Introduction
Autism is the most prevalent developmental disorder affecting one in every 166 children (“How Common?”, 2006). Symptoms of the disorder can be generally described as the incapability to adequately interact socially along with a disinterested demeanor. It is an abnormality in the structure of the brain caused by genetic predispositions or damage occurring during the development phase (Bryson & Smith, 1998).
Children afflicted with fetal alcohol syndrome, those infected with rubella while in the womb and those whose mother took drugs known to cause damage to the fetus show symptoms of autism to a greater degree than is typical. “Although the reported association between autism and obstetrical hazard may be due to genetic factors there is evidence that several different causes of toxic or infectious damage to the central nervous system during early development also may contribute to autism” (Williams & Hersh, 1997).
A malfunction in the neural circuitry of the brain of those with autism is the likely cause of their perceptions regarding social interaction and lack of adequate cognitive abilities. Studies have yet to produce evidence that demonstrates specific areas of the brain are damaged in persons with autism. On the contrary, several sections of the brain have shown abnormalities during image scans. There is overwhelming evidence, however, for a genetic influence. The identical twin is more likely to have autism if their twin has it but fraternal twins have no more of a predisposition to contract the disorder than would the general public (Cook, 1998).
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The severity of autism varies widely among individuals as does its related symptoms but there are certain aspects relating to social interaction shared by all with the disorder.
Avoiding direct eye contact, distinctive body posturing and facial expressions as well as other nonverbal communication deficiencies are a common traits. Autistic children seldom associate with those of their own age group as well as showing a general disinterest in interacting with any other people. They also do not demonstrate empathy because they lack an understanding of another person’s sorrow or pain.
Deficiencies in communication skills can include symptoms such as a delay in speaking development or not being able to speak at all. About half of those with autism never learn to talk. Of those that do, most have great difficulty focusing and staying within the subject parameters of a conversation. Habitual repetitiveness of words or phrases is a common trait as is the lack of understanding satire or an implied, underlying meaning. A lack of interest in play or other activities is common as is being fixated on a single item. Young autistic children usually focus their concentration on one part of a toy instead of playing with the toy as a whole.
Teenagers and adults are frequently mesmerized by such things as license plates, bus schedules and weather patterns, for example. The compulsion for routines such as insisting that they always eat the meat portion of a meal before the salad and must be driven along the same route illustrate this need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same roads to school. Lastly, is the well-recognized rocking back and forth behavior commonly observed in those with autism (Volkmar, 2000).
The testing of a child suspected of having autism should begin with an assessment of behaviors. Health professionals possess questionnaires and guidelines that assist them in determining the particular variety of developmental disorder a child may have and how far behind they are as compared to typical aged children. First, the child’s medical history is reviewed. The parents are questioned as to whether the child demonstrates what they want by pointing at the object.
Autistic children point to things they want but do not look back at the parent to see if they acknowledge the desire. Developmental delays in physical, cognitive and decision-making abilities are observed. Assessments of specific physical abilities and growth patterns are assessed to determine whether or not the symptoms are purely physical in nature. Hearing is checked because this may retard language skills not associated with autism.
Additionally, children suspected of a developmental disorder are tested for lead poisoning. “Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible” (“Autism Disorder”, 2000).
Autism and other neurological disorders are defined by characteristics of behavior and are commonly considered to be biological in origin and not caused by improper parenting or by varying social situations a young child may have experienced. The precise fundamental neurological causes have not been identified but remain the source of the condition. Though differing theories have been postulated, none have stood up to intense scientific scrutiny and analysis.
Many variables are present when attempting to specifically define the source although autism unquestionably does not originate from how a child is nurtured. Because of many possible causes and varying severities of the disorder, there is no one definitive type of treatment. However, there are strategies that have proven to help all autistic children to enhance overall physical and cognitive functions and to realize their potential. For example, “behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication” (Committee on Children with Disabilities, 2001). Also included are specialized treatments to improve speech and physical deficiencies.
Medication to treat hyperactivity, depression and/or compulsive behaviors are commonly prescribed as well which put the child in state of mind more susceptible to learning modified behaviors.
The objective of treatment is to enhance the child’s language and social development and to curb behaviors that impede the child’s learning capabilities. A cure is not possible because autism is a chronic cognitive disorder, its disabling effects last for a lifetime. Learning programs adapted to the autistic child’s specific needs and abilities if applied early on in their life greatly increases their ability to learn language skills and helps to increase their ability to learn other aspects of communication as well. Well-structured education curriculums assist autistic children to attain social skills in addition to learning to attend to their own needs.
Studies over the past decade have consistently demonstrated encouraging outcomes even for children of a very young age. Three decades of research has demonstrated the effectiveness of functional behavioral techniques which has generally proved to reduce improper social behavior patterns and enhance communication skills. A study of intervention methods was conducted on autistic children who were treated with extensive behavior modification therapy for two years as compared to a control group that was provided no such training.
“Follow-up of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling” (Lovaas, 1987).
Autism is very much an inherited disorder. If an identical twin is autistic, the other twin also will be in nine out of 10 cases.
