Autistic Disorder
Meaning
What is autistic?
Autistic Disorder or Autism is one of the development disorders. The children cannot develop their social skill, linguistic skill, and communication skill in accordance with their ages. They have the behavior of repeating, non-flexible interest and activities. The problem starts at an early age and expressed before the age of 3. It is more than 60 years that the scholars have attempted to study the disease in detail, however, its causes are still unclear.
The word Autism has its root from Greek: Auto meaning Self; it means that separation in the own world like a transparent wall or mirror that separate them for the community.
Autistic is diagnosis as PDD or Pervasive Developmental Disorders. It was found that the number of autistic children is rising and it was found more in male than in female. Even though its causes are unclear there something we can practice. The care of these children has been improved and especially, if the child has been diagnosed and help since at an early time.
Cause
Why autistic?
Attempt has been put into the study of the cause of the autistic however, the cause is still vague. In present, there are some evidences supporting that it is caused from the brain disorder rather than the environment.
In the past it is believed that autistic is from the Refrigerator Mother however, from the evidences it is clear that the way of bringing up is not the cause of autistic. The appropriate care will, however, help improving the childs development.
In present it was found that the disease is highly connected to the genetic factors. It interrelates with some chromosomes such as at positions 15q 11-13, 7q, and 16p etc. In the future, it is expected the cause of autistic will be clear. From the study of twins, it was found that identical twin with identical genetic code tend to become autistic higher than fraternal twin.
Cerebral electrical activity: the cerebral electrical activity is found abnormal in this group more than the normal population. However the specific characteristic to explain the brain disorder is not found. The study of brain and nervous system found that there are many forms of abnormalities such as the volume of the brain is increased except the Frontal Lobe. And it was also found that the head perimeter at birth is normal and it changes in the early to middle of the childhood. It was also found the decreasing of Purkinje Cell.
Neural Imaging: found various forms of abnormalities but still vague such as denser than normal Cerebellar Vermis, large Third Ventricle, and small caudate, etc.
Pharmacology: it was found that the disease is related to the chemical serotonin. The number of platelet is found higher without clear explanation.
Is it real that autistic is found in creasing in number?
In epidemiology study, it was difficult to perform since the diagnosis criteria for autistic are always changed. From the epidemiological information or the past 30 years it was found that the prevalence of the disease is 4.8 per 10,000 populations, or about 1 person per 2,000 populations. If the Aspergers disorder is to be added, the prevalence of the disease will be about 1 person per 1,000 populations.
From the recent epidemiological information, it was found that the prevalence is increased and the maximum prevalence is 1 person per 250 populations (all PDD are included). The increasing prevalence reflects the event of growth. However it partly relates to the wider criteria which cover more populations and people are recognized more about autistic.
In California, USA., is found the increasing number of autistic. It was found to increase by 273% in 12 year duration (1987-1998) and it still tends to increase especially in the Silicon Valley industrial zone; the number is 1 person per 150 populations.
It was found in male higher than in female for 3-4 times however in female found often more severe. Previously it was believed that it tends to be found among the high economical status in the society. In present it was found that the chance is equal in every class of the society. This can be due to the fact that the high economical status access more to the medical and sanitary service.
Symptoms
What are the autistics symptoms?
Autistic children have different symptoms, ten children with ten symptoms and even hundred children with hundred symptoms. The natures they will have in common and to be called autistic are they are in their own world, no surrounding interest, not turn when called, no eye contact, no interest in others, no interaction, inappropriate playing, incapable of imagination, non-speaking or speaking with non-sense, alien language, repeatedly doing something with pattern, no flexibility, immersion interest.
The case that the child prefer to live in his/her own world, he/she will timely stimulate him/herself such as tuning his/her body, swaying his/her body, standing on tiptoe, shaking his/her hands out, playing his/her hands, making noise, etc.
To see if the child is autistic or not it is not difficult if the syndrome is sever. If the child with little syndrome, we employ the specialist such as child and adolescent psychiatrist. In some cases the assessment and following up must be performed for a certain of time before coming the conclusion.
During the first year of the baby, it is difficult to find autistic since the baby is lovely, no outside characteristic which is doubtful. The child will not make eye contact, no turn when called, plain face, no smiling or laughing, not like to be carried, no attention seeking, quiet and easy going.
