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Autism spectrum disorders (ASD) are abnormalities that affect the way the brain develops and functions. Most of the child development is affected and results in problems in communication, unusual behaviours, and social interactions are impacted. There is a range of conditions under this title which includes autism, Asperger's syndrome, and high functioning autism. It may present with moderate symptoms that affect the child slightly, to being severe such that it affects the child's life in whole. Learning and thinking capabilities of children with these disorders may vary from individuals who are well gifted to those who are severely limited. It starts to present at the age of 3 years and may cause problems throughout the life of a person. It occurs in all races, ethnic, and social-economic groups. Males are more prone to get autism than females.
Scientists believe that both genes and environment exposure play a significant role in causing autism, but no known cause of autism is known. It has been shown that it runs in families as for identical twins if one has autism there is an eighty percentage that the other also has autism (Nan, 2017). A firstborn child with autism in a family there is also a high chance that other children who are going to follow might have autism (Eve, 2012). Some evidence is available that supports the theory that viruses and infections may cause some form of autism. Inadequate parenting does not cause autism as people have tried to suggest. However, parents may play a significant role in planning and doing interventions after the diagnoses of autism. According to World Health Organization 1 in 160 children has ASD. It is an estimate of different studies gives different figures. The prevalence in low and middle-income countries is unknown. There has been an increase in the number of cases of children with autism which may be attributed to increased awareness, better diagnostic tools, and improved reporting.
Modern medicine has based its treatment options on scientifically approved options. It has been a known tradition that has been practised for long, and it is continuing to receive appraisal on its use in the medical field. The educational sector also requires the use of appropriate interventions to assist in the classroom learning. Such interventions can only be standardised by scientifically based studies. They have been promoted in the ASD community currently as previously controversial methods have been used with few positive results and has resulted in the delay of identifying appropriate interventions to individuals suffering from ASD.
A significant hindrance occurs in the use of evidence-based practices in the management of ASD which is lack of an agreement on how to recognise and examine scientifically effective and standardised interventions. For a specific method to be termed scientific, it has to comply with particular standards, gives positive outcomes, and pass a thorough peer review process. Moreover, they have to undergo a specific design of randomised samples with control groups and experimental groups. It has been criticised that it has many restrictions that have researched ASD to be challenging to conduct. Although with its incorporation improved outcomes have been documented.
American Academy of Pediatrics described the various basic principles that should be used for a successful early intervention to occur. It is advised that the best time to start intervention is when ASD is suspected and not when a precise diagnosis is made. Educator to students' ratio should approach a 1:1 ratio, this ensures individualised care is achieved. Intensive therapy should be given to children 25 hours per week for 12 months. Guardians should be incorporated into the training and another family member. Social interaction, especially with peers, should be encouraged as it assists these students to relax and become more proactive socially. Continuous assessment of the skills learned helps monitor the progress of the child.
Applied behaviour analysis (ABA) is a process of using behavioural principles to bring about change in specific behaviours while assessing the success of the intervention. It concentrates on prevention and remediation of problem behaviour (Eve, 2012). Most of the attention is directed to the physical and social environment, also the antecedent conditions and consequences that stimulate and maintain behaviour. Various studies have recorded the effectiveness of ABA with patients who have ASD. It should be done in the presence of a trained behaviour analyst. Studies have shown it should be started at an early for positive outcomes to be achieved, optimally below the age of 5 years (Mody Maria, 2013). In a week the 15 to 40 hours is the optimum amount of time an individual should receive ABA depending whether it is being applied to comprehensive educational programming in schools or to a targeted behavioural treatment program. Health care providers training to provide ABA in rural areas and the community is proving to be a strategic approach to these areas also teleconsultation is assisting in providing these service. Parent training has been shown to be too useful in reducing and building social communication in children with ASD. ABA can be used for all ages and ability levels.
Discrete trial training was vigorously used by Ivar Lovaas and is incorporated in behaviour learning theory and applied behaviour analysis. It is where a child is presented with a stimulus and based on the response the child gives he gets a consequence which is a reward (Young et al, 2016). It employs modelling, errorless learning, shaping, correction, and facing to foster skill acquisition. It is the best approach for skills that are well taught in small, repetitive steps (Shillingsburg et al, 2014). Substantial evidence has shown that this method can produce powerful behavioural outcomes in the field of language, imitation and play, motor skills, academics emotional expression, and reduction of aggressive and self-stimulatory behaviours (Radley et al, 2015). Specialized training is required to provide this intervention, but it may be used for all ages and ability levels.
