autism essay introduction

Introduction to Autism

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General Information

Autism spectrum disorder, the name adopted in 2013, is a developmental disorder characterized by persistent problems in social communication and interaction, along with restricted and repetitive patterns of behavior, interests or activities. 1  It replaces the older terms of autistic disorder, Asperger's syndrome and other conditions envisioned on "the great continuum" of autism. 2  Still, the defining features of the condition commonly referred to as "autism" remain essentially the same.

But what does autism  look  like? As you observe a person's behavior, what might make you suspect he or she could have autism? To explore this question, we return to the very first written account of autism.

First Accounts of Autism: Defining Characteristics

It is likely that autism has existed through the ages, but the first ever clinical account of the disorder was published by Dr. Leo Kanner in 1943. 3  Dr. Kanner, who developed the first child psychiatric service at a U.S. hospital, described a group of 11 children – eight boys and three girls – who had "autistic disturbances of affective contact." 4

Dr. Kanner based his report on direct observation, and much of what he set down has stood the test of time. He vividly depicted the essential features of autism, all of which are echoed in current-day diagnostic manuals. It is interesting to note that, just as in Kanner's study, the rate of autism in males continues to be much higher than the rate in females.

Hans Asperger, an Austrian pediatrician, was working at nearly the same time as Kanner with a similar group of children on the other side of the Atlantic. A milder form of autism, Asperger syndrome, was named after him.

About Autism

As the word "spectrum" suggests, people with autism spectrum disorder (ASD) may have challenges that run the gamut from mild to severe, with different levels of ability and disability. Someone may have no functional speech, or may have a rich vocabulary. He or she may be intellectually disabled or have an average or above average IQ. He may be socially withdrawn or may be socially active, although in an oblivious, eccentric way. He may be fixated on lining up toys in a certain order, or have an encyclopedic knowledge of animals or another favorite topic.

To learn about the symptoms of autism spectrum disorder, please see our  About Autism  section.

Newly Diagnosed?

Parents of children who have just been diagnosed with ASD often feel both devastated and panicked. In our  Newly Diagnosed  section, we address some of the issues most on the minds of parents in this situation.

Exploring Autism Treatments

When a child is diagnosed with an autism spectrum disorder, families face the next challenge: choosing the right treatments and therapies for their child. What are these treatments and therapies? How much do we know about them? How can a family best evaluate whether a treatment is working for their child?

In our  Autism Treatments  section, we explore current autism treatments, the evidence behind them, and what we are learning from the experience of individuals and families who have tried them.

Challenging Behaviors

Children with autism spectrum disorder may exhibit many behaviors their family, teachers and others find challenging. At the same time, those children often find the world at large a challenge, and the behavior of other people may be confusing to  them .

What are the behaviors that distinguish a child with an ASD from his or her typically-developing peers? Although these will vary according to the severity of a person's autism and their age, there are core issues that affect most people with autism spectrum disorder. See our  Challenging Behaviors  section to explore those topics.

Adults With Autism

Many of the children diagnosed when autism rates began rising in the 1990s are, or soon will be, adults. Visit our  Adults with Autism  section for articles on topics of interest to teenagers and adults, such as the transition to adult services, getting a driver's license, employment, housing and romantic relationships.

So Much Still to Learn: A Quest For Answers

Since the 1940s, when Doctors Kanner and Asperger were putting their remarkable insights regarding socially different children on paper, we have learned a great deal. As you peruse this website and other sources of information on autism, you will see how much has been discovered about autism spectrum disorder from research in a wide variety of fields, including genetics, neuroscience, and cognitive psychology.

What will also become evident is how many questions remain unanswered. We still don't know exactly what causes autism; we haven't yet been able to identify specific subtypes of autism; and we still have very few proven treatments for autism.

The answers to our urgent questions will only come through research. The Interactive Autism Network was created to facilitate just that.

We hope individuals with ASD and their families will use this site to become informed consumers of autism research, and to become part of research studies themselves. Care providers, educators, researchers,

We salute each and every one of you who is committed to finding answers: individuals with autism and their families, researchers and educators, doctors and therapists, advocates and policy makers. We are here for you, and hope you will contact us with your questions, ideas, and concerns.

• American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders  (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Grandin, T. (2006).  Thinking in pictures: My life with autism  (Exp. ed.). New York: Vintage Books. (Pg. 47.)
• Volkmar, F., & Klin, A. (2005). Issues in the classification of autism and related conditions. In F. Volkmar et al. (Eds.),  Handbook of Autism and Pervasive Developmental Disorders  (pp.5-41). Hoboken, NJ: John Wiley & Sons.
• Kanner, L. (1943).  Autistic disturbances of affective contact. Nervous Child, 2 , 217-250.

Educating Children with Autism (2001)

Chapter: 1 introduction.

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1 Introduction FEATURES OF AUTISM Autism is a disorder that is present from birth or very early in devel- opment that affects essential human behaviors such as social interaction, the ability to communicate ideas and feelings, imagination, and the estab- lishment of relationships with others. It generally has life-long effects on how children learn to be social beings, to take care of themselves, and to participate in the community. Autism is a developmental disorder of neurobiological origin that is defined on the basis of behavioral and de- velopmental features. Although precise neurobiological mechanisms have not yet been established, it is clear that autism reflects the operation of factors in the developing brain. As yet, known direct links between pathophysiology and behavior in autism are still rare and have not yet had great influence on treatments or diagnoses (see Rumsey et al., 2000). Nevertheless, current biologic research, such as in genetics, may already have important implications for families of children with autistic spec- trum disorders. Autism is best characterized as a spectrum of disorders that vary in severity of symptoms, age of onset, and associations with other disorders (e.g., mental retardation, specific language delay, epilepsy). The manifes- tations of autism vary considerably across children and within an indi- vidual child over time. There is no single behavior that is always typical of autism and no behavior that would automatically exclude an indi- vidual child from a diagnosis of autism, even though there are strong and consistent commonalities, especially in social deficits. 11 

12 EDUCATING CHILDREN WITH AUTISM A number of years ago, the concept of pervasive developmental dis- order (PDD) was introduced to provide an umbrella term for autism and other disorders that include similar impairments in basic social skills but vary in severity or the presence of communication delay and repetitive behaviors. Because of the continuity across autistic disorders, this report addresses both the more narrowly defined disorder of autism and the broader range of autistic spectrum disorder including pervasive develop- mental disorder—not otherwise specified (PDD-NOS), Asperger’s disor- der, and childhood disintegrative disorder. Autistic spectrum disorders are unique in their pattern of deficits and areas of relative strengths. Be- cause of the special characteristics of Rett’s syndrome (i.e., its onset and pattern of deficits), it is not specifically considered in this report. Chil- dren with Rett’s syndrome, however, may require similar services to chil- dren with autism in some circumstances. THE CHALLENGE OF EDUCATING CHILDREN WITH AUTISM Education, both directly of children, and of parents and teachers, is currently the primary form of treatment in autism. For the purposes of this report, education is defined as the fostering of acquisition of skills or knowledge—including not only academic learning, but also socialization, adaptive skills, language and communication, and reduction of behavior problems—to assist a child to develop independence and personal re- sponsibility. Education includes services that foster acquisition of skills and knowledge, offered by public and private schools; infant, toddler, preschool and early education programs; and other public and private service providers. Young children are defined here as children 8 years or younger. Because children with autism are at high risk for other impair- ments, educational planning must address both the needs typically asso- ciated with autistic spectrum disorders and needs associated with accom- panying disabilities. Education of children with autism was accepted as a public responsi- bility as part of the Education Act of All Handicapped Children in 1975. Yet today, 25 years later, despite the federal mandate for appropriate education and intervention services, the goals, methods, and resources available vary considerably from state to state and from school system to school system. In the last few years, courts have become increasingly active forces in determining the methods applied and the resources allo- cated by school systems for the education of children with autistic spec- trum disorders. Although there is a very substantial body of research on the treatment and education of these children (Rumsey et al., 2000), this work has not often been clearly integrated into educational decision-making and policy at local or state levels. For example, many treatment approaches and 

INTRODUCTION 13 demonstration projects have disseminated information, yet most have not yet provided appropriate, scientifically rigorous documentation of effec- tiveness and efficiency. While research in developmental psychology, child psychiatry, and pediatric neurology has become increasingly well integrated, there is a need for more effective communication between professionals in these disciplines and the educators and other profession- als who carry out the bulk of treatment and intervention-oriented re- search. THE COMMITTEE’S WORK Charge At the request of the U.S. Department of Education’s Office of Special Education Programs, the National Research Council formed the Commit- tee on Educational Interventions for Children with Autism and charged the committee to integrate the scientific, theoretical, and policy literature and create a framework for evaluating the scientific evidence concerning the effects and features of educational interventions for young children with autism. The primary focus of the charge was early intervention, preschool, and school programs designed for children with autism from birth to age 8. The charge included specific suggestions to examine sev- eral issues pertaining to education of children with autism: early inter- vention, diagnosis and classification, the rights of children with autism under IDEA, mainstreaming, and assistive technology. To carry out its charge, the committee examined the scientific litera- ture; commissioned papers addressing science and policy issues; exam- ined solicited reports provided by leaders of model intervention pro- grams; and conducted two workshops at which researchers, educators, administrators, practitioners, advocates of individuals with autism, and other interested participants presented to the committee information and perspectives on approaches to address the educational needs of children with autism. The committee also solicited and reviewed written state- ments, provided by individuals and organizations, summarizing their perceptions of the educational needs of young children with autism. The committee also addressed a specific charge to survey the developing field of assistive technology for young children with autism. Thus, the committee’s activities served as a forum for interdisciplinary discussion of theory and scientific research concerning the evaluation of educational needs of, and methods used with, young children with autism. The committee conceptualized its task as the integration and evalua- tion of existing information from multiple sources in order to provide recommendations regarding educational policies affecting families with young children with autism. These policies are carried out in school 

