Autism and Asperger Syndrome: strategies to promote prosocial behaviours

Autism and Asperger Syndrome: strategies to promote prosocial behaviours

CAROL GREENWAY
Psychological Service, City of Westminster, 2nd NW8 8EA, UK

SUMMARY The social deficits of children on the autistic spextrum represent a major barrier to their successful inclusion into mainstream schools. This presents a significant challenge for educational psychologists (EPs). This paper surveys the literature for social skil ls screening instruments and interventions, which have the greatest relevance to the work of the EP in supporting inclusion in the mainstream setting. Although not specifically designed for pupils on the autistic continuum, several screening instruments are identified that not only provide a description of the problem area and an understanding of the pupil ’s behaviour, but also provide pointers for interventions. Those found in the research literature that have been particularly successful in mainstream are the Social Stories and Circle of Friends approaches. Other interventions are also described that have potential for pupils on the autistic spectrum who are being considered for integration.

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Autism in Mathematics

Author: Ioan James An excerpt.

The cause of autism is mysterious, but genetic factors are important. It takes a variety of forms; the expression autism spectrum, which is often used, gives the false impression that it is just the severity of the disorder that varies.

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Children with Autism Attending Preschool

Children with Autism Attending Preschool Facilities: the experiences and perceptions of staff

ROY McCONKEY* and SONEE BHLIRGRI
School of Nursing, University of Ulster, Newtownabbey BT37 0QB, UK

Increasing numbers of children are being identified from age 2 years onwards as having autistic spectrum disorders. The majority of parents aspire for their child to attend mainstream education facilities, and many already do so. However, there is limited knowledge about the needs of preschool personnel if they are to support the inclusion of children with autistic spectrum disorders. In particular, what are their experiences of taking such children, what supports are available to them and what help do they require? This survey of fifty- six staff working in thirty-eight preschools of various types in the Greater Belfast area found that a sizeable number had the experience of taking with children with autistic spectrum disorders and that staff do receive some advice and support from a range of professionals. Nearly all were committed to enrolling such children in the future but they felt that a lack of staffing could preclude this. A majority of staff felt they have had inadequate or no training to equip them to meet the children’s particular needs, and they report a lack of knowledge and skills to help these children. The implications of these results are discussed in terms of the specific skills required by staff to manage these children and promote their learning; the professional support required and the contribution this could make to the preschool and the training requirements of staff working on these setting in either a paid or voluntary capacity.

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Congenital Versus Regressive Onset

Congenital Versus Regressive Onset of Autism Spectrum Disorders: Parents’ Beliefs About Causes

Robin P. Goin-Kochel and Barbara J. Myers

Recent studies have validated the phenomenon of autistic regression, but little is known about how regressive and congenital onsets of the disorder influence parents’ thinking about autism and its etiology. Parents (N= 327) of children with autism spectrum disorders completed an online questionnaire about their children’s development. Approximately half of the sample indicated that their children showed signs of autism from birth or shortly thereafter; the remaining half described their children as developing autism in the regressive fashion. Parents’ beliefs about the causes of autism varied widely, but two of the most popularly cited explanations were “genetics” and “external mechanisms” (e.g., vaccinations, environmental toxins). When analyzed relative to type of autism onset, parents more often advocated genetics as the cause for autism when their children exhibited the congenital type and external mechanisms when their children presented with the regressive type.

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Coping by Redefinition

Coping by Redefinition: Cognitive Appraisals in Mothers of Children With Autism and Children Without Autism

Belgin Tunali,1,3and Thomas G. Power2

To test a model of how mothers cope with the stresses of raising a child with autism (Tunali & Power, 1993), mothers of children with and without autism were interviewed. As predicted, mothers of autistic children: (1) placed less emphasis on career success and were more likely to believe that mothers of young children should not work outside of the home; (2) spent more leisure time with their extended family; (3) placed less emphasis on others’ opinions of their child’s behavior; (4) placed more emphasis on spousal support and parental roles in their discussions of marriage; (5) had more difficulty understanding their child’s behavior; and (6) showed a marginally significant difference in their tolerance of ambiguity. Moreover, mothers of children with autism who showed these characteristics had the greatest life satisfaction overall.

