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ASD and potential barriers to normal lifestyle

Discuss about Autism Spectrum Disorder in the adolescent.

Every 1 in 100 children experiences difficulty in learning as well as in communicating with the external environment all over the world (Autism spectrum disorder (ASD), 2018). The reason behind this can include a wide variety of disorders that affect mental and developmental stages of life such as dyslexia, autism, dysgraphia and many others. In connection with classroom and learning, the paper focuses on Autism Spectrum Disorder (ASD) in children and adolescents as a potential barrier to normal lifestyle. Children are identified with this disorder at the earliest by 2 to 3 years of age. Sometimes symptoms of this disease are ignored and misinterpreted as it appears to be as a mild impairment in learning new words or understanding languages. Later during adolescence, the symptoms become prominent and the condition turns out to be more challenging for the affected individual in terms of learning and social communication. Exact cause of the disease is a topic of current research but several assumptions have been made by scientists regarding the cause of ASD. Therapies and approaches are available to address this condition.

Most recommended approaches involve helping the children in developing confidence about themselves and supporting them in performing normal activities. The following sections will discuss ASD in details and the interventions that can help the individuals suffering from this disorder.

Sources of information for this paper are primarily peer reviewed journals and articles. Those articles are accessible from Google scholar. Those articles have proper research methodologies and there are citations from other renowned publications. Each source belongs to recent five years and hence provides the latest information about the topic. The paper has taken data from websites recognised by the Government of New Zealand and Australia. These sites are authenticated by the Government and hence provide credible information.

The emerging number of individuals being diagnosed with ASD has become a concern for the family members, healthcare professionals and researchers in recent years. Autism is less a physical challenge and more an emotional difficulty in making a productive connection with the surrounding. Following sections will elaborate about the disease in details.

ASD is characterized on the basis of behavioural changes in children and adolescents compared to the normal behaviour in terms of speaking, social interaction, repetitive actions. It is originally a neuro-developmental impairment that affects both verbal and non-verbal communication, social abilities and behaviour. Generalised symptoms of this condition include a marked abnormality in non-verbal behaviours such as the autistic individual refuses to make eye contact with others even with the parents, abnormal facial expression, postures, failure to develop a friendship with friends of the similar age group and a feeling of discomfort with response to normal external stimuli. As the name suggests, ASD indicates a spectrum of symptoms and signs with different age group. In the age group 1 to 8 years, symptoms of ASD are unwillingness of the child to be picked up, to make eye contact, to respond to the name and other behavioural abnormalities (Lord et al., 2013). The neurologic symptoms such as seizures, impairment in motor neurons, insomnia are very common in children of the age group 8-16 years. There are evidence where adolescents with autism have been found without seizures. Medical signs of ASD are gastrointestinal complications such as irritable bowel, diarrhoea, vomiting and frequent abdominal pain (Hsiao, 2014). This disorder alters the hormonal signalling pathways in the body and the affected young individuals exhibit excess salivation, maturation delay of sex organs or rapid maturation of the same (Putnam et al., 2015). Another notable sign of the disorder is repeating certain actions or words or a phrase for a number of times. This phenomenon is called Echolalia. Autistic young of this age group use uncommon words which seem to be very abnormal with their age. They experience extreme difficulty in learning new things in school and cannot cope with their mates. A little change in the daily schedule such as a school excursion, makes them uncomfortable and extremely upset (Mannion, Leader & Healy, 2013). They do not intend to address others when they verbally communicate instead they talk on a particular topic with an unusual accent and tone. Abnormally obese condition has been detected in adolescents with ASD due to presence or absence of certain hormones and enzymes (Egan et al., 2013).

Symptoms of ASD in children and adolescents

Around 21.7 million individuals are affected with ASD worldwide. In New Zealand 1 in 66 individuals is diagnosed with this disorder. The estimated number of affected individuals in New Zealand is 65,000 (Altogether Autism, 2018). ASD is more prevalent than other disabilities such as cerebral palsy, deafness and blindness (Mannion, Leader, & Healy, 2013). Boys are 4 times more likely to be affected with ASD than girls due to some genetic complications (Schaefer & Mendelsohn, 2013). According to the statistical report, it seems that a large number of children and adolescents are detected with ASD in recent times than in the past. This is because earlier ASD diagnosis was not made until an individual reached his adulthood. The scenario has changed now and better diagnosis methods are available for the condition.