14 EDUCATING CHILDREN WITH AUTISM systems and state and federal programs. The committee applied strict standards to assess the quality of the large body of information that it assembled. The committee considered arguments of legal rights and documentation of public policy, and current practices in well-established programs, as well as empirical data concerning the effectiveness of vari- ous techniques. Within its evaluation of the current scientific literature, the committee’s goal has been to interpret findings as broadly as possible in terms of their implications for early educational practices, while retain- ing scientific integrity and perspective in considering the strengths and limitations of various bodies of work. Committee’s Process for Evaluating Evidence Science is a systematic way of gathering, analyzing, and assessing information. One of the strengths of the field of autism is the many disciplines and areas of scientific inquiry within which it has been ad- dressed. The committee’s approach was to gather information from as wide a range of sources as possible, to assess the strengths and limitations of different sources of information, and to assess the results with an eye toward convergence, particularly from independent sources, of descrip- tive data, inferential data, and theory. For example, within the field of autism, there are many approaches to intervention that are widely disseminated but little researched. Some approaches have been greeted with great enthusiasm initially, but have relatively quickly faded out of general use, in part because of their failure to demonstrate worthwhile effects. Other approaches have withstood the test of time across sites and the children and families they serve, though they continue to be largely supported by clinical descriptions of effective- ness, rather than by formal evaluations. Yet wide use and respect cannot be interpreted as clear evidence of effectiveness; therefore, the committee elected to consider information about these approaches in light of more empirically oriented studies. To achieve a systematic and rigorous assessment of research studies, the committee established guidelines for evaluating areas of strength, limitations, and the overall quality of the evidence; these guidelines are presented in Box 1-1. They are based on approaches used by scientific societies and in recent publications, including: the American Academy of Neurology (Filipek et al., 2000); the American Psychological Association (American Psychological Association, 2000; Barlow, 1996; Chambless and Hollon, 1998); the Society for Clinical Child Psychology (Lonigan et al., 1998); and the New York State Department of Health (1999). A number of comprehensive reviews concerning early intervention in autism also pro- vided examples of ways to systematize information (Dawson and Osterling, 1997; Howlin, 1998; Rogers, 1998; Rumsey et al., 2000). These 

INTRODUCTION 15 BOX 1-1 Guidelines Used to Evaluate Studies Every research report considered by the committee was assigned to one category (I-IV) for each area (A, B, and C). A. Internal Validity: Control for nonspecific factors, such as matura- tion, expectancy, experimenter artifacts I. Prospective study comparing the intervention to an alternative in- tervention or placebo in which evaluators of outcome are blind to treat- ment status II. Multiple baseline, ABAB design, or reversal/withdrawal with mea- surement of outcome blind to treatment conditions or pre-post design with independent evaluation III. Pre-post or historical designs or multiple baseline, ABAB, reversal/ withdrawal not blind to treatment conditions IV. Other B. External Validity/Selection Biases I. Random assignment of well-defined cohorts and adequate sample size for comparisons II. Nonrandom assignment, but well-defined cohorts with inclusion/ exclusion criteria and documentation of attrition/failures; additionally, ad- equate sample size for group designs or replication across three or more subjects in a single-subject design III. Well-defined population of three or more subjects in single-subject designs or sample of adequate size in group designs IV. Other C. Generalization I. Documented changes in at least one natural setting outside of treatment setting (includes social validity measures) II. Generalization to one other setting or maintenance beyond exper- imental intervention in natural setting in which intervention took place III. Intervention occurred in natural setting or use of outcome mea- sures with documented relationship to functional outcome IV. Not addressed or other guidelines were used by both committee members and commissioned paper authors in their reviews of the literature. Figures 1-1, 1-2, and 1-3 present summarized data from journal articles cited within the areas ad- dressed during the workshops (communication, social development, problem behaviors, intervention methods, and sensorimotor develop- 

16 EDUCATING CHILDREN WITH AUTISM 100 90 80 Level I 70 Level II 60 Percent Level III 50 Level IV 40 30 20 10 0 Social Communication Problem Intervention Sensory-Motor (N = 47) (N = 60) Behavior Methods (N = 22) (N = 9) (N = 13) FIGURE 1-1 Internal validity. NOTES: Level I represents the strongest methodological controls and IV the least strong (see Box 1-1); N is the number of studies. SOURCES: For social studies, McConnell (1999); for communication studies, Goldstein (1999); for problem behavior studies, Horner (2000); for intervention studies, Kasari (2000); for sensory-motor studies (Baranek, 1999). ment), in terms of percentages of studies falling into different levels of rigor with respect to internal validity, external validity, and generaliza- tion. This information is discussed in more detail in Chapter 15 and in the chapters describing those content areas. (For details on the coding of individual studies, see the appendices of the papers cited in the figures.) One of the difficulties in interpreting research, particularly longitudi- nal studies, is that standards for scientific research within different theo- retical perspectives have changed enormously in the last 20 years, and they continue to evolve. Twenty years ago, behavioral researchers were not as concerned with rigorously standardizing measures or diagnoses, maintaining independence between intervention and assessment, or ana- lyzing the effects of development. Similarly, group designs based on a clinical trials model were not expected to monitor treatment fidelity, equate participants for intellectual or language level, address generaliza- tion or maintenance of effects, or justify measures by their clinical value. Therefore, particularly when depicting outcomes from longitudinal stud- ies, reviewers of the literature often have to piece together information 

INTRODUCTION 17 100 90 80 Level I 70 Level II Percent 60 Level III 50 Level IV 40 30 20 10 0 Social Communication Problem Intervention Sensory-Motor (N = 47) (N = 60) Behavior Methods (N = 22) (N = 9) (N = 13) FIGURE 1-2 External validity. NOTES: Level I represents the strongest methodological controls and IV the least strong (see Box 1-1); N is the number of studies. SOURCES: For social studies, McConnell (1999); for communication studies, Goldstein (1999); for problem behavior studies, Horner (2000); for intervention studies, Kasari (2000); for sensory-motor studies (Baranek, 1999). fragmented across studies. Today, that information would have been an expected component of a research design from the start. Clinical research always involves compromises based on such factors as access to populations and acknowledgment of clinical needs; often, expense is also considered. Even today, there are very different standards across journals and across research communities as to what are consid- ered unacceptable compromises and what is deemed a necessary part of dealing with complex questions. One of the goals that arose from this review was to identify ways of bridging gaps between perspectives in setting guidelines for research about autism. The committee recognized that a range of emphases and designs is important for different questions. Because of the varied nature of the research, the guidelines presented in Box 1-1 were used to characterize the research reviewed. In this way, the strengths and limitations of individual studies could be considered when deriving conclusions based on the consistencies and inconsistencies ob- served across investigations and theories. Evidence concerning the effectiveness of instructional and compre- hensive programs, strategies, and approaches to intervention for young 

18 EDUCATING CHILDREN WITH AUTISM 100 90 Level I 80 Level II 70 Level III Percent 60 50 Level IV 40 30 20 10 0 Social Communication Problem Intervention Sensory-Motor (N = 47) (N = 60) Behavior Methods (N = 22) (N = 9) (N = 13) FIGURE 1-3 Generalization. NOTES: Level I represents the strongest methodological controls and IV the least strong (see Box 1-1); N is the number of studies. SOURCES: For social studies, McConnell (1999); for communication studies, Goldstein (1999); for problem behavior studies, Horner (2000); for intervention studies, Kasari (2000); for sensory-motor studies (Baranek, 1999). children with autism was considered. The committee’s strategy in assess- ing the effectiveness of components of intervention programs and ap- proaches was to consider, along with the findings of individual research papers, the methodological challenges that many clinical studies face in attempting to control for nonspecific factors, selection biases, and the difficulty in measuring meaningful, generalizable outcomes. Some as- pects of interventions, particularly short-term, problem-focused treat- ments, are much more easily researched than longer-term interventions aimed at more multifaceted concerns (American Psychological Associa- tion, 2000). The committee summarized results across areas of interest and approaches to intervention, taking these factors into account. The goal was to integrate this information into a coherent picture of appropri- ate educational interventions for young children within the autism spec- trum, and to acknowledge points of convergence and points of contro- versy to be addressed in future educational research, practice, and policy. There are no strong studies that compare one comprehensive intervention program with another. Because programs are evolving (and better ap- proaches may be developed in the future), the committee chose to focus on discussion of the effective components and features of each program— 

INTRODUCTION 19 identified on the basis of theory, empirical reports, and consensus across representative programs—rather than to attempt any ranking of specific programs. There are several related areas the committee hoped to address but, because of limited resources and time, did not. Two issues we did not address are the feasibility and costs of various programs and treatments. Because feasibility and cost-effectiveness formulations involve not only short-term costs to school systems but also short- and long-term costs to health systems and society as a whole, and this information and its analy- sis are not readily available, it was felt that it would be inappropriate for us to analyze these questions in a superficial way. However, this infor- mation is much needed. We were also interested in more directly ad- dressing ways of implementing the changes we recommended, but we were unable within the constraints of this project to acquire sufficient information and expertise about strategies for educational change. Be- cause discrepancies in the kind of programs provided are so great across the United States (Hurth et al., 2000; Mandlawitz, 1999), questions con- cerning implementation are also crucial. ORGANIZATION OF THE REPORT The report is organized according to relationships among issues that, the committee believes, represent the key areas pertaining to educational interventions for young children with autism. Part I addresses the gen- eral issue of goals for children with autistic spectrum disorders and their families. Within Part I, Chapter 2 describes how autistic spectrum disor- ders are diagnosed and assessed and prevalence estimates, Chapter 3 considers the impact on and the role of families, and Chapter 4 discusses appropriate goals for educational services. Part II presents the characteristics of effective interventions and edu- cational programs. Chapters 5 through 10 discuss fundamental areas of development and behavior that must be addressed by such programs: communication; social, cognitive, sensory and motor development; and adaptive and problem behaviors. Chapter 11 analyzes the characteristics of representative instructional strategies, and Chapter 12 analyzes the features of ten model comprehensive programs and approaches to inter- vention. Part III examines the policy and research contexts within which inter- ventions are developed, implemented, and assessed: Chapter 13 presents an overview of public policy and legal issues pertaining to education for children with autism, Chapter 14 addresses the needs for personnel prepa- ration to implement policies, and Chapter 15 identifies the experimental design and methodological issues that should be considered by future researchers in educational interventions for children with autism. 

20 EDUCATING CHILDREN WITH AUTISM Our final chapter summarizes the committee’s findings and presents conclusions about the state of the science in early intervention for chil- dren with autism and its recommendations for future intervention strate- gies, programs, policy, and research. 

I Goals for Children with Autism and Their Families 

Autism is a word most of us are familiar with. But do we really know what it means?

Children with autism are challenged by the most essential human behaviors. They have difficulty interacting with other people—often failing to see people as people rather than simply objects in their environment. They cannot easily communicate ideas and feelings, have great trouble imagining what others think or feel, and in some cases spend their lives speechless. They frequently find it hard to make friends or even bond with family members. Their behavior can seem bizarre.

Education is the primary form of treatment for this mysterious condition. This means that we place important responsibilities on schools, teachers and children's parents, as well as the other professionals who work with children with autism. With the passage of the Individuals with Disabilities Education Act of 1975, we accepted responsibility for educating children who face special challenges like autism. While we have since amassed a substantial body of research, researchers have not adequately communicated with one another, and their findings have not been integrated into a proven curriculum.

Educating Children with Autism outlines an interdisciplinary approach to education for children with autism. The committee explores what makes education effective for the child with autism and identifies specific characteristics of programs that work. Recommendations are offered for choosing educational content and strategies, introducing interaction with other children, and other key areas.

This book examines some fundamental issues, including:

• How children's specific diagnoses should affect educational assessment and planning
• How we can support the families of children with autism
• Features of effective instructional and comprehensive programs and strategies
• How we can better prepare teachers, school staffs, professionals, and parents to educate children with autism
• What policies at the federal, state, and local levels will best ensure appropriate education, examining strategies and resources needed to address the rights of children with autism to appropriate education.

