Q. Do symptoms of autism change over time?

Q. Do symptoms of autism change over time?

http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

Autism can occur concurrently with other disabilities. Approx. 75% of the population with autism also also have mental retardation. Current statistics show that 1 in 110 people are affected with the disorder. Autism occurs more frequently in males than in females, with a ratio of one girl to every four boys.

The number of children diagnosed with an Autism Spectrum Disorder has increased markedly in the last 20 years.

ASDs occur on a spectrum from “full blown” autism, to Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), to the mildest version, Asperger’s Syndrome. We have yet to adequately answer the question, “What causes autism?” Psychogenic etiology, Bettleheim’s “refrigerator mother theory,” has fallen out of favor, and there is growing consensus that autism is caused by complex gene/environment interactions (e.g., DeLong, 2011; Herbert, 2005). Genes “load the gun” and the environment “pulls the trigger,” making autism a complex, multi-systemic, environmentally affected condition—an ongoing biological process rather than a hardwired brain state (Herbert, 2005; Jepson, 2007; Sears, 2010). Given the exponential rise in cases, autism cannot be strictly genetic, as our gene pool cannot shift that quickly (Jepson, 2007), but examination of environmental triggers has become controversial and politicized as vaccines are frequently cited as potential culprits.

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by impaired social interactions, deficits in verbal and nonverbal communication, and repetitive behaviors or unusual or severely limited interests (American Psychiatric Association 2000).

POPULATION AND SEVERITY
(diversity, range, statistics, Aspergers)

-Classic autism only part of autism spectrum disorders (ASD). Others include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder.

Medications are widely prescribed in children with autism spectrum disorders. Most commonly these medications are used to decrease symptoms that fall under three main clusters: irritability, ADHD-like symptoms, and repetitive behaviors. In this guide we introduce basic approaches to medications in children with autism and review the scientific evidence in each symptom cluster. SIBLINGS

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  Auditory hypersensitivity
  
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  Tactile defensiveness
  
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  Exhibit sensory behaviors such as crashing, squeezing, spinning, flapping
  

In the three decades since, autism has gone from obscurity to painful familiarity. The Centers for Disease Control and Prevention estimates that about 1 in 110 children in the United States are autistic. Yet the disorder remains enigmatic.

Autism Spectrum Disorders (ASD) are a group of neurodevelopmental disorders that

can be diagnosed during early childhood. The three core symptoms characteristic of

ASD (i.e., impairments in communication, impairments in socialization, and

restricted interest and repetitive behaviors) are chronic and continue into adulthood

(Beadle-Brown et al. 2002; Lord 1995; Matson et al. 1996; Matson et al. 2008c;

early identification and treatment is essential for maximizing potential

improvements in children with ASD. Due to the lifelong nature of symptoms of ASD, not only does early diagnosis

appear to be a top priority, but the importance of tracking the pattern of symptom

expression over time is also magnified. many of these studies the

participant sample is categorized by individuals who meet criteria for any of the

three most common ASD diagnoses: AD, PDD-NOS, or Asperger’s Syndrome (AS). Core features of AD include social skills deficits, communication impairments, insistence on sameness and restricted interests (Matson and Boisjoli 2008; Matson

et al. 2008a; Matson and Wilkins 2008).

Autistic Disorder (AD), the most common and severe autism spectrum disorder (ASD), is defined by a triad of impairments in communication, social reciprocity, and repetitive/restricted interests and behaviors (American Psychiatric Association 2000). Children with AD often exhibit maladaptive behaviors, defined as co-occurring internalizing (e.g. emotionally reactive, depressed/anxious affect, somatic complaints and withdrawal) and externalizing (e.g. aggression, defiance and inattentive) behavior problems that negatively impact everyday activities (Bradley et al. 2004; Eisenhower et al. 2005; Brereton et al. 2006). Maladaptive behaviors often cause more distress to caregivers than the core autistic symptoms (Hastings et al. 2005; Lecavalier et al. 2006). Maladaptive behaviors can also interfere with intervention efforts and thereby impact the long-term prognosis of children with AD (e.g. Horner et al. 1992).

