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PROBLEM IDENTIFICATION

1.1 UNDERSTANDING DISABILTY

There is no universal definition of disability; however there are two conceptualizations that most
definitions fit into: impairment and activity limitation.

Impairment is a broad concept. It is defined as a physical or mental loss or condition that limits a
person’s ability to function. Example of impairment includes hearing loss or loss of a limb. Activity
limitations are a narrow concept of disability; not everyone with impairment has an activity
limitation. An activity is an impairment that leads to an ability to perform, or a limitation in
performing, roles and tasks such as reading, talking on phone or cooking dinner.

The Americans with disabilities act use an impairment definition of disability:

“…..a physical or mental impairment that substantially limits one or more major life activities, a
record of such an impairment or being regarded as having such an impairment.”

The two definitions can be found in the national policy for education in Pakistan,

“…..disability means the lack of ability to perform an activity in a manner that is considered to be
normal.”

“…..a person with disabilities means a person who, on account of injury, disease or congenital
deformity, is handicapped in undertaking any gainful profession or employment. Include persons
who are visually impaired and physically and mentally disabled.”

A disability may be visible or hidden, may be permanent or temporary and may have a minimal or
substantial impact on a person’s abilities. A disability may affect mobility, ability to learn, or ability
to communicate easily.

The Disability Discrimination Act (1992) defines disability as:

o total or partial loss of a person’s bodily or mental functions

o total or partial loss of a part of the body
o the presence in the body of organisms causing disease or illness
o the malfunction, malformation or disfigurement of a part of a person’s body
o a disorder or malfunction that results in a person learning differently from a person
without the disorder or malfunction
o A disorder, illness or disease that affects a person’s thought processes, perception
of reality, emotions or judgment, or those results in disturbed behaviour.

The majority of people with disability have a physical disability (83.9 per cent), 11.3 per cent have
mental illness and behavioural disability and 4.8 per cent have an intellectual or developmental
disability.

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1.2 WHAT IS AUTISM?

Autism is a complex developmental disability characterized by lack of normal social interaction,

impaired communication and imagination, delayed and absent language, self-stimulating behavior
and a highly restricted range of activities and interests2 as a result of a neurological disorder that
affects the functioning of the brain, typically appears during the first three years of life.3

Autism impacts the normal development of the brain in the areas of social interaction and
communication skills. Children and adults with autism typically have difficulties in verbal and non-
verbal communication, social interactions, and leisure or play activities.

Recent evidence suggests that autistic individuals suffer from a specific impairment in mentalist
reasoning and in the early capacities believed to underlie it. Autistic individual fails tasks that
require an understanding of others’ cognitive states, and their vocabularies rarely contain such
words as “believe,” “think,” “know,” and “pretend.” In addition their ability to imitate and engage in
make-believe play is limited. Yet other cognitive skills- especially those that involve the physical
world- are intact.4 an autistic baby may fail to notice the emotional signals of others and may
refused to cuddle or to make eye contact, may speak in a singsong voice, paying little or no
attention to the listener.5 Severely autistic children often show repetitive behaviors, such as
spinning, rocking, hand- flapping, and head- banging, and are obsessed with certain subjects, rituals,
or routines.6

1.3 TYPES OF AUTISM

Autism refers to a group of autistic spectrum disorders (ASD) ranging from mild to severe, which
may be more common than previously thought (Papalia, 2006). It is one of five disorders coming under
the umbrella of Pervasive Developmental Disorders, a category of brain disorders that affect the
way people speak, socialize, play and react to their environment.

Below are definitions and characteristics of these five disorders among people with an ASD.

1.3.1 Kanner's Syndrome (Classic autism) —this particular type of autism was named after a
Dr. Kanner. He described and studied it in the 1930s and into the 1940s7. This is the most severe
form of autism. People with classic autism have problems talking and relating to people. They can be
hypersensitive to their environment. Certain sounds, colors and textures can upset them. They
compulsively cling to rituals, want everything to be the same all of the time, such as eating the same
foods or watching the same TV show every day at the same time. Changes in routine can upset
them7, 8

1.3.2 Asperger's Syndrome —in the type of autism, children are often misdiagnosed at first,
and are thought to have Obsessive-Compulsive Disorder*, or perhaps Attention Deficit* Disorder.
They are often clumsy, as motor skills are under developed. Those with Asperger's are thought to
have a talent that they focus on almost exclusively, and are considered to be highly intelligent.
Recent findings indicate that Albert Einstein may have had this condition7. It causes problems with
social and communication skills, but does not trigger language delays. People with Asperger are can
be socially awkward, may not understand conventional social rules or may show a lack of empathy.
[2] American Academy of Pediatrics (AAP), Committee on children with disabilities. (2001).
The Pediatrician’s role in the diagnosis and management of autistic spectrum disorder
in the children. Pediatrics, 107(5), 1221-1226. PROBLEM IDENTIFICATION Chapter 1
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They may make limited eye contact, seem to be unengaged in a conversation and not understand
the use of gestures. They also have average or above-average intelligence7, 8

1.3.3 Childhood Disintegrative Disorder — A type of autism that develops in children who
previously seemed perfectly normal. Sometime between ages 2 and 4 these children7, 8 stop talking,
lose potty-training skills and stop socializing. They can stop playing, lose motor skills and fail to make
friends.

1.3.4 Rett Syndrome — Rett's is a rare and relatively little-known type of autism diagnosed
since the sixties, first described by Dr. Rett9 A condition that usually affects girls and is marked by
poor head growth. People with this disorder have poor verbal and social skills, often have problems
with muscle atrophy*, and tend to do repetitive hand motions such as hand-wringing, excessive
hand-washing and clapping. Mental retardation is common7, 8.