Children with autism present educators with one of their most difficult challenges. Through a comprehensive examination of the scientific knowledge underlying educational practices, programs, and strategies, Educating Children with Autism presents valuable information for parents, administrators, advocates, researchers, and policy makers.

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• v.9(Suppl 1); 2020 Feb

Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation

Holly hodges.

1 Department of Pediatrics, Baylor College of Medicine and Meyer Center for Developmental Pediatrics, Texas Children’s Hospital, Houston, TX, USA;

Casey Fealko

2 Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA;

Neelkamal Soares

3 Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. There have been recent concerns about increased prevalence, and this article seeks to elaborate on factors that may influence prevalence rates, including recent changes to the diagnostic criteria. The authors review evidence that ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain, and enumerate factors that correlate with ASD risk. Finally, the article describes how clinical evaluation begins with developmental screening, followed by referral for a definitive diagnosis, and provides guidance on screening for comorbid conditions.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors ( 1 ). In 2013, the Diagnostic and Statistical Manual of Mental Disorders —5 th edition (DSM-5) was published, updating the diagnostic criteria for ASD from the previous 4 th edition (DSM-IV) ( Table 1 ) ( 1 , 2 ).

ASD, autism spectrum disorder; SPCD, social (pragmatic) communication disorder.

In DSM-5, the concept of a “spectrum” ASD diagnosis was created, combining the DSM-IV’s separate pervasive developmental disorder (PDD) diagnoses: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), into one. Rett syndrome is no longer included under ASD in DSM-5 as it is considered a discrete neurological disorder. A separate social (pragmatic) communication disorder (SPCD) was established for those with disabilities in social communication, but lacking repetitive, restricted behaviors. Additionally, severity level descriptors were added to help categorize the level of support needed by an individual with ASD.

This new definition is intended to be more accurate and works toward diagnosing ASD at an earlier age ( 3 ). However, studies estimating the potential impact of moving from the DSM-IV to the DSM-5 have predicted a decrease in ASD prevalence ( 4 , 5 ) and there has been concern that children with a previous PDD-NOS diagnosis would not meet criteria for ASD diagnosis ( 5 - 7 ). There are varying reports estimating the extent of and effects of this change. One study found that with parental report of ASD symptoms alone, the DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses ( 8 ). However, a systematic review suggests only 50% to 75% of individuals maintain diagnoses ( 9 ) and other studies have also suggested a decreased rate of diagnosis of individuals with ASD under the DSM-5 criteria ( 10 ). Often those who did not meet the requirements were previously classified as high functioning Asperger’s syndrome and PDD-NOS ( 11 , 12 ). Overall, most studies suggest that the DSM-5 provides increased specificity and decreased sensitivity compared to the DSM-IV ( 5 , 13 ); so while those diagnosed with ASD are more likely to have the condition, there is a higher number of children whose ASD diagnosis is missed, particularly older children, adolescents, adults, or those with a former diagnosis of Asperger’s disorder or PDD-NOS ( 14 ). Nevertheless, the number of people who would be diagnosed under the DSM-IV, but not under the new DSM-5 appears to be declining over time, likely due to increased awareness and better documentation of behaviors ( 4 ).

It has yet to be determined how the new diagnosis of SPCD will impact the prevalence of ASD. One study found the new SPCD diagnosis encompasses those individuals who possess subthreshold autistic traits and do not qualify for a diagnosis of ASD, but who still have substantial needs ( 15 ). Furthermore, children who previously met criteria for PDD-NOS under the DSM-IV might now be diagnosed with SPCD.

Epidemiology

The World Health Organization (WHO) estimates the international prevalence of ASD at 0.76%; however, this only accounts for approximately 16% of the global child population ( 16 ). The Centers for Disease Control and Prevention (CDC) estimates about 1.68% of United States (US) children aged 8 years (or 1 in 59 children) are diagnosed with ASD ( 6 , 17 ). In the US, parent-reported ASD diagnoses in 2016 averaged slightly higher at 2.5% ( 18 ). The prevalence of ASD in the US more than doubled between 2000–2002 and 2010–2012 according to Autism and Developmental Disabilities Monitoring Network (ADDM) estimates ( 6 ). Although it may be too early to comment on trends, in the US, the prevalence of ASD has appeared to stabilize with no statistically significant increase from 2014 to 2016 ( 19 ). Changing diagnostic criteria may impact prevalence and the full impact of the DSM-5 diagnostic criteria has yet to be seen ( 17 ).

Insurance mandates requiring commercial plans to cover services for ASD along with improved awareness have likely contributed to the increase in ASD prevalence estimates as well as the increased diagnosis of milder cases of ASD in the US ( 6 , 20 , 21 ). While there was only a modest increase in prevalence immediately after the mandates, there have been additional increases later as health care professionals better understood the regulatory and reimbursement process. The increase in prevalence may also be due to changes in reporting practices. One study in Denmark found the majority of increase in ASD prevalence from 1980–1991 was based on changes of diagnostic criteria and inclusion of outpatient data, rather than a true increase in ASD prevalence ( 21 ).

ASD occurs in all racial, ethnic, and socioeconomic groups, but its diagnosis is far from uniform across these groups. Caucasian children are consistently identified with ASD more often than black or Hispanic children ( 6 ). While the differences appear to be decreasing, the continued discrepancy may be due to stigma, lack of access to healthcare services, and a patient’s primary language being one other than English.

ASD is more common in males ( 22 , 23 ) but in a recent meta-analysis ( 24 ), true male-to-female ratio is closer to 3:1 than the previously reported 4:1, though this study was not done using the DSM-5 criteria. This study also suggested that girls who meet criteria for ASD are at higher risk of not receiving a clinical diagnosis. The female autism phenotype may play a role in girls being misdiagnosed, diagnosed later, or overlooked. Not only are females less likely to present with overt symptoms, they are more likely to mask their social deficits through a process called “camouflaging”, further hindering a timely diagnosis ( 25 ). Likewise, gender biases and stereotypes of ASD as a male disorder could also hamper diagnoses in girls ( 26 ).

Several genetic diagnoses have an increased rate of co-occurring ASD compared to the average population, including fragile X, tuberous sclerosis, Down syndrome, Rett syndrome, among others; however, these known genetic disorders account for a very small amount of overall ASD cases ( 27 - 30 ). Studies of children with sex chromosome aneuploidy describe a specific social functioning profile in males that suggests more vulnerability to autism ( 22 , 23 , 31 , 32 ). With the increased use of chromosomal microarray, several sites (chromosome X, 2, 3, 7, 15, 16, 17, and 22 in particular) have proven to be associated with increased ASD risk ( 28 ).

Other risk factors for ASD include increased parental age and prematurity ( 33 - 35 ). This could be due to the theory that older gametes have a higher probability of carrying mutations which could result in additional obstetrical complications, including prematurity ( 36 ).

ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain. Ongoing research continues to deepen our understanding of potential etiologic mechanisms in ASD, but currently no single unifying cause has been elucidated.

Neuropathologic studies are limited, but have revealed differences in cerebellar architecture and connectivity, limbic system abnormalities, and frontal and temporal lobe cortical alterations, along with other subtle malformations ( 28 , 37 , 38 ). A small explorative study of neocortical architecture from young children revealed focal disruption of cortical laminar architecture in the majority of subjects, suggesting problems with cortical layer formation and neuronal differentiation ( 39 ). Brain overgrowth both in terms of cortical size and additionally in terms of increased extra-axial fluid have been described in children with ASD and are areas of ongoing study both in terms of furthering our understanding of its etiology, but also as a potential biomarker ( 40 , 41 ).

Genetic factors play a role in ASD susceptibility, with siblings of patients with ASD carrying an increased risk of diagnosis when compared to population norms, and a much higher, although not absolute, concordance of autism diagnosis in monozygotic twins ( 42 - 44 ).

Genome wide association studies and whole exome sequencing methods have broadened our understanding of ASD susceptibility genes, and learning more regarding the function of these genes can shed light on potential biologic mechanisms ( 45 ). For example candidate genes in ASD include those that play a role in brain development or neurotransmitter function, or genes that affect neuronal excitability ( 46 , 47 ). Many of the genetic defects associated with ASD encode proteins that are relevant at the neuronal synapse or that are involved in activity-dependent changes in neurons, including regulatory proteins such as transcription factors ( 42 , 48 ). Potential “networks” of ASD genetic risk convergence include pathways involved in neurotransmission and neuroinflammation ( 49 ). Transcriptional and splicing dysregulation or alterations in epigenetic mechanisms such as DNA methylation or histone acetylation and modification may play a role ( 42 , 49 - 51 ). A recent study describes 16 newly identified genes associated with ASD that raise new potential mechanisms including cellular cytoskeletal structure and ion transport ( 52 ). Ultimately, ASD remains one of the most genetically heterogeneous neuropsychiatric disorders with rarer de novo and inherited variants in over 700 genes ( 53 ).

While genetics clearly play a role in ASD’s etiology, phenotypic expression of genetic susceptibility remains extremely variable within ASD ( 54 ). Genetic risk may be modulated by prenatal, perinatal, and postnatal environmental factors in some patients ( 35 ). Prenatal exposure to thalidomide and valproic acid have been reported to increase risk, while studies suggest that prenatal supplements of folic acid in patients exposed to antiepileptic drugs may reduce risk ( 55 - 57 ). Research has not confirmed if a small positive trial of folinic acid in autism can be used to recommend supplementation more broadly ( 58 ). Advanced maternal and paternal age have both been shown to have an increased risk of having a child with ASD ( 59 ). Maternal history of autoimmune disease, such as diabetes, thyroid disease, or psoriasis has been postulated, but study results remain mixed ( 60 , 61 ). Maternal infection or immune activation during pregnancy is another area of interest and may be a potential risk factor according to recent investigations ( 62 - 65 ). Both shorter and longer inter-pregnancy intervals have also been reported to increase ASD risk ( 66 ). Infants born prematurely have been demonstrated to carry a higher risk for ASD in addition to other neurodevelopmental disorders ( 34 ). In a prior epidemiologic review, obstetric factors including uterine bleeding, caesarian delivery, low birthweight, preterm delivery, and low Apgar scores were reported to be the few factors more consistently associated with autism ( 67 ). A recent meta-analysis reported several pre, peri and postnatal risk factors that resulted in an elevated relative risk of ASD in offspring ( 35 ), but also revealed significant heterogeneity, resulting in an inability to make true determination regarding the importance of these factors.

Despite the hysteria surrounding the now retracted Lancet article first published in 1998, there is no evidence that vaccines, thimerosal, or mercury is associated with ASD ( 68 - 70 ). In the largest single study to date, there was not an increased risk after measles/mumps/rubella (MMR) vaccination in a nationwide cohort study of Danish children ( 70 ).