The disorder may be found during the 2 years old. The child will speak alien language. He/she is not interested in toys, surrounding people, does not use the index finger to point to tell his/her need. If required something, he/she will do for it him/herself or hold the parents hand to get it without any talking. He/she will like to stare at the shining surface, light, shadow, or turning things such as electrical fan, turning wheel, playing his/her hands, shaking hand out, turning his/her body, swaying his/her body, standing on tiptoe.
From the age of 3 years old the disorder will be more obvious and severe if the child is not brought to the helping process.
For social : the child will not make an eye contact, not understand facial emotion or mood of others, cannot play with other children with the same age but playing with adult or older, having no interest in what general children will play, playing what should not been played, no imagination, cannot assume one thing as another such as wooden block put orderly to form toy train, rock as sweet, cannot differentiate or avoid dangerous thing such as when seeing the barking, aggressive dog the child walking in and touch the dog.
For Language: many children begin to talk but with the repeated words, talking without knowing the meaning, wrong order of words in the sentence, cannot answer the question, speak the alien language.
For Behavior: the children will have strange individual poses, jumping while shaking their hands out when glad or excited, walking on tiptoe. They will pay too much attention on something such as good logos, bottle collection, look at the same picture, stare for a long time at electrical fan, shaking out CD to look at the light and shadow, having the same menu, wearing the same shirt or same color. If the routine activities are changed they will be angry and aggressive.
Although, the autistic children do not understand others mood from facial expression and gesture, they have their own. They may be angry, sad, lonely, jealous, and glad. They also need love and attraction as the normal children do.
The naughty, non-calm behavior as known as Hyperactive can be found by 70% among the autistic children.
They are often found to have intellectual disability by 50%-70% while also found that they have talents by 10%.
Lorna Wing divided the autistic into 3 groups according to their behavior and social interaction as follow:
1. Aloof
2. Passive
3. Active but Odd
It was found that such classification is relating to the IQ. The separated group is also having the intellectual disability. The group with social participation generally have high intellectual.
Caring/ cure
How to diagnose autistic?
The manual for psychiatry diagnosis, DSM-IV, 1994 by the Psychiatrist Association of America has defined autistic disease into Pervasive Developmental Disorders; PDDs which will express the symptoms obviously in the childhood and will result in social interaction and communication developments unusual. The child will have unusual behavior, interest and activities.
Pervasive Developmental Disorders; PDDs is comparable to Autistic Spectrum Disorder which is classified into 5 categories:
1. Autistic Disorder
2. Retts Disorder
3. Childhood Disintegrative Disorder
4. Aspergers Disorder
5. Pervasive Developmental Disorder Not Otherwise Specified; PDD-NOS
Hereby, only the autistic diagnosis criteria will be mentioned; the criteria are:
A. meet 6 or more of the following criteria (1), (2), and (3) and at least 2 must be from item (1) while the rest must contain item from (2) and (3).
1. The behavior of social disorder; at least 2 of them
1.1. Incapability of doing poses (eye contact, facial expression, behavior, or social action).
1.2. Cannot establish relationship among friends of the same age.
1.3. Express no interest to join the group, activities, or help other to work (No expression, ideas, interest, etc.).
1.4. No emotional relative to social
2. The behavior of social disorder, at least 1 of them
2.1. Non-speaking or delay development of speaking without showing that the other ways of communication are required.
2.2. In the case of speaking capable, unable to begin speaking or continue conversation with others.
2.3. Repeating certain words or alien language.
2.4. No various role plays, no imagination, no imitation appropriate to development.
3. Having limited behavior, interest, or activities, repetition and keeping, showing at least 1 of the followings;
3.1. Immerse to the same behavior, limited interest in things which is the disorder of violence or interest.
3.2. Addicted to routine activities or repeat doing something without flexibility.
3.3. Repeat the same action such as, turning, swaying, etc.
3.4. Concentrate on some parts of object
B. Delay or abnormal before 3 years old, at least 1 of the followings:
(1) Social interaction
(2) Communication language
(3) Role play or imagination
C. Retts Disorder or better fit Childhood Disintegrative Disorder
Autistic Caring Guide
1) Family Empowerment
The family plays the most important role in caring the autistic not ones responsibility. The power of family is the power of success.