1.3.5 Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) — A condition

in which some — but not all — of the symptoms of classic autism and another pervasive
developmental disorder are seen. In these cases, there can be social and speech problems, as well
as unusual sensitivities to specific sights and sounds7. They will need the same interventions and
help that autistic children require. The differences between PDD-NOS and autism are minor and
usually only obvious to researchers and doctors8.
Though there are more autism types out there, these tend to be the most common.
Asperger’s disorder is most common, which affects about 1 in 500 children 9 it is estimated that it
occurs in approximately 1 in every 150 individuals (quote reference over here), about 6 children in
1,000 have one of these disorders10 and is 4 times more prevalent in males than females11, 12. It is
most prevalent in Caucasian males, although it occurs in every race. About 3 out of 4 autistic
children are mentally retarded13, but they do well on tests of manipulative or visual-spatial skill and
may perform unusual mental feats, such as memorizing entire train schedules 14.

1.4 SYMPTOMS OF AUTISM?

Symptoms of Autism categorized as:

1.4.1 Possible Indicators of Autism Spectrum Disorders:

o Does not babble, point, or make meaningful gestures by 1 year of age

o Does not speak one word by 16 months
o Does not combine two words by 2 years
o Does not respond to name
o Loses language or social skills

[3] Papalia, D E. (2006), Human Development. 9TH Edition. Tata Mc Grow-Hill Publishing
Company Ltd, New Delhi.
PROBLEM IDENTIFICATION Chapter 1
[4] Baron-Cohen, 1991; Tager- Flusberg, 1992; Berk, 2001.
[5] Sigman, Kasari, Kwon, and Yirmiya, 1992; Paplia, 2006
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1.4.2 Some Other Indicators:

o Lacks eye contact

o Doesn't seem to know how to play with toys in the usual manner
o Excessively lines up toys or other objects
o Is attached to one particular toy or object
o Doesn't smile (socially, but may smile during periods of self-stimulatory behavior)
o At times seems to be hearing impaired

1.4.3 Social symptoms:

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn
toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to
faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday
human interaction. Even in the first few months of life, many do not interact and will avoid eye
contact, seeming indifferent to other people.

Autistic children often appear to prefer being alone rather than in the company of others may resist
attention or passively accept such things as hugs and cuddling without caring. Later, they seldom
seek comfort or respond to parents' displays of anger or affection in a typical way. Research has
suggested that although autistic children are attached to their parents, their expression of this
attachment is unusual and difficult to "read." To parents, it may seem as if their child is not attached
at all. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may
feel crushed by this lack of the expected and typical attachment behavior.

Children on the autism spectrum also are slower in learning to interpret what others are thinking
and feeling. Subtle social cues — whether a smile, a wink, or a grimace — may have little meaning.
To a child who misses these cues, "Come here" always means the same thing, whether the speaker
is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without
the ability to interpret gestures and facial expressions, the social world may seem bewildering. To
compound the problem, people on the autism spectrum have difficulty seeing things from another
person's perspective. Neurotypicals 5-year-olds understand that other people have different
Knowledge, feelings, and goals than they have. An autistic person may lack such understanding, an
inability that leaves them unable to predict or understand other people's actions.

Although not universal, it is common for autistic people to have difficulty regulating their emotions.
This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem
inappropriate to those around them. The autistic individual might also be disruptive and physically
aggressive at times, making social relationships still more difficult. They have a tendency to "lose
control," particularly when they are in a strange or overwhelming environment, or when angry and
frustrated. They may at times break things, attack others, or hurt themselves. In their frustration,
some bang their heads, pull their hair, or bite their arms.

1.4.4 Self-stimulatory Behavior:

[6] National Institute of Neurological Disorders and Stroke, (1999, November 10). Autistic
[Fact sheets]. (NIH Publication No. 96-1877.) Bethesda, MD: National Institute of Health.
[7] http://www.iser.com/resources/autism-types.html PROBLEM IDENTIFICATION Chapter 1
[8] http://www.statesman.com/metrostate/content/metro/autism/types_of.html
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Other indicator of autistic individual is the practice of self-stimulatory behavior. Stereotype or self-
stimulatory behavior refers to repetitive body movements or repetitive movement of objects.
Stereotype can involve any one or all senses.

senses Stereotypic Behavior

Visual Staring at lights, repetitive blinking, moving fingers in front of eyes, hand flapping.

Auditory Tapping ears, Snapping fingers, making vocal sounds

Tactile Rubbing the skin with one’s hands or with another object, scratching

Taste Placing body parts or objects in one’s mouth, licking objects

Smell Smelling objects, Sniffing people

Ref [15]

[9] Autism-part I. (2001, July). The Harvard Mental Health Letter, 17(12), pp.1-4.
[10]Fombonne, E. (2003). The Prevalence of Autism. Journal of the American Medical
Association, 289, 87-89.. PROBLEM IDENTIFICATION Chapter 1
[11] Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., and Murphy, C.
(2003)The Prevalence of Autism in a US metropolitan area. Journal of the American
Medica Association, 289, 47-55.
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? Ref [16]

[12] http://www.autism-society.org/site/PageServer
[13] American Psychiatric Association, 1994.
[14] Papalia, D E. (2006). Human Development. 9TH Edition., Tata Mc Grow-Hill Publishing PROBLEM IDENTIFICATION Chapter 1
Company Ltd, New Delhi.
[15] www.autismpakistan.org
[16] http://www.autism-india.org/research_awareness.html
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1.5 TECHNIQUES FOR DIAGNOSIS AND EVALUATION