Ultimately, research continues to reveal factors that correlate with ASD risk, but no causal determinations have been made. This leaves much room for discovery with investigators continuing to elucidate new variants conveying genetic risk, or new environmental correlates that require further study ( 52 ).

Evaluation in ASD begins with screening of the general pediatric population to identify children at-risk or demonstrating signs suggestive of ASD, following which a diagnostic evaluation is recommended. The American Academy of Pediatrics (AAP) guidelines recommend developmental surveillance at 9, 15 and 30 months well child visits and autism specific screening at 18 months and again at 24 or 30 months ( 28 , 71 ). Early red flags for ASD include poor eye contact, poor response to name, lack of showing and sharing, no gesturing by 12 months, and loss of language or social skills. Screening tools for ASD in this population include the Modified Checklist for Autism in Toddlers, Revised, with Follow-up (M-CHAT-R/F) and Survey of Wellbeing of Young Children (SWYC) ( 72 , 73 ). Red flags in preschoolers may include limited pretend play, odd or intensely focused interests, and rigidity. School age children may demonstrate concrete or literal thinking, have trouble understanding emotions, and may even show an interest in peers but lack conversational skills or appropriate social approach. If there is suspicion of ASD in these groups, screening tools available include the Social Communication Questionnaire (SCQ), Social Responsiveness Scale (SRS), and Autism Spectrum Screening Questionnaire (ASSQ) ( 74 - 76 ).

If concerns are raised at screening, primary care clinicians are recommended to refer the child to early intervention if less than 3 years of age or to the public school system for psychoeducational evaluation in order to establish an individual education program (IEP) if the child is three years of age or older. Clinicians should additionally refer the child to a specialist (pediatric neurologist, developmental-behavioral pediatrician, child psychiatrist, licensed child psychologist) for a definitive diagnosis and comprehensive assessment ( 71 ). A comprehensive assessment should include a complete physical exam, including assessment for dysmorphic features, a full neurologic examination with head circumference, and a Wood’s lamp examination of the skin. A parent interview, collection of any outside informant observations, and a direct clinician observation of the child’s current cognitive, language, and adaptive functioning by a clinician experienced with ASD should be components of this comprehensive assessment. ( 28 , 71 , 77 , 78 ).

Additionally, primary care clinicians need to be aware of (and evaluate for) potential co-occurring conditions in children with ASD. According to a surveillance study of over 2,000 children with ASD, 83% had an additional developmental diagnosis, 10% had at least one psychiatric diagnosis, and 16% at least one neurologic diagnosis ( 79 ). In the past, rates of co-morbid intellectual disability (ID) in patients with ASD were reported from 50% to 70%, with the most recent CDC estimate reported at 31.0% (26.7% to 39.4%) with ID defined as intelligence quotient (IQ) ≤70 ( 6 , 80 ). Other common co-occurring medical conditions include gastrointestinal (GI) disorders, including dietary restrictions and food selectivity, sleep disorders, obesity, and seizures ( 81 - 84 ). Studies using electronic health record (EHR) analysis revealed prevalence of epilepsy ~20% and GI disorders [without inflammatory bowel disease (IBD)] at 10–12% ( 82 ). Epilepsy has been shown to have higher prevalence rates in ASD with comorbid ID and medical disorders of increased risk such as tuberous sclerosis complex (TSC) ( 85 - 87 ). GI disorders or GI symptomatology, including diarrhea, constipation, restrictive eating, or reflux, have been shown to be prominent in ASD across multiple studies ( 81 , 82 , 88 , 89 ). Sleep problems have been reported to occur in anywhere from 50% to 73% of patients with ASD with variation in prevalence dependent on the definition of sleep symptoms or the measurement tool used ( 90 - 92 ). Rates of overweight and obesity in ASD are reported to be roughly 33% and 18% respectively, higher than rates in typically developing children ( 81 - 84 , 93 ).

Other behavioral or psychiatric co-occurring conditions in ASD include anxiety, attention deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder, and mood disorders or other disruptive behavior disorders ( 81 ). Rates of co-occurring ADHD are reported anywhere from 25% to 81% ( 81 , 94 ). A recent meta-analysis of 30 studies measuring rates of anxiety and 29 studies measuring rates of depression reported a high degree of heterogeneity from the current literature, but stated pooled lifetime prevalence for adults with ASD to be 42% for any anxiety disorder and 37% for any depressive disorder, though the use of self-report measures and the presence of ID could influence estimates ( 95 ). In children with ASD seeking treatment, the rate of any anxiety disorder was found to be similar at 42% and in addition this study reported co-morbid oppositional defiant disorder at a rate of 46% and mood disorders at 8%, with 66% of the sample of over 600 patients having more than one co-occurring condition ( 94 ).

Currently no clear ASD biomarkers or diagnostic measures exist, and the diagnosis is made based on fulfillment of descriptive criteria. In light of a relatively high yield in patients with ASD, clinical genetic testing is recommended and can provide information regarding medical interventions or work up that might be necessary and help with family planning ( 96 ). The American College of Medical Genetics and Genomics (ACMGG) guidelines currently recommend chromosomal microarray for all children, fragile X testing in males, and additional gene sequencing, including PTEN and MECP2 , in certain patients as first tier genetic testing in the work up of ASD ( 97 ). High resolution G-banded karyotype, once recommended for all patients with ASD, is no longer routinely indicated based on recent consensus recommendations, but might still be performed in patients with a family or reproductive history suggestive of chromosomal rearrangements or specific syndromes such as sex chromosome anomalies or Trisomy 21 ( 96 - 98 ). Several professional societies recommend genetic testing for ASD, including the American Academy of Neurology, the AAP, ACMGG, and the American Academy of Child and Adolescent Psychiatry, and a child may require further referral to a geneticist and/or genetic counselor, depending on results of testing ( 25 , 28 , 97 , 99 ). As the field of genetics continues to advance rapidly, recent publications suggest whole exome sequencing may become the preferred method for clinical genetic testing in individuals with ASD ( 100 , 101 ).

Aside from genetic testing, no other laboratory work up is routinely recommended for every patient with a diagnosis of ASD. However, further evaluation may be appropriate for patients with particular findings or risk factors. Metabolic work-up should be considered in patients with any of the following concerning symptoms or signs: a history of clear developmental regression including loss or plateau of motor skills; hypotonia; recurrent episodes of vomiting, lethargy or hypoglycemia; microcephaly or poor growth; concern for other organ involvement; coarse features; or concern for seizures or ataxia. Based on the patient’s history and presentation, components of a metabolic laboratory evaluation could include complete blood count (CBC), liver and renal function tests, lactate, pyruvate, carnitine, amino acids, an acylcarnitine profile, urine organic acids and/or urine glycosaminoglycans ( 97 , 102 ). Children with a history of pica should have a lead level measured ( 28 , 103 ). In a child with significantly restricted food intake, one should consider a laboratory evaluation of nutritional status. Sleep symptoms may warrant a referral for a possible sleep study, and if restless sleep symptoms are present, an evaluation for iron deficiency is not unreasonable, particularly if dietary rigidity limits iron intake ( 104 ).

Neuroimaging is not routinely recommended for every patient with ASD ( 28 , 99 ), but may be appropriate in patients with a suspicion for TSC or other neurocutaneous disorders, microcephaly, or an abnormal neurologic exam (spasticity, severe hypotonia, unilateral findings). Patients with suspected seizures should have an electroencephalography (EEG) obtained ( 102 ). If accessible, it might be appropriate to immediately refer children with concern for further genetic, metabolic or neurologic conditions to a specialist who can then obtain and interpret the aforementioned testing. At this time there is inadequate evidence to recommend routine testing for celiac disease, immunologic or neurochemical markers, mitochondrial disorders, allergy testing, hair analysis, intestinal permeability studies, erythrocyte glutathione peroxidase studies, stool analysis, urinary peptides or vitamin and mineral deficiencies without a history of severe food selectivity.

ASD is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. Recent changes to the diagnostic criteria occurred with the transition to the new diagnostic manual (DSM-5) and will likely impact prevalence, which currently stands at 1 in 59 children in the US. ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain. Research continues to reveal factors that correlate with ASD risk and these findings may guide further etiologic investigation, but no final causal pathway has been elucidated. Clinical evaluation begins with developmental screening of the general pediatric population to identify at-risk children, followed by referral to a specialist for a definitive diagnosis and comprehensive neuropsychological assessment. Children with ASD should also be screened for common co-morbid diagnoses. While no clear biomarkers or diagnostic measures exist, clinical genetic testing is recommended as part of the initial medical evaluation. Further medical work up or subspecialist referrals may be pursued based on specific patient characteristics.

Acknowledgments

Funding: None.

Ethical Statement : The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflicts of Interest : The authors have no conflicts of interest to declare.

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What is Autism?

Autism is a developmental disorder with symptoms that appear within the first three years of life. Its formal diagnostic name is autism spectrum disorder. The word “spectrum” indicates that autism appears in different forms with varying levels of severity. That means that each individual with autism experiences their own unique strengths, symptoms , and challenges. 

Understanding more about ASD can help you better understand the individuals who are living with it. 

How autism spectrum disorders are described

Psychiatrists and other clinicians rely on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to define autism and its symptoms. The  DSM-5 definition  recognizes two main symptom areas:

• Deficits in social communication and interaction
• Restricted, repetitive behaviors, interests, or activities

These symptoms appear early in a child’s development—although diagnosis may occur later. Autism is diagnosed when symptoms cause developmental challenges that are not better explained by other conditions.

The definition of autism has been refined over the years. Between 1995 and 2011, the DSM-IV grouped Asperger’s Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) with autism. Asperger’s syndrome was an autism spectrum disorder marked by strong verbal language skills and, often, high intellectual ability. PDD-NOS was a more general diagnosis for people who did not fit clearly into the other two categories. 

However, the DSM-5 no longer recognizes Asperger’s syndrome or PDD-NOS as separate diagnoses. Individuals who would previously have received either of these diagnoses may now receive a diagnosis of autism spectrum disorder instead. 

Autism symptoms and behaviors

Individuals with autism may present a range of symptoms, such as: 

• Reduced eye contact
• Differences in body language
• Lack of facial expressions
• Not engaging in imaginative play
• Repeating gestures or sounds
• Closely focused interests
• Indifference to temperature extremes

These are just a few examples of the symptoms an individual with autism may experience. Any individual could have some, all, or none of these symptoms. Keep in mind that having these symptoms does not necessarily mean a person has autism. Only a qualified medical professional can diagnose autism spectrum disorder. 

Most importantly, an individual with autism is first and foremost an individual. Learning about the symptoms can help you start to understand the behaviors and challenges related to autism, but that’s not the same as getting to know the individual. Each person with autism has their own strengths, likes, dislikes, interests, challenges, and skills, just like you do. 

How autism is diagnosed

There is no known biological marker for autism. That means that no blood or genetic test can diagnose the disorder. Instead, clinicians rely on observation, medical histories, and questionnaires to determine whether an individual has autism. 