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Couple charged in autistic son's fire death

By The Associated Press
ALBANY, Ore. — A couple killed their autistic son by setting fire to their apartment while the young man was locked inside, Albany police said.
Nicolaas Dirk DeGroot, 45, and Agnes Elizabeth DeGroot, 48, were charged with arson and manslaughter, police said.
Christopher Aire DeGroot was alone in the apartment when firefighters arrived May 14. The 19-year-old, who had severe autism, was flown to a Portland hospital, where he died Friday.
''The fire started on some paper on the living room floor,'' Police Capt. Jeff Hinrichs said Monday. ''Probable cause indicates the parents started the fire.''
In a statement, police said Christopher DeGroot could not escape because he had been locked inside the apartment by his parents, who had left him alone on the morning of the fire. The parents had installed a dead bolt lock on the door that required a key to unlock it from the inside. Locks had also been placed on the windows, police said.
The fire was contained to the DeGroots' apartment, which is located in a small complex in southeast Albany. Damage was estimated to be $77,000.
Two cats were rescued and taken to Linn Veterinary Hospital. A firefighter was injured and treated at the scene.
On Friday, the parents voluntarily went to the police department for questioning and were arrested by detectives. Both DeGroots were lodged in the Linn County Jail on $500,000 security.
They were arraigned Monday in Linn County Circuit Court.

Location of potential autism gene found

Location of potential autism gene found

In another step toward unravelling the origins of autism, a new study confirms that a region of chromosome number 3 seems to be involved in the development of the disorder.

There was no evidence, however, that mutations in one suspect gene increase the risk of autism.

Analysing DNA from 31 members of a family of Northern European ancestry in which 7 individuals had autism or an autism-related disorder, researchers found that a portion of chromosome 3 appeared to be linked with the disorder.

The investigators, from the University of Utah in Salt Lake City, say their findings are remarkably similar to previous ones by scientists in Finland - confirming that a gene in this chromosomal region likely contributes to autism.

Autism is a developmental brain disorder that impairs, to varying degrees, a person's use of language and ability to communicate, interact socially and form relationships. Experts believe that genes play a central role in autism development and that variations in multiple genes are probably involved.

Scientists have found a number of chromosome regions that most likely linked to autism. The goal is to weed out the genes residing in these areas that confer susceptibility to the brain disorder.

Identifying the culprit genes will shed light on how autism develops, explained Dr Hilary Coon, the lead author of the new study.

Understanding "even one mechanism" underlying the disorder, she told Reuters Health, could aid in creating new treatments.

Experts also hope that with the major autism genes in hand, they will eventually be able to screen young children for autism risk and begin behavioural therapy as early as possible. Autism is typically evident by age 3.

FXR1 has been considered a good "candidate" gene associated with autism risk, Coon noted. The gene is similar to an X-chromosome gene involved in fragile X syndrome, a genetic disorder that causes learning disabilities and other mental impairments.

However, when the researchers looked at FXR1, they found no evidence that mutations in the gene were related to autism, according to the report published online by the journal Human Heredity.

Her team's findings, Coon said, do not rule out a role for FXR1 in autism. It's possible that very subtle alterations in the gene that the study did not detect contribute to the disorder. The gene may also simply not be relevant in this particular family.

Coon and her colleagues are now focusing their research on other genes in the same chromosome region.

New Findings Help Pinpoint Causes of Autism

New Findings Help Pinpoint Autism's Genetic Roots
Main Category: Autism News
Article Date: 08 May 2006 - 9:00am (PDT)

By deleting a gene in certain parts of the brain, researchers at UT Southwestern Medical Center have created mice that show deficits in social interaction that are reminiscent of humans with autism spectrum disorders.

The investigators also found physical abnormalities in the brains that mimic some cases of autism, showing that the research animals can be useful in studying the mysterious condition.

The finding - to be published in the May issue of the journal Neuron - confirms recent indications that a mutation in this particular gene could cause at least some forms of autism, said Dr. Luis F. Parada, director of the Center for Developmental Biology and the study's senior author. Dr. Parada also directs the Kent Waldrep Center for Basic Research on Nerve Growth and Regeneration.

"The exciting thing about this mouse is it helps us to zero in on at least one anatomic location of abnormality, because we targeted the gene to very circumscribed regions of the brain," he said. "In diseases where virtually nothing is known, any inroad that gets into at least the right cell or the right biochemical pathway is very important."

