Monday, January 15, 2007

USA---News--Autism statistics

Sunday, January 14, 2007

Estimates of the number of people with autism vary. A May 2005 publication of the National Institutes of Health said the best conservative estimates at that time were that 1 in 1,000 children had an autism spectrum disorder.

A May 2006 fact sheet from the Centers for Disease Control and Prevention reported that two surveys of parents estimated that 5.5 to 5.7 per 1,000 school-aged children had been diagnosed with autism.

Both of those surveys indicated that boys were nearly four times more likely to have been diagnosed with autism than girls.
 

Washtenaw Community Support and Treatment Services has about 648 adults with developmental disabilities enrolled in its programs, which is approximately one-third of all adults in the county with developmental disabilities.

USA---News--What is autism?

Sunday, January 14, 2007

Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain in social interaction and communication skills.

Both children and adults with autism typically show difficulties in verbal and nonverbal communication, social interactions and leisure or play activities. Autism affects each individual differently and at varying degrees. Among other things, the autistic person may insist on a set routine, may not respond to verbal cues or may exhibit extreme oversensitivity or undersensitivity to pain.

Autism is one of five disorders under the umbrella of Pervasive Developmental Disorders (PDD), or Autism Spectrum Disorders, a category of neurological disorders characterized by "severe and pervasive impairment in several areas of development.''

Teaching Tips for Children and Adults with Autism

Good teachers helped me to achieve success. I was able to overcome autism because I had good teachers. At age 2 1/2 I was placed in a structured nursery school with experienced teachers. From an early age I was taught to have good manners and to behave at the dinner table. Children with autism need to have a structured day, and teachers who know how to be firm but gentle.

Between the ages of 2 1/4 and 5 my day was structured, and I was not allowed to tune out. I had 45 minutes of one-to-one speech therapy five days a week, and my mother hired a nanny who spent three to four hours a day playing games with me and my sister. She taught 'turn taking' during play activities. When we made a snowman, she had me roll the bottom ball; and then my sister had to make the next part. At mealtimes, every-body ate together; and I was not allowed to do any "stims." The only time I was allowed to revert back to autistic behavior was during a one-hour rest period after lunch. The combination of the nursery school, speech therapy, play activities, and "miss manners" meals added up to 40 hours a week, where my brain was kept connected to the world.

1.) Many people with autism are visual thinkers. I think in pictures. I do not think in language. All my thoughts are like videotapes running in my imagination. Pictures are my first language, and words are my second language. Nouns were the easiest words to learn because I could make a picture in my mind of the word. To learn words like "up" or "down," the teacher should demonstrate them to the child. For example, take a toy airplane and say "up" as you make the airplane takeoff from a desk. Some children will learn better if cards with the words "up" and "down" are attached to the toy airplane. The "up" card is attached when the plane takes off. The "down" card is attached when it lands.

2.) Avoid long strings of verbal instructions. People with autism have problems with remembering the sequence. If the child can read, write the instructions down on a piece of paper. I am unable to remember sequences. If I ask for directions at a gas station, I can only remember three steps. Directions with more than three steps have to be written down. I also have difficulty remembering phone numbers because I cannot make a picture in my mind.

3.) Many children with autism are good at drawing, art and computer programming. These talent areas should be encouraged. I think there needs to be much more emphasis on developing the child's talents. Talents can be turned into skills that can be used for future employment.

4.) Many autistic children get fixated on one subject such as trains or maps. The best way to deal with fixations is to use them to motivate school work. If the child likes trains, then use trains to teach reading and math. Read a book about a train and do math problems with trains. For example, calculate how long it takes for a train to go between New York and Washington.

5.) Use concrete visual methods to teach number concepts. My parents gave me a math toy which helped me to learn numbers. It consisted of a set of blocks which had a different length and a different color for the numbers one through ten. With this I learned how to add and subtract. To learn fractions my teacher had a wooden apple that was cut up into four pieces and a wooden pear that was cut in half. From this I learned the concept of quarters and halves.

6.) I had the worst handwriting in my class. Many autistic children have problems with motor control in their hands. Neat handwriting is sometimes very hard. This can totally frustrate the child. To reduce frustration and help the child to enjoy writing, let him type on the computer. Typing is often much easier.