Physicians and specialists may use one or several of the following screening tools : 

• Modified Checklist for Autism in Toddlers , Revised (M-CHAT), a 20-question test designed for toddlers between 16 and 30 months old. 
• The Ages and Stages Questionnaire (ASQ) , a general developmental screening tool with sections targeting specific ages used to identify any developmental challenges a child may have. 
• Screening Tool for Autism in Toddlers and Young Children (STAT) , an interactive screening tool, comprising 12 activities that assess play, communication, and imitation. 
• Parents’ Evaluation of Developmental Status (PEDS)  is a general developmental parent-interview form that identifies areas of concern by asking parents questions.  

The American Academy of Pediatrics encourages autism screening for all children at their 18 and 24-month well-child checkups. Parents and caregivers can also ask their pediatrician for an autism screening if they have concerns. In rare cases, individuals with autism reach adulthood before receiving a diagnosis. However, most individuals receive an autism diagnosis before the age of 8.

Prevalence of autism

For many years, a diagnosis of autism was rare, occurring in just one child out of 2,000. One reason for this was the diagnostic criteria. Autism was not clearly defined until 1980 when the disorder was included in the DSM-III. Before that time, some cases of autism spectrum disorder may have been mistaken for other conditions. 

Since the ’80s, the rate of autism has increased dramatically around the world. In March 2020, the US Federal Centers for Disease Control announced that  1 in every 54 children  in the United States is affected by autism. 

Although autism is more likely to affect boys than girls, children of all genders have been diagnosed with ASD. Several recent studies investigate the impact of race, ethnicity, and socioeconomic  disparities on the diagnosis of autism spectrum disorder. 1,2,3,4

A short history of autism

Researchers have been working on autism and autism-like disorders since the 1940s. At that time, autism studies tended to be small in scale and used varying definitions of the disorder. Autism was also sometimes lumped in with other conditions.

Focused research into ASD became more common in the 1980s when the DSM-III established autism as a distinct diagnosis. Since then, researchers have explored the causes, symptoms, comorbidities, efficacy of treatments, and many other issues related to autism. 

Researchers have yet to discover a cause for autism. Many of the ideas put forth thus far have been disproven. Likely a combination of genetic , neurological , and environmental factors are at work, which is the case with many psychiatric disorders and conditions. 

Autism Prognosis

Autism is a lifelong condition, and a wide variety of treatments can help support people with ASD. The symptoms and comorbidities—conditions occurring in the same individual—are treatable. Early intervention delivers the best results. Parents and caregivers should seek out the advice of a qualified medical professional before starting any autism treatment. 

Advances in understanding autism, its symptoms, and comorbidities have improved outcomes for individuals with autism. In recent years, more children with autism have attended school in typical classrooms and gone on to live semi-independently. However, the majority remain affected to some degree throughout their lifetime. 

Co-occurring conditions

When a person has more than two or more disorders, these conditions are known as comorbidities. Several comorbidities are common in people with autism. 

These include: 

• Gastrointestinal and immune function disorders
• Metabolic disorders
• Sleep disorders

Identifying co-occurring conditions can sometimes be a challenge because their symptoms may be mimicked or masked by autism symptoms. However, diagnosing and identifying these conditions can help avoid complications and improve the quality of life for individuals with autism. 

Autism in pop culture

Movies and books featuring characters with autism have helped bring autism spectrum disorder into the public consciousness. Some have ignited controversy; others have increased the public’s general understanding of autism. A few have done both. At ARI, we hope that people will rely on evidence-based research to understand autism spectrum disorder better.   

Learn more about autism spectrum disorder by watching one of our expert-led webinars . They help you learn about ASD from clinicians, researchers, and therapists who research autism and support individuals with ASD. 

• Donohue MR, Childs AW, Richards M, Robins DL. Race influences parent report of concerns about symptoms of autism spectrum disorder. Autism . 2019;23(1):100-111. doi:10.1177/1362361317722030
• Durkin MS, Maenner MJ, Baio J, et al. Autism Spectrum Disorder Among US Children (2002-2010): Socioeconomic, Racial, and Ethnic Disparities. Am J Public Health . 2017;107(11):1818-1826. doi:10.2105/AJPH.2017.304032
• Newschaffer CJ. Trends in Autism Spectrum Disorders: The Interaction of Time, Group-Level Socioeconomic Status, and Individual-Level Race/Ethnicity. Am J Public Health . 2017;107(11):1698-1699. doi:10.2105/AJPH.2017.304085
• Yingling ME, Hock RM, Bell BA. Time-Lag Between Diagnosis of Autism Spectrum Disorder and Onset of Publicly-Funded Early Intensive Behavioral Intervention: Do Race-Ethnicity and Neighborhood Matter?. J Autism Dev Disord . 2018;48(2):561-571. doi:10.1007/s10803-017-3354-3

Motor Skills and Executive Function in Autism

autismAdmin 2024-03-01T12:48:58-05:00 May 8th, 2024 | Back to School , Early Intervention , Educational Therapies , Executive Function , Health , Parenting , Sensory , Social Skills , Webinar |

Free webinar at 1 p.m. Eastern time (US), Wednesday, May 8, 2024 Learn about emerging research on the relationship between the development of motor skills and executive function in autistic children.

Editorial – Addressing delays: proactive parent-led interventions during waiting periods

Melanie Glock 2024-04-28T15:40:41-05:00 December 6th, 2023 | News |

The wait for an autism diagnosis and subsequent intervention can be highly stressful for many families, especially when access to needed health and educational services also hinges on the approval of insurance

Prenatal exposure to cannabis may increase likelihood of autism

Melanie Glock 2024-04-28T15:45:52-05:00 August 29th, 2023 | News |

Cannabis use during pregnancy may alter placental and fetal DNA methylation (the process of turning genes “on” and “off”) in ways that increase the likelihood of autism spectrum disorder (ASD) or other

New multi-national study adds to evidence linking alterations of the gut microbiome to autism

Melanie Glock 2024-04-28T15:46:00-05:00 August 29th, 2023 | News |

Strong new evidence linking alterations of the gut microbiome to autism spectrum disorders (ASD) comes from a new multi-national study by James Morton and colleagues. In the study, researchers in North America,

Sleep problems in infancy associated with ASD, autism traits, and social attention alterations

Melanie Glock 2024-04-28T15:47:35-05:00 July 20th, 2023 | News |

A new study from the United Kingdom indicates that sleep problems in infancy may help to predict later social skills deficits, autism traits, and autism diagnoses in children. Jannath Begum-Ali and colleagues

Preemptive therapy prior to autism diagnosis may be highly cost-effective

Melanie Glock 2024-04-28T15:47:42-05:00 July 17th, 2023 | News |

Preemptive therapy for infants who display early symptoms of autism may be highly cost-effective, according to a new study from Australia. Leonie Segal and colleagues based their economic analysis on a 2021

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Autism: A Very Short Introduction

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Autism: A Very Short Introduction asks: What causes autism? Is it a genetic disorder, or due to some unknown environmental hazard? Are we facing an autism epidemic? What are the main symptoms, and how does it relate to Asperger syndrome? It explores the relevance to autism of neuroscience, psychology, brain development, and genetics. Everyone has heard of autism, but the disorder itself is little understood. It has captured the public imagination through films and novels portraying individuals with baffling combinations of disability and extraordinary talent, and yet the reality is more often that it places a heavy burden on sufferers and their families.

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One-To-One Programs: Supporting Autistic Children Essay

Introduction, literature review, challenges teachers and children with autism face, potential benefits of one-to-one programs, potential disadvantages of one-to-one programs, suggestions and recommendations.

Autism is defined as a neuro-developmental disorder which mostly affects children by impairing their neural development making it difficult for them to interact with other children and adults socially (Newschaffer et al 2007).

The impairment in their neural developmental network causes the sufferer to engage in repetitive behaviour such as repeating the same words or actions because it affects the information processing part of the brain (Caronna et al 2008).

The causes of autism are mostly genetic although some disorders have been caused by birth defects, exposure to heavy metals or vaccinations which might affect children of three years and below. This disease is mostly common in children during their first two years and it continues to progress without any form of remission (Gerber and Offit 2009).

The prevalence of autism according to the Centre for Disease Control and Prevention (CDC) has been estimated to be about 1 to 2 people per every 1,000 people around the world. The number of children that suffer from autism has been estimated to be 9 per every 1,000 children world wide.

The Centre for Disease Control and Prevention has also estimated the ratio of male to females who have autistic disorders to average 4.3:1 (CDC 2010). In the UK, the prevalence rate of children with autism was estimated to be 4.5 per 10,000 children in 1966 while in 1979, the figure rose to 20 per 10,000 children when the criteria for autistic spectrum disorders (ASD) was introduced to determine the prevalence of the disorder in the country.

Before the 1990s, the prevalence rate of autism within the country was estimated to be 4 to 5 cases per 10,000 people. However, according to previous studies conducted by medical researchers and paediatricians, the prevalence rate of autism in 2006 was estimated to be 116 per 10,000 children in the UK.

The researchers noted that the prevalence rate of the disease had increased when compared to the statistics for the previous years. The Centre for Disease Control and Prevention (CDC) released new data on the prevalence rate of autism and autistic spectrum disorders in 2007 which revealed that prevalence rates of the disorder averaged between 66 to 67 per 10,000 children (Zhang 2008).

Other studies conducted in the UK to determine the prevalence rate of the disorder revealed that 39 per 10,000 children had autism and 77 per 10,000 had autistic spectrum disorders. The total prevalence rate of the disorder in the UK based on the number of children who have been identified with the disease is 44 per 10,000.

Professor Gillian Baird who conducted the study in South London noted that the findings demonstrated children with autism and other autistic spectrum disorders constituted 1% of the child population in Britain (Lister 2006). For years the most suitable estimate for determining the prevalence rate of autism in children three years and below has always been four to five per 10,000 children in the United Kingdom as well as the rest of the world.

The recent studies have however demonstrated that the current diagnostic criteria used to determine the prevalence rate of the disease has been changed to reflect 1 in 500 children with autism and 1 in 166 children with autistic spectrum conditions. These estimates show that the disorder has grown steadily in the UK over the past decades as more and more young children develop autism spectrum conditions (Zhang 2008).

A consensus estimate conducted in 1978 revealed that the prevalence of autism was 4 in 10,000 while the current estimate has shown that autism affects approximately 1% of the population in UK (Cohen et al 2009).

The number of people that have been diagnosed with autism has increased rapidly over the years because of changes to the diagnostic procedures for detecting the disorder. This massive increase can be attributed to a variety of factors which have made it possible to detect and treat children with autism.

These factors include improved recognition and detection technology, changes in the methods used to study the disorder , increasing availability of diagnostic services in many hospitals and specialised care facilities, an increasing awareness by healthcare professionals and parents on ways of dealing with autistic children and the widening criteria that can be used to detect and diagnose the disease.

Such factors have made it easy to determine the various methods and interventions that can be used to deal with the increasing number of autistic children in the UK (Cohen et al 2009).