If a sibling has it, their brothers and sisters are 35 times as likely to have it than the average (“Gene Linked”, 2006). Just because the disorder is of biological origin does not imply that the condition cannot be improved upon. “It is now known that early, intensive behavioral programs can eliminate completely the symptoms of autism in some children and greatly improve the lives of many others” (Smith, Eikeseth, Kelvstrand & Lovaas, 1997).
The four main developmental disorders identified as Autism are ‘Rett’s Syndrome,’ ‘Childhood Disintegrative Disorder,’ ‘Asperger’s Disorder’ and ‘Pervasive Developmental Disorder (PDD)’ (DSM-IV, 1994).
Presently, there are no physical, neurological or genetic indicators which can be used to differentiate an autistic person from those with comparable behavioral dispositions. The term autism is used for people that display particular behaviors. Some of the characteristics which relate specifically to autism should be apparent before a child reaches age three.
These characteristics include considerable problems interacting socially, in other words, rarely notices other people; doesn’t attempt to interact with others; has substantial difficulty when trying to communicate either verbally or nonverbally; simply takes or leads someone to retrieve something they want; repeatedly mimics words and phrases; shows little imagination, plays by stacking lining up toys and plays only with a single part; stares at objects and are not comfortable with change (DSM-IV, 1994).
Unlike autism, ‘Rett’s Disorder is related to a loss of previously mastered hand-eye coordination skills in children up to three years of age and signals the onset of acute mental retardation. Repetitive hand movements take the place of lost motor skills. ‘Childhood Disintegrative Disorder’ describes a sizeable deficit of language, social behavior, and play after developing normally for at least the first two years of life. Both Rett’s and Childhood Disintegrative Disorder are rare, much more so than autism.
‘Asperger’s Disorder’ primarily concerns the area of social relations. Language and cognitive development is not delayed significantly. Development of other adaptive behavior, cognition, and language are not significantly delayed. The child also displays repetitive behavior patterns. The ‘Pervasive Developmental Disorder’ label is applied when “severe impairments in reciprocal social interaction or communication skills are present or when stereotyped and restricted activities and interests are exhibited” (DSM-IV, 1994). The symptoms are similar to autism but fail to meet most of those listed for autism. This development impaired category is sometimes referred to as ‘atypical autism.’
Behavioral studies and therapy programs have, for the most part, evolved separately because of issues regarding initial diagnosis. Behavioral investigations begin with a detailed study of the individual including their current life circumstances, needs and strengths. Autism studies before 1980 were categorized as either a variation of schizophrenia or psychosis. Therapeutic research regarding autism had been placed under these descriptions.
Those diagnosed under this criteria should be re-examined to establish if they are classified improperly, therefore, receiving inappropriate treatments. Those persons identified as mentally retarded prior to the 1980s may in fact suffer from autism. “Although not required by behavior analysts for planning and implementing intervention programs, a diagnosis based on complete neurophysiologic and psychological examinations is essential” (DSM-IV, 1994).
Well-designed and personalized programs targeted to manage an autistic person’s biological disorder have proven to take full advantage of their learning potential thus lessening the effects of autism. This affliction that causes anti-social actions is a product of nature and the effects can be greatly reduced by nurturing its behavioral aspects.
Biological causes and environmental solutions function in an interdependent fashion. Environmental stimulation influences the maturation process of all people, autistic persons are no exception. When people seldom interact with others, they cannot effectively learn and withdraw from social activities. Those that focus too much of their concentration on the same type of activity or thing are not developing and learning at an optimum rate.
People who tend to do this the majority of the time are labeled as autistic. Interaction is the founding principle of the behavioral approach to teaching autistic students: “… they need specially prepared programs that will teach them to learn from their parents, siblings, peers and others” (Rutter, 1997).
Autism is a condition commonly misunderstood by those not directly affected by it. The numerous therapies such as music, touch, speech, physical, audio/visual and drugs are designed to alleviate symptoms and the subject of debate as to their effectiveness in particular cases among those more knowledgeable of this affliction. While no therapy can cure autism, their use whether individual or combined has shown to ease the debilitating effects of the ailment. Autistic children do not normally demonstratively share feelings of affection. They shy away from hugs and show little if any noticeable response when experiencing pleasure.
This emotional disconnection, or more precisely, the inability to show appropriate emotions, is the most difficult aspect of this affliction for parents. The use of massage therapy has proved beneficial for autistic children who typically dislike being touched. Following massage techniques a lesser degree of autistic mannerisms is discernable.
Studies have shown that autistic children become more attentive, socially aware, are less averse to touch and not as likely to withdraw after receiving a massage treatment from their parents.
Massage therapy offers the nurturing all children crave and is perceived by the autistic child as non-threatening.
“Given that autistic children have been reported to be opposed to physical contact, it is interesting that many massage therapists, and parents, are finding great success in the use of massage therapy with autistic children” (Allen, 2007)
Oxytocin is a hormone that is significantly deficient in autistic children. This hormone is related to emotions such as feelings of affection. Increasing the level of Oxytocin triggers relaxed sensations, decreases stress and promotes congenial reactions when interacting with others. Several studies have confirmed that the body releases Oxytocin not only during but also following a gentle massage or touch.