Autism is a brain disorder in which people have trouble with communication and social interaction and engage in repetitive movements. Usually manifesting in childhood, it affects about one in every 250 people, primarily males.

The researchers focused on a gene called Pten, which is also known to suppress cancers in humans. Some people with autism have mutations in Pten, but it has been unclear if that's what causes the disease, Dr. Parada said. To test that hypothesis, the researchers deleted the gene in the front of the mouse brain and in areas of the hippocampus, a structure involved in memory and other functions.

Mice, which are social animals, are a good model for studying the disease, Dr. Parada said. Their behavior can be studied when they are exposed to other mice, when they are provided with inanimate objects and material for making nests, and when they are placed in unfamiliar environments.

In each of those conditions, the mutant mice were distinctly different from normal mice that came from the same litter.

Mice lacking the Pten gene were generally uninterested in unfamiliar mice, while normal mice approached the strangers. When mutant mice were exposed to both an inanimate object and another mouse, they showed about equal interest in each - echoing the way children with autism prefer toys to people - while the normal mice preferred the other mouse.

When given raw material for nesting, the mutants ignored it, while the normal mice teamed up to build nests. And the pups of mutant females often died from lack of maternal care.

The genetically altered mice were also hypersensitive to stressful stimuli, such as being picked up, being subjected to a sudden noise, or being put in a lighted or open area. People with autism are similarly overly sensitive to sensory stimuli.

The mutant mice's brains were also noticeably altered in the areas where the gene was deleted. The nerve cells were thicker than normal and had a higher-than-normal number of connections to other nerve cells. This may lead to the sensory overload that people with autism experience, Dr. Parada said.

"It would be really exciting if it turned out that we've zeroed in on the anatomical regions where things go wrong in autistic patients, regardless of how the autism occurs," he said, adding that the next step in the research is to treat the mice with drugs to see whether it's possible to reverse the condition.

Autism-like syndromes are being studied at UT Southwestern from another angle through the work of Dr. Lisa Monteggia, assistant professor of psychiatry.

Her investigation of the role of a gene called MeCP2 in mediating autistic-like behavior has been published recently in the journals Biological Psychiatry and Current Biology. Mutations in MeCP2 occur in a pervasive developmental disorder called Rett syndrome, a human disease that shares many clinical features with autism. Mutations in MeCP2 also have been identified in autism patients.

In Biological Psychiatry, she described how the selective deletion of MeCP2 in the brains of mice - in similar areas as those targeted by Dr. Parada - creates many of the features of Rett syndrome that are also observed in autism patients, including reduced social interaction, abnormal repetitive behavior and increased anxiety.

Current Biology reported her collaborative study with Dr. Ege Kavalali, associate professor in the Center for Basic Neuroscience, in which recorded signals from nerve cells in the mouse brain showed that in those lacking MeCP2, there was an imbalance between signals that excite nerve cells and those that inhibit neural activity. Such an imbalance in nerve transmission has been hypothesized as a feature of human autistic disorders; however, this is the first report demonstrating such an imbalance.

Lead authors in the Pten study from the Center for Developmental Biology were Dr. Chang-Hyuk Kwon, postdoctoral researcher; former graduate student Bryan Luikart, now at Oregon Health & Science University; and Dr. Craig Powell, assistant professor of neurology and psychiatry at UT Southwestern. The work was supported by the American and Lebanese Associated Charities, the National Institutes of Health and the American Cancer Society.

UT Southwestern scientists participating in the MeCP2 research were Erika Nelson, student research assistant in psychiatry, and Terry Gemelli, former research associate in psychiatry.

Dr. Monteggia's research is supported in part by the National Alliance for Autism Research, Once Upon A Time …, and the Rett Syndrome Research Foundation.

Mutant Mice Show Key Autism Traits
Main Category: Autism News
Article Date: 07 May 2006 - 20:00pm (PDT)

While the causes of autism remain complex and mysterious, researchers are steadily adding pieces to its intricate puzzle. In what they believe to be a significant new approach to understanding "autism spectrum disorders" (ASD), researchers have developed a mouse that shows abnormal social interactions and brain hypertrophy characteristic of the disease.