Discussion

Children with AD exhibit more maladaptive behaviors

than their typically developing peers and peers

with ID because of other aetiologies (Bradley et al.

2004; Brereton et al. 2006). These maladaptive

behaviors are distressing to caregivers and can

interfere with intervention services (Hastings et al.

2005; Lecavalier et al. 2006). Little is known about

the prevalence of maladaptive behaviors during

early childhood (_5 years), which is a critical

period for intervention efforts (Harris & Handleman

2000; Stone &Yoder 2001). In this study, we

examined the prevalence of parent-rated Clinically

Significant maladaptive behaviors in a large and

well-defined sample of young children (5 years old)

with AD.We also identified subject characteristic

correlates of maladaptive behaviors.

One-third of young children with AD had a

CBCL Total Problems score in the Clinically Significant

range, indicating the presence of maladaptive

behaviors at a level that markedly impacts

daily functioning and thus is likely to interfere with

early learning activities.

Journal of Intellectual Disability Research volume 52 part 10 October 2008

S. L. Hartley et al. • Maladaptive behaviors in children with Autistic Disorder

© 2008 The Authors. Journal Compilation © 2008 Blackwell Publishing Ltd

young children with AD were rated as exhibiting a

Clinically Significant level of withdrawal behavior.

Impairment in social relatedness is a core feature of

AD, and thus it is not surprising that the majority

of young children with AD were reported to have

difficulty engaging with others. A similar prevalence

of withdrawal behavior has been reported for older

children with ASD (Bolte et al. 1999). Clinically

Significant levels of attention problems were

reported for 38.5% of young children with AD,

which is consistent with past reports of a high

prevalence of inattention in younger children with

ASD (e.g. Gadow et al. 2004, 2005); Weisbrot et al.

2004). In support of previous findings, aggressive

behavior was common among young children with

AD (e.g. Green et al. 2000; Horner et al. 2002),

with 22.5% of children exhibiting Clinically Significant

problems with aggression. Overall, the greatest

behavioral obstacles for successful early intervention

services appear to be getting young children

with AD to engage with providers, ensuring that

they sustain attention during activities, and managing

aggressive behavior.

In the present study, there was a relatively low

prevalence of Clinically Significant anxious or

depressed mood. This finding is consistent with

findings from a previous study (Gadow et al. 2004)

suggesting that difficulties with affect regulation are

not common during early childhood in ASD. There

was a high rate of co-morbidity of maladaptive

behaviors in the present study. One-third (33.4%)

of young children with AD were rated as having two

to three Clinically Significant maladaptive behaviors

and 13.4% were rated as having four or more

Clinically Significant maladaptive behaviors. This

finding suggests that behavior management strategies

included in early intervention programs

should be designed to address numerous internalizing

and externalizing maladaptive behaviors, as

children with AD are likely to demonstrate more

than one problem behavior.

Several subject characteristic correlates of maladaptive

behaviors were identified in the present

study. The strongest predictor of overall externalizing

maladaptive behavior was non-verbal cognitive

ability and the strongest predictor of overall internalizing

maladaptive behavior was adaptive behavior.

This finding is consistent with research in

older children and adults with ASD (e.g. de Bildt

across the lifespan, individuals with low cognitive

ability and adaptive behavior are at a greater risk

for maladaptive behaviors than high functioning

individuals. In the present study, non-verbal cognitive

ability and adaptive behavior accounted for

8% to 10% of the variance in internalizing and

externalizing behaviors, respectively, suggesting

that these subject characteristics have important but

limited predictive value in early childhood.

Low expressive language was a risk factor for

inattention as well as several internalizing maladaptive

behaviors in this study. This finding supports

research of individuals with developmental disabilities,

and indicates that maladaptive behaviors may

often be inappropriate attempts to communicate

needs (e.g. Durand, 1993; Day & Horner 1994).