The exact reasons behind ASD occurrence in children and adolescents are still under investigation. Research evidence shows that there can be various factors associated with ASD. The primary finding in this context is anomaly in the genetic composition of an individual. It has been identified that mutation in specific essential genes and disorders in genetic loci are the key player in bringing about autism (Ronemus et al., 2014). Genetic analysis of patients revealed that the major genetic disorders responsible for ASD are cytogenetic chromosomal abnormality, copy number variation and single nucleotide polymorphism. Two of a few candidate genes for ASD discovered by researchers are neurexin1 on chromosome 1 and contactin4 on chromosome3 (Schaefer & Mendelsohn, 2013). Other genetic abnormalities associated with the disorder are fragile X-syndrome, abnormal metabolism of creatine and urea (Ronemus et al., 2014). The other causes are attributed as any damage to the brain by encephalitis, synaptic imparity, tuberous sclerosis, and contamination of maternal blood with rubella virus, heavy metals and other air pollutants during pregnancy (Sealey et al., 2016). Exposure to certain drugs during pregnancy can also lead to autistic child-birth (Zerbo et al., 2015). Another report shows that a child with an autistic sibling is 25 times more likely to show ASD. Physicians have identified that overdose of Mumps, Measles and Rubella vaccine can cause Autism Spectrum Disorder (Marques et al., 2014).

 The significant effect of such disorder on the adolescents is on the socialisation. With increasing speaking disabilities, difficulty in responding to external environment, physical challenges, feeling discomfort to normal transitions, frequent occurrence of digestive system disorder make the sufferer unable to concentrate on other issues around him except his difficulties (Hsiao, 2014). The child feels comfortable when he is alone. He does not want to show social gestures like smiling back, responding to his name. In this disorder, the child becomes distant from his parents, or he sometimes becomes extremely attached to his parents (Mannion, Leader & Healy, 2013). Inside the school premises, the child feels extreme challenge in keeping apace with the peers. New words, phrases seem to be impossible to learn to the child. Whenever asked, he talks on a single topic for unnecessarily long period instead of interacting with others. This creates an absolute hindrance to the process of socialisation of the child. The child refuses to go to school and avoids social gatherings. Children with abnormal physical appearance along with detected ASD, experience more challenges to overcome the problems. They cannot respond to both way conversations. They focus on insignificant actions such as moving an object from one place to another. As a result of these, the affected adolescents feel irritated without any valid reason. Synaptic dysfunction and other neuronal imparity make them intolerant to high pitch sounds, high-intensity light and other stimuli (Lord et al., 2013). This behaviour and the disorder does not affect the sufferers only, but it does potentially affect the parents and their psychological integrity adversely. Despite such difficulties, in some instances, young individuals with ASD have been found to excel in singing, painting, mathematics and other technological works (Sealey et al., 2016). They need proper guidance and a methodical approach so that they can overcome as much as possible regarding learning, socializing and behaving normally.

Incidence of ASD in New Zealand and worldwide

Cultural values lead our thoughts and feelings toward a specific direction. Likewise, Autism is believed and explained differently by people with different cultural belief. The disorder has been formally recognised as a disease since 1940s (Constantino & Charman, 2016). Despite this extended period of existence, queries regarding the disorder are yet to be resolved. Some people believe that Autism is an outcome of superior intelligence in mathematics and literature. According to their belief, those highly intelligent people are more likely to give birth to an autistic child. For example, Albert Einstein is known to have gone through ASD (Lord et al., 2013). Europeans believe that the reasons behind autism are associated with physical factors such as any harm or damage caused to the child in the mother womb or after birth. Some other communities like African and American feel that this defect in children is as a result of inadequate and inappropriate diet (Constantino & Charman, 2016). Some other views include connecting religious and superstitious aspects with Autism. They believe that Autism is a punishment from God or a result of witchcraft or black magic. Parents and family members with such unscientific belief make it extremely difficult for the child with the disorder to recover and the physicians are also unable to carry out proper treatment. Another critical issue in this connection is less supportive approach to the child and his family. In some instances, the family members are on different poles of concepts regarding the steps taken to overcome the problem (Hayes & Watson, 2013). The major issue regarding the disorder is the loss of efficiency in socialization in the adolescents. This makes the child with ASD excluded from all cultural associations. The active intervention would be to make the child culturally active using cultural programs and social activities involving the diseased (Kasari & Smith, 2013). Despite the need for enthusiastic support from the society, these sufferers get only refusal and very little acceptance. There is also a concept of different schools for autistic children. This leaves a negative impact on those affected and their family members. They start feeling isolated and inferior. Here is the need for awareness campaigns. These are under the cultural barriers to diagnose and treat the disorder.