Diagnosis of autism has remained difficult at best because of a lack of etiology ascribed to this
disability. This has led the medical world to diagnose this condition based solely upon behavioral
criteria. Developing such diagnostic criteria has been important to the scientific community for a
number of reasons. First, because of the heterogeneity of the group, research is difficult. For
researchers to develop a meaningful basis for research it is necessary to develop subgroups, and
relate them based upon similar characteristics. Primarily, autism is separated into three groups for
research purposes, classically autistic, childhood schizophrenics with autistic features, and
neurologically impaired autistic children. Although each group supports many classical autistic
features, different etiology can be ascribed to each subgroup making research more reliable and
reproducible.

1.5.1 Diagnostic criteria:

For administrative and legislative purposes, a more comprehensive listing of diagnostic criteria was
developed by the national society of autism. This list attempts to create a more specific classification
for behaviors displayed by autistic individuals.

o Language deficiency.
o Disturbed interpersonal relationships.
o Inconsistent responses to sensory stimulation.
o Developmental delays. .
o Onset prior to 30 months.

Although this creates a descriptive diagnosis for autism, it does not describe symptomatic
behavioral characteristics of the individual. This becomes important because each autistic individual
may display a different series of behaviors, with little or no overlap. In evaluation and diagnosis, as
well as treatment, this heterogeneity can create problems unless a more specific evaluation of the
individual is made. Mainly due to this fact, a large number of more exact evaluation criteria have
been developed to pinpoint the behaviors elicited by the individual.

1.5.2 Related Disorders

It is important to note the similarity in behaviors that may exist between autism and other
disorders. Because of this overlap, many individuals who suffered from autism were originally
inaccurately classified under other disorders, making evaluation and treatment difficult or
ineffective. The following is a short listing of related disorders, and includes the respective
similarities and differences from autism.

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Childhood Schizophrenia

Similarities Differences

Sustained impairment of social relations, Age of onset

Resistance to make change environment,
Speech abnormalities,
Family history of mental illness
Poor physical health
Poor motor performance
Higher levels of language skills, and Presence of
delusions and hallucinations

Developmental Aphasia

Similarities Differences

Echolalia, Language deficits not as pronounced.

Pronominal reversal Engage in imaginative play.
Sequencing problems Usually normal intelligence
Difficulties in comprehension, and Exhibit emotional intentions, and
Secondary problems of social relations Meaningful communication through gesture

Mental Retardation

Similarities Differences

Poor intellectual abilities, Display appropriate social behavior.

Echolalia, Willingness to communicate
Self-stimulatory behavior Abnormal physical development
Self-injurious behavior, and Delayed motor abilities, and
Attentional deficits Wide ranging intellectual impairment

Environmental Deprivation

Similarities
Maternal deprivation,
Analytic depression and Hospitalism
Delayed motor skills development.
Delayed speech development
Engage in unusual motor activity, and
Show little interest in toys.
Differences:
.
Marked improvement in enriched environment
Do not engage in repetitious, stereotypical play.
Do not exhibit echolalia.
Do not exhibit pronominal reversal, and
Do not avoid social contact
………….
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1.5.3 Evaluative procedures:

Due to the heterogeneity of the autistic population, evaluation is a key step in the diagnosis as well
as treatment phases. Each individual's behavior must be carefully evaluated to discover what
characteristically autistic behaviors exist. Many early standardized testing procedures were
inappropriate for these children due to language deficits, hyperactivity, and lack of motivation,
attention deficits, and severe withdrawal from environmental stimuli. It was therefore necessary to
develop new testing procedures utilizing interviews and observations that better assess these
children. These tests have become standardized in their own way, allowing physicians, after an
initial evaluation, to determine which tests are most applicable for assessing the child's level in the
respective problem areas. Although some standardized tests, such as is tests, are still able to yield
reliable results for children, these are now normally utilized only for supplemental information.
Assessment procedures may include evaluation in a number of areas beyond those of specific
behaviors. Appraising intellectual abilities and expressive/receptive communication will assist the
physician in creating a treatment program that will potentially yield the best results. Social
maturation, family interaction, parental behavior, and emotional responses are examined, as well as
physical development. Testing is utilized continuously to evaluate progress in the treatment process.
A number evaluation tools have been developed in recent years, such as the behavior observation
scale for autism (1978), a checklist based upon direct observations which evaluates 67 operationally
defined behaviors. Another such tool is the childhood autism rating scale (1980), this is also based
upon direct observation, “and assesses 15 separate sub-scales of behaviors. Unfortunately, test
reliability and validity are undetermined for many areas of the tests due to a lack of sufficient
numbers of subjects tested. It should be noted that evaluation is an essential part of treatment due
largely to the fact that a diagnosis of autism tells little about each individual's affliction.
Heterogeneity of the population makes any single treatment for all individuals impossible.

1.6 CAUSES OF AUTISM?

1.6.1 What Causes Autism?

The bottom line is, no one knows for sure what causes autism. Most experts will say that autism is
probably caused by a combination of genetic and environmental factors. Even those experts,
though, do not have a definite answer. For many people, this uncertainty is terribly frustrating. On
the plus side, interest in and funding for autism research is on the rise, so new and better
information should be forthcoming in the next months and years.

