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Social skills: People with ASDs might not interact with others the way most people do, or they might not be interested in other people at all. People with ASDs might not make eye contact and might just want to be alone. They might have trouble understanding other people's feelings or talking about their own feelings. Children with ASDs might not like to be held or cuddled, or might cuddle only when they want to. Some people with ASDs might not seem to notice when other people try to talk to them. Others might be very interested in people, but not know how to talk, play, or relate to them. autistic resources and blogs.

Speech, language, and communication: About 40% of children with ASDs do not talk at all. Others have echolalia, which is when they repeat back something that was said to them. The repeated words might be said right away or at a later time. For example, if you ask someone with an ASD, "Do you want some juice?" he or she will repeat "Do you want some juice?" instead of answering your question. Or a person might repeat a television ad heard sometime in the past. People with ASDs might not understand gestures such as waving goodbye. They might say "I" when they mean "you", or vice versa. Their voices might sound flat and it might seem like they cannot control how loudly or softly they talk. People with ASDs might stand too close to the people they are talking to, or might stick with one topic of conversation for too long. Some people with ASDs can speak well and know a lot of words, but have a hard time listening to what other people say. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone.

Repeated behaviors and routines: People with ASDs might repeat actions over and over again. They might want to have routines where things stay the same so they know what to expect. They might have trouble if family routines change. For example, if a child is used to washing his or her face before dressing for bed, he or she might become very upset if asked to change the order and dress first and then wash. autistic resources and blogs.

Children with ASDs develop differently from other children. Children without ASDs develop at about the same rate in areas of development such as motor, language, cognitive, and social skills. Children with ASDs develop at different rates in different areas of growth. They might have large delays in language, social, and cognitive skills, while their motor skills might be about the same as other children their age. They might be very good at things like putting puzzles together or solving computer problems, but not very good at some things most people think are easy, like talking or making friends. Children with ASDs might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words, but not be able to tell you what sound a "b" makes. A child might also learn a skill and then lose it. For example, a child may be able to say many words, but later stop talking altogether. autistic resources and blogs.

ASDs include autistic disorder, pervasive developmental disorder - not otherwise specified (PDD-NOS, including atypical autism), and Asperger disorder. These three conditions all have some of the same symptoms, but they differ in terms of when the symptoms start, how fast they appear, how severe they are, and their exact nature. These three conditions, along with Rett syndrome and childhood disintegrative disorder, make up the broad diagnosis category of pervasive developmental disorders. autistic resources and blogs.

We track the number of children with ASDs and four other disabilities in a five-county area in metropolitan Atlanta (Georgia) through the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). In 1996, 3.4 of every 1,000 children 3 through 10 years of age in metropolitan Atlanta had at least one ASD autistic resources and blogs.

We are now working with several states to learn how many children in other parts of the country have ASDs. These states are developing or improving programs that track the number of children in their areas with ASDs. The program,s began gathering information in 2002, and we expect that they will start reporting findings in late 2003. autistic resources and blogs.

We also know that in the United States during the 2000-2001 school year, more than 15,000 children 3 through 5 years of age and more than 78,000 children and adults 6 through 21 years of age were classified as having autism under the Individuals with Disabilities Education Act (IDEA). IDEA is the federal law that supports special education and related services for children and youth with disabilities. However, there are more children with ASDs who are classified under IDEA in a disability category other than autism. There are, however, some children with ASDs who are not included in these counts, such as children who are in regular education classes, who attend private school, or who are home schooled. autistic resources and blogs.

We do not know if ASDs are becoming more common in the United States. We do know that today more children are being identified as having an ASD than in the past. The studies that have looked at how common ASDs are often used different ways to identify children with ASDs, and it is possible that researchers have just gotten better at identifying these children. It is also possible that professionals know more about ASDs now and are therefore more likely to diagnose them correctly. Also, a wider range of people are now being classified as having ASDs, including people with very good language and thinking skills in some areas who have unusual ways of interacting or behaving. Clearly, we have much more to learn. CDC studies in Atlanta and CDC-funded studies in the states will continue over time and will help answer this important question of whether ASDs are truly becoming more common in the United States. autistic resources and blogs.