Diagnosis:

Diagnosis of ASD in children is of extreme importance for various reasons. Diagnosis allows access to proper resources, mental and physical support and guidance for the children as well for the parents. The diagnosis helps the parents in interacting with their offspring with ASD and plan for a better future that would be different from what they have already planned for. In New Zealand, there are several Government guidelines available where best possible planning and practices are outlined (Altogether Autism, 2018). The assessment guidelines are not only for the healthcare professionals but also for the family members. Diagnostic approaches are not similar for sufferers of all parts of New Zealand taking into account the cultural and social issues. All the different approaches can be summed up in generalised guidelines which are essentially to be followed while diagnosing an adolescent with ASD. Firstly, the parents and the child should be informed prior in the form of discussion about the assessment process. This allows the parents to know and clarify whether they will be benefitted with the process or not and they will be asked for permission before asking for detailed explanation about the symptoms and disorder. The next step is recording the family history of the child, accidental incident happened during birth, when communication and social skills started developing, difficulties in learning, speaking and other abnormal behaviours observed in the child. The expression of the child is noted in different environments like inside the school, inside the diagnostic clinic, inside a play school environment. The child is under observation for identifying the exact difficulty in interacting, understanding a word, learning and remembering new concepts and other emotional activities are also noted. The child may be asked for an interview by a trained person who can make the child feel comfortable in answering to the questions (Altogether Autism, 2018). Diagnosis of ASD is as sensitive as the disease is. As there is no available method of detection of this disorder such as blood test or radiographic analysis, the method of screening should be useful and it should consider the psychological condition of the child and his parents. No stress should be imposed on the child in the process of diagnosis. The diagnosis should be made by skilled personnel such as occupational therapist, speech-language therapist. They assess the speech impairment, learning disabilities employing a team effort.  Geneticists are employed to carry out karyotyping and other genetic analysis in order to identify whether genetic inheritance is the reason behind the disorder. Medicine physicians are also a part of this diagnosis procedure as some children are affected with epilepsy, hearing inefficiency and blurred vision. Psychologists assess the strength and difficulties in the thinking ability of the child. Psychotherapists are not only needed to talk to the children but also to the parents. Parents with autistic child feel elevated stress than other parents. They also need support from the therapist to find ways to cope with this stress (Hayes & Watson, 2013). ASD is attributed with defective motor neuronal activities. The occupational therapist diagnoses such motor neurone defects regarding handwriting, reaction to usual sound and light, lack of coordination and finds proper link of all these symptoms to the disease (Altogether Autism, 2018). The diagnosis is elaborate, time-consuming and includes a myriad of variation and it is justified with the sensitivity of the disease.

Causes and genetic abnormalities associated with ASD

The risk factors associated with ASD include several environmental, genetic, biological and social issues. The debate among scientists regarding the genetic cause behind autism has finally come to an end and many genes have been so far identified to be associated with ASD. Inheritance and pedigree analysis also suggested that incidence of ASD in family history of a child potentiates risk of being affected (Schaefer & Mendelsohn, 2013). Chance of occurrence of ASD is influenced when the child has some other medical complications such as epilepsy, Down syndrome, tuber sclerosis. Development of ASD starts before birth, in the mother womb. Taking harmful drugs such as thalidomide, valproic acid during pregnancy can increase the chance of ASD occurrence (Lyall, Schmidt & Hertz-Picciotto, 2014). In certain studies, it has been stated that Vitamin D deficiency can contribute to the risks associated with ASD (Mazahery et al., 2016). Vaccination is a known issue with respect to ASD as heavy metals (mercury) are often used to preserve vaccines in laboratory. An overdose of these metals in the blood can lead to impairment of neurodevelopmental structure of a child (Sealey et al., 2016). Society and the environment around the child play a key role in ASD development. A gap in relationship with parents and family members enforces stress on the mind of a child and leads them to take the worst decision as suicide when they enter the adolescent stage. Unwillingness of the neighbours, peers in interacting increase the degree of challenges of ASD to a superior level. Myth and misconception about the disease among people surrounding the autistic individuals make it more difficult to overcome the problem.