1.6.2 A Controversial Topic:

The question of what causes autism is highly controversial. Many people are passionate about the
issue, and hold strong beliefs. Books, articles and TV programs have raised awareness -- and heated
up the argument. This article provides an overview of different theories, all of which have strong
supporters.

1.6.3 Is Autism Genetic?

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It is likely that autism has a genetic basis of some sort. Many studies have shown that parents from
families with autistic members are more likely to have autistic children. It is also the case that many
families with one autistic child are at increased risk of having more than one autistic child.

1.6.4 Is Autism Caused By Atypical Brain Development?

Some researchers have found differences between the autistic brain and the typical brain. Autistic
individuals seem to have larger brains. They also seem to process information differently; in other
words, their brains are "wired" differently. Research on this issue is ongoing at The University of
Pittsburgh.

1.6.5 Is Autism an Immune Deficiency Problem?

There is some evidence that autism is linked to problems in the immune system. Autistic individuals
often have other physical issues related to immune deficiency. Some researchers say they have
developed effective treatments based on boosting the immune system. The NIH, however, states
that the evidence is not yet strong enough to show a causal relationship.

1.6.6 Is Autism Caused By Food Allergies?

There is some evidence that allergies to certain foods could contribute to autistic symptoms. Most
people who hold to this theory feel that gluten (a wheat product) and casein (a dairy product) are
the most significant culprits. Explore the Autism Institute's website for more on this theory.

1.6.7 Is Autism Caused By Poor Nutrition?

It seems unlikely that malnutrition can cause autism. But megavitamin therapies have been used for
many years to treat autistic symptoms. Dr. Bernard Rimland, of the Autism Institute, has been a
leader in this area.

1.6.8 Do Vaccines Cause Autism?

Two theories link autism and vaccines. The first theory suggests that the MMR (Mumps-Measles-
Rubella) vaccine may cause intestinal problems leading to the development of autism. The second
theory suggests that a mercury-based preservative called thimerosal, used in some vaccines, could
be connected to autism.

1.6.9 So...What DOES Cause Autism?

It likely seems, from the researches so far that autism is genetic, as it seems to run in families,
sometimes environmental factors, such as exposure to certain viruses or chemicals may trigger an
inherited tendency towards it. But most experts will say that several factors combine to cause
autism. For example, it may be that certain children are genetically more susceptible to certain
types of food allergies, or more likely to react badly to certain environmental toxins. The claim that
the rise in autism rates is related to administration of the measles-mumps-rubella vaccine has not
been substantiated.
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Until we have more definitive answers, though, it seems to make sense to focus more on treatments
-- and to support researchers as they learn more about causes.

1.7 DIFFICULTIES FACED BY AUTISTIC’S

1.7.1 Communication:
Autistic children nearly always start learning to talk late, if at all. Their progress with speech is often slow and
the things they say are sometimes quite odd. They may have difficulty understanding what other people say,
and may not seem to notice when people talk to them.

1.7.2 Socialization:
Autistic people lack awareness of other people. They may not respond to other people, or may respond
oddly.

1.7.3 Imagination:
Autistic children rarely have much pretend play. Instead they tend to concentrate on the physical properties
of things, so will like to look at things from odd angles, or line them up, or tap or spin things. They are not
usually able to play interactively with other children.

Other common features:-

o General learning disabilities. About a third of autistic people have severe learning disabilities,
and another third have moderate learning disabilities.
o Obsessive interests, for example in trains, or vacuum cleaners, or collecting bottle tops.
o An insistence on doing certain things exactly the same way every time; for example always
taking the same route to school. Many autistic children get very upset if their usual routine is
disrupted.
o A patchy profile of abilities; for example some autistic children are very good at computing, or
at jigsaw puzzles, or at reading, despite having great difficulties with more simple tasks.
o Odd physical mannerisms, typically hand flapping and jumping up and down when excited, and
walking on tiptoe. The more severely affected children often rock, or bang their heads, or bite
the back of their hands.

1.7.4 Personality Differences:

While autistic people do differ from one another radically, it is fairly typical for people on the
spectrum to:

o Engage in repetitive behaviors and ritualized activities, ranging from lining up items to
following a rigid routine,
o Have one or a few passionate interests,
o Have difficulty in making and keeping multiple friends,
o Prefer activities that require relatively little verbal interaction.

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It also seems to be the case -- for as-yet-undetermined reasons -- that certain interests are of
particular interest to many people on the autism spectrum. For example, an enormous number of
young children with ASD's are fascinated by trains (and the Thomas the Tank Engine toy), while a
great many older children and adults on the spectrum are interested in computers, science,
technology, and animals.

1.8 EFFECTS IN EDUCATION

Autism presents in a wide degree, Children with autism are affected with these symptoms every
day. These unusual characteristics set them apart from the everyday normal student. Because they
have trouble understanding people’s thoughts and feelings, they have trouble understanding what
their teacher may be telling them. They do not understand that facial expressions and vocal
variations hold meanings and may misinterpret what emotion their instructor is displaying. This
inability to fully decipher the world around them makes education stressful. Teachers need to be
aware of a student's disorder so that they are able to help the student get the best out of the
lessons being taught.

Some students learn better with visual aids as they are better able to understand material
presented this way. Because of this, many teachers create “visual schedules” for their autistic
students. This allows the student to know what is going on throughout the day, so they know what
to prepare for and what activity they will be doing next. Some autistic children have trouble going
from one activity to the next, so this visual schedule can help to reduce stress.