Functional communication training is a method that focuses on replacing inappropriate behaviours with appropriate ones and effective communication (Mody Maria, 2013). Through functional behavioural analysis, the inappropriate actions are identified then socially, and acceptable responses are taught to replace the former (Schmidt et al, 2014). Studies have shown it is a very useful method for reducing problem behaviour and promoting communication and social interactions. It can be used by individuals of all ages, but it is more effective in kids whose language and cognitive abilities are limited (Fragale et al, 2016). It should be delivered through weekly training sessions with both the children and their guardians.
Pivotal response training is quite effective in developing play, communication, and social behaviours as it builds on the child's interests and initiative. It employs various learning variables which include self-management, self-initiation, multiple cues, and motivation (Brock, Dueker, & Barczak, 2017). Studies have outlined the effectiveness of this method in promoting play and language skills. It should be given by guardians and educators in the natural context (Mohammadzaheri, Koegel, Rezaei, & Bakhshi, 2015). It is best for young children and adults with moderate cognitive impairments.
Antecedent-Based interventions are where conditions are put in place that increases the chances of success and reduces the chances of problem behaviour occurring. Certain antecedent procedures are used and include cueing, modifying task demands, errorless learning, time delay behavioural momentum, and priming (Nan, 2017). It has been associated with high chances of success. It may be used for all ages and ability levels.
Early intensive interventions programs that combine ABA methods with developmental approaches research have shown they improve behaviour, cognitive, and communication abilities. As suggested earlier in discrete trial training used by Lovaas are the most used, and most studies for these type of program have been done.
Social skills training is another approach that has been shown by NCPC and NAC standards to work. Social interactions are a major problem in ASD thus interventions which are directed to various social skills have been shown to remedy the situation (Mody Maria, 2013). In developing prosocial skills, these groups have shown telling of social stories is an excellent approach to assist these individuals. Encouraging peers to help them develop these skills is also a good strategy that has been shown to work. Research has shown that certain parts of interaction such as eye contact, verbal greetings can be acquired by these patients with focused training. It is still a new trend rather an established way of doing things according to NAC but with a high success rate.
Cognitive-behavioural therapy is among the most applied strategy that is used in people with various emotional and mental disability such as major depressive disorder, and it is currently being utilized in autism. Studies on these approach among young adults with mood disorders are diverse (Wood et al, 2015). It aims at substituting inappropriate train of thoughts and behavioural patterns with better strategies that assist in improving adaptive functioning and the mood of the patient (Selles et al, 2015). Self-management is the most studied in this category it is where the learner is given independence to manage his behaviour and act in the right way in the natural setting of class, home, and in the community (Wolters et al, 2016). Individuals are taught to differentiate between inappropriate and appropriate behaviours, assess and record their behaviour, and congratulate themselves for behaving in an accepted way. It is a good strategy since as learners become more aware of their challenges the burden shift from guardians, educators and other caregivers to themselves.
Pharmacological therapy is quite challenging to use in the treatment of autism as there is no medication that can directly treat social and language difficulties that are observed in autism (Stepanova et al, 2017). However, there are various psychiatric conditions that their signs resemble those of ASD and are managed by drugs. They include depression, anxiety, sleep disorders, attention deficit hyperactive disorder, and obsessive-compulsive disorder (Rudolph, & Mohler, 2014). Medicines that are employed to manage these conditions are the selective serotonin reuptake inhibitors such as fluoxetine, antipsychotics such as risperidone to treat repetitive and mood conditions, and stimulants used to treat attention deficits (Dineley, Pandya, & Yakel, 2015). Although there are studies that have confirmed the use of atypical antipsychotics to treat problematic repetitive disorder they are associated with significant side effects.
The picture exchange communication system is a strategy aimed at assisting people with expressive communication difficulties (Cooper, 2017). Therapists teach individuals to exchange pictorial cards for desired items; they then tag a verbal label on the exchanged items (Thiemann-Bourque, 2016). It also targets initiation of social contact in kids with ASD. After this intervention, studies have shown an improvement in functional communication.
Visual supports which are designed work tasks and schedules that are given visually have been shown to assist these individuals...
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