A study that concentrated solely on autistic children reported oxytocin helped these individuals maintain the capability to appraise the emotional nuances of language usage. This hormonal release decreases the instances and severity of repetitive behaviors distinctive to autism. Autistic children seldom remain asleep the entire night and are generally restless even while sleeping. Massage therapy promotes a more restful, less disrupted and longer duration of sleep.
“Through the use of massage therapy, our basic human need for safe, nurturing contact is met with often wonderful results. For children with autism, it provides not only a positive experience of being touched, but the effects hold lifelong benefits” (Allen, 2007)
All five senses are essential for correctly interpreting life experiences. The autistic child suffers from a synaptic disconnect which means they often misinterpret what is sensed and how it is perceived. For instance, when most people eat a peach, they use the sense of smell, taste and touch to identify the experience. However, the autistic child might interpret the fuzz of the peach as painful to the touch and what is a pleasant smell to others might cause them to become physically ill. Some autistic children find common, everyday sounds to be extraordinarily annoying, even painful.
Professionals in the field have termed this disconnection between what is interpreted by senses of autistic children and what is reality as ‘sensory integration difficulty’. The sense of touch, as discussed, for many autistic children is not thought of as comforting but irritating. The automatic retraction after being touched, displaying violent behaviors and declining to eat specific types of food because of its texture are all indications of autism manifested as a ‘sensory integration dysfunction’ of the nervous system. (Cutler, 2007)
The nervous system and skin emanate from the same component of the embryonic tissue. Because of this, those with an underdeveloped nervous system such as autistics, have an extreme sensitivity to even gentle touching. “A properly functioning tactile system accurately transmits information from the skin’s receptors to the central nervous system. When the tactile system is immature and working improperly, neural signals sent to the brain’s cortex interfere with other brain processes. This interference causes over-stimulation of the brain, making it difficult to both organizational behavior and concentrate and can cause a negative emotional response to touch” (Cutler, 2007) A typical indication of autism is a child who will band their head on the wall without feeling apparent pain but recoils sharply when lightly touched.
Massage therapy applied to autistic children should take this into account. “Since light touch is over-stimulating to those with autism, deeper massage techniques and joint compression are better tolerated. Utilizing methods of sustained moderate pressure can help dampen the nervous system’s over-reactivity” (Cutler, 2007)
Effective massage techniques have been designed specifically for those with an immature nervous system such as autistic children. The session should begin in a relaxed, quiet environment with deep massaging strokes, not light touches so that the child accepts the nurturing contact.
Background music of the child’s choosing often helps to create a suitable atmosphere. Initiating the massage requires performing a task previously not considered by either the parent or child and should be approached with great care and forethought.
After explaining in calm, sure voice what is about to occur then “place your hands on his/her upper back or back of the head for as long as they allow. If no resistance is met, proceed and do a back or head massage using deeper strokes. If there is resistance, remove your hand, wait a few seconds, and then return your hand to its original position” (Regina-Whiteley, 2005) Some children will refuse to accept touching of any kind at first. Asking them to use their own hand to massage their leg, another hand, arm, etc. will act to reassure and calm them. The message sessions should be kept short in the beginning and slowly expanded over time. Only touch the parts of the body that the child considers comfortable and by incorporating breathing exercises helps them to relax.
According to a 1997 study at the Touch Research Institute, touch therapy was shown to be useful in reducing the frequency and intensity of typical autistic behavior such as withdrawal, aversion to touch and inattentiveness.
Researchers at the Institute further demonstrated that touch therapy improved communication skills and increased the attention span of autistic children. The benefits of massage are likely attributed to the relaxing nature of the event, the physical contact between parent and child, an act not previously a part of the relationship and the invigoration of the nervous system. “The dysfunction of the nervous system’s sensory integration typically seen with autism can be minimized with touch therapy. Massage therapists showing interest in this condition can be a child’s bridge between autism’s seclusion and normal, developmental socialization” (Regina-Whiteley, 2005)
Touch therapy is proven to be an effective method by which to diminish the effects of autism and forge a deeper bond between parent and child. With frequent breaks to employ massage therapy techniques, the experience can be productive. Massage during play will allow the child to participate for a longer period thus gain more from the experience. Parents should not be locked into past misconceptions regarding the limitations of autism and seek innovative ways to give their autistic child a ‘normal’ life as possible such as combining massage therapy with an activity previously thought impossible for the autistic child to enjoy.
Conclusion
The principal objective in the treatment of autism is to enhance the overall capacity of a child to function in society at the highest level possible given the unique circumstances for each individual. The most important factor in the treatment of autistic children and ensuring they reach their optimum potential is identifying the developmental disorder as early as possible. The behaviors and symptoms of autism are many, varied and are capable of intertwining in a countless number of ways including different levels of severity. Additionally, an individual’s behaviors and symptoms frequently change with time.
Autistic children are most responsive to treatment that is specialized, amply structured and custom-tailored to suit the individual’s needs. Treatment programs that focus on assisting parents in improving behavioral, social, adaptive and communicative skills collectively in a positive, customized learning environment will ensure that the autistic child will be able to make the most out of their life.
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