Research has shown that working in pairs may be beneficial to autistic children. Autistic students
have problems in schools not only with language and communication, but with socialization as well.
They feel self-conscious about themselves and many feel that they will always be outcasts. By
allowing them to work with peers they can make friends, which in turn can help them cope with the
problems that arise. By doing so, they can become more integrated into the mainstream
environment of the classroom.

A teacher's aide can also be useful to the student. The aide is able to give more elaborate directions
that the teacher may not have time to explain to the autistic child. The aide can also facilitate the
autistic child in such a way as to allow them to stay at a similar level to the rest of the class. This
allows a partially one-on-one lesson structure so that the child is still able to stay in a normal
classroom but be given the extra help that they need.

There are many different techniques that teachers can use to assist their students. A teacher needs
to become familiar with the child’s disorder to know what will work best with that particular child.
Every child is going to be different and teachers have to be able to adjust with every one of them.
Students with Autism Spectrum Disorders typically have high levels of anxiety and stress, particularly
in social environments like school. If a student exhibits aggressive or explosive behavior, it is
important for educational teams to recognize the impact of stress and anxiety. Preparing students
for new situations by writing Social Stories can lower anxiety. Teaching social and emotional
concepts using systematic teaching approaches such as The Incredible 5-Point Scale or other

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Cognitive Behavioral strategies can increase a student's ability to control excessive behavioral
reactions.

1.9 TREATEMENT AND THERAPIES FOR AUTISTIC DISORDER17(a):

Autism has no known cure, but improvement, sometimes substantial, can occur, especially with
early diagnosis and intervention. Some autistic children can be taught to speak, read, and write.
Behavior therapy can help them learn such basic social skills as paying attention, sustaining eye
contact, and feeding and dressing themselves and can help control problem behaviors. Physical and
occupational therapy, highly structured social play situations, and extensive parent training may be
part of the prescribed treatment (Papalia, 2006). Newer, safer medicines have shown effectiveness
in managing specific symptoms (AAP Committee on children with disabilities, 2001; Papalia, 2006).
However, only about 2% of autistic children grow up to live independently; most need some degree
of care through life. Children with Asperger’s syndrome generally fare better (“Autism-Part II,’’
2001).

Because their isolation is so moving and their symptoms so pronounced, great deal of attention has
been given to trying to improve the condition of children with autism. More recently, various psych
pharmacotherapies have been studied with positive results. Treatments for autistic children usually
try to reduce their unusual behavior and improve their communication and social skills. Sometimes
an eagerly sought, after goal for a family is simply to be able to take their autistic child to a
restaurant or a market without attracting negative attention.

1.9.1 Behavioral treatment of children with autism:

Using modeling and operant conditioning, behavioral therapists have taught autistic children to talk,
modified their echolalia speech, encouraged them to play with other children, and help them
become more generally responsive to adults. There is reason to believe that the education provided
by parents is more beneficial to the child then is clinic or hospital based treatment. Parents are
present in many different situations and thus can help children generalize the gains they make. For
example, Koegel and his colleagues (1982) demonstrated that 25 to 20 hours of parent training was
as effective as 200 hours of direct clinic treatment in improving the behavior of autistic children.
More recently Koegel’s research group has focused on comparing different strategies for behavioral
parent training with interesting discoveries. One of the first intervention that sought to include
parents in the treatment process TEACHC program, or treatment and education of autistic and
related communication handicapped children, developed by Schopler and colleagues at the
University of North Carclina (Schopler, 1986) this Community based intervention emphasizes
parents and teachers working together in the treatment of autism. It must be clearly understood,
however that some autistic and other severely disturbed children can be adequately cared for only
in a hospital or in a group home staffed by mental health professionals.

1.9.2 Psychodynamic treatment of children with autism:

Bruno Bettelheim 1967, 1974 argued that a warm, loving atmosphere must be created to encourage
the child to enter the world and what Rogerinans would call unconditional positive regard were
believed to be necessary for the child with autism to begin to trust others and to take chances in
[17(a) the Basics by Lisa Jo Rudy, About.com Guide, Updated August 21, 2007
About.com Health's Disease and Condition content is reviewed by the Medical Review Board PROBLEM IDENTIFICATION Chapter 1
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establishing relationships. At his ORTHOGENIG SCHOOL at the University of CHICAGO, Bettelheim

and his colleagues reported many instances of success, but the uncontrolled nature of their
observation makes it difficult to evaluate their claims.

1.9.3 Applied Behaviour Analysis:

Applied Behaviour Analysis (ABA) is based on the principle that influencing a response associated
with a particular behaviour may cause that behaviour to be shaped and controlled. ABA is a mixture
of psychological and educational techniques that are tailored to the needs of each individual child to
alter their behaviours. ABA involves the use of behavioural methods to measure behaviour, teach
functional skills, and evaluate progress.

ABA techniques have been proven in many studies as the method of choice on treating deficits in
the behaviours of children with Autism Spectrum Disorder (ASD) at any level. ABA approaches such
as discrete trial training (DTT), Pivotal Response Training (PRT), Picture Exchange Communication
System (PECS), Self-Management, and a range of social skills training techniques are all critical in
teaching children with autism. Ultimately, the goal is to find a way of motivating the child and using
a number of different strategies and positive reinforcement techniques to ensure that the sessions
are enjoyable and productive. In all ABA programs, the intent is to increase skills in language, play
and socialization, while decreasing behaviours that interfere with learning. The results can be
profound. Many children with autism who have ritualistic or self-injurious behaviours reduce or
eliminate these behaviours. ABA helps to establish better to normal eye contact and encourages
learning to stay on task. Finally the children acquire the ability and the desire to learn and to do
well. Even if the child does not achieve a “best outcome” result of normal functioning levels in all
areas, nearly all autistic children benefit from intensive ABA programs.