No one knows exactly what causes ASDs, but scientists think that both genetic and environmental factors might play a role. We do know that parental actions do not cause children to have ASDs. We are now planning the Children's Longitudinal Development Study (CHILD Study), which will look at what factors make it more likely that a child will have an ASD. We are also funding several state projects that will study such factors autistic resources and blogs.

If you would like to learn more about a specific genetic condition that you think could cause an ASD, you can go to the National Library of Medicine's Genetics Home Reference Web site. Information on each genetic condition includes symptoms, how common it is, related genes, treatments, and links to resources where you can learn more about the condition. The Genetics Home Reference also can help you learn more about genetics, including genetic testing, genetic counseling, and gene therapy. autistic resources and blogs.

There is no known cure for ASDs. However, early and intensive education can help children grow and learn new skills. The goal of these efforts is to help with the difficult symptoms of an ASD in a child and to improve the child's skills that help him or her talk, interact, play, learn, and care for his or her needs. Medicines can relieve symptoms and be helpful for some people, but structured teaching of skills (often called behavioral intervention) is currently the most effective treatment. autistic resources and blogs.

The links below go to the Web sites of federal agencies or programs that are federally-funded. CDC has no control over the content on these sites. Links to these sites are included for information only. The views and opinions expressed there are not necessarily those of CDC, the Department of Health and Human Services (HHS), or the U.S. Public Health Service (PHS). autistic resources and blogs.

MEDLINEplus is an online service of the National Library of Medicine that is designed to link users to information on specific health topics, including autism and Asperger's syndrome. MEDLINEplus brings together information from many sources and is updated every day. The site includes information on the latest news, general overviews, projects at the National Institutes of Health, clinical trials, diagnosis and symptoms, rehabilitation, research, specific conditions, treatment, directories, organizations, children, and teenagers. Some of the materials are available in Spanish autistic resources and blogs.

NCBDDD staff have written scientific papers on ASDs. These papers look at such topics as how common ASDs are and vaccines. You can see a list of these papers (starting in 1990) by using the keyword search on the NCBDDD publications Web page. Choose "autism" in the keyword box on the search page. You can choose whether you want the list to be sorted by author or by date. You can also choose to have the list appear with or without graphics. Click on the Submit button. You will see a list of papers that are about ASDs. The list will include the complete reference for each paper and a link to an abstract of the paper or to the full text, when available. autistic resources and blogs.

National Information Center on Children and Youth with Disabilities (NICHCY) NICHCY provides information on disabilities and disability-related issues for families, teachers, and other professionals. NICHCY has a fact sheet about autism that includes information on topics such as characteristics of children with autism, the impact of autism on a child's education, and resources. The fact sheet is available in both English and Spanish. autistic resources and blogs.

NICHCY also has a more detailed paper about pervasive developmental disorders that includes information about all forms of autism spectrum disorders (ASDs) but focuses mostly on pervasive developmental disorder not otherwise specified (PDD-NOS). The paper has information on the causes, symptoms, diagnosis, and treatment of pervasive developmental disorders. autistic resources and blogs.

NICHD has several fact sheets and other publications related to ASD. Some give basic information about ASDs, including symptoms, causes, and treatment. Others talk about vaccines, the role of genetics, and programs funded by NICHD. Many of these materials are available in both English and Spanish. autistic resources and blogs.

NINDS has a fact sheet on autism that includes information on common signs of the condition, diagnosis, causes, treatment, and where to go for more information. The fact sheet includes links to information sheets about pervasive developmental disorders and Asperger disorder. The sheet is available in both English and Spanish. autistic resources and blogs.

PubMed is an online service of the National Library of Medicine that lets users search scientific journals for articles of interest. You can enter a keyword or the subject you are interested in (for example: "autism" or "asperger") in the Search box and then click on Go. You will see a list of matching articles, with links to more information. You can limit your search to certain years, journals, languages, etc., by following the directions given on the PubMed Web site. autistic resources and blogs.

Autism (sometimes called "classical autism") is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Experts estimate that three to six children out of every 1,000 will have autism. Males are four times more likely to have autism than females. autistic resources and blogs.

There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling. autistic resources and blogs.

The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement. autistic resources and blogs.

Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They lack empathy. autistic resources and blogs.

Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me." Children with autism don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking. autistic resources and blogs.

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged. autistic resources and blogs.

Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism. autistic resources and blogs.

Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism. These behaviors are: impaired ability to make friends with peers impaired ability to initiate or sustain a conversation with others absence or impairment of imaginative and social play stereotyped, repetitive, or unusual use of language restricted patterns of interest that are abnormal in intensity or focus preoccupation with certain objects or subjects inflexible adherence to specific routines or rituals autistic resources and blogs.

Doctors will often use a questionnaire or other screening instrument to gather information about a child's development and behavior. Some screening instruments rely solely on parent observations; others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of autism, doctors will ask for a more comprehensive evaluation. autistic resources and blogs.

Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis. autistic resources and blogs.

Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Children who develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative disorder. Girls with autistic symptoms may be suffering from Rett syndrome, a sex-linked genetic disorder characterized by social withdrawal, regressed language skills, and hand wringing. autistic resources and blogs.

Scientists aren't certain what causes autism, but it's likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved. autistic resources and blogs.

Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism. autistic resources and blogs.

For many children, autism symptoms improve with treatment and with age. Some children with autism grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed. autistic resources and blogs.

There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better. autistic resources and blogs.

Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child. Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity. Other therapies: There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments. autistic resources and blogs.

The National Institute of Neurological Disorders and Stroke (NINDS) is one of the federal government's leading supporters of biomedical research on brain and nervous system disorders. The NINDS conducts research in its laboratories at the National Institutes of Health in Bethesda, Maryland , and also awards grants to support research at universities and other facilities. autistic resources and blogs.

As part of the Children's Health Act of 2000, the NINDS and three sister institutes have formed the NIH Autism Coordinating Committee to expand, intensify, and coordinate NIH's autism research. Eight dedicated research centers across the country have been established as "Centers of Excellence in Autism Research" to bring together researchers and the resources they need. The Centers are conducting basic and clinical research, including investigations into causes, diagnosis, early detection, prevention, and treatment, such as the studies highlighted below: investigators are using animal models to study how the neurotransmitter serotonin establishes connections between neurons in hopes of discovering why these connections are impaired in autism researchers are testing a computer-assisted program that would help autistic children interpret facial expressions a brain imaging study is investigating areas of the brain that are active during obsessive/repetitive behaviors in adults and very young children with autism other imaging studies are searching for brain abnormalities that could cause impaired social communication in children with autism clinical studies are testing the effectiveness of a program that combines parent training and medication to reduce the disruptive behavior of children with autism and other ASDs autistic resources and blogs.

The definition of autism is based on the diagnostic criteria provided in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM - IV.) Autism is included under DSM-IV's pervasive developmental disorders. This is a category of disorders in which many basic areas of infant and child psychological development are affected at the same time, and to a severe degree. Autistic disorder has three major hallmarks: qualitative impairment in social interaction, qualitative impairment in communication, and restricted, repetitive and stereotypical patterns of behavior, interests, and activities. Onset in delays is very early, prior to three years of age. autistic resources and blogs.

Pervasive Developmental Disorders (PDD) as defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) is a category of disorders incorporating extreme developmental abnormalities with onset in the first three years of life. Pervasive Developmental Disorder represents a distortion in basic development with characteristic features including: Severe and pervasive impairment in reciprocal social interaction; Severe and pervasive impairment in communication skills; and Presence of stereotyped behavior, interests and activities. autistic resources and blogs.

Childhood Disintegrative Disorder is characterized by development that appears normal through the first two years of life. Following this, abnormalities develop in at least two of the following areas: social interaction, communication, and restricted, repetitive, stereotyped patterns of behavior, interests, and activities. In addition, there is clinically significant loss of previously acquired skills (before age 10), in at least two of the following areas: expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, play, and motor skills. (DSM-IV, 1994). autistic resources and blogs.