In an article in the May 2006, Neuron, Luis Parada and his colleagues report the results of removing (knocking out) a single gene associated with brain disorders in mice. The gene, called Pten, had been associated with a broad array of such disorders when knocked out throughout the animals' bodies. However, Parada and colleagues engineered mice to knock out the gene only in mature, or "postmitotic," neurons of the cerebral cortex and hippocampus in the brain. These regions are associated with higher brain function such as learning and memory.

The mutant mice showed major abnormalities in a variety of social interactions normally undertaken in mice, found the researchers. For example, they were far less likely to approach and sniff new mice introduced into their cage, compared to normal mice. And while normal mice show markedly less interest when such new mice are later reintroduced, the mutant mice did not show such a reduction in interest. This abnormality indicated "impaired social learning or inability to identify the juvenile due to the low level of initial interaction," wrote the researchers.

In other tests of social behavior, the researchers found that--when given the choice of investigating a cage holding another mouse or an empty cage--the mutant mice showed similar preference for the two. Normal mice by far prefer investigating the caged mouse.

The researchers also found the mutant mice to be deficient in nest-forming and sexual and maternal behavior. In tests of their reaction to such sensory stimuli as bright environments, the mutant mice showed hyperactivity and increased anxiety. They also showed sporadic seizures.

The researchers concluded that "the mutant mice exhibited deficits in all social paradigms tested and also showed exaggerated reaction to sensory stimuli, anxiety-like behaviors, seizures, and decreased learning, which are features associated with ASD."

Finally, the researchers found that the mutant mice showed the same kind of abnormal overgrowth of neurons and their interconnections seen in some people with ASD that also show increased brain volume and enlarged heads.

Wrote Joy Greer and Anthony Wynshaw-Boris in a preview in the same issue of Neuron, "caution is warranted because there are aspects of ASD that are not recapitulated in the Pten mutants. For example, the Pten mutants do not display the expression of abnormal repetitive behaviors seen in ASD, although it is unreasonable to expect perfect phenotypic overlap of human ASD with any mouse model."

Also, they wrote, "as appropriately pointed out by the authors, Pten deletion is restricted to postmitotic neurons in the CNS [central nervous system] in their model, and current evidence suggests that ASD is a developmental rather than a neurodegenerative disorder."

Greer and Wynshaw-Boris concluded that "Whether or not the findings . . . have direct relevance to ASD, the experimental results described are intriguing and represent an important entry point to understanding the role of Pten in postmitotic neurons of the hippocampus and cortex as well as providing new insight into the molecular correlates mediating social- and anxiety-related behaviors in the postnatal CNS."

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The researchers include Chang-Hyuk Kwon, Bryan W. Luikart, Craig M. Powell, Jing Zhou, Sharon A. Matheny, Wei Zhang, Yanjiao Li, and Luis F. Parada of the University of Texas Southwestern Medical Center in Dallas, TX; Suzanne J. Baker of St. Jude Children's Research Hospital in Memphis, TN. This work was supported in part by the American and Lebanese Associated Charities, NIH grant NS44172 (to S.J.B), and NIH grant R37NS33199 and the American Cancer Society (to L.F.P.).

Kwon et al.: "Pten Regulates Neuronal Arborization and Social Interaction in Mice." Publishing in Neuron, 50, 377–388, May 2006. DOI 10.1016/j.neuron.2006.03.023 whttp://www.neuron.org/

Autism Has High Costs To US Society
Main Category: Autism News
Article Date: 27 Apr 2006 - 18:00pm (PDT)

It can cost about $3.2 million to take care of an autistic person over his or her lifetime. Caring for all people with autism over their lifetimes costs an estimated $35 billion per year. Those figures are part of the findings in the first study to comprehensively survey and document the costs of autism to U.S. society. Michael Ganz, Assistant Professor of Society, Human Development, and Health at Harvard School of Public Health, authored the study, which appears in a chapter titled, "The Costs of Autism," in the newly published book, Understanding Autism: From Basic Neuroscience to Treatment (CRC Press, 2006). Ganz hopes his research will help policymakers allocate scarce resources to its treatment and prevention as well as provide a useful reference for policymakers and advocates to help them more fully understand the financial impact of autism on U.S. society.