The purpose of conducting this essay will be to examine the educational intervention of one-to-one support programs during normal school times within a mainstream classroom and also to discuss the challenges faced by teachers and autistic children as well as the advantages and disadvantages of providing one-to-one support to autistic children.

One-to-one educational interventions in treating autism deal with how teachers or class instructors offer children suffering from autism intervention strategies that are meant to address their cognitive and behavioural problems within the classroom setting. One-to-one educational interventions attempt to increase the functional independence of autistic children within the classroom setting where they are able to learn on their own without any assistance from their teachers and peers.

This type of educational intervention is meant to promote self efficacy skills on the part of the autistic child where they are able to do learning tasks on their own. Teachers under the one-to-one support programs design learning programs that they will use to guide the learning of the autistic child.

The main focus of these programs is to reduce the associated deficits of the disease by increasing the independence of the child within the classroom environment and also improving their social interaction with peers (Caronna et al, 2008).

Various researchers such as Johnson and Myers (2007) have conceded that one-to-one programs are usually successfully when all the school resources are utilised to improve the performance of the child in their learning process.

Such resources include classroom peers where their participation in the one-to-one program occurs when they are prevailed upon by their class teachers to engage with the autistic child during class time sessions; the class teachers or instructors who play a major role in designing the learning programs and techniques that will be used to educate the autistic child and the school administration which provides the necessary learning aids, materials and equipment that will be needed to design the learning program (Johnson and Myers 2007).

Medical researchers and paediatricians have been able to note that teaching children in a highly structured one-to-one support setting is an effective technique of teaching children with autism communication skills, interpersonal skills, social interaction skills and behavioural skills. If autistic children are going to succeed in classroom environments, they need to learn how they will behave and learn within social groups.

One-to-one teaching techniques are able to foster the development of learning skills in autistic children and they have been deemed to be effective in teaching autistic children within a classroom set up of eight to ten children.

The one-to-one teaching of autistic children has also been seen as an essential teaching technique for children who have autism and other mental disorders because it offers personalised training and teaching that allows the child to learn at their own pace through the guidance of their course instructor (Cohen et al 2009).

One-to-one educational programs have been developed in educational systems to help children with autism in acquiring self care and social skills as well as behavioural skills that will enable them to associate well with their peers. These programs have also been designed to improve the functioning behaviours of autistic children and to also help them decrease the severity of symptoms related to their disorder.

Medical studies have showed that interventions that are undertaken on autistic children before the age of three are more than likely to help these children with their compulsive and restrictive behaviour. Interventions therefore need to be undertaken during the formative years of the child’s development to ensure that they are able to develop socially and intellectually (Arndt et al 2005).

The National Research Council has endorsed the use of one-to-one training in teaching autistic children with the main reason being that the needs of the child will be adequately addressed during the learning process. The council recognised that one-to-one interventions provided many autistic children with the opportunity to enter into mainstream educational programs that would be beneficial in their intellectual development.

These programs enable the child to progress from one level of education to another as the teacher equips the child with the necessary educational information for their class grade. The specialised attention that the child gets during these programs is also beneficial as it allows the child to progress at their own rate within the classroom setting (Cohen et al 2009).

Kurtz (2008) notes that one-to-one educational programs are suitable educational interventions for children suffering from autism as they allow them to develop social skills during class interactions with their teachers and peers.

This method of teaching and learning caters for the various stages of an autistic child’s development which include the developmental stage that encompasses intellectual and emotional growth, the individual based development of the child where their communication, social, thinking and learning skills begin to form and the relationship based development of the child where their social interaction skills begin to form.

One-to-one support programs cover all the stages of the autistic’s child’s growth thereby ensuring they are able to operate properly within social settings (Rapin and Tuchman 2008).

One-to-one support programs are also beneficial to autistic children as they allow them to gain receptive processing skills as well as social communication skills that will allow them to communicate and process information they acquire from their instructors.

The scheduled sessions that are developed for one-to-one programs are meant to move the autistic child from one level of the learning program to another thereby developing their intellectual, emotional, thinking, learning and social interaction skills (Kurtz 2008). One-to-one support programs also increase the ability of the child to have emotional connections with their parents, siblings and other people who are important to the child.

This method ensures that the child is able to participate in social relationships by equipping them with emotional and social information. Autistic children under one-to-one support programs are able to become more aware of their environments by being equipped with perceptive and relationship building skills.

This method ensures that children suffering from autistic disorders are able to have a better quality of life in the event their behaviour does not become disruptive or problematic (Siegel 2008).

Because the autistic child gets to learn on a one on one basis with their teachers or instructors, their verbal behaviour becomes improved especially during the reading and speaking assignments which allows them to communicate better with their peers and parents.

As outlined earlier in this discussion, autistic children suffer from an inability to effectively communicate with others as they mostly speak in a repetitive manner where their spoken words are disorderly. This method therefore enables them to verbally relay their emotions and feelings to people that are close to them thereby enhancing social understanding.

The one-to-one approach also improves the organizational and planning abilities of autistic children allowing them to adapt to changes in their daily routines which is important given that most autistic children have restricted daily routines that cannot be subjected to change (Gutstein 2007).

The major limitation or challenge of this type of approach in providing educational support to autistic children is that it proves difficult for the teacher to manage especially in a class of ten children or more. The teacher’s attention is usually divided between managing the learning objectives and outcomes of the autistic child and those of the rest of the class during learning sessions.

This might mean that whatever the teacher set out to cover with the autistic child might not be achievable especially if they are forced to pay attention to the learning needs of the rest of the class (Gutstein 2004). One-to-one learning approaches might also require the teacher to allocate a substantial amount of time from their teaching schedules so that they can be able to develop learning goals and objectives for the autistic child.

This presents a challenge for teachers especially in the event the school administrators and paediatricians concerned with the health of the child have been unable to resolve the work schedule for the affected teacher. The workload therefore becomes too much as they have to handle the needs of the autistic child as well as the needs of the other children within the class.

Heavy workloads therefore results in cases of neglect which means that the educational interventions for the child will not be met. Another limitation of one-to-one programs is that additional costs and resources will be needed to manage the teacher-student sessions that come with this type of support program.

School administrators will have to acquire teaching aids designed for autistic children as well as other materials that are needed for the instructors at an increased additional cost to ensure that the child is properly taught on reading, writing and speaking skills (Robledo and Kucharski 2005).

The availability of one-to-one support programs also presents a major challenge to many schools with autistic children especially in the public schools that are funded by the government. Such schools are unable to provide language services that are useful in the one-to-one support programs because of a shortage of language specialists who can be able to properly communicate with the autistic child.

Certain school districts in the UK and in the US have also been unable to provide the recommended intervention of one-to-one instruction for their autistic students because of the high expense incurred by this type of educational intervention (Howlin 2005).

While most autism experts and paediatricians agree that one-to-one support programs for autistic children are usually beneficial, they present a myriad of challenges to both the teachers and students who interact with the autistic child in the classroom everyday. One such challenge is that a substantial amount of time is needed for the one-to-one sessions every day of the week.

The teacher is meant to set aside about 20 to 40 hours every week to provide support for the autistic child during classroom sessions. The reason why a lot of time is needed for these programs is to ensure that the teacher is able to achieve a high level of success during the one-to-one sessions.

This might prove to be a heavy workload for the teacher who has other students to deal with in the classroom and therefore allocating such a huge amount of time to one student might seem to be a waste of their time (Turkington and Anan 2007).

One-to-one programs are also a challenge to class teachers in the event they have to undergo training to enable them to properly conduct the one-to-one learning sessions. This training might require more of their time and effort which becomes a challenge if they have a large workload to deal with in the classroom.

The teachers might at times be required to work hand in hand with autism experts and therapists to ensure that the behavioural and cognitive problems of the child have been properly addressed.

The challenge lies in trying to strike a meaningful relationship between the teacher and the experts where the teacher might feel that a certain educational strategy would be useful in helping the autistic child to learn while the experts might hold a different opinion of how the one-to-one sessions should be conducted by the teacher (Turkington and Anan 2007).

Teachers also face the challenge of overlooking the educational needs of the other children in the classroom especially if the teacher decides to concentrate on the learning efforts of the autistic child. Trying to achieve a balance between managing the learning needs of the autistic child and managing the needs of the other children in the class becomes a challenge.

Also within the classroom, teachers are faced with the challenge of protecting the autistic child from any victimization from the rest of the class. Children who do not properly understand the condition might make fun of the affected child during class sessions such as reading tasks which might further increase the child’s self esteem issues. It therefore falls on the teacher to keep the rest of the class in check when it comes to the learning needs of autistic children (Levy 2006).

The challenges that children with autism face within the school system are usually based on their behavioural problems and the severity of the disorder in the child’s cognitive capabilities. These factors impact significantly on the type of interactions that the child will have with their peers and teachers within the classroom setting.

Since autistic children suffer from emotional and behavioural problems, the kind of interaction that these children have with their teachers and peers might worsen especially for teachers who have less willingness to teach autistic children.

Various studies conducted by researchers such as Cook and Landrum, Pavri and Monda have shown that children with more advanced autistic tendencies might affect the attitudes of teachers when it comes to interacting with the child (Levy 2006).

Autistic children also face the challenge of being taught by uneducated teachers and classroom instructors who have not received any special training to cater for the educational needs of the autistic child.

Most public school systems lack the necessary funds and resources to train their teachers on how they can be able to meet the learning needs of autistic children which means that the children end up not understanding what is being taught in class.

Additionally, the lack of long-term structures in most school systems to address the needs of autistic children makes it difficult for most parents to find conducive environments for their autistic children (Levy 2006).

Children who are transitioning from intensive behavioural programs into the school based systems might find it difficult to adjust to the learning conditions where the characteristics of autistic children present a great inhibition to inclusion. The benefits of placing autistic children within normal school systems is that they can be able to learn from observing the actions of their peers in the classroom and also in the playground. Being included in peer related programs enables the autistic child to learn real-life skills within realistic contexts and settings.

The challenge however becomes determining whether the child will be socially responsive to such a setting and whether they will actively participate in classroom sessions or playtime activities. Since all autistic children are unresponsive to their environment, they might not be able to gain any valuable educational experiences from such contexts (Handleman et al 2004).

According to Siegel (2008), most parents and educators view one-to-one programs as the first step in teaching children with autism on how to communicate or engage in the socialization process before they are integrated into a classroom setting or social group. One-to-one programs offer autistic children with the opportunity to develop an awareness of their environment and surroundings by focusing on the particular needs of the autistic child.

There are an increasing number of schools that can be able to offer one-to-one teaching for autistic children where the teachers involve the use of various one-to-one teaching techniques that are meant to provide the child with basic social and communication skills.

Some of the most commonly used one-to-one treatment programs for autistic children include relationship development interaction (RDI), peer to peer tutoring, facilitated communication and the DIR/floor time model for educational intervention (Siegel 2008).