Hingtgen & Bryson (1972) reviewed over 400 research articles pertinent to the field of autism that were published between 1964 and 1970. They concluded that behaviorally-based interventions demonstrated the most consistent results. In a follow-up study, DeMeyer, Hingtgen & Jackson (1981) reviewed over 1,100 additional studies that appeared in the 1970s. They examined studies that included behaviorally-based interventions as well as interventions based upon a wide range of theoretical foundations. Following a comprehensive review of these studies, DeMeyer, Hingtgen & Jackson (1982) concluded "...the overwhelming evidence strongly suggest that the treatment of choice for maximal expansion of the autistic child's behavioral repertoire is a systematic behavioral education program, involving as many child contact hours as possible, and using therapists (including parents) who have been trained in the behavioral techniques" (p.435). autistic resources and blogs.

Support of the consistent effectiveness and broad-based application of ABA methods with persons with autism is found in hundreds of additional published reports. Baglio, Benavidiz, Compton, et al (1996) reviewed 251 studies from 1980 to 1995 that reported on the efficacy of behaviorally-based interventions with persons with autism. Baglio, et al (1996) concluded that since 1980, research on behavioral treatment of autistic children has become increasingly sophisticated and encompassing, and that interventions based upon ABA have consistently resulted in positive behavioral outcomes. In their review, categories of target behaviors included aberrant behaviors (ie self injury, aggression), language (ie receptive and expressive skills, augmentative communication), daily living skills (self-care, domestic skills), community living skills (vocational, public transportation and shopping skills), academics (reading, math, spelling, written language), and social skills (reciprocal social interactions, age-appropriate social skills). autistic resources and blogs.

In 1987, Lovaas published his report of research conducted with 38 autistic children using methods of applied behavior analysis 40 hours per week. Treatment occurred in the home and school setting. After the first two years, some of the children in the treatment group were able to enterkindergarten with assistance of only 10 hours of discrete trial training per week, and required only minimal assistance while completing first grade. Others, those who did not progress to independent school functioning early in treatment, continued in 40 hours per week of treatment for up to 6 years. autistic resources and blogs.

Subsequent to the work of Lovaas and his associates, a number of investigators have addressed outcomes from intensive intervention programs for children with autism. For example, the May Institute reported outcomes on 14 children with autism who received 15 - 20 hours of discrete trial training (Anderson, et al, 1987). While results were not as striking as those reported by Lovaas, significant gains were reported which exceeded those obtained in more traditional treatment paradigms. Similarly, Sheinkopf and Siegel (1998) have recently reported on interventions based upon discrete trial training which resulted in significant gains in the treated children's' IQ, as well as a reduction in the symptoms of autism. It should be noted that subjects in the May and Sheinkopf and Siegel studies were given a far less intense program than those of the Lovaas study, which may have implications regarding the impact of intensity on the effectiveness of treatment. autistic resources and blogs.

Behavioral intervention is not without controversy, despite the empirical support. Detractors theorize behavioral programs produce robotic children. Research reviewed by MADSEC reveals nothing to substantiate this theory. On the contrary, one of the more consistent findings of the research is improved social skills in those children treated (eg Lovaas, 1987; Maurice, 1993). Others question whether Lovaas (1987) used a representative sample of children with autism. While that debate continues, subsequent research using a variety of samples (eg Anderson, et al, 1987; Sheinkopf & Seigel, 1998; Birnbrauer & Leach, 1993; Fenske, et al, 1985) shows that unlike other treatments proposed for autism, there have been no studies which do not support the effectiveness of behavioral intervention. To date, there are no published studies which refute the effectiveness of this approach. autistic resources and blogs.

There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include "meaningful" outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning. These reflect clinically-significant quality of life improvements. While studies varied as to the magnitude of gains, all have demonstrated long term retention of gains made. autistic resources and blogs.

Over 30 years of rigorous research and peer review of applied behavior analysis' effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science. Professionals considering applied behavior analysis should portray the method as objectively substantiated as effective. Methods of applied behavior analysis should be considered to evaluate the effectiveness of any intervention used to help individuals with autism. Researchers should continue to vigorously investigate behavioral intervention as the most promising area of research and treatment benefiting individuals with autism known today. Early interventionists should leverage early autism diagnosis with the proven efficacy of intensive ABA for optimal outcome and long-term cost benefit. autistic resources and blogs.

