Autism spectrum disorder (ASD) is a developmental disorder associated with language and cognitive problem like impaired social skills, repetitive behaviors, speech impairment and challenges in non-verbal communication. The different range of problems under ASD is caused by genetic and environmental influences. The symptoms of autism can be detected between 2 and 3 years. It is necessary to screen and diagnose early to provide necessary intervention to children as soon as possible (Lord et al., 2013). The essay provides an overview of the epidemiology of the developmental disability, common challenges associated with the disorder and known and hypothesized cause of ASD. It particularly describes one therapeutic approach needed to address the disorder and evaluates the effectiveness of the approach by means of critical appraisal of two research articles on the therapeutic approach.
In terms of the epidemiology of the ASD in Canada, it is the fastest growing neurological disorder in the country and one in every sixty eight children are currently being diagnosed with ASD. The prevalence of the disease has increased considerably in the last 10 years. The disorder is common in all groups and it is 4 times more common in males than in females (Autism Speaks Canada, 2017). The common characteristics of ASD include difficulties in social interaction, communication, behavior and sensory response. Unusual behavior is seen mainly due to the difficulties in responding to the environment or heightened sensitivity to any stimulus. This leads to unusual behavioral symptoms like repetitive body movement (example-hand flapping), repetitively using certain objects, strictly sticking to same routines, strange sensory interest and avoidance of everyday sounds and certain textures (Harms et al., 2010). The challenges in social interaction is seen as people with ASD fail to maintain relationship and respond to non-verbal forms of communication such as facial expressions, emotions and physical gestures. They fail to interpret needs of others and this impairs their ability enjoy and share interest with others. Another challenging symptoms affected people with autism include delay in language development, initiating and sustaining conversation and repeatedly using certain words or phrases. The degree of speech impairment varies from person to person and those who can speak uses language in unusual ways (Christensen, 2016).
The above mentioned challenges in behavioral and social response is seen in people with ASD as a result of genetic predisposition, environmental factors and other unknown factors. The research into the cause of autism reveals inheriting certain genes from parents makes a child more vulnerable to developing ASD (Lichtenstein et al., 2010). Secondly, along with genetic vulnerability to ASD, the risk of developing the condition increases when a person is exposed to specific environmental triggers such as air pollution, heavy metal, born prematurely or exposed in the womb to alcohol and certain medications (Herbert 2010). Other clinical conditions also increases the risk of developing ASD such as muscular dystrophy, Down’s syndrome, cerebral palsy and certain rare genetic disorders (Lichtenstein et al., 2010).
ASD is a persistent neuro-developmental disorder leading to mild to severe symptoms ad intra-individual variability over time and different context. The neurodevelopmental disorder also leads to poor intellectual functioning and maladaptive behavior in affected person. Co-occurring mental disorder seen in people with autism includes anxiety disorder, depression and attention deficit disorder. They are found to have symptoms of anxiety, mental distress and nervousness. Hence, high level of co-occurring psychiatric problem and emotional disorder is high in patients with ASD and there remains a conceptual challenges in diagnosing and measuring the the problem. In order to treat such mental health disorder, medications or behavioral therapy is needed to control their behavior and reduce the chance of worsening the symptoms (Ozsivadjian, Hibberd, & Hollocks, 2014). The research into common behavioral problems seen in children with ASD revealed high rate of sleep, toileting and eating diificulty, self-injury and sensory related problems. Along with this, frequency of anxiety and aggression is seen irrespective of age and ability of children (Maskey et al., 2013). Intellectual disability is seen in almost 50% of children with ASD, which is associated with behavioral and mental problems. There is a need to observe the function of mental health services and see how they are involved in addressing the characteristics of poor physical functioning, present symptoms and psychosocial problem in affected person (Salomone et al., 2014).
There are many treatment options for addressing behavioral or mental problem in patients with ASD. To address behavioral problems such as develop children’s communication and social skills, behavioral interventions may help to reduce the severity of symptoms. There are many behavioral therapies for treating children with ASD. This may include Applied Behavior Analysis and Pivotal Response Training (Bishop-Fitzpatrick, Minshew, & Eack, 2014). Another important and powerful approach to treating children and adults with ASD is Cognitive Behavioral Therapy (CBT). CBT is a behavioral intervention based on the science of behavior and it takes into account the thought and feelings about people that result in usual behavior in an individual. It is a structure goal-directed approach based on specific plan and sessions for affected individual. It is particularly used to treat clinical manifestations of anxiety and cognitive impairment in people with ASD. The anxiety level is high due to poor response to social interaction and social situations. Although the intervention is not specifically for ASD population, however it is increasingly being used now to improve depressive symptoms, social skills and activity level in ASD people (Weitlauf et al., 2014).