Ganz's analysis of the costs includes direct and indirect medical costs associated with the disorder. But he believes the $35 billion annual societal cost for caring for and treating people with autism likely underestimates the true costs because there are a number of other services that are used to support individuals with autism, such as alternative therapies and other family out-of-pocket expenses, that are difficult to measure. In addition, Ganz believes that the level of cost could be higher if there were more useful and widespread treatment options available. "Given that the federal autism research budget has been historically less than $100 million per year and given that research budgets for other conditions with similar numbers of affected individuals are sometimes orders of magnitude higher, I hope that my research can help focus more attention on directing more resources toward finding prevention and treatment options for autism," Ganz said. (For comparison purposes, he notes estimated annual costs of other conditions, including Alzheimer's disease ($91 billion); mental retardation ($51 billion); anxiety ($47 billion); and schizophrenia ($33 billion).)

Autism is a pervasive developmental disorder (PDD) that involves severe deficits in a person's ability to communicate and interact with others. Children with autism often have trouble using their imagination, have a limited range of interests, and may show repetitive patterns of behavior or body movements. The disorder is often associated with some degree of mental retardation. Autism is the most prevalent PDD and the most common of all serious childhood disorders. It affects an estimated 1.5 million Americans and is increasing at a rate of 10-17 percent each year. It is four times more common in boys than in girls. The exact cause of autism is not known and there is currently no cure for the disorder.

Ganz broke down the total costs of autism into two components: direct and indirect costs. Direct costs include direct medical costs, such as physician and outpatient services, prescription medication, and behavioral therapies (estimated to cost, on average, more than $29,000 per person per year) and direct non-medical costs, such as special education, camps, and child care (estimated to annually cost more than $38,000 for those with lower levels of disability and more than $43,000 for those with higher levels).

Indirect costs equal the value of lost productivity resulting from a person having autism, for example, the difference in potential income between someone with autism and someone without. It also captures the value of lost productivity for an autistic person's parents. Examples include loss of income due to reduced work hours or not working altogether. Ganz estimates that annual indirect costs for autistic individuals and their parents range from more than $39,000 to nearly $130,000.

Since people with autism receive services from a wide variety of sources, Ganz believes future research efforts should focus on identifying those sources and linking those costs to non-financial data about the burdens of autism. These complementary sources of data can provide a richer picture that will be useful to policymakers in the future to assist them in devoting resources to address the financial and non-financial effects of autism.

Police: Mom admits to killing Woman reportedly said she wanted to end child's pain

Thursday, May 18, 2006
BY KAREN MCDONALD
OF THE JOURNAL STAR
PEKIN - Hours after allegedly killing her 3-year-old autistic daughter, Dr. Karen McCarron tried to overdose on over-the-counter medication.
She told police she "had just wanted to end her pain and (her daughter's) pain."
Toddler Katherine "Katie" McCarron had retreated into her own autistic world Saturday afternoon and wouldn't take a nap, according to court documents.
So Karen McCarron told her mother, who was visiting the family's Morton home, she planned to take Katherine for a car ride - as was common - to calm her down, Morton Police Chief Nick Graff said Wednesday.
But on this trip, McCarron drove to her mother's Morton home, placed a plastic garbage bag over her daughter's head and suffocated her, Graff said. She returned home to her mother and 2-year-old daughter, Emily, and took her dead daughter to her bedroom.
McCarron originally told police she tried to wake Katherine from a nap but found her
not breathing. Another visiting family member called 911 about 4 p.m. while Karen McCarron performed CPR on her child, who later was pronounced dead at OSF Saint Francis Medical Center in Peoria.
McCarron was not yet a suspect in the case Saturday evening and was allowed to return home, Graff said.
Mother's Day confession
Early on Sunday, Mother's Day, emergency crews again were called to the McCarron home at 390 E. Idlewood St., but this time for Karen McCarron, who had overdosed on some type of medication, Graff said.
Police found Karen and husband Paul, who had just returned from a business trip in North Carolina, in an upstairs bedroom embracing one another. Paul was crying, but Karen, who had told her husband she put a plastic bag over their child's head to calm her down, was unemotional, court documents stated.
When police asked Karen what happened, she replied, "Nothing is going to help and it's not going to make any difference."
Paramedics took Karen McCarron to St. Francis, where she told police "she had just wanted to end her pain and Katie's pain" and admitted to killing her daughter, Morton police Detective Ray Ham wrote in an investigation report.
McCarron, 37, a certified pathologist with no previous criminal record, now faces two charges of first-degree murder, each of which are punishable by 20 to 60 years in prison.
Tazewell County State's Attorney Stewart Umholtz said he does not plan to seek the death penalty, and no one else is expected to be charged.
"Obviously, this is a tragic circumstance. It's a terrible incident anytime a mother would be charged with murdering her child. But it's particularly troubling when it occurs over Mother's Day weekend," Umholtz said.
He would not discuss the mother's mental state or whether she is being treated for any conditions.
Karen McCarron, a pathologist, worked at Methodist Medical Center and Proctor Hospital and occasionally filled in at Pekin Hospital. She also was a volunteer clinical assistant professor at the University of Illinois College of Medicine at Peoria, officials said.
She is scheduled for a June 8 preliminary hearing in court.
Remembering Katherine
At Katherine's visitation Wednesday evening, a program showed Jesus cuddling a child in his lap with his hand on another child.
People stood around weeping. There were pictures of Katherine on a swing and in a red coat. In one photo, she was on a man's shoulders with her head thrown back in apparent glee.
Dr. David Ayoub said he met with Karen McCarron shortly after her daughter was diagnosed with autism.
"She was very dedicated to trying to get treatment for her daughter," Ayoub said. "I've met with a lot of parents who are dealing with autistic children, and she was one of the most loving mothers. This is a story that's been played over and over again. Homicide, suicide. The families just don't have the support."
The brain disorder in autism interferes with the ability to interact and communicate to others and causes difficulties with communication, motor skills, social and play skills, and coping with their environment.
Sue Grimm of Groveland, who has two autistic children, said she thought McCarron was a fantastic mother.