1.9.4 Speech Therapy:

Almost all people with autism have issues with speech and language. Sometimes these issues are
obvious; many people with autism are non-verbal or use speech very poorly. Sometimes the issues
relate not to articulation or grammar but to "speech pragmatics" (the use of speech to build social
relationships). Across the board, though, speech and language therapy is likely to be helpful for
people with autism.

o Why Would a Person With Autism Need to See a Speech Therapist?

Almost anyone diagnosed with an autism spectrum disorder will be recommended for speech
therapy. This may seem odd, as many autistic people are either non-verbal (at the lower end of the
spectrum) or extremely verbal (at the upper end of the spectrum). But even very verbal people with
Asperger Syndrome are likely to misuse and misunderstand language on a regular basis. And even
non-verbal people can certainly develop communication skills - and may even develop spoken
language skills over time.

o What Does a Speech Therapist Do for People with Autism?

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 Speech therapy involves much more than simply teaching a child to correctly pronounce
words. In fact, a speech therapist working with an autistic child or adult may work on a wide
range of skills including:
 Non-verbal communication: This may include teaching gestural communication, or training
with PECS (picture exchange cards), electronic talking devices, and other non-verbal
communication tools.
 Speech pragmatics: It's all well and good to know how to say "good morning." But it's just as
important to know when, how and to whom you should say it.
 Conversation skills: Knowing how to make statements is not the same thing as carrying on
conversations. Speech therapists may work on back-and-forth exchange, sometimes known
as "joint attention."
 Concept skills: A person's ability to state abstract concepts doesn't always reflect their ability
to understand them. Autistic people often have a tough time with ideas like "few," "justice,"
and "liberty." Speech therapists may work on building concept skills.

1.9.5 Occupational Therapy:

Occupational therapy focuses on building daily living skills. Since many people with autism have
delays in fine motor skills, occupational therapy can be very important. Occupational therapists may
also have training in sensory integration therapy - a technique which may help autistic people
manage hypersensitivity to sound, light, and touch.

o Why Would a Person With Autism Need to See an Occupational Therapist?

In the case of autism, occupational therapists (OT's) have vastly expanded the usual breadth of their
job. In the past, for example, an occupational therapist might have worked with an autistic person
to develop skills for handwriting, shirt buttoning, shoe tying, and so forth. But today's occupational
therapists specializing in autism may also be experts in sensory integration (difficulty with
processing information through the senses), or may work with their clients on play skills, social skills
and more.

o What Does an Occupational Therapist Do for People with Autism?

 Since people with autism often lack some of the basic social and personal skills required for
independent living, occupational therapists have developed techniques for working on all of
these needs. For example:
 Provide interventions to help a child appropriately respond to information coming through
the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole
gamut of other activities aimed at helping a child better manage his body in space.
 Facilitate play activities that instruct as well as aid a child in interacting and communicating
with others. For the OT specializing in autism, this can translate specifically into structured
play therapies, such as Floortime, which were developed to build intellectual and emotional
skills as well as physical skills.
 Devise strategies to help the individual transition from one setting to another, from one
person to another, and from one life phase to another. For a child with autism, this may

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involve soothing strategies for managing transition from home to school; for adults with
autism it may involve vocational skills, cooking skills and more.
 Develop adaptive techniques and strategies to get around apparent disabilities (for example,
teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to
enhance focus; etc.)

1.9.6 Social Skills Therapy:

One of autism's "core deficits" is a lack of social and communication skills. Many children with
autism need help in building the skills they need to hold a conversation, connect with a new friend,
or even navigate the playground. Social skills therapists can help out setting up and facilitating peer-
based social interaction.

o Why Would a Person With Autism Need to See a Social Skills Therapist?

One of the most significant problems for people on the autism spectrum is difficulty in social
interaction. This difficulty is, of course, made more significant by problems with speech and
language. But autism also seems to create problems with "mind reading" -- that is, with knowing
what another person might be thinking. Most people can observe others and guess, through a
combination of tone and body language, what's "really" going on. In general, without help and
training, autistic people can’t. This "mind blindness" can lead even the highest-functioning person
on the autism spectrum to make social blunders that cause all kinds of problems. Without knowing
why, a person on the autism spectrum can hurt feelings, ask inappropriate questions, act oddly or
generally open themselves up to hostility, teasing, bullying and isolation.

o What Do Social Skills Therapists Do for People with Autism?

 Since there is no official certification for social skills therapists, techniques vary. In a school
setting, social skills therapy may consist of group activities (usually games and conversation)
with autistic and typically developing peers. Groups may be overseen by school psychologists
or social workers, and may be held in the classroom, lunchroom or playground. Generally
speaking, school social skills groups focus on game playing, sharing and conversation.
 Out-of-school social skills groups are similar in style, but are paid for privately (medical
insurance is unlikely to cover such programs). Children are grouped by age and ability, and
may make use of specific social skills curricula as developed by well-established practitioners
of social skills therapy.
 Drama therapy, a variation of social skills therapy, is somewhat unusual -- but where it's
offered, it has the potential to be both fun and educational. Video modeling, video critiques
of interactions, group therapy and other approaches may also be available in your area, and
are especially appropriate for teens and adults. Typical cognitive therapy with a psychologist
or psychiatrist may also be helpful.
 In theory, social skills therapy will provide people on the autism spectrum with the ability to
converse, share, play and work with typical peers. In an ideal world, such therapy will allow
people on the autism spectrum to become almost indistinguishable from their typical peers.