Intense research and dedicated studies by physicians and research groups have made available a vast range of interventions to treat ASD. The therapies are in terms of medication, learning programs, school-based approach, behavioural and developmental skill training. The basis of these interventions is certain theories which validate those methods. One category of such methods is behavioural intervention (Kasari & Smith, 2013). This approach focuses on teaching the child new behaviours and actions with the help of structured techniques. One of such methods is incidental teaching technique which is established and supported by research to be effective. It promotes social interaction, learning enthusiasm in children with ASD. Another investigation approved behavioural approach to ASD is positive behavioural learning and it improves communication ability, academic efficiency, daily living activities. The developmental approach to address ASD refers to a method which enables a child to form positive, constructive bonding with his friends, family. There is not enough research evidence which can support this method as an effective method, but indeed it would not worsen the condition. Certain therapy based methods are also available to treat this disorder. For example speech therapy, use of sign languages, providing communication training, developing daily life based physical skills and sharing pictures of known objects to create a concept about those objects. Therapy-based treatments are mostly combined with other methods in order to achieve the best possible result. All of these approaches should be adopted by school authorities (MacDonald, Lord  & Ulrich, 2013). They should train their teachers with the help of psychologists and they should appoint therapist inside the school premises. The core medical treatments should be provided by physicians. The medicines are not effective in curing the disease. They can reduce the intensity of symptoms exhibited by the ASD affected children such as hyperactivity, anxiety, sleeping disturbances, obsessive compulsive disorder, and suicidal tendency. Both typical and atypical antipsychotics, stimulant drugs can be administered to get rid of the ASD associated over-reactions (Spencer et al., 2013). Medications should be prescribed only under the strict instructions of doctors. Some medicines such as naltrexone have caused long-term side effects in autistic children. Apart from all of these strategies, alternative methods are being structured by experts all over the world. Although these methods are not supported by research yet, the approaches are in the right direction. One such example is secretin therapy. The concept behind this therapy is that children with ASD can be injected with secretin. Secretin is a hormone essential for normal functioning of the stomach and intestine (Hsiao, 2014). ASD patients lack this hormone and thereby exhibit digestion impairment. This method can be harmful or can impart deleterious effects on children. Other interventions like modification in diet, music therapy are under extensive research to get approved and applied.

Effects of ASD on socialisation and behavior

 ASD is a disease of the body as well as of the mind. That is the reason why it should be addressed more compassionately and less professionally. There are research approved guidelines available to the teachers, parents, psychotherapists. These guidelines should be followed strictly. The parents should always take the first step. They should ignore all the wrong suggestions and they should seek help from psychologists as soon as ASD is detected in their children. School authorities should also play a responsible role in helping the children out from these problematic situations. School counsellors need to be appointed in each school. They are skilled personnel who boost up students and parents. They should also educate students other than those who have ASD and help them in interacting with the autistic students thereby promoting a healthy environment inside the school campus. There should be psychologist in every school. There are plans to be followed for these specially-abled students. At regular intervals, there should be learning programs, behaviour promoting programs inside the school. Classrooms for such students should be made more colourful with wall painting. The concept of digital classroom is also appreciated where auditory and visual barriers can be easily overcome. Some ASD children are found to have expertise in singing, painting and other innovative activities. The therapists should bring out all those qualities along with identifying the abnormalities. Parents should treat their children with attention, utmost care and delicacy. They should take a healthier and more cautious lifestyle approach such as avoiding alcohol and drugs during pregnancy. Vaccination of the child should be completed on time and from a registered and licensed clinic.