Support key for dealing with autism Caring for child with disorder can be lonely and frustrating

Thursday, May 18, 2006
BY DAYNA R. BROWN
OF THE JOURNAL STAR
PEORIA - Parents of autistic children say they are devastated by a mother's apparent killing of her 3-year-old child with the disorder, but some understand how a parent can be driven to such a desperate act.
While not supporting such an act, parents said the stress of raising a child with this complex disorder is sometimes unbearable. While support groups, friends and families can help, it often is a lonely and terribly frustrating journey for the parents.
"No one can understand. It is devastating. It can break you, even the strongest of mothers. Only other parents going through it can truly understand," said Libby Taylor, president of ANSWERS, an autism support group.
Dr. Karen McCarron of Morton is accused of suffocating her autistic daughter, Katherine, on Saturday, reportedly telling police she wanted to "end her pain and Katie's pain."
Autism is a developmental disability that affects an individual in the areas of social interaction and communication.
Parents deal with the frustration of not being able to secure services, dealing with the outbursts and sometimes being pushed away from the children they so dearly want to help.
Taylor, who has a 6-year-old autistic son, said her message to other autistic families is "be verbal and be loud and don't be afraid to say, 'I have these needs.'"
She recommends joining a support group, like ANSWERS, which McCarron was a member of, and creating a support network of family and friends.
"Parents need to talk to other parents because parents of children with autism are going to relate better," said Julie Matthews, executive vice president of programs at Easter Seals.
One of the biggest frustrations locally is there is no central location for people needing autism services to go for help, Matthews said. While Easter Seals has plans for this type of facility, the money isn't currently available.
Easter Seals does provide pediatric therapy and has an early diagnosis clinic for children suspected of having autism.
One Easter Seals program for parents called "Respitality" provides gift certificates for hotels, restaurants and theaters so parents of special-needs children get a night out. There is also an in-home respite program that allows families a weekend away.
"Having a child with a disability places a stress on a family," Matthews said.
There also is a need for a school for autistic children, similar to the one McCarron attended in North Carolina, autism experts said.
The Mariposa School provides year-round instruction for children with autism, and McCarron had attended from October 2004 through April 27.
"The students all have one-on-one therapy and each child's program is tailored for them. . . . That allows them to make great progress, and I can tell you, Katie had made some great progress here," said Cynthia A. Peters, president of Mariposa School. "We are missing her, and we all loved her dearly."