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 In fact, social skills therapy tends to be offered no more than an hour or two a week -- and
while it may provide autistic learners with specific skills and techniques ("look at a person's
face when you're conversing," for example) it's unlikely to make an autistic person appear
typical. A program most likely to have such an impact would be very intensive -- unlike the
vast majority of existing social skills programs.

1.9.7 Physical Therapy:

o Why Would a Person With Autism Need to See a Physical Therapist?

Autism is a pervasive developmental disorder. This means that most people on the autism spectrum
have delays, differences or disorders in many areas -- including gross and fine motor skills. Children
on the spectrum may have low muscle tone, or have a tough time with coordination and sports.
These issues can interfere with basic day-to-day functioning -- and they're almost certain to
interfere with social and physical development. Children with autism would rarely be termed
physically disabled (though there are some autistic children with very low muscle tone, which may
make it difficult to sit or walk for long periods). Most children with autism do, however, have
physical limitations.

o What Does a Physical Therapist Do for People with Autism?

 Physical therapists may work with very young children on basic motor skills such as sitting,
rolling, standing and playing. They may also work with parents to teach them some
techniques for helping their child build muscle strength, coordination and skills.
 As children grow older, physical therapists are more likely to come to a child's preschool or
school. There, they may work on more sophisticated skills such as skipping, kicking, throwing
and catching. These skills are not only important for physical development, but also for social
engagement in sports, recess and general play.
 In school settings, physical therapists may pull children out to work with them one-on-one,
or "push in" to typical school settings such as gym class to support children in real-life
situations. It's not unusual for a physical therapist to create groups including typical and
autistic children to work on the social aspects of physical skills. Physical therapists may also
work with special education teachers and aides, gym teachers and parents to provide tools
for building social/physical skills.

1.9.8 Play Therapy:

One of autism's "core deficits" is a lack of social and communication skills. Many children with
autism need help in building the skills they need to hold a conversation, connect with a new friend,
or even navigate the playground. Social skills therapists can help out setting up and facilitating
peer-based social interaction.

o Why Would a Person With Autism Need to See a Play Therapist?

Autism is largely a social-communication disorder. Children with autism find it extremely difficult to
relate to others -- particularly to peers -- in ordinary ways. Instead of playing with toys in

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imaginative or symbolic ways (pretending a doll is really "my baby," for example) they may
perseverate on objects, use them for self-stimulation, and become entirely self-absorbed. Play is a
wonderful tool for helping children (and sometimes even adults) to move beyond autism's self-
absorption into real, shared interaction. Properly used, play can also allow youngsters to explore
their feelings, their environment, and their relationships with parents, siblings and peers. Very
often, too, play therapy can allow parents to take an active role in their autistic child's growth and
development. Play therapy can be taught to parents, and, over time, parents can become their
child's therapist while also building a stronger, more meaningful relationship.

o What Does a Play Therapist Do for People with Autism?

 A good play therapist will get down on the floor with your child and truly engage him
through the medium of play. For example, the therapist might set out a number of toys that
a child finds interesting, and allow her to decide what, if anything, interests her. If she picks
up a toy train and runs it back and forth, apparently aimlessly, the therapist might pick up
another train and place it in front of the child's train, blocking its path. If the child responds --
verbally or non-verbally -- then a relationship has begun.
 If the child doesn't respond, the therapist might look for high-interest, high-energy options
to engage the child. Bubble blowing is often successful, as are toys that move, squeak,
vibrate, and otherwise DO something.
 Over time, the therapists will work with the child to build reciprocal skills (sharing, turn-
taking), imaginative skills (pretending to feed a toy animal, cook pretend skills) and even
abstract thinking skills (putting together puzzles, solving problems). As a child becomes
better able to relate to others, additional children may be brought into the group, and more
complex social skills are developed.
 Many parents find they can do play therapy on their own, using videotapes and books as a
guide. Others rely on the experience of trained play therapists. And still others choose to
simply bring their children to a play therapist or have the therapist come to their home. In
any case, play therapists can provide parents with tools to connect with and have fun with
their children on the autism spectrum.

1.9.9 Behavior Therapy:

Children with autism are often frustrated. They are misunderstood, have a tough time
communicating their needs, suffer from hypersensitivities to sound, light and touch ... no wonder
they sometimes act out! Behavior therapists are trained to figure out just what lies behind negative
behaviors, and to recommend changes to the environment and routines to improve behavior.

o Why Would a Person With Autism Need to See a Behavior Specialist?

Almost everyone on the autism spectrum has at least some challenging behaviors. These may range
from the odd (spinning, flapping) to the self-injurious (head banging) to the truly dangerous (hitting,
kicking, dashing into traffic). Autistic people may also find undesirable ways to avoid doing what
they don't want to do: they may hum, slide under the table, or otherwise avoid non-preferred
activities. Often, parents and teachers are uncertain how to manage these behaviors. Unlike many
people, they are not deliberately misbehaving -- nor are they seeking attention. For the average

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educator or caregiver, it's hard to know how to improve behaviors while also, for example, cooking
dinner or teaching 20 other children.

o What Does a Behavior Specialist Do for People with Autism?