The understanding of autistic can be achieved from learning and it is necessary because it will help in caring the autistic on the right way. All parents begin with the unknown knowledge and the goal of success is different depending on the individual learning.
Various skills shall be collected in accordance with experience. It shall not be worried but starting to train the child and later develop by instruction from the specialist.
2) Ability Enhancement
If the correction is only emphasized on the disorder it will discourage our will in that we will see only problems. If we also emphasize on the ability enhancement we will get will power from the improvement.
The talents in this case are not necessary always the big things but some thing that children can do such as what sounds they can produce, what they do say, what they can play, what they do help themselves. Later these abilities shall be extended to be better. Give opportunity to the children so that they can do it regularly and add something close and similar that they can further practice. This will make learning easier and more extended. To give the chance for the children so that they can participate in various activities such as music, sports, art, normal works of parents, will help the children to reveal their abilities.
3) Early Intervention
Development enhancement is to arrange activities for children recognizing the principles and the childs developments. They shall be provided when the child was young and shall be regular and continuous with sufficient time. The practice shall be performed in accordance with the problem conditions, ability, and learning proficiency which is different individually.
The fundamental skills primarily trained, in order to bring the children out of their private world, are eye contact, concentration, listening, and order following. These skills at the beginning of training may take time and slow improvement which will cause stress to both children and parents. However, when the children have some basic skills, further practice will not difficult anymore.
4) Behavior Therapy
The behavioral therapy program composes of Applied Behavior Analysis ABA and Behavioral Modification Procedure, which aims to enhance the appropriate behavior to be sustainable, stop negative behavior, and build new behavior.
The behavioral therapy performed at the very young and with continuality will enhance the skills on linguistic, social, and others, including decreasing the parents stress.
The fundamental technique is from the learning theory. The technique that yields the satisfying result is reinforcement when expressing positive behavior. Reinforcement includes concrete objects such as sweet, toys, stickers and abstract such as praise, applaud, smile, hug, etc.
5) Medical Rehabilitation
The medical rehabilitation composes of speech correction, occupation therapy, or physical therapy (in the case of muscular and movement problems).
Speech Therapy
The sooner the child can speak the more chance the language development will be reach. At the same time, inappropriate language use is decreased. Thus speech correction is significant.
Speech correction expert is Speech Therapist/ Speech Pathologist. The one who play the important role is, however, the parents who are close to their child. Parents shall not wait for the training day to come because it is rather useless to do that. Parents can stimulate the child to talk by creating the situation such as jigsaw composition. One piece may be hidden and waiting for the call from the child; or to put another childs shoes and the child shall say no or not mine and ask for his/her own shoes. In additions, techniques which are gained from the specialist are recommended for home practice.
Speaking is the best way of communication. If the child cannot speak, other method shall compensate in order for the child to communicate what they want. These methods are called Augmentative and Alternative Communication; AAC and to be used temporary, or permanently in the case of severe speaking for example Visual Strategies, Picture Exchange Communication System; PECS, Communication Devices, and talking program etc.
Occupational Therapy
To apply activities to be used in assessment, diagnosis, enhancement, therapy, and rehabilitation so that the children can live their life in the community. It will also help concentration, thinking skill, fine motor development, and muscles coordination through various kinds of learning by the Occupational Therapist who will apply different activities for individual in accordance with his/her problems.
6) Educational Rehabilitation
The educational rehabilitation plays an important role in enhancing social skill, communication, including thinking skill. In the long term, it will be fertilized. The content of the curriculum will emphasize on the preparation or daily life instead of academic learning only.
Individualized Education Program; IEP needs to be designed to meet ability, disability and interest of individual child in order for the child to remember easily and not without confusion. The children can use the skill from the classroom for everyday activities.
Nowadays, there are more educational options which include special education, co-education, parallel classrooms, ordinary classroom, including non-formal and informal education.
7) Social Rehabilitation
Social rehabilitation composes of daily skill and social skill practice in order for the autistic children can live their life in the community as normal.
Activity of Daily Living Training
There shall be a learning procedure management about the routine life. It will enable the children to help themselves with their ability with least assistance.