One of the instructional methodologies frequently used in ABA-based programs is Discrete Trial Training (DTT). Discrete trial training and ABA are not synonymous. While DTT is based upon principles of learning theory and has been demonstrated to be an effective intervention methodology, it represents only one of dozens of teaching strategies within the field of ABA. For example, other methods of teaching used within ABA-based programs include PECS (Picture Exchange Communication System), photo activity schedules, chaining, shaping, graduated guidance, and functional communication training. ABA also relies heavily upon incidental teaching procedures, once children have a core set of skills necessary to learn incidentally. These include attending and imitation. autistic resources and blogs.

Once the child has learned to sit quietly and attend, more complex skills such as social behaviors and communication can be taught. Social skills training begins with eye contact, and moves toward imitation, observational learning, expressive affection and social play. Communication skills generally begin with receptive object labels, progress to expressive verbal and/or augmentative expressive language, then seek spontaneous communication. As these tasks are mastered, the child is taught to make expressive demands. The goal is that the child will learn that functional language results in something the child wants. Generalization training then moves the drills into more naturalistic environments and incidental teaching (McGee, Krantz & McClannahan, 1985). Children with autism typically do not learn from their environment spontaneously, and therefore need to be taught virtually everything they are expected to learn (Green, 1995). Therefore, as part of a broader applied behavior analysis intervention, discrete trials target numerous goals and objectives. Consequently an effective ABA intervention requires numerous hours of child:therapist sessions per week. According to Green (1995), "For young children with autism, the treatment of choice is intensive application of the methods of applied behavior analysis. "Intensive" means one-to-one treatment in which carefully planned learning opportunities are provided and reinforced at a high rate by trained therapists and teachers for at least 30 (preferably 40) hours a week, 7 days a week, for at least two years. Young autistic children who received less intensive treatment made some modest gains, but normal or near-normal functioning was achieved reliably only when treatment was provided for 30 - 40 hours a week, on average, for at least two years (eg Anderson, et al, 1987; Birnbrauer & Leach, 1993; Fenske, et al, 1987; Lovaas, 1987; Maurice, 1993; McEachin, Smith & Lovaas, 1993; Perry, Cohen & DeCarlo, 1995; Smith, 1993)." autistic resources and blogs.

"Lovaas Therapy" derives its name from O. Ivar Lovaas, PhD, a psychologist who has researched methods of applied behavior analysis for over 30 years. Lovaas gained more mainstream recognition from the 1987 publication of a study he conducted with children with autism. Based upon his research, Lovaas concluded intensive behavioral intervention (including the use of discrete trials) offered much hope for improving the outcomes of children with autism. Forty-seven percent of children in the study ultimately gained normal functioning such that they were virtually indistinguishable from their peers (Lovaas, 1987). A follow-up study of these same children in 1993 concluded the results were sustained (McEachin & Lovaas, 1993). While Lovaas is due credit for the rigor and value of his work, ABA professionals emphasize behavioral intervention in any form is not the domain of any one professional or group. Therefore, "Lovaas Therapy" is an appropriate term only when specifically referring to Lovaas' work, methods and protocols. Otherwise, the broader terms "applied behavior analysis" or "ABA" should be used. autistic resources and blogs.

Hypersensitive hearing of persons with autism has been widely recognized by many professionals (eg Cordon, 1975; Delacato, 1974; Grandin & Scariano, 1986; Hayes & Gordon, 1977; Rimland, 1964.) Auditory integration training (AIT) was developed in France, by otolaryngologist Guy Berard, on the theory that human behavior is largely conditioned by the manner in which one hears (Berard, 1993) autistic resources and blogs.

Auditory integration training is said to address the hearing distortions, hyperacute hearing, and sensory processing anomalies which cause discomfort and confusion in persons suffering from learning disabilities, including autism (Stehli, 1995). Auditory training seeks to retrain the auditory system by correcting hearing distortions. During 20 half-hour training sessions which take place over 10 to 14 days, participants listen with headphones to a musical program modified and filtered through an electronic device called an AudioKinetron (Stehli, 1995). autistic resources and blogs.