Functional communication training aimed at teaching

young children with AD appropriate ways to

communicate their needs may lead to declines in

maladaptive behaviors. In contradiction to our

hypothesis and past research of children with ASD

(Dominick et al. 2007), severity of autistic behaviors

was not predictive of maladaptive behaviors.

Severity of autistic behaviors may be an important

risk factor for maladaptive behaviors when considering

an ASD population, given the large variation

in the presentation of autistic behaviors. However,

severity of autistic behaviors may not be a key risk

factor for maladaptive behaviors when more

defined population of young children with AD is

considered.

Gender was largely unrelated to maladaptive

behaviors in the present study, with the exception

that girls with AD evidenced more sleep problems

and difficulty with emotional reactivity than boys.

This finding is consistent with previous findings

that girls with ASD have a slightly more severe presentation

than boys, although gender differences are

limited (Nyden et al. 2000; Gadow et al. 2004;

de Bildt et al. 2005; Holtmann et al. 2005; Herring

et al. 2006; Shattuck et al. 2007). Age was positively

associated with internalizing maladaptive behaviors,

and specifically somatic complaints and withdrawal

in the present study. This finding parallels

the pattern seen in typically developing children

(van der Valk et al. 2003; Frigerio et al. 2004) and

supports a previous report (Eisenhower et al. 2005)

of an increase in internalizing maladaptive behavior.

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Journal of Intellectual Disability Research volume 52 part 10 October 2008

© 2008 The Authors. Journal Compilation © 2008 Blackwell Publishing Ltd

iours and decrease in externalizing maladaptive

behaviors during early childhood for ASD. In the

present study, non-Caucasian children with AD displayed

more maladaptive behaviors than Caucasian

children. Within the typically developing

literature, ethnic-minority children also score higher

than Caucasian children on parent-report

behavior measures (Sandberg et al. 1991; Raadal

determine whether this finding reflects differences

in maladaptive behaviors because of being an

ethnic-minority, differences in socioeconomic status,

measurement bias or differences in parent

perspectives.

There are several limitations to this study. The

number of correlations conducted between CBCL

scores and subject characteristics increases the

chance of type 1 errors (i.e. erroneously finding a

significant association). However, stepwise regression

analyses were conducted to account for interrelationships

among subject characteristics and

consistent trends emerged in the data. In order to

increase confidence in findings, follow-up studies

are needed. Moreover, this study used a penetrated

measure of maladaptive behaviors. Observational

and interview measures of maladaptive

behaviors are needed in order to strengthen conclusions.

The extent to which parent-factors, such

as level of distress, availability of supports, or cultural

and socioeconomic differences, influenced

parent ratings of maladaptive behaviors could not

be determined.

Participants in this study were referred to an

autism clinic located in a large tertiary hospital and

research university that serves a wide geographical

region. Young children with AD included in this

study are thought to be similar to those referred to

other large specialty autism clinics. However, results

from this study may not generalize to children with

AD who are not referred for AD diagnosis until

later ages or children with AD diagnosed outside of

a specialty autism clinic. In addition, 27.8% of participants

assessed in the autism clinic were excluded

from this study because of incomplete data. The

subject characteristics of the excluded participants

did not differ from those of the participants in the

study. However, there may be important differences

in parent or environmental characteristics between

these groups.

Research is needed to identify additional risk

factors for maladaptive behaviors in young children

with AD as the subject characteristics included

in this study accounted for a limited portion of

variance. Additional research is also needed to identify

the prevalence of Clinically Significant maladaptive

behaviors in other ASD groups such as

young children with PDD-NOS and Asperger’s

Disorder and determine the similarities or dissimilarities

to that of children with AD. Furthermore, in

this study maladaptive behaviors were considered

as co-occurring behavior problems. The high

prevalence of many maladaptive behaviors in children

with AD begs the question of whether these

behaviors are better considered features of AD as

opposed to separate co-morbid problems. This issue

has been brought up by several other researchers

(Matese et al. 1994; Tsai 1996; Perry 1998; Gillberg

& Billstedt 2000; Gadow et al. 2005). Consensus

has yet to be reached on the best approach for conceptualizing

co-morbid maladaptive behaviors in

an AD population and thus this issue is in need of

further research attention and discussion.