The Genetics of Autism

The Genetics of Autism

Rebecca Muhle, BA; Stephanie V. Trentacoste, BA; and Isabelle Rapin, MD

ABSTRACT. Autism is a complex, behaviorally defined, static disorder of the immature brain that is of great concern to the practicing pediatrician because of an astonishing 556% reported increase in pediatric prevalence between 1991 and 1997, to a prevalence higher than that of spina bifida, cancer, or Down syndrome. This jump is probably attributable to heightened awareness and changing diagnostic criteria rather than to new environmental influences. Autism is not a disease but a syndrome with multiple nongenetic and genetic causes. By autism (the autistic spectrum disorders [ASDs]), we mean the wide spectrum of developmental disorders characterized by impairments in 3 behavioral domains: 1) social interaction; 2) language, communication, and imaginative play; and 3) range of interests and activities. Autism corresponds in this article to pervasive developmental disorder (PDD) of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and International Classification of Diseases, Tenth Revision. Except for Rett syndrome—attributable in most affected individuals to mutations of the methyl-CpG-binding protein 2 (MeCP2) gene—the other PDD subtypes (autistic disorder, Asperger disorder, disintegrative disorder, and PDD Not Otherwise Specified [PDD-NOS]) are not linked to any particular genetic or nongenetic cause. Review of 2 major textbooks on autism and of papers published between 1961 and 2003 yields convincing evidence for multiple interacting genetic factors as the main causative determinants of autism. Epidemiologic studies indicate that environmental factors such as toxic exposures, teratogens, perinatal insults, and prenatal infections such as rubella and cytomegalovirus account for few cases. These studies fail to confirm that immunizations with the measles, mumps, rubella vaccine are responsible for the surge in autism. Epilepsy, the medical condition most highly associated with autism, has equally complex genetic/nongenetic (but mostly unknown) causes. Autism is frequent in tuberous sclerosis complex and fragile X syndrome, but these 2 disorders account for but a small minority of cases. Currently, diagnosable medical conditions, cytogenetic abnormalities, and single-gene defects (eg, tuberous sclerosis complex, fragile X syndrome, and other rare diseases) together account for <10% of cases. There is convincing evidence that “idiopathic” autism is a heritable disorder.

