Autism and the family

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One of the most common developmental disabilities affects two out of every ten thousand children and appears before the age of three (Encarta, 2000). The disorder is autism. It is a disorder that severely impairs development of a persons ability to communicate, interact with other people, and maintain normal contact with the outside world. Autism is often referred to as a spectrum disorder, a disorder in which symptoms can occur in any combination and with varying degrees of severity (Encarta, 2000).


Symptoms of autism usually begin during infancy. They may stiffen or go limp when picked up by parents rather than clinging up to them. Autistic infants often show little or no interest in other people and lack typical social behaviors. Another affect of autism is difficulty with language. Some never learn to speak or develop very limited speech. Over the past thirty years major advances have been made in the education and treatment of autistic individuals. While it is important for patients to receive outside therapy it is also critical that the families get involved and continue the therapy at home. In this paper we will look at not only at the types of home therapy programs, but also the effectiveness of these programs on the mental and physical limitations that autism puts on a child compared to outside therapies.


Children with autism need both physical and behavioral treatment programs. Not much research has been done on what parents can do to improve the limitations that autism cause and the research done was mainly on behavioral treatment, so that is what the focus will be on. This paper will focus
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on the social communication, emotional regulation, and IQ that a home based behavioral therapy program can improve.
It is well documented that positive long-term outcomes for children with autism spectrum disorder (ASD) are strongly correlated with the achievement of communicative competence (Sheinkopf and Siegel, 1998). Two studies tried to focus on this aspect of autism. A controlled trail conducted in the United Kingdom on parent training intervention by Drew et al. focused specifically on improving the communication of pre-school children with autism, especially non-verbal social communicative skills.
This study used the clinical interviews and the Autism Diagnostic Interview-Revised (ADI-R) to assess social interaction, non-verbal social communication abilities. Twenty four children entered the study and were entered either into the parent training group or a local service group. The parent training group used joint attention behavior, mirror games, and behavioral management strategies. The most important aspect of this study was that the parents were acting as the everyday therapists ( Drew, 2002). The local therapy received, speech and language therapy as well as occupational and physio therapy. After implementation of the program the children were the reassessed twelve months later.


Another study that attempted to show the benefits of parental intervention on communicative skills compared to those of a control group using the Psychoeducational Profile-Revised (PEP-R), which is a developmental test
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designated for assessing both the typical strengths and the characteristic weaknesses of children with autism (Ozonoff and Cathcart, 1998). In this study the parents imitated the therapies that the children were receiving outside the home and then performed them at home. Eventually, outside therapies were gradually reduced and, by the last two weeks of a ten week study, the work at home became the primary place of therapy. The therapies used focused on tasks that are visual in nature and rely more on eye-hand integration( Oznoff and Cathcart, 1998).


Although the two studies have different methods of seeing the effects of a home based program compared to those in a clinical setting, they found very similar results. Drew et al. found that after the completion of the study that the children in the home based treatment program had greater increases in non-verbal language then those in the control group. At the initial assessment all the children, both in the parent and control groups, were considered non verbal, but by the end had dramatic increases in their verbal abilities. After the study the number of children considered nonverbal, less than five words, had been cut in half for the parent group, while for the local service group only two of the eleven were no longer non verbal. However, one of the greatest improvements was in the number of words understood. In the initial testing both groups understood about 50 words, but thats were the similarities end. By the end of the study the parent training group children now understood more than 176 words, while those participating the local services about one hundred words.
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Similar results of cognitive function were also found among those in the Ozonoff and Cathcart study. Using the PEP-R study, this shows the mental age in a particular area such as cognitive performance, cognitive verbal, and perception. Before the intervention none of the children had very high cognitive performance or verbal scores. The treatment group improved their cognitive performance by eleven months, their cognitive verbal by five months, and their perception by a staggering eighteen months. However the control group on improved on the cognitive performance by two months, there was no improvement on their verbal abilities, and only six months on their perception. An important factor when considering these results were that the majority of these results occurred within a ten week period.
A third study by Sheinkopf and Siegel focused more on the IQ of children with autism. Parents received a detailed manual of treatment methods, including general principles of learning and operant conditioning, and hierarchically organized curriculum. Therapy sessions were modeled on a discrete trial (prompt-response-reinforcing stimulus) Sessions focused on receptive language skills, nonverbal imitation, nonverbal problem solving, and expressive language skills. Later activities addressed verbal expression, preacademic classroom skills, and play and social skills (Sheinkopf and Siegel, 1998). All in which the parents acted as the primary therapists, although they did receive assistance from specialized clinicians. These results were compared to a control group which received standard school based intervention. A child from
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each group was paired off with one another according to pre-test results, and then after interventions was once again compared to each other. This gave the research a greater ability to see the affect that a home based program has on children with autism in comparison to those who just receive school based assistance.


The results of the study produced results similar to those done by Dawn et al. and Ozonoff and Chathcart. After receiving intense home therapy the IQ scores went up about twenty five points. After treatment, all children in the experimental group had IQ estimates above sixty five. By contrast, only six of the eleven children in the control group had and IQ above sixty five after the follow up (Sheinkopf and Siegel, 1998). This study also showed that the more hours per week a autistic child participates in a therapy the greater the increases they had in their IQ scores.Children who received greater than twenty eight hours a week of multiple therapies had slightly higher IQs then those that received less then twenty seven hours per week. These results were especially seen in their non verbal communication aspect of the IQ test.


One of the most devastating affects of autism is the limited communication that the disease causes. Some autistic children never learn to speak and if they do their vocabulary is very limited. But researchers are doing more studies focusing on early interventions in order to reduce these limitations. While it is important for autistic children to receive some outside medical therapies such as occupational therapy and speech and language therapy recent studies have
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shown, as evident in this paper, the implications that a home based therapy program can do.


These studies show that the home program intervention was effective in enhancing the behavioral and developmental limitations. Home based programs have especially shown to increase language, especially non verbal. While these studies show that a home based program can be very beneficial in improving the language development of children with autism much more research needs to be done.
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References
Drew, Karen et al. (2002). A pilot randomized control trial of a parent training
Intervention for pre-school children with autism.European Child and
Adolescent Psychiatry. 266-271.


Oznoff, Sally & Cathcart. (1998). Effectiveness of a home program intervention
for young children with autism. Journal of Autism and Developmental
Disorders, 28, 25-32.


Sheinkopf, Stephen & Siegel. Home-based behavioral treatment of young
children with autism. Journal of Autism and Developmental
Disorders, 28, 15-23.


www.encarta.com/autism (2000)