Within the Spectrum
Monday September 28, 2009
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But no amount of education or clinical experience could prepare him for the role he would assume just a few years later as the parent of a child with autism.
“I remember thinking his challenges were the result of ‘bad parenting’,” says Smith, an assistant professor of physical therapy at Utica College in Upstate New York. “Then I remembered a friend of mine who ran a birth- to 3-years program. We took him to her house, and she watched us with him ... he was just over 2 years old.”
On the advice of that family friend, the couple began months of testing Patrick. They received an official diagnosis of autism by the time he was 3 years old, and he was also given a parallel diagnosis of attention deficit hyperactivity disorder — a fairly common occurrence for many on the spectrum.
After many years of early and intensive behavioral intervention by therapists and support from his family, Patrick is 14 years old, included in mainstream classrooms, and an honors student. He expends his naturally high energy by participating in extreme sports, such as whitewater canoeing, which he does with his dad. “I believe early intervention was critical to helping my son become who he is today,” Smith says.
Typical early signs that development may not be progressing smoothly include lack of big smiles by six months; no interactive sounds, smiles, or facial expressions by nine months; no babbling or pointing, reaching, or waving by 12 months; no words by 16 months; and no two-word phrases by 24 months of age. Children also may demonstrate little or no eye contact, repetitive motor mannerisms, fixation on parts of objects, and lack of spontaneous play and interest in peers.
According to the Mayo Clinic, there are three fundamental areas of development in which medical professionals look for delays: Social interaction, language, and behavior. However, since symptoms vary greatly between spectrum diagnoses, each child presents differently.
Those variants have led researchers to expand the definition of autism, now calling it autism spectrum disorder. ASD includes five classifications — recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) — which present with overlapping degrees of common impairments:
Autism: Individuals with limited or no verbal skills, and significant neuromotor developmental delays.
Asperger’s Syndrome: Considered a milder form of autism, individuals are verbal and often extremely intelligent, but avoid eye contact, have poor coordination, and exhibit difficulty reading emotions.
Rett Syndrome: A childhood neurodevelopmental disorder that mostly affects females, RS is characterized by typical early development followed by loss of certain hand movements, gait abnormalities, slowed brain and head growth, and mental retardation.
Childhood Disintegrative Disorder: This also is characterized by early normal development until age 3, followed by a severe loss of communication, socialization, and other skills.
Pervasive Developmental Delay - Not Otherwise Specified: This condition embodies a group of developmental conditions including delays in communication and social skills.
Even children with ASD who speak have trouble understanding verbal instructions. When there is trouble with language comprehension, it’s helpful to make explanations simple and use tools like sequencing pictures that show a child what to do, in the order of how they will do it. For example, cards depicting taking off the shoes, getting on a therapy ball, or using a particular treatment toy can address issues many children with ASD have with successfully performing transitions.
Many children with ASD also have sensory challenges. Although touch often plays an important role in physical therapy, for a child with autism the wrong hands-on approach can turn a good treatment into a session that ends in a tantrum. Some children, however, are hypersensitive while others are hyposensitive. For the hypersensitive child, start treatments as mildly as possible and help the child desensitize to the touch. Since lights and sounds can be distracting, try to work in a quiet place with low lighting.
Children without ASD often can be motivated with stickers and the promise of playing with small toys, but this approach may hold no value for a child with autism. “Find out what motivates the child and incorporate it into the therapy,” Schreibman says. Therapists need to be sure to ask parents which approaches can facilitate communication, trigger tantrums, and motivate movement, she says.
There still is no cure for ASD, and a child’s best chance at a good quality of life is early diagnosis and the right therapeutic intervention. Schreibman and her team of researchers hope to discover more in their study of behavioral interventions for children with autism from birth to age 3.
“We do know that behavioral intervention has a significant impact on children with autism,” she says. “Now what we’re looking at is how to tailor specific interventions to specific children. If you can figure out what behavioral intervention works for each [child], you enhance their treatment.”
Marnie McLeod Santoyo is a medical writer for Today n PT. To comment, e-mail pteditor@gannetthg.com.