7.) Some autistic children will learn reading more easily with phonics, and others will learn best by memorizing whole words. I learned with phonics. My mother taught me the phonics rules and then had me sound out my words. Children with lots of echolalia will often learn best if flash cards and picture books are used so that the whole words are associated with pictures. It is important to have the picture and the printed word on the same side of the card. When teaching nouns the child must hear you speak the word and view the picture and printed word simultaneously. An example of teaching a verb would be to hold a card that says "jump," and you would jump up and down while saying "jump."

8.) When I was a child, loud sounds like the school bell hurt my ears like a dentist drill hitting a nerve. Children with autism need to be protected from sounds that hurt their ears. The sounds that will cause the most problems are school bells, PA systems, buzzers on the score board in the gym, and the sound of chairs scraping on the floor. In many cases the child will be able to tolerate the bell or buzzer if it is muffled slightly by stuffing it with tissues or duct tape. Scraping chairs can be silenced by placing slit tennis balls on the ends of the legs or installing carpet. A child may fear a certain room because he is afraid he may be suddenly subjected to squealing microphone feedback from the PA system. The fear of a dreaded sound can cause bad behavior. If a child covers his ears, it is an indicator that a certain sound hurts his ears. Sometimes sound sensitivity to a particular sound, such as the fire alarm, can be desensitized by recording the sound on a tape recorder. This will allow the child to initiate the sound and gradually increase its volume. The child must have control of playback of the sound.

9.) Some autistic people are bothered by visual distractions and fluorescent lights. They can see the flicker of the 60-cycle electricity. To avoid this problem, place the child's desk near the window or try to avoid using fluorescent lights. If the lights cannot be avoided, use the newest bulbs you can get. New bulbs flicker less. The flickering of fluorescent lights can also be reduced by putting a lamp with an old-fashioned incandescent light bulb next to the child's desk.

10.) Some hyperactive autistic children who fidget all the time will often be calmer if they are given a padded weighted vest to wear. Pressure from the garment helps to calm the nervous system. I was greatly calmed by pressure. For best results, the vest should be worn for twenty minutes and then taken off for a few minutes. This prevents the nervous system from adapting to it.

11.) Some individuals with autism will respond better and have improved eye contact and speech if the teacher interacts with them while they are swinging on a swing or rolled up in a mat. Sensory input from swinging or pressure from the mat sometimes helps to improve speech. Swinging should always be done as a fun game. It must NEVER be forced.

12.) Some children and adults can sing better than they can speak. They may respond better if words and sentences are sung to them. Some children with extreme sound sensitivity will respond better if the teacher talks to them in a low whisper.

13.) Some nonverbal children and adults cannot process visual and auditory input at the same time. They are mono-channel. They cannot see and hear at the same time. They should not be asked to look and listen at the same time. They should be given either a visual task or an auditory task. Their immature nervous system is not able to process simultaneous visual and auditory input.

14.) In older nonverbal children and adults touch is often their most reliable sense. It is often easier for them to feel. Letters can be taught by letting them feel plastic letters. They can learn their daily schedule by feeling objects a few minutes before a scheduled activity. For example, fifteen minutes before lunch give the person a spoon to hold. Let them hold a toy car a few minutes before going in the car.

15.) Some children and adults with autism will learn more easily if the computer key-board is placed close to the screen. This enables the individual to simultaneously see the keyboard and screen. Some individuals have difficulty remembering if they have to look up after they have hit a key on the keyboard.

16.) Nonverbal children and adults will find it easier to associate words with pictures if they see the printed word and a picture on a flashcard. Some individuals do not under-stand line drawings, so it is recommended to work with real objects and photos first. The picture and the word must be on the same side of the card.

17.) Some autistic individuals do not know that speech is used for communication. Language learning can be facilitated if language exercises promote communication. If the child asks for a cup, then give him a cup. If the child asks for a plate, when he wants a cup, give him a plate. The individual needs to learn that when he says words, concrete things happen. It is easier for an individual with autism to learn that their words are wrong if the incorrect word resulted in the incorrect object.

18.) Many individuals with autism have difficulty using a computer mouse. Try a roller ball (or tracking ball) pointing device that has a separate button for clicking. Autistics with motor control problems in their hands find it very difficult to hold the mouse still during clicking.

