Parents usually notice signs in the first two years of their child's life. Although early behavioural or cognitive intervention can help children gain self-care, social, and communication skills, there is no known cure
Social development
Social deficits distinguish autism and the related autism spectrum disorders (ASD; see Classification) from other developmental disorders. People with autism have social impairments and often lack the intuition about others that many people take for granted.
Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name.
Autistic toddlers have more striking social deviance; for example, they have less eye contact and anticipatory postures and are more likely to communicate by manipulating another person's hand. Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers. They display moderately less attachment security than usual, although this feature disappears in children with higher mental development or less severe ASD. Older children and adults with ASD perform worse on tests of face and emotion recognition.
Contrary to common beliefs, autistic children do not prefer being alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Sometimes a friendship can be difficult to start with an autistic child, but can be beneficial to their social development and skills.
There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD. The limited data suggest that, in children with mental retardation, autism is associated with aggression, destruction of property, and tantrums.
A 2007 study interviewed parents of 67 children with ASD and reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in children with a history of language impairment.
A 2008 Swedish study found that, of individuals aged 15 or older discharged from hospital with a diagnosis of ASD, those who committed violent crimes were significantly more likely to have other psychopathological conditions such as psychosis.
Categorizes as follows.
1. Stereotypy is repetitive movement, such as hand flapping, making sounds, head rolling, or body rocking.
2. Compulsive behaviour is intended and appears to follow rules, such as arranging objects in a certain way.
3. Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
4. Ritualistic behaviour involves the performance of daily activities the same way each time, such as an unvarying menu or dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.
5. Restricted behaviour is limited in focus, interest, or activity, such as preoccupation with a single television program or toy.
6. Self-injury includes movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging. A 2007 study reported that self-injury at some point affected about 30% of children with ASD.
No single repetitive behaviour seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviours. Available approaches include applied behaviour analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.
Occupational Therapy and Sensory Integration Therapy
Traditional occupational therapy often is provided to promote development of self-care skills (eg, dressing, manipulating fasteners, using utensils, personal hygiene)and academic skills (eg, cutting with scissors, writing).
Occupational therapists also may assist in promoting development of play skills, modifying classroom materials and routines to improve attention and organization, and providing prevocational training. However, research regarding the efficacy of occupational therapy in ASDs is lacking. Sensory integration (SI) therapy often is used alone or as part of a broader program of occupational therapy for children with ASDs. The goal of SI therapy is not to teach specific skills or behaviours but to remediate deficits in neurologic processing and integration of sensory information to allow the child to interact with the environment in a more adaptive fashion. Unusual sensory responses are common in children with ASDs, but there is not good evidence that these symptoms differentiate ASDs from other developmental disorders, and the efficacy of SI therapy has not been demonstrated objectively. Available studies are plagued by methodological limitations, but proponents of SI note that higher-quality SI research is forthcoming. “Sensory” activities may be helpful as part of an overall program that uses desired sensory experiences to calm the child, reinforce a desired behaviour, or help with transitions between activities.
Education, Training, and Behavioural Interventions
1. An organized and structured full-day, full-year educational program that includes a predictable schedule and routine, curriculum modifications, and the services of well trained and experienced educational staff.
2. Applied behaviour analytic procedures to teach basic skills (communicative, adaptive, and academic), with specific strategies for generalization. A combination of discrete trial, verbal behaviour, incidental teaching, and pivotal response training should be provided.
3. Cognitive-behavioural strategies for executive function weaknesses and difficulties with temporal and sequential concepts (e.g., daily schedules and calendars depicting the major events, transitions, and responsibilities of the day, etc.).
4. Operant behavioural programming strategies (e.g., differential reinforcement procedures) are recommended to extinguish maladaptive behaviours, and foster adaptive ones – paying attention to the motivating potential of selected reinforces and the most effective length of reinforcement intervals.
5. Periodic functional analyses of behaviour will be of benefit in accurately identifying salient antecedent and consequent conditions that serve to maintain both adaptive and maladaptive patterns of behaviour. An in-home component is also quite important in order to foster the maintenance and generalization of adaptive skills.
6. A comprehensive social skills training program that spans school, home, and community environments. This should include curriculum-based training, ideally presented in a small group setting. Specific strategies should be implemented for enhancing skill generalization across social environments (school, home, community).
7. Ongoing communication training by an experienced speech and language pathologist is also most important, emphasizing pragmatics and semantics (within both verbal and nonverbal domains).
8. Adaptive skill training, basic social judgment, appropriate school-related social skills.
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