Conclusion:

From the above discussion, it can be concluded that Autism Spectrum Disorder is not an incurable disease. It is a disease which starts affecting the child even before birth. Parents can detect the disorder after their children become 1 or 2 years old. They found their children with difficulties in speaking, interacting with others. Some children with ASD have poor vision and hearing defects. They struggle with the simplest daily life works such as wearing dresses, moving an object. Parents feel extremely devastated and need moral; support in this condition. Some misconception among people deteriorates the condition. They believe that this is an incurable disease and it might be a punishment from God and they accept this and stay aloof without trying to solve this problem. Studies are being conducted to uncover the ways to treat the disease as well as to break this delusion among people. The exact cause of ASD is yet to be discovered. With the available information about the possible reason behind ASD, many interventions and methods have been devised worldwide. Certain pros and cons of these methods do not allow them to be called as fully approved method. However, they are competent enough to lower the risk factors for ASD. Intervention methods emphasize on model programs that enable the autistic students to get over the inertia of staying back at home. School authorities are taking active steps by employing trained professionals. A little more awareness, positive approach, right decision and education can help those innocent children with ASD to enter into the regular stream of life.

Cultural beliefs surrounding ASD

References:

Autism spectrum disorder (ASD). (2018). https://www.kidshealth.org.nz/autism-spectrum-disorder-asd

Constantino, J. N., & Charman, T. (2016). Diagnosis of autism spectrum disorder: reconciling the syndrome, its diverse origins, and variation in expression. The Lancet Neurology, 15(3), 279-291.

Diagnostic Assessment for Autism Spectrum Disorder in Children and Young People in NZ: What to Expect. - Altogether Autism. (2018). https://altogetherautism.org.nz/autism-information/2979/diagnostic-assessment-for-autism-spectrum-disorder-in-children-and-young-people-what-to-expect/

Egan, A. M., Dreyer, M. L., Odar, C. C., Beckwith, M., & Garrison, C. B. (2013). Obesity in young children with autism spectrum disorders: prevalence and associated factors. Childhood Obesity, 9(2), 125-131.

Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of autism and developmental disorders, 43(3), 629-642.

Hsiao, E. Y. (2014). Gastrointestinal issues in autism spectrum disorder. Harvard review of psychiatry, 22(2), 104-111.

Kasari, C., & Smith, T. (2013). Interventions in schools for children with autism spectrum disorder: Methods and recommendations. Autism, 17(3), 254-267.

Lord, C., Cook, E. H., Leventhal, B. L., & Amaral, D. G. (2013). Autism spectrum disorders. Autism: The Science of Mental Health, 28(2), 217.

Lyall, K., Schmidt, R. J., & Hertz-Picciotto, I. (2014). Maternal lifestyle and environmental risk factors for autism spectrum disorders. International journal of epidemiology, 43(2), 443-464.

MacDonald, M., Lord, C., & Ulrich, D. A. (2013). The relationship of motor skills and social communicative skills in school-aged children with autism spectrum disorder. Adapted Physical Activity Quarterly, 30(3), 271-282.

Mannion, A., Leader, G., & Healy, O. (2013). An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(1), 35-42.

Marques, F., Brito, M. J., Conde, M., Pinto, M., & Moreira, A. (2014). Autism spectrum disorder secondary to enterovirus encephalitis. Journal of child neurology, 29(5), 708-714.

Mazahery, H., Camargo, C. A., Conlon, C., Beck, K. L., Kruger, M. C., & von Hurst, P. R. (2016). Vitamin D and Autism Spectrum Disorder: A Literature Review. Nutrients, 8(4), 236. https://doi.org/10.3390/nu8040236

Putnam, S. K., Lopata, C., Thomeer, M. L., Volker, M. A., & Rodgers, J. D. (2015). Salivary cortisol levels and diurnal patterns in children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27(4), 453-465.

Ronemus, M., Iossifov, I., Levy, D., & Wigler, M. (2014). The role of de novo mutations in the genetics of autism spectrum disorders. Nature Reviews Genetics, 15(2), 133.

Schaefer, G. B., & Mendelsohn, N. J. (2013). Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. Genetics in Medicine, 15(5), 399.

Sealey, L. A., Hughes, B. W., Sriskanda, A. N., Guest, J. R., Gibson, A. D., Johnson-Williams, L., ... & Bagasra, O. (2016). Environmental factors in the development of autism spectrum disorders. Environment international, 88, 288-298.

Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., ... & Jain, A. (2013). Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics, peds-2012.

Zerbo, O., Qian, Y., Yoshida, C., Grether, J. K., Van de Water, J., & Croen, L. A. (2015). Maternal infection during pregnancy and autism spectrum disorders. Journal of autism and developmental disorders, 45(12), 4015-4025.

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