (2007). "One 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, (Montes & Halterman, 2007) and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment (Montes & Halterman, 2008). An in recent years, a number of U.S. states have shifted the cost of care for autism to parents by requiring private health insurance to cover autism services (Reinke, 2008). This has been highly problematic for families who lack insurance.

Although not the focus of this study, it is important to note that people with autism continue to require care after they reach adulthood, when key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.

The purpose of the review is to investigate the diagnosis patterns of children who have been classified within the autistic spectrum disorder (ASD) on socio-demographic and psychosocial characteristics. The review assesses factors such as early detection, communication training, and social adjustment looking for potential qualitative and quantitative social implications.

Studies on the diagnosis of autism

There has in recent years been a substantial push (by everyone from physicians to daycare providers to public health agencies) to make parents aware of the initial symptoms of autism so that children can be diagnosed as early as possible and, if they are found to be autistic, that they receive treatment as young as possible. This section examines some of the recent research on diagnosis, taking into account both research that focuses on behavioral cues as well as that focused on looking for genetic or biological cues that lead to a diagnosis of autism.

Study I

Lathe (2009) investigated the relationship between Fragile X syndrome and autism. The condition, also called Martin Bell syndrome, is the result of a single error on the X chromosome that results in the non-expression of a gene that is necessary for normal neural development. The behavioral characteristics associated with Fragile X syndrome mirror those of autism. Moreover, about ten percent of children with autism have Fragile X syndrome, which is present in about 1 in 2000 males and 1 in 4000 to 6000 females in the general population.

The study is a review or meta-analysis of a dozen previous studies on the relationship between Fragile X syndrome and autism. Without a comprehensive review of the previous studies it is difficult to assess the rigor of the methodologies involved; however, all of the previous studies were published in peer-reviewed academic journals.

Lathe's hypothesis was that if Fragile X is indeed linked to autism, then as rates of autism rise the rate of Fragile X incidence within the autistic population will itself fall. His results confirm this hypothesis, supporting the idea that in at least some cases autism does seem to have a genetic component.

Study II

Macedoni-Luksic et al. (2009) also tested the connection between Fragile X syndrome and autism. Rather than looking at the genetic correlation per se, however, they investigated differences between two groups of children: Children with both Fragile X syndrome and autism and children with only Fragile X syndrome. Their hypothesis was that children with both conditions would do less well on non-meaningful imitation tasks than children with only Fragile X syndrome. Their reasoning was that since both conditions tend to create interference with such tasks that there would be a compounding effect when both conditions were present.

The researchers worked with twenty-eight children with FXS, aged 5 to 14 years, and asked them to perform a series of imitative acts, such as raising an eyebrow or putting one's hand in… READ MORE

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