In practice, children need to learn until they can do from what they have learnt. They will be familiar with these activities which will stay with them to be used in everyday life. And that they can help themselves in accordance with their potential, reducing caring by parent, and they will be proud of themselves when they can do the activities.
Social Skill Training
Social skill is the autistics disorder. The practice thus shall be especially performed. The practice may simulate social events or situations in which the child can practice. The dialogues may be taught in order to be directly used by the child.
To teach about social story which is originated by Carol Gray, the story or social event or situation will be defined emphasizing on significant social features, interaction from both general and autistic children including the reason of the answers. This will help the autistic children to understand the social situation, understand mood and others feeling, and finally behave in synchronization with the situation.
8) Vocational Rehabilitation
The idea of vocational rehabilitation has currently changed from working in the hospital or health services to the real laboring markets or own business under the systematic supervision, training, job seeking, and support.
To reach the goal which the autistic people can work, having their own income, and living with freedom and less dependent, it is necessary to prepare the working skills for them such as punctuality, adaptation to the head at office and colleagues, safety at work, etc. This includes the basic vocational skills training along this time.
The autistic people can have their career as normal people do if the preparedness is appropriate arranged and welcome by the community.
9) Pharmacotherapy
Pharmacotherapy does not aim to directly cure for the autistic but to mitigate some parallel symptoms. Not all children do need pharmacotherapy and once taking pharmacotherapy it is not necessary to take it for life. The doctor may adjust the dose or stop taking when the target is mitigated.
Nowadays, it has not found that which medicine helps correcting social and communication disorders which are the main problems of the autistic child. The medicine using is found to be useful for mitigate naughty behavior, non-concentration, aggressiveness, and immersion.
10) Alternative Therapy
Besides the mainstream of therapy mentioned above, we presently have various ways of alternative therapy which can be used to support the mainstream therapy as appropriate regarding the childs response.
The most important thing to understand is the alternative therapy is used to support the main therapy for better efficiency. It shall never been singularly used. The alternative therapy includes:
1. Augmentative and Alternative Communication; AAC
2. Art Therapy
3. Music Therapy
4. HEG; Hemoencephalogram
5. Acupuncture
6. Animal Therapy
7. Robot Therapy
Recommendations
What to do when your child found autistic?
Although nowadays, no medical care that will permanently cure the autistic, it can improve the childs development to the full potential. He/she can learn and living their life as happy as normal child.
The way of care, in whatever directions, shall begin with love and the child can reach his/her goal with full potential reasonably.
Care with love is something inundated in the parents hearts. It, however, sometimes is blocked by stress, worry, bore, tiredness, and other feelings for some times. It is normal for the parents to feel such emotions. More important is they must manage their feeling with care.
Inundation love might not be enough for the child assistance if lack of understanding. Taking care of the child needs special development procedure. Knowledge, understanding, right attitude, good skill and adaptive techniques shall contain in parents.
Caring needs different ways together by the professional staff from different disciplines. The care will meet individual child for the most efficient. For the main route of help, it will be further mention in the 10 ways to health the autistics.
How will they be in an adult life?
It was found that 2 out of 3 of the autistic children have to be dependent on others and need one who takes care for life. 1 out of 3 can help themselves and need only advice occasionally while 1%-2%are fully self-dependent and have a career and live their life like normal people.
The key to tell whether the children will have their clear future is the intellect and ability to communicate. From the report it tells that the children with low IQ (<50), have epilepsy during teenage, or non-speaking at 5 years old, have not so bright tendency.
It was found that 4%-32% of the autistic commonly have epilepsy which will be found when they are growing, especially when they are teenager which tends to worse situation.
It was found that an appropriate care based on the academic principles if performed in the first 3 years of age will result in better than later given. Therefore, the earlier the diagnosis the better the result of caring.
How to prevent autistic?
To prevent autistic is currently not applicable because we can still not to locate the cause of the disease and yet no way to detect before pregnancy. It, however, can prevent the severe symptom by doing screening test to get the right problem as soon as possible, then enter the assistance program earlier and continuously.
The important keys for autistic prediction for the child of 18 months old or older compose of 4 factors. If found 2 factors or more then think of autistic and proceed to confirm the diagnosis with in time assistance.
1. No role play, no imagination
2. Cannot use finger to point out their need
3. No interest to join the group