Berard had used auditory integration therapy with over 8,000 individuals with hearing impairments at his clinic in France. Forty-eight of these patients were diagnosed as having autism (Berard, 1993). One patient is reported to have recovered from autism after receiving auditory integration training (Stehli, 1991). Three studies have been conducted to determine the efficacy of this approach in the education and treatment of children with autism (Link, 1997; Rimland & Edelson, 1995; Rimland and Edelson, 1994). Link (1997) presented case studies of three boys with autism that received 20 half-hour sessions of auditory integration training. The study looked at the impact of AIT on sound hypersensitivity, as well as on cognitive and behavioral problems. Link found no change in hypersensitivity to sound, and few beneficial effects on the behavior or cognitive skills of the three boys. autistic resources and blogs.

There are few validated studies regarding the use of auditory integration training. According to Smith (1996), there is no scientific evidence to substantiate the theory that hypersensitivity to sound causes aberrant behaviors, interferes with social skills, and is a basis for cognitive deficits. In addition, there is currently no scientific evidence to support the effectiveness of auditory integration training in reducing hypersensitivity to sound in children with autism. According to the American Academy of Pediatrics Committee on Children with Disabilities, current information does not support the use of auditory integration training and, therefore, its use is not yet warranted other than in research protocols. autistic resources and blogs.

Preliminary research and anecdotal reports suggest AIT may show promise (Rimland & Edelson, 1994; Rimland & Edelson, 1995; Stehli, 1991; Stehli, 1995), but it is not yet objectively substantiated as effective subject to the rigors of good science. Researchers should consider further investigation using research protocols. Professionals considering AIT should portray the method as experimental, and should disclose this status to key decision makers influencing the child's intervention. autistic resources and blogs.

Rosemary Crossley first introduced facilitated communication (FC) in Australia in the 1970s, as a technique to help individuals with cerebral palsy and physical disabilities communicate. In 1989, Douglas Biklen began to use FC in the United States, with people who have autism. According to Smith (1996), "Facilitated Communication (Bilken, 1993) derives from the hypothesis that children and adults with autism or other developmental disabilities have a motor deficit that prevents them from expressing themselves even though they possess a sophisticated understanding of spoken and written language. To overcome this conjectured problem, trained facilitators (professionals or nonprofessionals who have completed a workshop on the treatment) hold people's hands, wrists, or arms to help them spell messages on a keyboard or a board with printed letters.... According to reports, when people who were previously thought to have no communicative language participated in Facilitated Communication, they began to compose poetry, divulge personal thoughts and feelings, excel at advanced schoolwork, and display many other complex language skills." autistic resources and blogs.

There is some confusion between the terms "facilitated communication" and "augmentative communication" or "augmentative and alternative communication" (AAC). Facilitated communication is based upon the premise that individuals with autism have "undisclosed literacy" (Biklen, 1990). "It is a technique wherein a facilitator touches the hand, arm or shoulder of a person with communication deficits while they jointly point to symbols, letters or words... FC is not to be confused with use of appropriately applied manual guidance or other prompts to teach communication and other skills, nor should it be confused with independent use of nonspeech communication systems that may involve letterboards, keyboards, or other symbol systems" (ABA, 1995). autistic resources and blogs.

Over the past 20 years, Stanley Greenspan, MD and colleagues have published numerous articles on theories of child development. Only one relates specifically to children with autism; others may include references to autism among an array of disabilities. At the National Center for Clinical Infant Programs, Greenspan et al have worked with children with a wide range of disabilities from infancy through age 10. Greenspan and others have created a developmental approach for early intervention with infants and children with disabilities, titled Developmental Individual-Difference, Relationship-Based Model (DIR, commonly referred to as the "Floor Time" approach) (Greenspan, 1998). There have been no peer-reviewed, published studies of Greenspan's DIR/Floor Time's effectiveness for children with autism. autistic resources and blogs.

Floor Time is based upon Greenspan's theories of six functional milestones necessary for a child to succeed in further learning and development. According to Greenspan, these are: "The dual ability to take an interest in the sights, sounds and sensations of the world and to calm oneself down. The ability to engage in relationships with other people. The ability to engage in two-way communication with gestures. The ability to create complex gestures, to string together a series of actions into an elaborate and deliberate problem-solving experience. The ability to create ideas. The ability to build bridges between ideas to make them reality-based and logical" (Greenspan, 1998). autistic resources and blogs.