Peer-to peer tutoring as an approach of one-to-one support programs in the classroom has grown with significance because it improves the child’s social and communication skills among their peers. This method is also suitable as it develops the behaviour of the child to enable them interact with other children during playtime and study group discussions.

Peer tutoring enables the child to demonstrate their intellectual capability by leading other children in classroom activities such as singing, reading and drawing. All these one-to-one techniques are therefore important addressing the communication disabilities of autistic children as their needs are specifically addressed by tutors, peers and teachers (Gutstein 2007).

Peer to peer tutoring is defined as a one-to-one method of teaching autistic children which focuses on educating autistic children together with non-autistic children where they are able to learn faster by observing the behaviour of their peers during class sessions.

This teaching method is mostly common in inclusion schools and also special education classes where the non-autistic children within the class lead the autistic children through a number of tasks that have specific instructions.

The tutor or teacher who utilises this method in treating autistic children first identifies the behavioural issues that are presented by the autistic students in the class. The teacher then makes a list of these behaviours and categorises them to determine how they can be managed in the class (Kurtz 2008).

A peer tutoring program is then developed based on this list where children who are non autistic become the peer tutors of autistic children in the class for a day or two. The children with autism are also allowed to be tutors to their peers in the class which enables them to develop both interpersonal and leadership skills.

Another way to conduct peer-to-peer support within the classroom is when the autistic child is paired with a normal child. The purpose of doing this is to ensure that the autistic child is able to learn from the actions of the normal child during class assignments. The normal children are able to help their autistic peers with the class assignments, homework and other tasks that have been assigned by the teacher.

Peer tutoring is therefore an important one-to-one teaching method that helps to build the social and behavioural learning objectives of autistic children especially when they are given leadership roles within the classroom setting. Peer support proves beneficial in helping the autistic child to develop friendships with their peers within the classroom (Sailor et al 2009).

The relationship development interaction (RDI) is another approach used in one-to-one support programs for autistic children where dynamic sets are developed to measure intelligence in the autistic child so as to improve their quality of life. This educational intervention allows children to participate in genuine emotional relationships that they are exposed to in their current environment.

The main goal that underlies RDI is to systematically develop emotional relationships through the use of motivational tools which enable the child suffering from autism to successfully interact in various social relationships.

The main aspects that are focused on in the relationship development intervention method are the establishment of building blocks that will be used in fostering social connections that are a common feature in early childhood development (Gerber and Offit 2009).

Relationship interaction development is an important technique because it helps the child to have a stronger relationship with their peers and teachers which will eventually lead to cognitive remediation for the child. Cognitive remediation refers to the process of restoring the optimal neural connectivity of the autistic child through a series of self-discovery activities that will be important in their intellectual development process.

The relationship development method is therefore an important technique that can be used to restore the social interaction and connectivity of the child to their school environment since it focuses on specific activities in autistic children that will elicit interactive behaviours (Lam and Aman 2007).

Another one-to-one treatment program for autistic children is the floortime or DIR model which offers a comprehensive framework for understanding and treating children with autism. The acronym DIR stands for three components that make up the floor time model which include developmental, individual difference and relationship-based.

The floortime model of one-to-one treatment focuses on helping autistic children with their communication problems as well as their interpersonal skills rather than on treating them for a particular set of behaviours. The floortime or DIR model was developed by child psychiatrist, Stanley Greenspan, who was also a specialist in autism related disorders.

Greenspan developed a model that would be a comprehensive and interdisciplinary approach that would help autistic children with social-emotional functions, psychomotor skills, thinking and learning skills (Kurtz 2008).

The DIR approach basically focuses on floor-time sessions that are meant to enhance the emotional and social interactions that the autistic child has with his/her peers within the school and classroom context so as to facilitate emotional and cognitive growth. The model also focuses on providing therapeutic remedies which can be used to remediate biologically based processing capacities that are necessary in intellectual growth (Myers and Johnson 2007).

The aspect of developmental in the floor time model involves focusing on the developmental aspects of children that are needed for them to grow and mature intellectually and emotionally. This component determines which developmental milestones are important for the autistic child in their childhood so that they can be able to mature intellectually (Kurtz 2008).

The Individual difference component refers to understanding the autistic child’s sensory processing differences which are unique from those of normal children. This particular component of the DIR involves determining how these unique differences will impact on the learning and behavioural patterns of the autistic child.

The relationship-based component of the floor time model focuses on helping the autistic child to develop social interactions and relationships with their primary caregivers and peers which will enable the child to foster social development tendencies. All these components are important in the floor time model as they enable the trained consultant or teacher to design programs that will meet the specific development, relationship and individual needs of the autistic child (Kurtz 2008).

Facilitated communication is another one-to-one method that can be used to teach autistic children within classrooms settings. Facilitated communication involves the teacher physically guiding the learning and communication activities of the autistic child. The tutor or facilitator basically places a hand over the autistic child’s hand or wrist and guides them during the learning process.

The tutor guides the child by holding their hand in identifying various objects, pictures and images to express their thoughts. The purpose of facilitated communication in one-to-one educational support is to enable the child build on their perception, communication and interaction skills.

The child is able to communicate with their hands to the facilitator or tutor allowing them to express their thoughts and opinions. This method also allows autistic children to demonstrate their intelligence levels during the facilitation sessions (Kurtz 2008).

The advantages of one-to-one support programs are that they enable children to adapt to mainstream classroom and playground settings where the child is taught on social interaction and communication skills.

These programs cater for the various stages of a child’s development which include the developmental stage that encompasses intellectual and emotional growth, the individual based development of the child where their communication, social, thinking and learning skills begin to form and the relationship based development of the child where their social interaction skills begin to form.

One-to-one support programs also allow the autistic child to learn at their own pace without necessarily being influenced by the learning progress of other children in the classroom (Gutstein 2004).

One-to-one support programs are beneficial to autistic children since they allow them to develop an awareness of their school environment where they observe the actions of their peers, educators and other important elements of the school system improving their cognitive and behavioural abilities.

One-to-one programs that are peer supported are mostly beneficial for autistic children as they learn from observing the learning actions of their peers. Peer tutors provide the much needed guidance for autistic children as they can be able to interact and relate on the same intellectual level. Autistic children who engage in peer-to-peer support groups can be able to accrue the potential benefits that come with taking turns during tutoring sessions or during playtimes (Siegel 2008).

One-to-one support programs ensure that autistic children receive the best educational training from teachers who are more than likely trained to teach children with this disorder. These support programs have structured moment-to-moment activities that ensure the child is able to cover the curriculum within the allocated time for the sessions.

One-to-one support programs provide a degree of consistency and routine for autistic children allowing them to take advantage of the learning opportunities offered to their peers and also to develop intellectually. This form of educational intervention is also beneficial for the autistic child as it allows the instructor to improve their speech and language difficulties.

In the event the programs are offered in consultation with an autism expert, the instructor might be able to develop language therapy sessions that will allow the child to improve on their speech and language difficulties (Goldstein 2002).

Relative interaction development techniques have proven to be beneficial one-to-one support programs for autistic children as their social and communication skills are improved where the teacher elicits some verbal emotions from the autistic child. RDI improves the ability of the child to relay their emotions and feelings to the people who are close to the child thereby improving social interactions.

Social and emotional skills allow autistic children to be more aware of their environments as their perceptive skills become increased with every relationship building exercise they are engaged in. One-to-one support programs ensure that the child’s learning process is supported throughout every step by the teacher or facilitator so that they can be able to achieve the learning outcomes set by their teacher (Dodd 2005).

According to various studies conducted on autism and the educational interventions that can be used for autistic children (Eikeseth et al 2002: Howard et al 2005: Sallows and Graupner 2005), one-to-one support programs have proven to be efficient in providing autistic children with early intensive behavioural treatment that is important in increasing the academic performance of these children as well as increasing their IQ levels and adaptive behaviour.

When combined with other educational interventions such as applied behavioural analysis, the support programs increase the adaptive behaviour of children that suffer from autism. The studies conducted on this method of treating autism have mostly focused on the treatment of unwanted behaviours such as communication impairment and repetitive behaviour (Lovaas 2003).

A major disadvantage of this method of treating autism is that it focuses on establishing relationships rather than on academic learning and thinking. While these relationships are important to the child, they do not teach the child on how they can be able to form interactions during the learning process.

One-to-one programs in class settings that have eight children or more might fail to be successful because the teacher’s attention will be divided amongst the rest of the class. Some of the approaches used in one-to-one training mostly focus on play times rather than on academic learning which makes this method weak in educational programs (Myers and Johnson 2007).

One-to-one support programs also prove to be disadvantageous when the attention of the teacher is focused on the autistic child rather than on the whole class. Time and attention is taken away from the rest of the class who might in the end feel neglected by the teacher especially if it is a class of ten to twenty students (Lieberman et al 2004).

One-to-one support programs that are administered within the mainstream context pose a challenge to the academic education of autistic children when the teachers who conduct the sessions lack the necessary training to guide the autistic child’s learning process. Teachers who are in mainstream classes within the public school systems lack the proper training and skills that can be used to accommodate the special needs of the autistic child within the general education classes.

Research work has revealed that teachers who are not aware of the learning needs required by autistic children are more than likely to resist having these children in their classrooms. The negative impact of this is that it can lead to a form of regression in autistic children which in the end affects their classroom productivity and educational outcomes (Suomi et al 2003).

Another limitation of one-to-one support programs is that they are generally expensive to operate especially for public schools that are required by the state government to provide special education classes without any additional funds.

The cost of one-to-one support programs according to a 2005 Special Education Expenditures Program (SEEP) report developed by the United States revealed that the cost for student’s in special education programs such as one-to-one educational interventions amounts to $10, 558 when compared to the cost charged for regular education amongst normal children which averaged $6,556 (Schiller et al 2007)

While one-to-one support programs present various challenges, studies conducted on this form of educational intervention have revealed that the benefits far outweigh the challenges. One-to-one support programs need to be improved on to ensure that there are no challenges presented to the student and teacher during the learning process and that the objectives of the program have been met by both the autistic child and instructor.

There should be access to these programs especially in the public school systems to ensure that autistic children from poor income families are able to access special educational services that will meet their learning needs. More awareness needs to be created on the importance of one-to-one support programs especially in the mainstream so that both the teachers and students are able to adapt to the autistic child’s educational needs.

This will also improve peer-to-peer tutoring where normal children will be willing to provide assistance to autistic children during class assignments and tasks. A major recommendation for the study is that more research needs to be conducted on one-to-one support programs in educating autistic children as very few authors used in the study have been able to provide substantive information that can be used to explain this type of educational intervention.

The discussion has focused on one-to-one support programs in the classroom setting by focusing on the challenges, benefits and limitations of this type of programs on the education of an autistic child. The essay has been able to provide an in-depth analysis of one-to-one support programs by examining the various approaches used in teaching autistic child within the classroom.