19.) Children who have difficulty understanding speech have a hard time differentiating between hard consonant sounds such as 'D' in dog and 'L' in log. My speech teacher helped me to learn to hear these sounds by stretching out and enunciating hard consonant sounds. Even though the child may have passed a pure tone hearing test he may still have difficulty hearing hard consonants. Children who talk in vowel sounds are not hearing consonants.

20.) Several parents have informed me that using the closed captions on the television helped their child to learn to read. The child was able to read the captions and match the printed works with spoken speech. Recording a favorite program with captions on a tape would be helpful because the tape can be played over and over again and stopped.

21.) Some autistic individuals do not understand that a computer mouse moves the arrow on the screen. They may learn more easily if a paper arrow that looks EXACTLY like the arrow on the screen is taped to the mouse.

22.) Children and adults with visual processing problems can see flicker on TV type computer monitors. They can sometimes see better on laptops and flat panel displays which have less flicker.

23.) Children and adults who fear escalators often have visual processing problems. They fear the escalator because they cannot determine when to get on or off. These individuals may also not be able to tolerate fluorescent lights. The Irlen colored glasses may be helpful for them.

24.) Individuals with visual processing problems often find it easier to read if black print is printed on colored paper to reduce contrast. Try light tan, light blue, gray, or light green paper. Experiment with different colors. Avoid bright yellow--it may hurt the individual's eyes. Irlen colored glasses may also make reading easier. ( Click here to visit the Irlen Institute's web site.)

25.) Teaching generalization is often a problem for children with autism. To teach a child to generalize the principle of not running across the street, it must be taught in many different locations. If he is taught in only one location, the child will think that the rule only applies to one specific place.

26.) A common problem is that a child may be able to use the toilet correctly at home but refuses to use it at school. This may be due to a failure to recognize the toilet. Hilde de Clereq from Belgium discovered that an autistic child may use a small non-relevant detail to recognize an object such as a toilet. It takes detective work to find that detail. In one case a boy would only use the toilet at home that had a black seat. His parents and teacher were able to get him to use the toilet at school by covering its white seat with black tape. The tape was then gradually removed and toilets with white seats were now recognized as toilets.

27.) Sequencing is very difficult for individuals with severe autism. Sometimes they do not understand when a task is presented as a series of steps. An occupational therapist successfully taught a nonverbal autistic child to use a playground slide by walking his body through climbing the ladder and going down the slide. It must be taught by touch and motor rather than showing him visually. Putting on shoes can be taught in a similar manner. The teacher should put her hands on top of the child's hands and move the child's hands over his foot so he feels and understands the shape of his foot. The next step is feeling the inside and the outside of a slip-on shoe. To put the shoe on, the teacher guides the child's hands to the shoe and, using the hand-over-hand method, slides the shoe onto the child's foot. This enables the child to feel the entire task of putting on his shoe.

28.) Fussy eating is a common problem. In some cases the child may be fixated on a detail that identifies a certain food. Hilde de Clerq found that one child only ate Chiquita bananas because he fixated on the labels. Other fruit such as apples and oranges were readily accepted when Chiquita labels were put on them. Try putting different but similar foods in the cereal box or another package of a favorite food. Another mother had success by putting a homemade hamburger with a wheat free bun in a McDonald's package.

Recovery and rehabilitation

Recovery and rehabilitation

A wide variety of long-term interventions have been advocated for children with autism. These include applied behavioral analysis, use of pictures for expressive communication (as in the picture exchange communication system), and intensive exercise programs. Therapists working in schools now recognize the holistic learning needs of the child, including personal and emotional growth as well as opportunities to broaden their experiences, regardless of whether measurable developmental progress is made.

Clinical trials

As of early 2004, there were numerous open clinical trials for autism, including:

  • drug treatment for autism at the National Institute of Mental Health (NIMH)
  • synthetic human secretin in children with autism, sponsored by Repligen Corporation
  • improving attention skills of children with autism at the National Institute of Child Health and Human Development (NICHD) in collaboration with the National Institute of Mental Health (NIMH)
  • study of fluoxetine in adults with autistic disorder
  • a controlled study of olanzapine in children with autism, sponsored by the FDA Office of Orphan Products Development
  • randomized study of fluoxetine in children and adolescents with autism, sponsored by the FDA Office of Orphan Products Development and Mount Sinai Medical Center
  • valproate response in aggressive autistic adolescents at the NICHD and the NIMH

Prognosis

Among individuals suffering with autism, 75% have a poor outcome and 25% show significant improvement. Acquisition of language before the age of six years old, IQ levels above 50, and having a special skill, such as expertise in computers, predict good outcome. For people with severe autism, independent living and social functioning are unlikely. For those with higher functioning autism, the jobs acquired are often below their education level. The social interactions of most adults with autism are limited or modified.