 The role of the behavior specialist is to walk into a setting, observe the environment, the
activities, and the person in question; to gather data about what seems to set off or calm
difficult behaviors; to suggest appropriate changes and/or interventions; and to troubleshoot
until the interventions are successful. Interventions may range from behavior charts with
stickers and motivational prizes to changes in an environment that is creating sensory
overload or undue frustrations.
 Ideally, by involving a behavior specialist, a parent or teacher can develop a positive set of
tools to manage behaviors, improve outcomes, and generally make life easier for everyone.
In the best of circumstances, it may be relatively simple to change a situation for the better.
Changes in lighting, the addition of a visual schedule, extra warning time before transitions
and similar small tweaks can vastly improve the lives of people on the autism spectrum.

1.9.10 Developmental Therapies:

Floortime, Son-rise, and Relationship Development Intervention (RDI) are all considered to be
"developmental treatments." This means that they build from a child's own interests, strengths and
developmental level to increase emotional, social and intellectual abilities. Developmental therapies
are often contrasted to behavioral therapies, which are best used to teach specific skills such as
shoe tying, tooth brushing, etc.

o Pros and Cons of Developmental Therapies for Autism

It's important to note that developmental therapies are extremely child-oriented, which means that
there is no one-size-fits-all approach. In addition, they demand a great deal from parents.
Developers of these therapies see the family as the key to an autistic child's development, and they
want to see parents take on the lion's share of actual, day to day intervention. But because there is
no specific curriculum or single "approved" approach (after all, each child is unique), parents are
called upon to be very creative, engaged and energetic -- and must be willing and able to become a
therapist to their own child.

When a parent is personally and financially available, developmental therapy can be terrific.
Speaking from my own experience with Floortime, I can say that therapeutic play can be fun,
exciting and fulfilling. But there is a danger that parents who take on developmental therapy in their
own home can become exhausted, overwhelmed, and even guilt-ridden. This is especially the case
when, as so often happens, mothers leave their careers to care for their autistic child -- and find that
they may not be cut out to be fulltime therapists to their own offspring!

Of course, help is available -- but very little of that help is supported financially through insurance.
And while it's possible to convince a school district to provide developmental therapy for a
preschooler, it is a gargantuan task to push a district into individualized developmental
programming as a child moves into elementary school.

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Unlike behavioral therapies, developmental therapies are relatively new -- and relatively poorly
researched. While there is evidence that developmental approaches can be effective, no one has
actually compared developmental therapies head to head. And there is very little research
comparing the relative outcomes of developmental versus behavioral therapies. It may be the case
that the outcomes depend largely upon (a) the child's constellation of issues, deficits and strengths
and (b) the parent's ability to provide a great deal of high quality engagement.

All this said, however, developmental therapies have several great advantages.

 First, their impact is almost instantly obvious. After just one or two sessions, parents see that
their child really CAN engage with them, even if on a very simple level -- and that
engagement is inspirational.
 Second, if you have the inclination, it is possible to do a creditable job of developmental
therapy in your own home for very little money (just invest in a book and set of videos).
 Third, if you enjoy pretend play than developmental therapy can be a lot of fun.
 Fourth, again, if you enjoy the process, developmental therapy can be a terrific way to build
a relationship with your child with autism.
 It's really impossible to injure a child through developmental therapy; the worst that
happens is that nothing really comes of it!

o Floortime/DIR (Developmental, Individual Difference, Relationship Based Therapy:

Floortime/DIR was developed by Dr. Stanley Greenspan and associates. Its basic premise is that
autistic individuals learn to communicate when they are engaged at their own level, and by things
that interest them. Whether a child is lining up cars, flapping their hands or reading Harry Potter,
there is a way to connect. As the therapist begins to establish a relationship with the child, the child
begins to respond -- whether verbally or non-verbally. Over time, the child starts to open and close
"circles of communication" -- at first by knocking the parent's hand away, or by leading the parent to
a favored toy that's out of reach; later through words and multiple exchanges.

o RDI(Relationship Development Intervention)

RDI is similar to floortime in that addresses "core deficits" through individualized therapy -- and the
parent is the primary therapist. Some of the most important differences appear to be the level of
support and clarity of direction provided by the RDI organization. Dr. Steven Gutstein, creator of
RDI, has established a formal organization which trains consultants. Consultants work with parents
to evaluate children and create personalized therapeutic programs. They also put together concrete
benchmarks, so that parents know they have reached their goals.

o Son-Rise

The therapeutic concept behind Son-Rise is very similar to that of Floortime: parents become
therapists, and engage with their child at their child's own level of interest. Over time, relationships
and skills emerge. Some of the key differences include a tremendous focus on the idea of the family
as the key to success, and love and respect as the tools for success. There is also a focus on the

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home as the source of security and the foundation for growth. In practice, this translates into a
series of on-site workshops for parents and children, followed by a very unusual lifestyle in which
parents (or one parent) are homebound for a very protracted period of time. Son-Rise does
recommend that families recruit volunteers to work with their children in the home.

1.10 CONCLUSION:

Autism is not a disease but a neurological disorder, characterized by multiple disabilities. They are
slow learners and could not interpret and analyze what others are thinking and expecting of them,
their ability to instinctively empathize with others is also much weaker than normal people’s. But
they do feel love, happiness, sadness and pain just like everyone else. Just because some of them
may not express their feelings in the same way others do, does not mean at all that they do not
have feelings – they do!!

The children are not “crazy” or “retarded” but simply cannot react or respond to normal stimulus
around them; autistic children act as though they were indifferent to everything around them, as
though they were in a world of their own. The condition is often accentuated by lack of early
diagnosis and detection, due to its varying nature and complicated symptoms, and individual
specific interventions. With early detection and help many can live a normal live but all can surely
improve with specialized professional help and therapy and the sooner the child receives said help
and therapy, the better for the child and family.

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