DIR/Floor Time includes interactive experiences, which are child directed, in a low stimulus environment, ranging from two to five hours a day. During a preschool program, DIR/Floor Time includes integration with typically-developing peers. Greenspan contends that interactive play, in which the adult follows the child's lead, will encourage the child to "want" to relate to the outside world. Furthermore, Greenspan stipulates "In this model, the therapeutic program must begin as soon as possible so that the children and their parents are re-engaged in emotional interactions that use their emerging, but not yet fully developing capacities for communication (often initially with gestures rather than words). The longer such children remain uncommunicative and the more parents lose their sense of their child's relatedness, the more deeply the children tend to withdraw and become perseverative and self-stimulatory" (Greenspan, 1998). autistic resources and blogs.

In 1965, Arnold Miller, PhD and Eileen Eller-Miller, MA, CCC founded the Language and Cognitive Development Center (LCDC) in Boston, Massachusetts. The LCDC is a Massachusetts Chapter 766-approved day school, serving students with autism/PDD ages 3 - 14. The LCDC specializes in a particular approach to teaching children with autism, the Miller Method™. Additionally, founders of the LCDC have developed their own reading program, the Symbol Accentuation Reading Program. autistic resources and blogs.

The Miller Method™ extensively uses adaptive equipment, including platforms (that elevate the child in hopes of increasing eye contact), large swinging balls (to expand the child's reality system), and Swiss cheese boards (to teach motor planning, as well as to increase the child's understanding of his or her relation to environment and space.) (Miller, 1998). The Miller Method™ Symbol Accentuation Reading Program is designed to teach reading and writing by transforming pictures of objects into words. American Sign Language is used to teach communication (Miller, 1997). autistic resources and blogs.

Sensory Integration (SI) therapy is a sensory-motor treatment based upon theories developed over the last 30 years by Dr. A. Jean Ayres. Proponents theorize that sensory integration is an innate neurobiological process (Hatch-Rasmussen, 1995), and that children with autism and other developmental delays experience dysfunction in which sensory input is not integrated or organized appropriately by the brain. Fisher and Murray (1991) describe sensory integration as both "a neurological process, and a theory of the relationship between the neurological process and behavior." autistic resources and blogs.

According to Fisher, Murray and Bundy (1991) there are five major assumptions upon which SI theory is based. These are: "...there is plasticity within the central nervous system. Plasticity refers to the ability of the brain structure to change or be modified... ...the sensory integrative process occurs in a developmental sequence. In normal development, increasingly complex behaviors develop as a result of the circular process, and behaviors present at each stage in the sequence provide, in turn, the basis for the development of more complex behaviors... ...the brain functions as an integrated whole, but is comprised of systems that are hierarchically organized... ... evincing an adaptive behavior promotes sensory integration, and, in turn, the ability to produce an adaptive behavior reflects sensory integration... ...people have an inner drive to develop sensory integration through participation in sensorimotor activities..." autistic resources and blogs.

Sensory integrationists theorize sensory dysfunction is rooted in the central nervous system, and that successful integration of sensory input requires treatment. This treatment is comprised of vestibular, proprioceptive, and/or tactile stimulation. Ayres (1979) describes sensory integration therapy as sensory stimulation and subsequent adaptive responses which evolve according to the child's neurological needs. Therapy techniques include vestibular stimulation such as swinging in a hammock, and tactile stimulation achieved by brushing parts of the child's body (Smith, 1996). SI therapy is viewed as a direct intervention that can improve nervous system function. This is done by providing the child with enhanced levels of sensory information gleaned during physical activities that are meaningful to the child, and that elicit adaptive behaviors (Koomar & Bundy, 1991). autistic resources and blogs.