Special concerns

Most scientists concur that autism has a strong biological basis, with evidence continuing to accumulate for an underlying genetic cause that results in abnormal brain development. Future genetic and brain-imaging studies will undoubtedly contribute to a greater understanding of the disorder's etiology and pathophysiology. The combination of continually evolving methodological and technological advances will, hopefully, bring science closer to the goal of better and earlier intervention in autism.

Resources

BOOKS

Edelson, Stephen M., and Bernard Rimland. Treating Autism: Parent Stories of Hope and Success. San Diego, CA: Autism Research Institute, 2003.

Harris, Sandra L., and Beth A. Glasberg. Siblings of Children With Autism: A Guide for Families (Topics in Autism). Bethesda, MD: Woodbine House, 2003.

Seroussi, Karyn. Unraveling the Mystery of Autism and Pervasive Developmental Disorder: A Mother's Story of Research and Recovery. New York, NY: Broadway, 2002.

PERIODICALS

Baird, G., H. Cass, and V. Slonims. "Diagnosis of Autism." BMJM 327 (August 2003): 448�C493.

Kami��ska, B., et al. "Use of Secretin in the Treatment of Childhood Autism." Med Sci Monit 8 (January 2002): RA22�C26.

Nicolson, R., and P. Szatmari. "Genetic and Neurodevelopmental Influences in Autistic Disorder." Canadian Journal of Psychiatry 8 (September 2003): 526�C537.

Tidmarsh, L., and F. Volkmar. "Diagnosis and Epidemiology of Autism Spectrum Disorders." The Canadian Journal of Psychiatry 8 (September 2003): 517�C525.

Torres, A. "Is Fever Suppression Involved in the Etiology of Autism and Neurodevelopmental Disorders?" BMC Pediatric (September 2003): 3�C9.

Diagnosis---etc

Diagnosis

Currently, there are no objective medical tests for the diagnosis of autism and no reproducible genetic or biological markers for the disorder. The diagnosis is made with a multidisciplinary approach involving a developmental pediatrician, psychologist, speech and language professional, audiologist, and special educator.

Using a standardized rating scale, the specialist closely observes and evaluates the child's language and social behavior. A structured interview is also used to elicit information from parents about the child's behavior and early development. Reviewing family videotapes, photos, and baby albums may help parents recall when each behavior first occurred and when the child reached certain developmental milestones. The specialists may also test for certain genetic and neurological problems.

Treatment team

The treatment of childhood autism traditionally falls within the competence of the psychiatrist and the psychologist and involves the application of various methods of individual therapy. Speech therapists can work with children to help them develop social and language skills because children learn most effectively and rapidly when very young.

Moreover, occupational therapists and physiotherapists are important professionals in the development and life quality improvement for patients and parents. The treatment involves a therapist's work with the child and with the caregivers, who work with the child at home under the therapist's direction. Basic medical assistance is provided by the pediatrician and other physicians.

Treatment

No definitive treatment regimes have thus far been developed for this serious disturbance and therapy is generally merely supportive. Some attempts have been made to support such therapy with psychiatry and psychology, as well as high doses of vitamin B6, vitamin E, and magnesium. Various psychoactive drugs have also been tried, as well as a group of medications called H2 blockers. A "hugging machine" has been built to support therapy by the holding method. This device makes it possible for children with autism to overcome their fear of touch (tactile stimuli).

An alternative treatment approach has been attempted using secretin, which is a hormone secreted by cells in the digestive tract to help control digestion. The history of the application of secretin in the treatment of childhood autism dates back to 1996, when, by coincidence, a significant improvement in mental condition was noticed in a child with autism who had received secretin for diagnostic purposes. When it was administrated, one of the chief symptoms of autism, the avoidance of eye contact, was 75% reduced. Some additional children with autism also showed limited improvement after treatment with secretin. On January 5, 2004, results of a clinical trial revealed that the hormone was of little value in improving the socialization of young children with autism. Nevertheless, many parents and physicians continue to advocate development of the drug and further study.