The study has been able to determine that one-to-one programs ensure that children are able to achieve the learning objectives set by the trained instructors so that they can achieve academic excellence. Overall one-to-one support programs have been termed to be effective especially in developing the communication, behavioural and interpersonal skills of the autistic child

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I. Introduction An anonymous speaker once said, “some people with Autism may not be able to speak or answer to their name, but they can still hear your words and feel your kindness.” Approximately thirty percent of people diagnosed with Autism Spectrum Disorder never learn to speak more than a few words (Forman & Rudy, 2018). Fortunately in today’s society, new technologies have made it possible for these individuals to communicate and socialize with others. Purpose The primary focus of […]

Searching Employment Autism

Over the last 20 years, there has been an alarming increase for children who have been diagnosed with Autism Spectrum Disorder (ASD) in the United States. According to the Centers for Disease Control, in the year 2000 1 in 159 children would be diagnosed with ASD. In the latest version of the study, the number has been reduced to 1 in 59 children will be diagnosed with ASD (Centers for Disease Control and Prevention, 2018). This is a subject that […]

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How To Write an Essay About Autism

Understanding autism.

Before writing an essay about autism, it's essential to understand what autism is and the spectrum of conditions it encompasses. Autism, or Autism Spectrum Disorder (ASD), is a complex developmental disorder that affects communication and behavior. It is characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. Start your essay by explaining the nature of autism, its symptoms, and the spectrum concept, which acknowledges a range of strengths and challenges experienced by individuals with autism. It's also important to discuss the causes and diagnosis of autism, as well as the common misconceptions and stereotypes surrounding it. This foundational knowledge will set the stage for a more in-depth exploration of the topic.

Developing a Focused Thesis Statement

A strong essay on autism should be centered around a clear, focused thesis statement. This statement should present a specific angle or argument about autism. For example, you might discuss the importance of early intervention and therapy, the representation of autism in media, or the challenges faced by individuals with autism in education and employment. Your thesis will guide the direction of your essay and ensure that your analysis is structured and coherent.

Gathering and Analyzing Data

To support your thesis, gather relevant data and research from credible sources. This might include scientific studies, statistics, reports from autism advocacy organizations, and personal narratives. Analyze this data critically, considering different perspectives and the quality of the evidence. Including a range of viewpoints will strengthen your argument and demonstrate a comprehensive understanding of the topic.

Discussing Implications and Interventions

A significant portion of your essay should be dedicated to discussing the broader implications of autism and potential interventions. This can include the impact of autism on individuals and families, educational strategies, therapeutic approaches, and social support systems. Evaluate the effectiveness of these interventions, drawing on case studies or research findings. Discussing both the successes and challenges in managing and understanding autism will provide a balanced view and demonstrate a comprehensive understanding of the topic.

Concluding the Essay

Conclude your essay by summarizing the key points of your discussion and restating your thesis in light of the evidence and examples provided. Your conclusion should tie together your analysis and emphasize the significance of understanding and supporting individuals with autism. You might also want to highlight areas where further research or development is needed or the potential for societal changes to improve the lives of those with autism.

Final Review and Editing

After completing your essay, it's important to review and edit your work. Ensure that your arguments are clearly articulated and supported by evidence. Check for grammatical accuracy and ensure that your essay flows logically from one point to the next. Consider seeking feedback from peers or experts in the field to refine your essay further. A well-crafted essay on autism will not only inform but also engage readers in considering the complexities of this condition and the collective efforts required to support those affected by it.

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Home — Essay Samples — Nursing & Health — Autism — Why Autism Awareness is Important

Why Autism Awareness is Important

• Categories: Autism Psychological Disorders

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Published: Aug 24, 2023

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Jackie Schuld Art Therapy Blog

• Feb 17, 2023

The Great List of Autistic Essays

I’m a late-identified autistic who loves writing about autism. How much do I love it? I’ve written over 150 essays on it in the past six months alone.

How do I think of so many autistic topics to write about? I’m an art therapist who specializes in late-identified autistic adults. That means I not only have my personal experience to draw from, but also the hundreds of hours spent listening to my clients.

I share most of my essays here on Medium, which means it has now become quite the library. In an effort to make my essays more accessible to those wanting clear, relatable information about late-identified autism in adults, I’ve sorted my essays into topics below. While I wish I could provide a link to each of them for you… I’ve got to prioritize my time and energy. So if a specific essay interests you, just pop it into the search and it’ll come up

Autism in a Neurotypical World

What Would a World Designed by Autistic People Be Like

The Harm in "They're a Little Autistic"

Autism Does Not Directly Cause Socializing Problems

Please Trust My Lived Autistic Experience

Can Someone Please Create a Neurodivergent Intentional Living Community

What if I Accept that Most Neurotypicals Won't Like Me

How Neuro-Bias Shows Up in Professional Testing

Your Autistic Experience Sounds Just LIke my Neurotypical One

Neurotypical Words that Don't Work for Autistics: Overachiever

But Neurotypicals Experience That, Too!

Neurotypical Norms That Don’t Work for Autistics: Hustle Goals

The Fear of Being a Hypocritical Autistic

Neurodiversity: Us vs Them?

How to Meet an Autistic Adult Exactly Where They're At

Autism Characteristics

The Autistic Mind Loves to Take Detours

4 Reasons Why Autism Symptoms Lists are Confusing

My Autistic Brain: Sunshine and Detours

The Joys of Being Autistic: Part 1

Stop Saying Autistic People Can't Empathize

Redefining Fun for Autistic Adults

9 Reasons Why Autism Looks So Similar to CPTSD

We Need More Depictions of the Interior Experience of Autism

Clarity is What my Autistic Mind Craves

How Trauma and Autism Can be a Confusing Mix to Decipher

Why am I like This? Understanding the Autistic Brain

My Autistic Mind Does What it Wants

The Dissociated Autistic Performance State

The Joys of Being Autistic: Increased Creativity and Innovation

My Autistic Memory Is Not the Same as Others

The Firehouse Dilemma: Autism and Infodumping

The Variability of the Autistic Sensory System

5 Reasons Autistics are Especially Hard on Themselves

The Shame That Often Accompanies Autism

Knowing You’re Different as an Autistic Adult

3 Reasons Autism is Worse After You Learn You're Autistic

Disability and Internalized Ableism

I Had to Dismantle My Fear of Autistic People

Is Autism a Disability?

I’m Ok With Saying I have a Disability, Right?

Dog Training

The Difficulties of Adjusting to a New Dog When You're Autistic

Tips for Adjusting to a New Dog When You're Autistic

5 Tips to Integrate a Dog into Your Autistic Life

Defining and Explaining Autism

What I Wish Others Knew About Autism

Let’s Drop the “Disorder” From Autism Spectrum Disorder

How Low and High Autism Labels are Misleading

We Need All the Autism Theories and Models

Autism Can Be a Murky Thing To Understand

How I Explain Autism to Someone Unfamiliar With It

What is Late Identified Autism

Autistic Statistics are Not Accurate for Late-Identified Autistics

I'm Here for the Autistic Awakening

How It Helps to Know You’re Autistic

Why It Matters to Know You're Neurodivergent

What is Neurodiversity and Why Does it Matter

How Neurodivergent Acceptance Can Improve Our Lived Experiences

How Unidentified Autistics are Taught to Socially Camouflage and Mask

Is There a World Where I can Be Unmasked?

The False Dichotomy of Masked and Unmasked Autism

6 Reasons Why UnMasking Is Harder Than it Sounds

What if You have to Mask Everywhere?

My Personal Experience as an Autistic

Hating Cooking as an Autistic Adult

I Make Giant Lists About Autism for Fun

The Challenges of Writing Publically About Autism

The Risk of Sharing my Autistic Passions with Others

I'm Reclaiming Weird for My Autistic Self

I Expand and Then I Contract

I Stopped Seeing Myself As Broken When I learned I was Autistic

Respecting my Limits as an Autistic Business Owner

I Need to Lessen the Pressure on my Autistic Self

My Autistic Brain Doesn’t Want to Watch TV Right Now

Embracing Who I am as an Autistic Adult

I Used to be a Very Judgemental When I Didn’t Know I was Autistic

A Letter from An Autistic Adult to Trust

Don’t Get So Upset: A Line that Doesn’t Work for This Autist

Why This Autistic Writer Didn't Respond to Your Comment

Relationships

Is Dating Worth it as an Autistic Adult?

Is it Possible to be Happily Partnered as an Autistic Adult?

Not Liking People as an Autistic Adult

Self-Identification

So You Think You Might Be Autistic

Dearly Newly Identified Autistic Person

Am I Actually Autistic?

Dearest Smart, Weird, and Caring Autistic

I Am Deeply Unsure About Autism

How to Self Identify Autism as an Adult

When the Past Makes Sense after a Late-Identification of Autism

Where to Start When You First Learn You’re Autistic

6 Strategies to Harness the Hyperfocus Power of an Autistic Mind

Leave the Gremlin In the Cave: Self-Isolation as a Necessary Autistic Tool

No Plans Days as an Autistic Tool

Making Accommodations for Myself as an Autistic Adult

How Many Accommodations Can We Ask for as Autistic Adults?

Using Art to Help Your Autistic Mind

Dissociation as an Autistic Tool

The Power of the Home Environment for Autistics

Is It Ok to Honor My Autistic Needs?

Recognizing When It's Not Time to Make Decisions as an Autistic

Therapy for Autistics

Dearest Autistic Client of Mine

8 Ways Therapy Can Help With Late Identified Autism

Gaslighting the Autistic Experience

Dearest Therapist Who Knows Barely Anything About Autism

I'm an Autistic Therapist: Sometimes It's Easier Than Everyday Life

Does Your Therapist Know Enough About Autism to Help You?

Questions to Ask a Potential Therapist When You're Autistic

How I Work with Newly Identified Autistic People

What to Ask When You're Seeking Therapy for Late-Identified Autism

12 Ways Therapy Can Enhance Life for Late Identified Autistic Adults

Therapy is Not for Fixing Autism

The Harm I Caused When I Didn't Know about Autism

A Newly Identified Autistic Therapist Working with Newly Identified Autistics

Common Therapy Advice That is Counterproductive for Autistics

A Therapist Told Me Treating Autism is Like Treating Depression

Who Can Diagnose Autism in Adults?

Autistic Adults Deserve Better from the Mental Health Field

Undiagnosed Autism

The Correlation Between Intelligence and Undiagnosed Autism

10 Consequences of a Life with Unidentified Autism

The Gap Between “Diagnosable Autism” and a Lifetime of Unidentified Autism

Autism Diagnosis Criteria are Limiting for Men Too

No Autistic Should Receive a Diagnosis Letter Like Mine

Identifying Autism in Undiagnosed Women Abstract

How I Identify Autism in Undiagnosed Women

Autistic Stereotypes Block People From Knowing They're Autistic

Thank you for reading. If you’d like to read more, sign up for my FUNletter . If you would like to explore your autistic identity with an autistic therapist, you can learn more about my therapy services here .

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