A research by Storch et al., (2013) evaluated the effectiveness of cognitive behavioral therapy for addressing anxiety in children with ASD compared to normal treatment. It was a randomized controlled trial in which 45 children (between 7 and 11 years) with high ASD severity were randomized to receive either the CBT or normal treatment for similar period of time. This study was considered important because of the lack of empirically supported interventions for treating anxiety in people with ASD. There are many studies done on the efficacy of psychosocial and pharmacological interventions, however treatment approaches for addressing anxiety has not been addressed in research studies. There is practice recommendation to use CBT in developing children, hence the aim of the research was to evaluate whether CBT can lead too reductions in AST symptoms compared to normal treatment options. The Pediatric Anxiety Rating Scale (PARS) was used to measure the degree of impairment or distress in patient and 11 session of CBT was provided to develop coping skills and treat feared stimuli in participant. The 3-months follow-up of continuous outcome in both group revealed positive results for CBT compared to normal treatment in all outcome measures. However, some of the weakness seen in the study is the use of modest sample size and lack of evaluation of treatment mediators and moderators. Secondly, the time constraints in research may lead to insufficient evaluation of long-term treatment maintenance. Despite the limitation, the study finding is important as it highlights the efficacy of CBT. Hence, CBT can be developed for ASD group considering that there is no pharmacological treatments have met the criteria for efficacy.
Another research study evaluated the efficacy of Early Intensive Behavioral Intervention (EIBI) for young children with autism. EIBI utilizes the principal of operant learning to address language and social interaction skills deficits in children with ASD. As mixed outcome has been reported for this intervention in ASD population and there efficacy of the intervention was not clear for all outcome measures. Hence, this study is important as it evaluates the outcome of the intervention in all aspects such as verbal performance, intellectual development and adaptive behavior in ASD people. The systematic review of outcome seen after EIBI program revealed that the participants receiving EIBI intervention outperformed control group in all levels. Improvement was seen in EIBI groups in verbal IQs, expressive language, daily living skills, socialization skills, adaptive behavior skills and communication skills (Peters-Scheffer et al., 2011). Therefore, the study contribute to the limitations found in other studies and effectively demonstrates the efficacy of the intervention in all outcome measures of ASD. However, some limitation found in the meta-analysis is that considerable was seen in the intensity of treatment and participants group. Hence, in order to enhance the rigor of the study, it is necessary that future studies concentrate on child characteristics at the start of treatment to related it to treatment outcome.
The essay summarized the epidemiology of ASD in Canada as well as globally. Certain genetic and environmental risk factors are associated with great behavioral, mental and social problem in people with ASD. In order to enhance the ability of children and adults in living with ASD, development of cognitive skills, adaptive behavior and communication skill is necessary. Apart from pharmacological intervention, different types of behavioral interventions and therapy have the potential to develop coping skills of ASD patients and promote development of skills to better manage their developmental disorder and disability. In future, potential behavioral intervention may be strengthened as by means of planning strategies needed to improve outcome in people with varying degree of severe symptoms. This will help promote integrity of treatment and promote cognitive development of people with ASD.
Autism Speaks Canada. (2017). Autismspeaks.ca. Retrieved 5 April 2017, from https://www.autismspeaks.ca/about-autism/facts-and-faqs/
Bishop-Fitzpatrick, L., Minshew, N. J., & Eack, S. M. (2014). A systematic review of psychosocial interventions for adults with autism spectrum disorders. In Adolescents and adults with autism spectrum disorders (pp. 315-327). Springer New York.
Christensen, D. L. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR. Surveillance Summaries, 65.
Harms, M. B., Martin, A., & Wallace, G. L. (2010). Facial emotion recognition in autism spectrum disorders: a review of behavioral and neuroimaging studies. Neuropsychology review, 20(3), 290-322.
Herbert, M. R. (2010). Contributions of the environment and environmentally vulnerable physiology to autism spectrum disorders. Current opinion in neurology, 23(2), 103-110.
Lichtenstein, P., Carlström, E., Råstam, M., Gillberg, C., & Anckarsäter, H. (2010). The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. American Journal of Psychiatry, 167(11), 1357-1363.
Lord, C., Cook, E. H., Leventhal, B. L., & Amaral, D. G. (2013). Autism spectrum disorders. Autism: The Science of Mental Health, 28(2), 217.
Maskey, M., Warnell, F., Parr, J. R., Le Couteur, A., & McConachie, H. (2013). Emotional and behavioural problems in children with autism spectrum disorder. Journal of autism and developmental disorders, 43(4), 851-859.
Ozsivadjian, A., Hibberd, C., & Hollocks, M. J. (2014). Brief report: the use of self-report measures in young people with autism spectrum disorder to access symptoms of anxiety, depression and negative thoughts. Journal of Autism and Developmental Disorders, 44(4), 969-974.
Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60-69.
Salomone, E., Kutlu, B., Derbyshire, K., McCloy, C., Hastings, R. P., Howlin, P., & Charman, T. (2014). Emotional and behavioural problems in children and young people with autism spectrum disorder in specialist autism schools. Research in Autism Spectrum Disorders, 8(6), 661-668.
Storch, E. A., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S., ... & Murphy, T. K. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 132-142.
Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R., ... & Warren, Z. (2014). Therapies for children with autism spectrum disorder.
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