SI theorists also postulate that children with sensory dysfunction are either over- or under-responsive to sensory input. Children with autism may be startled by a slight sound (hypersensitivity), or may totally tune out external stimuli, such as language (under-responsive). SI practitioners further postulate that self-stimulation and stereotypic activities characteristic of many autistic children may be related to sensory dysfunction, and that therefore SI therapy may reduce the rates of self-stimulation and self-injurious behaviors. According to a critique by Arendt (1988), SI therapy does not seek to teach higher order skills, but rather to rearrange brain functioning (sensory processing capability) as a precursor to learning. Arendt challenges basic SI theory in his critique; he also asserts that even if Ayres' theories of nervous system hierarchy and neural plasticity are valid, the SI treatment model does not inherently address them. (Arendt, 1988). autistic resources and blogs.

Ray, King and Grandin (1998) examined the effect of vistibular stimulation (swinging) on speech sounds in children with autism. The researchers found a 15% increase in vocalizations while the child was on a swing than in the absence of this vestibular stimulation. Cook (1991) presents anecdotal case studies of on-task behavior and attending skills in three children with autism who received sensory motor interventions. Cook reported both teachers and parents noted significant improvements in both domains, and in all three children. However, these reports are based upon parent and teacher impressions, not empirical data, and therefore could be vulnerable to reporter bias and failure to establish SI as an independent variable responsible for the reported improvement. autistic resources and blogs.

According to Murray and Anzalone (1991), "care is required not to overstep the boundaries of sensory integration theory when applying these procedures to children and adults with autism." In a study designed to test the effectiveness of SI on self-injurious behaviors (SIB), Mason and Iwata (1990) found that SI was less effective than behavioral treatment in reducing SIB; in one case, the rate of SIB actually increased with SI treatment. A review of the literature did not yield any study concluding SI is an effective treatment for SIB or self-stimulation. Arendt (1988) examined the effectiveness of SI therapy as it applied to individuals with mental retardation. Arendt found that the database of studies was small, and that the methodology in most of the studies under his consideration had serious flaws. These flaws included examiner bias and uncontrolled variables. autistic resources and blogs.

Ottenbacher's analysis concluded that SI had a positive effect on the subjects receiving the therapy (1982). However, he later reports that his study had several limitations associated with interpretation of the data (1991): there was no consistency in subjects' areas of improvement, and much of the sub-analysis was confounded. Ottenbacher concludes in a 1991 textbook on sensory integration that "previous attempts to synthesize and interpret existing sensory integration research reveal that a clear empirical consensus does not exist regarding the validity of sensory integration theory, or the effectiveness of sensory integration practice." Ottenbacher further concludes more research is needed to reach empirical consensus. Smith examined several investigations evaluating SI's effectiveness for children with developmental disabilities (Smith, 1996). Smith concludes SI did not decrease self injury, did not reduce ritualistic behaviors and did not show increases in motor development. Like Arendt, Smith concludes "studies on sensory integration therapy are sparse, but they have consistently yielded adverse findings" (Smith, 1996). autistic resources and blogs.

The Son-Rise Program for Families with Children with Special Needs is a program offered at the Options Institute. The Options Institute is an educational organization founded in 1983 by Barry Neil Kaufman and Samahria Lyte Kaufman. The Option Institute teaches the Option Process®. This process involves a loving and non-judgmental method for resolving unhappiness and discarding self-limiting beliefs (The Option Institute and Fellowship, 1997). The Option Institute teaches a variety of programs and seminars for people of all ages. The Son-Rise Program was created by Barry and Samahria Lyte Kaufman in the 1970s, as a means to teach their own son, who was diagnosed with autism and mental retardation. The program ranges from one week to six months, and is designed to teach parents, professionals and support staff of children with a wide range of disabilities how to implement home-based programs based upon the Kaufmans' theories of learning. autistic resources and blogs.

There have been no studies of the Son-Rise Program's effectiveness. Researchers should consider investigation using research protocols. Professionals considering Son-Rise should portray the method as without scientific evaluation of any kind, and should disclose this status to key decision makers influencing the child's intervention. autistic resources and blogs.

TEACCH (Treatment and Education of Autistic and Communication Handicapped Children) is a statewide program in North Carolina. According to Trehin, "TEACCH is not a single approach and even less a method. It is a state program that tries to respond to the needs of autistic people using the best available approaches and methods." (Trehin, 1998). It is a program of services which makes use of several techniques, of several methods, in various combinations, depending upon the individual person's unique needs and emerging capabilities." autistic resources and blogs.

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