In conclusion, findings from this study highlight

the need to include behavioral management strategies

in any comprehensive intervention program

for young children with AD. This appears particularly

true for young children with AD who have low

non-verbal cognitive functioning, expressive language

and adaptive skills. Ethnic-minority children

and girls are also at a somewhat greater risk of maladaptive

behaviors during early childhood. Behavioral

management strategies will need to address a

variety of maladaptive behaviors given the high

rate of co-morbidity and increasingly be aimed at

internalizing behaviors as children with AD age

from the first to second year of life to age 5 years.

Most importantly, behavioral management efforts

should be aimed at increasing social engagement,

sustained attention and decreasing aggressive

behavior

individual must exhibit abnormalities described in one or two

items, as specified in each of the three categories (social

reciprocity, communication, and restricted behaviors and

interests) and reach a total across all items that is more than the

sum of each area. That is, to be diagnosed as having autism, one

must meet at least two of the criteria in social reciprocity, one

criterion each in communication and restricted and repetitive

behaviors and interests, and fulfill a total of six or more criteria

TR Implications:

A Recreational Therapist can have a great effect on individuals and families. There are various skills and developmental needs within the Autism spectrum. Included are only a few of the recognized needs; however, it is the duty and responsibility of the therapist to observe and identify specific concerns and needs. A therapist should consider both individual needs and family needs. Often times the families are neglected because they may not be seen as a direct client. Nevertheless, families create the environment in which Autistic children should thrive.

These are some the constraints that often shadow individuals with Autism:

Communication:
-various verbal communication issues: some do not speak, some only use a few words, some develop a vocabulary and then lose it, some possess an extensive vocabulary however cannot sustain a steady and mutual conversation.
-take what is being said very literally, and not aware of body language.  
-because they have trouble expressing needs verbally, they often times act inappropriately to get what they need.

Restrictions:
-language and social problems hold children with autism back socially. They do not engage in imaginative play and role playing.
-focus on repetition and a single subject very intensely, thus any disruption in schedule can cause an extreme emotional response.

Sensory:
-many are overwhelmed by their own senses. They may all react in different ways, watching movements, banging head, flapping fingers. Some high functioning adults with autism explain how painful their childhood was in which they were forced to withdraw from their environment or coming into a world of their own.

Treatment:
-most strongly recommended is behavioral and educational training.
-early intervention and treatment is key to helping autistic children grow into a healthy lifestyle (impact in brain development).
-They will need speech therapy, occupational therapy (sensory integration therapy), social skills therapy (play therapy).
-These will help child to respond and decrease symptoms.
-Thrive on positive reinforcement to boost language and social skills
-need structured, skill-oriented play to improve social and language abilities.
-Treatment and approach will change as autistic child grows and moves into different phases.
-20 minutes of vigorous exercise will help to decrease hyperactivity, aggression, self-injury and other autistic symptoms.

Family life:
-one parent may need to become a stay at home parent for a time to meet the needs of the child with autism. Thus reducing the family income, which can affect every aspect of family living.
-While some families are lucky to have a good supporting circle of friends and family, there are many who are alone. Due to society’s ignorance, many label the child as ‘disorderly’.
-Thus many families disconnect from their community because they feel uncomfortable if their child was to misbehave, and it is easier to deal with autistic behaviors in the privacy of own home.
-It is common for siblings of a child with autism to feel embarrassed by misbehavior, or even in their own home when guests are over.

-sleep patterns are different, and diets usually have specific needs. Because the child with autism has difficulty making and keeping friends, they develop awkward habits that drive the isolation circle.

-autistic behaviors may prevent families from attending events together.
- “without the support of friends and family, the world of autism can be a very lonely place. Not only for the child with autism but for the entire family”.

Asperger’s:
-similar to early childhood autism.
traits--

discomfort in social situations

difficulty in eye contact

lack facial and emotional expression

lack of gross motor coordination

-Asperger’s children are non-negotiable and insist on routines and/or rituals.

facts....