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Understanding Autism

Understanding Autism
Knowing the signs and pursuing early treatment tailored to your child's specific needs is key to helping him shoot for the stars.
With autism claiming countless headlines in the media, there isn't a parent today who hasn't had questions or concerns about this complex disorder. You've probably heard that there has been a rapid increase in the number of children diagnosed with autism and that certain vaccines could be a potential cause. You may even know or have a child who has been diagnosed with the disorder. Despite the amount of coverage that autism has received, it remains a mysterious and often difficult disorder to understand.
No doubt, a diagnosis of autism can be very upsetting; but for many parents it is a relief to have a name for their child's symptoms. The positive news is that autism is treatable, especially if caught early. There is no telling how much can be accomplished with early intervention and treatment.
Defining Autism
The National Institutes of Health estimates that one in 166 children are diagnosed with some form of autism. Autism is a developmental disorder that involves many challenges -- typically delays and impairment in social skills, language, and other behavior. Autism is a spectrum disorder, which means that there is a broad spectrum of such symptoms.
There is a core set of symptoms associated with autism, but it's important to note that these symptoms can be seen in children without autism or in children who might have other types of developmental challenges. Each symptom on its own should not be considered a sign of autism. The core set of symptoms includes:
• trouble forming relationships
• difficulty understanding or responding to emotional signals from others
• using language creatively and receptively
• self-absorption (the child seems to be in his own world, not tuned in to stimuli and people around him
• repetitive, self-stimulatory behavior, such as staring at a fan
• repeating words over and over again
• repetitive motor movements, such as hand flapping.
What Causes Autism?
The exact cause of this condition is unknown. Researchers are looking at potential genetic and environmental causes. Experts believe that autism may be a biologically based disorder. And while there is no general consensus on what environmental factors might be at play, two significant factors being studied include vaccines containing mercury and various forms of brain trauma.
We're also trying to figure out why there has been such a large increase in autism cases over the past 10 to 20 years. According to the Autism Research Center, the rate of autism has increased enormously throughout the world since the early 1990s. There are lots of debates about why: Some say it's due to toxic chemicals, but there's no compelling evidence yet. Others think there is a good chance that the children and disorder haven't changed as much as our definitions and classifications. Children who might have been labeled as retarded or "brain injured" a generation ago are now said to be on the autistic spectrum.
In all likelihood, what we call "autism" is an umbrella term for a number of different kinds of mental problems, but they all share some common symptoms -- just as a fever might be a sign of many different kinds of illnesses. Similarly, problems with relating, communicating, and thinking may be the common symptoms of many different fundamental problems. This is where our research is taking us now. The bottom line is that there is lots of research going on, but there are no conclusive answers.
Treating Autism Individually
There are many different approaches to treating autism, and there is a strong movement to treat these children with behavioral methods, including rewarding behaviors we want to see develop, such as more interactions with others and staying tuned in.
We believe that to help any particular child, you have to know how he is unique. While the common problem of autism lies in relating to and communicating with others, the behavior patterns of each child can be quite different. Some children are overreactive to touch and sound, for example, while others are underreactive to touch and sound. The overreactive child needs extra soothing, while the child who is underreactive needs very energetic and animated interaction. Similarly, some children with this diagnosis have very good memories of the things they've heard, while others have very poor auditory memories. In fact, some children are not easily able to remember anything that's been said to them.
Helping a child requires meeting him at his level. We have developed the DIR (Development, Individual Difference, and Relationship-Based) Floortime model to help parents and teachers do this. The DIR Floortime Model addresses a child's individual differences by encouraging you to look at:
• the way your child takes in, processes, and understands new experiences
• the way he reacts to things, such as touch and sound
• the way he comprehends visual experience
• the way he plans actions
• his level of handling relationships
For example, if your child is just beginning to learn how to engage and interact with others, he may sometimes be very self-absorbed and wander the room aimlessly. You'll need to persuade him to want to relate to others. He may be occupied, for example, with a little car he likes to hold. You might take the car in his hand and put it on his head, as a playful way of enticing him into interacting with you. If he is also very underreactive to touch and sound, has low muscle tone, and is very passive, you might have to use a higher energy level and be very animated to grab his attention. As you engage him, you start helping him move up the developmental ladder.
When working with an unresponsive child, a strategy might be to have two cookies -- one chocolate chip (that you know he likes) and one oatmeal (that you know he doesn't like). Hold up each one and say, "Which one do you want, the chocolate chip cookie or the oatmeal cookie?" The goal is to have him answer, "I want the chocolate chip." It may take many sessions, but using his interests to entice him to relate to you can help him use language meaningfully.
How Your Child's Teacher Can Help
Your child's school environment is also important to consider. The general goal at school is for the teacher to create learning settings tailored to the needs of your child. Forming a strong partnership and sharing information with your child's teacher is key. Accomplishing this goal may require having an aide to provide extra help in a preschool or kindergarten program. Other times, you might volunteer in the classroom. It's very hard to provide the necessary individualized work if there's only one teacher for many children. Confer with your child's teacher and school director to be sure your child's teacher has enough support.
One way your child's teacher can help your child is to foster learning interactions between your child and one or more other children who are functioning without any challenges or special needs. Other children can help to lure your child into interaction with games. For example, the teacher can ask a child to hold the little toy car, so that your child takes it from him rather than her. She might also invite the children to interact during adult-mediated pretend play. She can ask things, such as "I'll bet you can't get Johnny to ask you for that little car." She can model the behavior so the non-autistic child will try to entice your child into more interaction and more creative use of language. Very often, children without special needs become very interested in the children with special needs, and get much satisfaction from being helpful.
Stanley I. Greenspan, M.D., author of Engaging Autism: Helping Children Relate, Communicate and Think with the DIR Floortime Approach, is a clinical professor of psychiatry, behavioral science, and pediatrics at the George Washington University Medical School.

Working with Autism and Other Social-Communication Disorders

Working with Autism and Other Social-Communication Disorders

Marjorie F. OIney
University of Illinois at Urbana-Champaign

Individuals with autism and related developmental disabilities such as Asperger's Syndrome and Pervasive Developmental Disorder present special challenges to rehabilitation counselors. Although their experiences have been described clinically, seldom have the perceptions of individuals with autism and their parents been actively sought. This article reviews the literature on autism from a variety of perspectives: medical, behavioral, social, and personal. An analysis of 18 first hand accounts, interviews, and autobiographical works by people with autism and their parents contribute insights into the experience of autism and related disabilities. The article concludes with specific suggestions to help rehabilitation counselors maximize the success of individuals with autism and related disabilities.

To read entire paper, click attachment below.

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