Demographics

Demographics

Autism is a disorder that affects predominantly males (four times as many males as females have autism). According to studies, autism is increasing in the pediatric population. In 1966, 4–5 babies per 10,000 births developed autism, while in 2003, two studies showed that between 14–39 babies per 10,000 develop the disorder. Although there is no question that more clinical cases are being detected, the increase in prevalence of autism is in dispute as diagnostic practices have changed over the years and this heightened awareness has changed the evaluation of previously unrecognized cases.

Causes and symptoms

Although autism is behaviorally defined, it is now well recognized to be the endpoint of several organic causes. These include prenatal problems such as rubella (measles) infection, untreated metabolic disorders, and anticonvulsant medication taken during pregnancy, as well as postnatal infections such as encephalitis. A specific medical cause is found in only a minority of people with autism (6–10%, depending on the study). Epilepsy occurs more commonly than usual in patients with this disorder and was one of the early indications that this was a neurobiological problem and not one caused by parental behavior or the environment.

In most people with autism, genetic factors play a key role. Multiple genes are likely to be involved, and studies have identified possible candidate genes on chromosomes 2, 7, 16, and 19. Autism has been associated with some genetic abnormalities, especially on chromosome 15, and it is also found associated with the "fragile X syndrome." Despite the fact autism is now agreed to be a neurobiological disorder, results from structural brain scans have not shown consistent features that point to a diagnosis of autism.

Symptoms of autism usually appear during the first three years of childhood and continue throughout life. Some common symptoms are:

  • absence or impairment of imaginative and social play
  • impaired ability to make friends with peers
  • impaired ability to initiate or sustain a conversation with others
  • stereotyped, repetitive, or unusual use of language
  • restricted patterns of interests that are abnormal in intensity or focus
  • apparently inflexible adherence to specific routines or rituals
  • preoccupation with parts of objects

Children with some symptoms of autism, but not a sufficient number to be diagnosed with the classical form of the disorder, often receive the diagnosis of pervasive developmental disorder, not otherwise specified (PDDNOS). People with autistic behavior, but also have well-developed language skills, are often diagnosed with Asperger syndrome. Children who appear normal in their first several years, then lose skills and begin showing autistic behavior, may be diagnosed with childhood disintegrative disorder (CDD). Girls with Rett syndrome-linked genetic disorder characterized by inadequate brain growth, seizures, and other neurological problems, may also show autistic behavior. PDD-NOS, Asperger syndrome, CDD, and Rett syndrome are referred to as autism spectrum disorders.

Definition

Definition

Autism is a behavior disorder, characterized by an impairment in social communication, social interaction, and social imagination. Those with autism often have a restricted range of interests and display repetitive behavi mannerisms, along with altered reactions to the everyday environment.

Description

In 1943, the American physician Leo Kanner published his seminal paper, in which he described 11 children who were socially isolated, with "autistic disturbances of affective contact," impaired communication, and behavioral inflexibility. He coined the term "infantile autism" and discussed the causes in terms of biological processes, although at that time, most scientific attention was focused on analytical theories of the disorder. Kanner's paper did not initially receive much scientific credit, and children with autistic symptoms continued to be incorrectly diagnosed with childhood schizophrenia. His choice of the term "autism" may have created some confusion, because the word was first used to describe a mental state of fantastical, self-centered thought processes, similar to the symptoms of schizophrenia.

During the development of the disorder, the first year of life is usually marked with no clear discriminating features. Between two and three years of age, children show impairment in language development, especially comprehension; unusual language usage; poor response to name calling; deficient non-verbal communication; minimal recognition or responsiveness to other people's happiness or distress; and limited variety of imaginative play or pretence, and especially social imagination.

During school age, children's abnormalities in language development (including muteness or the use of odd or inappropriate words), their social withdrawal, inability to join in with the play of other children, or inappropriate attempts at joint play often alert teachers and others to the possibility of an autistic type disorder. The manifestations of autism can also change with time during childhood, depending on other developmental impairments, personality, and the addition of medical or mental health problems.